Category Archives: Physicians

Physical Exams: Hip And Lumbar Spine (Mayo Clinic)

Dr. Karen Newcomer – Hip and Lumbar Exam Guide

This video demonstration contains the components necessary to perform a physical examination on a patient with a complaint related to their lumbar spine and hip region. At the beginning of the video, I will demonstrate the basic examination components of inspection, palpation and range of motion I will then show you special tests including Trendelenburg test (compensaved and uncompensated), Stork test (provocation of posterior elements of spine and lumbar nerve roots), straight leg raise (lumbar radiculopathy), Faber test (intraarticular hip and sacroiliac joint provocation) and Fadir test (femoroacetabular impingement).

Telehealth: How Doctors Can Expand Care (AMA)

Continuing the AMA’s “Look Forward/Look Back” series, AMA CXO Todd Unger talks with Meg Barron, the AMA’s vice president of digital health strategy, about the role of telehealth post-pandemic and a new program that can help practices optimize and expand their telehealth efforts.

2021 HEART RESEARCH: TOP FINDINGS OF CARDIOLOGISTS

Coronary artery bypass graft (CABG) was supported as superior to fractional flow reserve (FFR)–guided percutaneous coronary intervention (PCI) for three-vessel coronary artery disease (CAD). PCI failed to meet noninferiority criteria at 1-year follow-up in a study comparing outcomes between FFR-guided PCI using contemporary stents and CABG. This adds to existing evidence showing superior outcomes with CABG in patients with the most-complex CAD.

The sodium–glucose transporter-2 (SGLT-2) inhibitor empagliflozin was found to be beneficial in heart failure with preserved ejection fraction. Empagliflozin is the first medication shown to improve outcomes in this population. It’s unknown if this is a class effect of all SGLT-2 inhibitors, but this could be a game changer.

Poor-quality carbohydrates were linked to cardiovascular mortality, around the world. Consumption of higher-glycemic-index carbohydrates was associated with higher rates of cardiovascular disease and mortality in countries all around the world. These data are particularly important because lower-income countries often have diets high in refined carbohydrates, which may worsen cardiovascular disparities.

New guidelines for managing valvular heart disease were released. These new guidelines add or elevate several recommendations for transcatheter therapy, and they lower thresholds for intervention in some conditions.

The editors of Circulation: Cardiovascular Quality and Outcomes addressed racial-ethnic disparities. The editors affirmed that structural racism is a public health crisis and that the scientific publishing community can play a role in addressing it.

Tricuspid annuloplasty for moderate regurgitation during mitral-valve surgery was of unclear benefit. Annuloplasty was associated with less progression of moderate tricuspid regurgitation but more pacemakers at 2 years. Unfortunately, this mixed outcome does not clearly inform the decision on performing annuloplasty at the time of surgery, and longer-term follow-up is needed.

Immediate angiography was not beneficial in out-of-hospital cardiac arrest without ST elevation. Patients with out-of-hospital cardiac arrest who did not have ST elevation on their initial ECG did not benefit from immediate angiography. Although a potential coronary culprit was identified in about 40% of patients, neurologic injury was by far the most frequent cause of death, negating any benefit from coronary revascularization.

Many statin side effects are related to the “nocebo” effect. A creative study enrolled 60 people with statin intolerance and gave them 12 randomly ordered 1-month treatment periods: 4 periods of no medication, 4 of placebo, and 4 of statin. Symptom intensity did not differ between placebo and statin periods and, interestingly, some even had more symptoms on placebo. This demonstrates that some cases of “statin intolerance” may be related to the “nocebo” effect.

Shorter duration of dual antiplatelet therapy following PCI/stent placement was found to be acceptable in patients with high bleeding risk. A large, randomized trial found that 1 month of dual antiplatelet therapy provided similar clinical outcomes and a lower bleeding risk than 3-to-6-month regimens for this challenging patient subset.

De-escalation” of dual antiplatelet therapy for patients undergoing PCI for acute myocardial infarction (MI). This industry-funded study evaluated patients who had received 1 month of aspirin plus ticagrelor after acute MI and stent placement and “de-escalated” half to aspirin plus clopidogrel. At 1 year, there was significantly less bleeding in the de-escalation group and a nonsignificant trend toward fewer ischemic events as well.

Opioids: Postsurgical Pain Management (Mayo Clinic)

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Covid-19: Is There Prior Infection Immunity?

Eric Rubin is the Editor-in-Chief of the Journal. Lindsey Baden is a Deputy Editor of the Journal. Stephen Morrissey, the interviewer, is the Executive Managing Editor of the Journal. E.J. Rubin, L.R. Baden, and S. Morrissey. Audio Interview: How Much Protection Does Prior SARS-CoV-2 Infection Provide? 

Mayo Clinic: ACL Tears – When Surgery Is Needed

ACL tears can sideline an athlete or crush an Olympic dream. It’s a common knee injury affecting nearly twice as many women than men. Dr. Cedric Ortiguera, a Mayo Clinic orthopedic surgeon and sports medicine specialist, says 150,000‒200,000 ACL injuries occur each year in the U.S., and that number is growing as more children become involved in competitive sports year-round. The good news is that surgery can help get some athletes get back in the game.

Medicine: What Causes Urinating Issues? (Video)

Trouble Urinating? There are many common causes for urinary issues in men. Learn about symptoms and treatment options offered by The Johns Hopkins Brady Urological Institute. https://www.hopkinsmedicine.org/brady…

Cancers: What Is Multiple Myeloma? (Mayo Clinic)

Multiple myeloma is a relatively uncommon form of blood cancer that affects less than 1% of the U.S. population, according the American Cancer Society. People younger than 45 rarely get the disease, and it occurs more in older men than women. And your risk is doubled if you’re African American.