April 3rd 2024
The Low EF AI is designed to detect low ejection fraction in 15 seconds during a primary care exam.
MDIs, Spacers, and Dry Powder Inhalers: What Patients Are Likely to Do Wrong
June 24th 2009Inhaled medications are the cornerstoneof therapy for most of themore than 30 million Americanswho have asthma or chronic obstructivepulmonary disease(COPD). Unfortunately, many ofthese patients use aerosol deliverydevices incorrectly.
Does This Method for Testing Inhaler Contents Still Float?
December 31st 2006Dr Mohammed M. Basha’s “Practical Pointer” recommendationthat patients determine how much medication is leftin their inhaler by placing the canister in a glass of water(CONSULTANT, April 1, 2003, page 502) is, unfortunately,not sound.
Focus on the Needs of Individual Patients- Not of Society as a Whole
December 31st 2006Any discussion of theutility and reliabilityof mammography mustfocus on what is good forindividual patients-not onwhat the results of a Europeanpublic health researchproject have determined isgood for society as a whole.What is good for most patientsis annual screeningmammography beginningat age 40 years (and for patientsat very high risk forbreast cancer, mammogramsbeginning much earlier,and possibly performedmore frequentlythan once a year).1
Timely, Appropriate Follow-up Is Critical
December 31st 2006The scientific literatureon screeningmammography can be confounding.This poses a continuingdilemma for bothpatients and clinicians. Nevertheless,objective analysisof the available data canprovide reasonable guidelinesfor the primary careclinician who must decidewhether screening mammographyhas benefit foran individual patient.
Practical Steps to Increase the Benefit of Mammography
December 31st 2006Although mammographyis still generallythought to be advantageous,a number of problemswith this screeningtool have recently beenbrought to light. Some ofthe latest studies suggestthat mammography maynot be as effective as washoped at decreasing mortalityfrom breast cancer.Moreover, the quality ofmammography itself hasbeen questioned-both theprocessing of films andtheir interpretation by radiologists.1 Errors can occuras a result of inadequateexposure or insufficientpenetration of the film. Radiologistswho have lesstraining in mammographyor who read a lower volumeof mammograms maymake more errors in interpretation.There are clearvariations between mammographycenters in ratesof false-positive and falsenegativeresults. While theanxiety and costs associatedwith false-positives areimportant, higher rates offalse-negatives are of mostconcern.
A Test With Inherent Limitations
December 31st 2006Mammography is auseful tool. However,it has limitations. Until recently,it had been viewedas the ultimate diagnostictest, capable of detecting allbreast cancers in their earliest,treatable stages. Thissimply is not true. Evenwhen performed by themost capable institutionsand radiologists, mammographyhas a sensitivity of80% to 85% for the detectionof breast cancer. This hasbeen established by numerousstudies.1,2
Choose a Set of Guidelines From a Major Medical Organization and Follow the Recommendations
December 31st 2006Breast cancer remainsa significant healthconcern for women. Amongwomen at average risk,breast cancer will develop in1 of 8, and 1 in 30 will die ofthe disease.1 Although therehas been recent excitementabout the potential of geneticscreening to predict individualbreast cancer risk, itis important to keep in mindthat nearly 75% of women inwhom breast cancer hasbeen diagnosed have hadno risk factors other thansex and age.2
Breast Cancer Screening: Making Sense of Controversial Issues
December 31st 2006For more than a decade,screeningmammography hasbeen the subject ofintense public scrutinyand debate. Probably atno time has this debatebeen more heated thanduring the last 3 years,which saw the publicationof the now-famous “Danishstudy” as well as a majorexposé of poor quality controland radiologic interpretationerrors in the mammographyindustry (Box).