Author Archives: Denise Fulton

The Labor Day Edition: The Policy & Practice Podcast

As U.S. workers came back from a brief Labor Day holiday, new federal health reform benefits are in the spotlight.

Morgantown, WV

Health reform benefits seek to help small businesses. Image courtesy flickr user jmd41280 (CC)

Two Affordable Care Act programs seek to help employers cover more of their workers — one seeks to encourage small businesses to continue to cover their workers, while the other helps companies to continue insurance benefits for early retirees.

And as summer turns to fall, so the nation’s attention turns to the upcoming midterm election in November. How will candidates’ support of health reform affect voters’ choices?

The Policy & Practice Podcast has more on these important issues. Take a listen and let us know what you think:

—Denise Fulton (@denisefulton on Twitter)

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Filed under Health Policy, health reform, IMNG, Podcast

Give Me a (Medical) Home: The Policy & Practice Podcast

While doctors are still peeved that there’s been no action to avoid the deep cuts in Medicare pay necessitated by the Sustainable Growth Rate formula, or SGR, the Obama administration has delivered some good news regarding a test of the Advanced Primary Care Practice concept, better known as the medical home.

For more on those stories, listen to this week’s Policy & Practice Podcast.

Not up to speed on the medical home? My colleague Mary Ellen Schneider can help you with that. As the medical home beat reporter for Elsevier Global Medical News—Notes From the Road’s sister news outlet—she’s covered the topic from most angles.

Image courtesy flickr user J. Steven Conn (CC)

Today, she wrote about an extensive test of the concept sponsored by the American Academy of Family Physicians; last week, she took a look at how specialists might lead the medical home for some of their patients.

See how much you can learn by reading Notes From the Road?

—Denise Fulton (@denisefulton on Twitter)
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Filed under Family Medicine, Health Policy, health reform, IMNG, Internal Medicine, Podcast, Practice Trends, Primary care, Rheumatology

One of These Things Is Not Like the Others

Courtesy flickr user pasma (CC)

One of these things is not like the others,
One of these things just doesn’t belong,
Can you tell which thing is not like the others
By the time I finish my song?
(Words and Music by Joe Raposo and Jon Stone, Sesame Street)

The current public health message to patients is to look for the ABCD’s of melanoma. But how many people do you think can actually remember what that mnemonic stands for?

The ugly duckling sign of melanoma was first described in 1998 by Dr. Jean-Jacques Grob of the University of Marsielle in Provence, France. It holds that nevi on a given individual tend to resemble each other, said Dr. Ashfaq A. Marghoob, at today’s meeting at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation. Most individuals harbor nevi that resemble each other like brothers. And when a lesion breaks that common mold, it becomes an ugly duckling…

This post first appeared in our sister blog, The Mole: the Skin & Allergy News blog. To read the whole post by managing editor Amy Pfeiffer, go here.

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Filed under Dermatology, Family Medicine, IMNG, Internal Medicine, Oncology

Straighten Out Your 3-Iron With CPAP

Courtesy flickr user anthony_goto (CC)

Finally, a way to motive patients to use the CPAP machine you’ve prescribed for them.

According to Dr. Marc L. Benton, golfers with obstructive sleep apnea can expect to knock strokes off their game by adhering to nighttime treatment with continuous positive airway pressure. What’s more, the better the player, the bigger the improvement in golf handicap resulting from sticking with CPAP.

Compliance with CPAP is notoriously poor, notes Dr. Benton, a sleep disorders and pulmonary medicine specialist in Madison, N.J. Many patients, put off by CPAP’s noise, inconvenience, and expense, remain unswayed by their physician’s warnings of the serious medical risks they face in foregoing treatment.

Not avid golfers, however. Dr. Benton has shown in a small prospective study that golfers with OSA are are willing–indeed, eager–to embrace the therapy. He calls the prospect of playing a better game a powerful and previously untapped motivator to seek out and adhere to treatment.

“The adherence in this study was absolutely through the roof,” Dr. Benton observed in presenting his study findings at the annual meeting of the American College of Chest Physicians, held in San Diego.

“More so than almost any other sport, golf has a strong intellectual component, with on-course strategizing, focus, and endurance being integral components to achieving good play,” he noted. “Through treatment with nasal positive airway pressure [NPAP] we can improve many cognitive metrics, including attention span, memory, decision-making abilities, and frustration management, which may in turn positively affect a person’s golf game.”

His study included 12 golfers with moderate-to-severe OSA and 12 controls matched by age and golf handicap. None of the golfers with OSA had previously been interested in treatment, but the glowing vision of a lower handicap lured them into study participation.

After 3-5 months of NPAP their handicap dropped from an average of 12.4 to 11.0. All of them felt better able to perform on the links. The control subjects had no change in handicap.

The outcomes were particularly striking among the 5 golfers with OSA who were already very good at the game as defined by a baseline handicap below 12. Their average handicap dropped from 9.2 to 6.3, and they were ecstatic about it. “Most of these better golfers were in their late 50s and early 60s, a time of life when the handicap index is typically going in the other direction due to issues related to the aging process,” Dr. Benton noted.

He estimated that 1-3 million American golfers have OSA. In most cases the disorder is undiagnosed and/or untreated.

—Bruce Jancin

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Filed under Family Medicine, IMNG, Internal Medicine, Pulmonary Diseases and Sleep Medicine, Sports Medicine

No SGR Fix So Far: The Policy & Practice Podcast

From press conferences, meetings, and more around Washington, D.C.

Courtesy flickr user takomabibelot under Creative Commons

Courtesy flickr user takomabibelot under Creative Commons

Too few votes on a procedural measure meant a fix to the Sustainable Growth Rate formula–a long-time thorn in doctors’ sides–was not taken up by the Senate last week. That’s the headline story in this week’s Policy & Practice Podcast.

Go ahead and take a listen to this week’s installment to learn more on an SGR fix–and physicians’ hope that one will be a part of health reform. We also cover a new report on health care quality and legislation that takes aim at malpractice insurers.

—Denise Fulton (@denisefulton on Twitter)
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Filed under health reform, Podcast, Practice Trends

Perfect Harmony: AAFP and Coca-Cola Get Cozy

From the annual American Academy of Family Physicians Congress of Delegates, Boston

Under fiscal pressure to make ends meet without raising its dues, the American Academy of Family Physicians has inked a consumer alliance with the Coca-Cola Company. At a town hall meeting held the opening evening of the Congress of Delegates, AAFP President-Elect Dr. Lori J. Heim unveiled the deal to angry members: Under a 1-year contract, the beverage company will pay AAFP a “strong six-figure sum” (around $600,000, rumor has it) to provide consumer education materials on, you guessed it, beverage choices for the academy’s Web site. The aim is to provide evidence-based, health-related information about sweetened, unsweetened, and artificially sweetened beverages. No specific brand names are supposed to appear, and the AAFP will maintain 100% editorial control, Dr. Heim stressed.

from flickr user Old Shoe Woman, under Creative Commons

from flickr user Old Shoe Woman, under Creative Commons

“I have had patients who’ve gotten better when they quit drinking Dr Pepper.… The evidence on this is clear and consistent. The single biggest contributor to the obesity epidemic is sugar-sweetened beverages,” said Dr. Robert Rauner, president of the Nebraska Academy of Family Physicians. The AAFP’s “guilt by association could be a problem here,” he said adding that the tobacco companies have waged similar consumer education campaigns as a means of a makeover.

Several clearly frustrated members took to the mic on the congress floor to express their concern about the AAFP tarnishing its image, especially while the stakes are so high and given the academy’s strong push for a health care reform bill acceptable to family physicians and their patients.

Dr. Heim urged members to take a wait and see approach and reserve judgment until the materials are up on the site. “It may be something that you actually don’t find to be appalling,” she said to a room of collective laughter.

As Dr. Richard Cirello, a delegate from New Jersey said,  “I have no objection to pursing this business approach; however, at a time when credibility is very important, let’s be honest. We’re not doing this to educate anybody. We’re doing this to create a revenue stream and apparently we need this revenue stream. If this is what we have to do to keep us whole and to keep the dues where they should be, well, we could put some lipstick on this pig and sell it.”

—Kathryn DeMott
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Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Practice Trends, Primary care

The Art of Medicine

From the 19th World Congress on Ultrasound in Obstetrics and Gynecology in Hamburg, Germany

At medical meetings, the art of medicine takes a back seat to the presentation of hard data and the science of medicine. The meshing of those two worlds was never so seamless though as in the exhibit hall of the Congress Center Hamburg where high-tech 2- and 3-D diagnostic ultrasound images from the likes of Toshiba, Medison, and Philips shared floor space with a premier showing of a collection of fantastical images of the human embryo.

Courtesy Prof. Jan E. Jirásek. M.D.

Courtesy Prof. Jan E. Jirásek. M.D.

 The artwork represents 50 years of fascination with human development, according to its creator Prof. Jan E. Jirásek, M.D., an instructor in embryology and reproductive medicine at the Institute for Care of Mother and Child in Prague.

“I became interested already in embryology at the time of my medical studies and after finishing medical studies my goal was to see all stages of human development, and I did it,” he said in an interview.

The advent of the personal computer, digital photography, and scanning electron microscopy has allowed the retired gynecologist and obstetrician to capture incredibly detailed images. There was a 1 mm trilaminar embryo within the amnionic sac (left), the head of an 11 mm 35 day-old embryo with distinct olfactory placodes (right), and a 27 mm 54-day embryo with amnion, yolk sac, and chorion.

Courtesy Prof. Jan E. Jirásek, m.D.

Courtesy Prof. Jan E. Jirásek, M.D.

Prof. Jirásek, now age 80, admits that some of the more colorful Warhol-like images have frightened a few viewers, but notes that “the morphology is real,” and that only the colors are computer generated based on his imagination. The end result is a fantastic celebration of the human form at its earliest stages.

—By Patrice Wendling (@pwendl on Twitter)
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Filed under Obstetrics and Gynecology

Town Hall Time: The Policy & Practice Podcast

From user BL1961 under creative commons

from Congressional hearings and press events in Washington, D.C.

House members have gone home for August and Senators are close behind. Health reform closure? Um, not so much. Take a listen to this week’s Policy & Practice Podcast to learn about the delays and divisions on health reform.

Policy & Practice Podcast August 3, 2009

As Congress recesses and Washington traffic dies down (YAY!), keep an eye out for your representative or senators this month. VFW halls and armories are good places to look. High school gyms and diners are possible too. It’s town hall time for them and they want to talk to you about health reform.

—Denise Fulton (@denisefulton on Twitter) posted at 5:06 pm EDT
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Photo by user BL1961 under creative commons. Thanks!

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One Vote Down, Many to Go: The Policy & Practice Podcast

From Congressional hearings, press briefings, and related health care events around Washington, D.C.

Technical quirks caused us to miss our Monday post, but here, one day late, is your weekly installment of the Policy & Practice Podcast. Last week, a Senate committee passed its bill, the AMA unexpectedly weighed in, and the President added his two cents. Take a listen: In just 2 minutes, you’ll be all caught up on the progress of health care reform.

Policy & Practice Podcast, July 20

Like what you hear? Check this space every Monday for your weekly 2-minute podcast. And let us know what you think!

—Denise Fulton (@denisefulton on Twitter)
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A billion here, a billion there: Soon you’re talking real money

From congressional hearings, press briefings, and assorted heath care events in Washington, D.C.

Pardon the paraphrase of the late Sen. Everett Dirksen (R-Ill.), the Grammy-winning orator who eventually lent his name to a Senate Office Building, but health reform last week focused on billions and billions of dollars. Where will they come from? How will we spend them? 

Want to know? Take a listen to the Policy & Practice Podcast. And remember to tune into this space every Monday for your 2-minute synposis of the most important goings on in health care reform.

Policy & Practice Podcast, 7/13/09

—Denise Fulton (@denisefulton on Twitter)
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Image via flickr user Adam Kuban under Creative Commons license

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