August 26th, 2008 by admin
I have been a community and hospital pharmacist for over thirty years … trained in clinical pharmacy at one of the largest healthcare centers in the South. I am a consultant pharmacist for Medication Therapy Management (MTM) for the State of North Carolina.
I search the Internet and other sources for information that I think you should be aware of; that should be interesting and important for you to know. When I see something that meets these criteria, I will let you know about it in my next article.
If you don’t see some information that you need and it is within my areas of education and expertise, I will try to post an article or an answer as soon as possible! You can put your request in the “Contact Us” area located above the upper left column on this page.
Bob Diamond R.Ph Pharmacist
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December 11th, 2011 by admin
|By Kristina Fiore, Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.
CHICAGO — Women ages 40 to 49 with no family history of breast cancer have similar rates of invasive disease as those with familial risk, radiologists reported here, firing yet another salvo at government mammography guidelines.
Among a group of more than 1,000 breast cancer patients, 64% of those with no family history of breast cancer had invasive disease, as did 63.2% of those with family history, a non-significant difference, according to Stamatia Destounis, MD, of Elizabeth Wende Breast Care in Rochester, N.Y., and colleagues.
“We were intrigued and surprised by the data,” Destounis said during a press briefing at the Radiological Society of North America meeting, noting that general wisdom suggests women with a family history are at greater risk of developing the disease than other women.
“Since there’s no difference in the rate of invasive breast cancer for women in their 40s whether they have a history of breast cancer or not, the recommendation should be that women in their 40s have screening mammography yearly,” Destounis said.
In 2009, the U.S. Preventive Services Task Force recommended against
routine screening for women ages 40 to 49, leaving patients and clinicians to make individual decisions based on their risk. Mammograms should start at age 50, the committee said, and be performed every two years.
Yet the American Cancer Society (ACS), the American College of Obstetricians and Gynecologists, and other groups have called for continued screening in this age group, which Destounis said has led to confusion among patients and their doctors.
Still, the debate
has shown few signs of letting up, as studies have continued to flood in — some showing that screening women 40 to 49 offers a robust mortality benefit
while others have found only a trivial benefit
Destounis and colleagues reviewed data on all breast cancer patients seen at their clinic between 2000 and 2010, with a total of 1,071 patients ages 40 to 49 treated for 1,116 cancers.
A total of 373 of those had been diagnosed via screening at their clinic; 61% of those patients had no family history of the disease, while 39% did. There were no significant differences in terms of the percentage of patients in either group who had a personal history of the disease.
The investigators also found that similar percentages of patients with and without familial risk had disease that metastasized to the lymph nodes (29.4% of those without versus 31.3% of those with).
“We agree with the ACS, which recommends screening for every woman in her 40s,” Destounis said.
Gary Whitman, MD, of MD Anderson Cancer Center in Houston, who was not involved in the study, told MedPage Today there are “very few mammographers who feel differently about the need to screen all women at 40 years of age.”
Edith Perez, MD, of the Mayo Clinic in Jacksonville, Fla., who also was not involved in the study, noted that it may show that family history isn’t necessarily useful for deciding whether a younger woman may be at greater risk of breast cancer, though this hypothesis would need further testing.
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October 31st, 2011 by admin
by Rosemary Gibson
The October 19 Health Affairs briefing entitled “Saving Medicare Dollars and Improving Care,” sponsored by the ABIM Foundation and other funders, was a watershed moment in which ideas that would require less spending on health care that would actually improve care for patients were discussed on K Street. This is a great message for patients and, it so happens, for the super committee deliberations a few miles away.
Dr. Nancy Morioka-Douglas, Clinical Professor of Medicine/Family and Community Medicine at the Stanford University School of Medicine highlighted seven often unnecessary things done in primary care, such as EKGs in patients without symptoms, that were identified by the Good Stewardship groupconvened by the National Physicians Alliance.
Later, Dr. Steve Weinberger, Executive Vice President and CEO of the American College of Physicians identified sensible principles to guide the integration of a “less is more” theme in public policy, such as:
- Avoid interventions that don’t help and may harm
- Give incentives to physicians and patients to avoid low value care
- Use payment approaches that are politically feasible, medically appropriate and minimally burdensome
- Recognize that there will always be exceptions.
The discussion addressed the tip of the iceberg. The next step is to move to the big-ticket items where the literature is quite clear that patients are harmed by back surgeries for which there is no evidence of efficacy, cardiac bypass surgeries that are unwarranted, and duplicative and unnecessary diagnostic imaging that exposes patients to cancer-causing radiation, among many other tests and procedures performed that may cause more harm than good.
We can’t put all of the health care reform burden on patients, even with shared decision-making. Physician leadership is essential. That’s why this meeting will hopefully be the first of many conversations on K Street and on Capitol Hill.
In the end, this is all about good care of the patient. That’s the primary motivation. It’s also true that as a society, we don’t have money to waste. As I wrote in The Treatment Trap, the best way to preserve Medicare is to pay for things that improve health and well-being, and to stop paying for things that don’t. If we don’t get it right, and get it right soon, even the good things will be cut. Let’s act on the wisdom we have that knows the difference.
Rosemary Gibson led national quality and safety initiatives at the Robert Wood Johnson Foundation. She is author of The Treatment Trap and Wall of Silence: The Untold Story of the Medical Mistakes that Kill and Injure Millions of Americans. This article originally appeared on The Medical Professionalism Blog.
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