Monday, July 24, 2017

Source:Levine GN. Balancing Ischemic and Bleeding Risks of Prolonged Dual Antiplatelet TherapyJAMA.2017;318(2):194-195. doi:10.1001/jama.2017.6698 

Dual antiplatelet therapy (DAPT) combines aspirin with a P1Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) to decrease the risk of coronary thrombosis. [start-highlighting]Compared with antiplatelet therapy with aspirin alone, DAPT after a myocardial infarction (MI) or percutaneous coronary intervention (PCI) reduces the risk of spontaneous MI and coronary stent thrombosis[end-highlighting] (Audio).1However, the addition, intensification, or prolongation of antiplatelet therapy necessitates a trade-off between decreasing ischemic risk and increasing bleeding risk.1 In addition to this trade-off, consideration also must be given to the implications of ischemic or bleeding events, how patients are selected for treatment with DAPT and its duration, and what can be done to reduce bleeding risk.

Saturday, July 22, 2017

The Aging Physician and the Medical Profession


Importance  The issue of the aging physician and when to cease practice has been controversial for many years. There are reports of prominent physicians who practiced after becoming dangerous in old age, but the profession has not demonstrated the ability to prevent this. A mandatory retirement age could be discriminatory and take many competent physicians out of practice and risk a physician shortage. An increasing body of evidence regarding the relationship between physicians’ age and performance has led organizations, such as the American College of Surgeons, to revisit this challenge.
Observations  Since 1975, the number of practicing physicians older than 65 years in the United States has increased by more than 374%, and in 2015, 23% of practicing physicians were 65 years or older. Research shows that between ages 40 and 75 years, the mean cognitive ability declines by more than 20%, but there is significant variability from one person to another, indicating that while some older physicians are profoundly impaired, others retain their ability and skills. There are age-based requirements for periodic testing and/or retirement for many professions including pilots, judges, air traffic controllers, Federal Bureau of Investigation employees, and firefighters. While there are not similar requirements for physicians, a few hospitals have introduced mandatory age-based evaluations.
Conclusions  As physicians age, a required cognitive evaluation combined with a confidential, anonymous feedback evaluation by peers and coworkers regarding wellness and competence would be beneficial both to physicians and their patients. While it is unlikely that this will become a national standard soon, individual health care organizations could develop policies similar to those present at a few US institutions. In addition, large professional organizations should identify a range of acceptable policies to address the aging physician while leaving institutions flexibility to customize the approach. Absent robust professional initiatives in this area, regulators and legislators may impose more draconian measures.

Thursday, July 31, 2014

Five Asean countries hail dengue vaccine advance | Bangkok Post: news

Five Asean countries hail dengue vaccine advance | Bangkok Post: news

Thailand and four other Asean countries have developed a new dengue vaccine that could mitigate the disease's severity by 88.5%, according to the Pediatric Infectious Disease Society of Thailand (PIDST).
PIDST president Usa Thisyakorn made the announcement at the sixth national vaccine conference in Bangkok yesterday.

The vaccine was developed under joint research between five countries — Vietnam, the Philippines, Indonesia, Malaysia and Thailand, she said.

Ms Usa said the vaccine can prevent and mitigate the impact of dengue and is the world's first advance against the disease.

"The vaccine was found to prevent dengue infection by 56.5% and mitigate its severity by 88.5%," the PIDST president said.

She said the vaccine was developed during experiments on more than 10,000 children, aged between two and 14.

The vaccine can prevent four strains of dengue, she added.

The research was first conducted at Photaram Hospital and Banpong Hospital in Ratchaburi and Kamphaeng Phet provincial hospital in 2009, areas which are prone to the disease, she said.

Those involved in the development phase of the vaccine will be followed for the next three years in line with World Health Organisation rules, Ms Usa said.

Five Latin American countries are also expected to announce successful development of their own dengue vaccine over the next few months, she said. Their research was conducted among more than 20,000 young people.

Department of Disease Control director-general Sophon Mekthon said the Asean dengue vaccine could be deployed in Thailand in two years' time.

It is now in the process of being registered with the Food and Drugs Administration (FDA), he said.

Dr Sophon said four public health campaigns encouraging people to come forward to be vaccinated will be announced

They are the vaccine to prevent the human papilloma virus which causes cervical cancer; the vaccine to prevent diarrhea in children; the vaccine to prevent diphtheria and tetanus in adults; and vaccinations of adults and medical personnel to prevent influenza and other diseases.

First glimmer: After Asian success, dengue vaccine trials come to India | The Indian Express

First glimmer: After Asian success, dengue vaccine trials come to India | The Indian Express

With no treatment in line for dengue, unlike malaria, control and prevention of this disease has posed a major challenge.
A dengue vaccine, tested on 10,275 children in the age-group of 2-14 years in Asia, has shown an overall efficacy of 56.5 per cent, according to study reported in The Lancet. More trials of the vaccine are now being conducted in India.
While leading company Sanofi Pasteur is the main funder, the chief investigator has been identified as Dr Maria Rosario Capeding of the Research Institute for Tropical Medicine, Philippines.
India has witnessed a dramatic rise in dengue from 18,860 cases recorded in 2011 to 75,454 cases reported last year, according to data from the National Vector Borne Disease Control Programme (NVBDCP). Following the promising results of the study, another trial of the vaccine is now being conducted in India to examine its success.
According to officials from the NVBDCP, the compilation of the trial results will be done by Sanofi Pasteur in December this year, while the results will be announced in 2015.
Dr A C Dhariwal, director of NVBDCP, told The Indian Express, “It is good news for us. The trial is now going on in India and we will examine the results before making it part of our dengue prevention measures.”
The vaccine trial in Asia, which was in its phase III, was conducted in five countries — Indonesia, Malaysia, Thailand, Philippines and Vietnam — for 25 months. Children were given a three-dose vaccination schedule with an interval of six months. The trial results showed 88.5 per cent reduction in dengue haemorrhagic fever (a nearly fatal stage of dengue) and 67 per cent drop in need for hospitalisation due to dengue.
According to Sanofi Pasteur, the vaccine trial will now be conducted in Latin America and the Caribbean on over 20,000 children aged nine to 16 years.
The World Health Organisation (WHO) estimates close to 100 million dengue infections, caused by mosquito Aedes Aegypti, every year, of which maximum are reported from Asia and Latin America.
With no treatment in line for dengue, unlike malaria, the control and prevention of this disease has posed a major challenge.
Dr Om Srivastava, director of department of infectious diseases at Jaslok Hospital (Mumbai), said, “The count of dengue cases in the country is huge. Though the efficacy of the trial is not very high, it will still reduce the burden of dengue to some extent.”
According to the research in The Lancet, the vaccine has shown varying effects on the four different dengue serotypes with efficacy ranging from 34.7 to 72.4 per cent. Experts said dengue control through this vaccine can vary depending on the serotype.
Dr Kalpana Baruah, joint director at NVBDCP, said, “In India, serotype-1 is the most common dengue virus. We are keenly awaiting the results of the trial in India because it will help in prevention of the disease. Our focus is more on prevention than treatment as there is only supportive treatment for dengue.”
This year till June-end, there have been 3,763 dengue cases reported from all over the country, including two deaths recorded in Kerala. Last year, there were 167 deaths due to dengue.

Thursday, July 03, 2014

Task force lists its priorities

PUTRAJAYA: The National Commit-tee on Dengue will meet on July 14 to tackle the current dengue epidemic. One item on the agenda is to get access to neglected buildings that are locked-up.
Health Minister Datuk Seri Dr S. Subramaniam said such premises com­­prised 30% of the places to be inspected for dengue.
“This will be among the issues raised in the coming meeting,” he told a press conference here yesterday.
Noting that 80% of dengue cases were spotted in houses or the surrounding areas, he urged people to clean up their living environment.
The national task force, which will be chaired by Deputy Prime Minister Tan Sri Muhyiddin Yassin, includes several ministries – Health, Urban Wellbeing, Housing and Local Go­­vernment, Works and Human Re­­sources.
It will work closely with state governments, local councils and re­­levant agencies to curb the scourge and implement effective preventive measures.
Dr Subramaniam also said that dengue infection was more serious than before with more multi-organ failures such as of the heart and kidneys.
“We are studying to find out if the serotype has changed or if the dengue virus has become more virulent,” he added.
There were 44,518 dengue cases reported this year up to June 28, compared to 12,858 in the same pe­­riod last year, an increase of 246% or 31,000 cases.
There were 85 and 27 deaths for the same period respectively.
Last week, 2,289 dengue cases and three deaths were reported nationwide. The total was an increase of 13% (268 cases) over the week before.
Dr Subramaniam said neighbouring countries were also experiencing a high number of dengue cases, with Singapore reporting 600 cases a week.

Wednesday, July 02, 2014

Number of dengue fever cases hits highest level in eleven years: CDC (Taiwan)

Number of dengue fever cases hits highest level in eleven years: CDC

The Centers for Disease Control (CDC) announced yesterday that 24 more cases of dengue fever were diagnosed last week, which, together with 61 existing patients in Taiwan since May, reached a record-breaking 11-year high.

The director of the CDC, Liu Ding-ping, said that because there have been thunderstorms recently, stagnant water will often become a sanctuary for mosquito reproduction, therefore the cases of dengue fever increased significantly. Last week 24 more patients from Taiwan and five more people who were infected in other countries were confirmed as having dengue fever, with the majority of patients from Kaoshiung City and one from Chiayi City.

There have been a total of 162 confirmed cases of dengue fever this year, with 87 people infected abroad and 75 in Taiwan. Since May 13 there have been 61 more cases. Statistically speaking, from 2003 to 2014, the number of confirmed cases peaked this summer, according to the CDC.

The CDC warned that as dengue fever is currently at its highest level, people who are experiencing fevers, headaches, eye pain, muscle and joint pains, or any similar symptoms, should seek medical attention immediately.

Sunday, June 01, 2014

10 Painfully Obvious Truths Everyone Forgets Too Soon - Eye Opening Info | Eye Opening Info

10 Painfully Obvious Truths Everyone Forgets Too Soon - Eye Opening Info | Eye Opening Info

You know how you can hear something a hundred times in a hundred different ways before it finally gets through to you?  The ten truths listed below fall firmly into that category – life lessons that many of us likely learned years ago, and have been reminded of ever since, but for whatever reason, haven’t fully grasped.
This, my friends, is my attempt at helping all of us, myself included, “get it” and “remember it” once and for all…

1.  The average human life is relatively short.

We know deep down that life is short, and that death will happen to all of us eventually, and yet we are infinitely surprised when it happens to someone we know.  It’s like walking up a flight of stairs with a distracted mind, and misjudging the final step.  You expected there to be one more stair than there is, and so you find yourself off balance for a moment, before your mind shifts back to the present moment and how the world really is.
LIVE your life TODAY!  Don’t ignore death, but don’t be afraid of it either.  Be afraid of a life you never lived because you were too afraid to take action.  Death is not the greatest loss in life.  The greatest loss is what dies inside you while you’re still alive.  Be bold.  Be courageous.  Be scared to death, and then take the next step anyway.

2.  You will only ever live the life you create for yourself.

Your life is yours alone.  Others can try to persuade you, but they can’t decide for you.  They can walk with you, but not in your shoes.  So make sure the path you decide to walk aligns with your own intuition and desires, and don’t be scared to switch paths or pave a new one when it makes sense.
Remember, it’s always better to be at the bottom of the ladder you want to climb than the top of the one you don’t.  Be productive and patient.  And realize that patience is not about waiting, but the ability to keep a good attitude while working hard for what you believe in.  This is your life, and it is made up entirely of your choices.  May your actions speak louder than your words.  May your life preach louder than your lips.  May your success be your noise in the end.
And if life only teaches you one thing, let it be that taking a passionate leap is always worth it.  Even if you have no idea where you’re going to land, be brave enough to step up to the edge of the unknown, and listen to your heart.  (Angel and I discuss this in more detail in the “Passion and Growth” chapter of 1,000 Little Things Happy, Successful People Do Differently.)

3.  Being busy does NOT mean being productive.

Busyness isn’t a virtue, nor is it something to respect.  Though we all have seasons of crazy schedules, very few of us have a legitimate need to be busy ALL the time.  We simply don’t know how to live within our means, prioritize properly, and say no when we should.
Being busy rarely equates to productivity these days.  Just take a quick look around.  Busy people outnumber productive people by a wide margin.  Busy people are rushing all over the place, and running late half of the time.  They’re heading to work, conferences, meetings, social engagements, etc.  They barely have enough free time for family get-togethers and they rarely get enough sleep.  Yet, emails are shooting out of their smart phones like machine gun bullets, and their day planners are jammed to the brim with obligations.  Their busy schedule gives them an elevated sense of importance.  But it’s all an illusion.  They’re like hamsters running on a wheel.
Though being busy can make us feel more alive than anything else for a moment, the sensation is not sustainable long term.  We will inevitably, whether tomorrow or on our deathbed, come to wish that we spent less time in the buzz of busyness and more time actually living a purposeful life.

4.  Some kind of failure always occurs before success.

Most mistakes are unavoidable.  Learn to forgive yourself.  It’s not a problem to make them.  It’s only a problem if you never learn from them.
If you’re too afraid of failure, you can’t possibly do what needs to be done to be successful.  The solution to this problem is making friends with failure.  You want to know the difference between a master and a beginner?  The master has failed more times than the beginner has even tried.  Behind every great piece of art is a thousand failed attempts to make it, but these attempts are simply never shown to us.
Bottom line:  Just because it’s not happening now, doesn’t mean it never will.  Sometimes things have to go very wrong before they can be right.  (Read The Success Principles.)

5.  Thinking and doing are two very different things.

Success never comes to look for you while you wait around thinking about it.
You are what you do, not what you say you’ll do.  Knowledge is basically useless without action.  Good things don’t come to those who wait; they come to those who work on meaningful goals.  Ask yourself what’s really important and then have the courage to build your life around your answer.
And remember, if you wait until you feel 100% ready to begin, you’ll likely be waiting the rest of your life.

6.  You don’t have to wait for an apology to forgive.

Life gets much easier when you learn to accept all the apologies you never got.  The key is to be thankful for every experience – positive or negative.  It’s taking a step back and saying, “Thank you for the lesson.”  It’s realizing that grudges from the past are a perfect waste of today’s happiness, and that holding one is like letting unwanted company live rent free in your head.
Forgiveness is a promise – one you want to keep.  When you forgive someone you are making a promise not to hold the unchangeable past against your present self.  It has nothing to do with freeing a criminal of his or her crime, and everything to do with freeing yourself of the burden of being an eternal victim.

7.  Some people are simply the wrong match for you.

You will only ever be as great as the people you surround yourself with, so be brave enough to let go of those who keep bringing you down.  You shouldn’t force connections with people who constantly make you feel less than amazing.
If someone makes you feel uncomfortable and insecure every time you’re with them, for whatever reason, they’re probably not close friend material.  If they make you feel like you can’t be yourself, or if they make you “less than” in any way, don’t pursue a connection with them.  If you feel emotionally drained after hanging out with them or get a small hit of anxiety when you are reminded of them, listen to your intuition.  There are so many “right people” for you, who energize you and inspire you to be your best self.  It makes no sense to force it with people who are the wrong match for you.

8.  It’s not other people’s job to love you; it’s yours.

It’s important to be nice to others, but it’s even more important to be nice to yourself.  You really have to love yourself to get anything done in this world.  So make sure you don’t start seeing yourself through the eyes of those who don’t value you.  Know your worth, even if they don’t.
Today, let someone love you just the way you are – as flawed as you might be, as unattractive as you sometimes feel, and as incomplete as you think you are.  Yes, let someone love you despite all of this, and let that someone be YOU. (Read Love Yourself Like Your Life Depends On It.)

9.  What you own is not who YOU are.

Stuff really is just stuff, and it has absolutely no bearing on who you are as a person.  Most of us can make do with much less than we think we need.  That’s a valuable reminder, especially in a hugely consumer-driven culture that focuses more on material things than meaningful connections and experiences.
You have to create your own culture.  Don’t watch TV, don’t read every fashion magazine, and don’t consume too much of the evening news.  Find the strength to fill your time with meaningful experiences.  The space and time you are occupying at this very moment is LIFE, and if you’re worrying about Kim Kardashian or Lebron James or some other famous face, then you are disempowered.  You’re giving your life away to marketing and media trickery, which is created by big companies to ultimately motivate you to want to dress a certain way, look a certain way, and be a certain way.  This is tragic, this kind of thinking.  It’s all just Hollywood brainwashing.  What is real is YOU and your friends and your family, your loves, your highs, your hopes, your plans, your fears, etc.
Too often we’re told that we’re not important, we’re just peripheral to what is.  “Get a degree, get a job, get a car, get a house, and keep on getting.”  And it’s sad, because someday you’ll wake up and realize you’ve been tricked.  And all you’ll want then is to reclaim your mind by getting it out of the hands of the brainwashers who want to turn you into a drone that buys everything that isn’t needed to impress everyone that isn’t important.

10.  Everything changes, every second.

Embrace change and realize it happens for a reason.  It won’t always be obvious at first, but in the end it will be worth it.
What you have today may become what you had by tomorrow.  You never know.  Things change, often spontaneously.  People and circumstances come and go.  Life doesn’t stop for anybody.  It moves rapidly and rushes from calm to chaos in a matter of seconds, and happens like this to people every day.  It’s likely happening to someone nearby right now.
Sometimes the shortest split second in time changes the direction of our lives.  A seemingly innocuous decision rattles our whole world like a meteorite striking Earth.  Entire lives have been swiveled and flipped upside down, for better or worse, on the strength of an unpredictable event.  And these events are always happening.
However good or bad a situation is now, it will change.  That’s the one thing you can count on.  So when life is good, enjoy it.  Don’t go looking for something better every second.  Happiness never comes to those who don’t appreciate what they have while they have it.

Your turn…

What else would you add to this list?  What important life lessons do you often forget?  Leave a comment below and share your thoughts.