Very useful article in this week’s New England Journal. We usually screen healthy adults for diabetes by drawing a fasting blood glucose as part of the annual physical. This study from Johns Hopkins suggests that glycated hemoglobin might be a better test.
Particularly impressive is the accuracy with which glycohemoglobin predicts cardiovascular outcomes such as heart attack and stroke in non-diabetics.
Glycohemoglobin is a well-known predictor of vascular events in people with diabetes – but the fact that it is such a powerful predictor of vascular disease and death in non-diabetics is big news.
Many of my patients have slightly high fasting blood sugars on their physical. It’s hard to know what to tell them. Does a blood sugar of 103 mean they are going to get diabetes? Do they need to be on medicine like metformin to lower their sugar?
It looks like glycohemoglobin (which gives an “average” for the blood sugar over a three month period) will be a much more accurate test. We can avoid frightening patients over meaningless random fluctuations in glucose; and we can better identify those in need of real risk factor modification or medicine to lower their blood sugar, before frank diabetes develops.
Tuesday, September 15, 2009
Swine flu (H1N1 influenza) may be contagious for several days after the fever breaks, according to an abstract presented at the American Society for Microbiology today. Usually we tell people to go back to work when their temperature returns to normal. With H1N1, it may be necessary to stay home and take precautions for as long as you are coughing.
AP article here.
Tuesday, September 15, 2009
Primary care doctor shortage continues in Mass
MMS Physician Workforce Study 2009
Mass Medical Society has released this year’s Physician Workforce Survey. The number of primary care practices accepting new patients has dropped from 58 to 44 percent. The practice climate for primary care is getting more difficult every year, with the flood of paperwork coming from the insurance companies, the advent of “tiering“, and primary care reimbursement dropping every year while specialty incomes rise. Most physicians completing residency programs and looking for careers in general medicine are sensibly choosing hospital medicine, where salaries are higher and the hours better.
I am a Democrat. I supported Barak Obama in his campaign. I think he’s a good president. From a citizen standpoint, I think his healthcare plan, if passed, will probably improve health care quality and access at least modestly. But from a primary care standpoint, I’m disappointed. None of the various drafts and proposals I’ve seen do a thing to address the crisis in primary care.
If we keep paying enormous sums for invasive procedures, and next to nothing for doctors to listen, think and communicate with patients, then we’ll continue to have an expensive, fragmented, procedure-based healthcare system rather than a humane and rational one focused on patient needs.
Friday, September 11, 2009
The New England Journal has the first two clinical trials of the H1N1 Influenza vaccine. The data are summarized in an editorial: NEJM — Pandemic Influenza Vaccine Policy — Considering the Early Evidence.
The standard vaccine seems to generate an adequate immune response in healthy adults after a single dose. It depends on the results of other trials, but maybe we’ll only need one dose of this vaccine. They were talking about two doses for everyone, which would pose a problem since supplies will be limited.
One dose should also be OK for older kids and pregnant women. No data yet on younger children and immunosuppressed persons (older and/or with chronic diseases).
No major adverse effects seen but the studies were not large enough to detect rare side effects.
Friday, February 20, 2009
I finally had a few minutes to look at the website again. I upgraded Wordpress. I put a new theme in place, hope you like it. There are some things in the About section that I need to update.
Maybe I will start posting blog entries again – I keep reading interesting journal articles and meaning to share them. Too busy taking care of patients to blog! Yikes. Remind me why I started this practice again?
Wednesday, August 13, 2008
I am (finally) upgrading this site, so please bear with me – it might look a bit funny while I’m working on it. Thanks for your patience, and thanks to all my patients for your loyal support of Lenox Internal Medicine!
Saturday, October 6, 2007
From Medgadget, I find that Nikon has posted the winning photographs in its Small World competition for photomicrography – photographs of microscopic structures and critters.
They are so cool!
Here is a picture of a cedar leaf in cross section, using polarized light.
And here’s a marine worm using a technique called confocal photography (which is explained in detail on the site, for you photomicrography bugs.
This one is the seed of the small-flowered willowherb (Epilobium parviflorum).
And this lovely scene is some rat hippocampal neurons being attacked by Alzheimer’s related neurotoxins>
I don’t know that these images demonstrate the beauty of nature, so much as the beauty of photographic images that depict nature in clear lines and bright, nifty colors.
Still, they’re great to look at.
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