DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING JULY 19, 2020.
Category Archives: PODCASTS
MEDICAL PODCAST: “ASSESSING CHEST PAIN” (BMJ)
Chest pain is a common chief complaint. It may be caused by either benign or life-threatening aetiologies and is usually divided into cardiac and non-cardiac causes. James E. Brown, Professor and Chair, Wright State University Boonshoft School of Medicine, Kettering, Ohio, gives us an overview of assessing chest pain in the emergency setting.
COMMENTARY
Dr. James E Brown of the Wright State school Of medicine in Kettering Ohio gave a very interesting discussion of chest pain.
One interesting takeaway is the value of a very experienced clinician dealing with large volumes of emergency room patients. This would make telemedicine with an emergency room hub in a teaching center a very attractive platform.
The consultant doctor in the center has the advantage of his vast experience in rapidly narrowing down the heterogeneous list of different diagnoses that must be considered- the “differential diagnosis”.
Dr. Brown mentioned the “gestalt”, the incorporation of subjective features such as facial and voice cues which add to the objective parameters in patient evaluation. This of course would be amenable to telemedicine although other old-time clinical information like the changes in breath sounds would be more favorable to conventional in-person evaluation.
Ultrasound would More easily be done locally as well.
An interesting take away from this discussion is the value of The patient’s history and past laboratory data, so undervalued by rushed modern doctors. For instance, Electronic medical records (EMR) could provide past history or a previous electrocardiogram for comparison.
Dr. Brown favors the division of chest pain causes into cardiac and non-cardiac. It is easy to develop tunnel vision and look at the patient only as a possible coronary thrombosis. In fact it is better to Rapidly consider the non-cardiac causes that would demand immediate attention while waiting for the results of the Troponin-T test.
For instance pulmonary embolism, aortic dissection, tension pneumothorax, cardiac Tamponade should be considered.
These considerations should be running through the head of the clinician as the IV, EKG, and pulse oximetry are being set up.
In addition to the Troponin-T, bedside ultrasound, and Higher “slice count” CAT machines, and higher “Tesla” MRIs are becoming available major centers which could support small emergency rooms.
If there is One place where “the Flow” would be Appropriate it would be in the mind of the emergency room doctor evaluating acute chest pain.
I have a hard time imagining artificial intelligence endangering her job.
—Dr. C.
DR. C’S PODCAST: WEEKLY MEDICAL NEWS (JULY 4)
DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING JULY 4, 2020.
COVID-19 UPDATE PODCAST: HOW RESEARCHERS ARE SIMULATING OUTBREAKS
Researchers have run numerous military-style simulations to predict the consequences of fictitious viral outbreaks. We discuss how these simulations work, what recommendations come out of them and if any of these warnings have been heeded.
24:08 One good thing
Our hosts pick out things that have made them smile in the last week, including audience feedback, the official end of the Ebola outbreak in the northeastern Democratic Republic of the Congo, and an enormous t-shirt collection.
News: World’s second-deadliest Ebola outbreak ends in Democratic Republic of the Congo
28:50 The latest coronavirus research papers
Benjamin Thompson takes a look through some of the key coronavirus papers of the last few weeks.
DR. C’S PODCAST: WEEKLY MEDICAL NEWS (JUNE 27)
DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING JUNE 20, 2020.
DR. C’S PODCAST: WEEKLY MEDICAL NEWS (JUNE 20)
DR. C REVIEWS MAJOR MEDICAL NEWS FOR THE WEEK ENDING JUNE 20, 2020.
“THE WEEK THAT WAS”: DR. C’S PODCAST FOR JUNE 13, 2020
A weekly summary of medical, telehealth and patient health issues.
PODCASTS: TELEMEDICINE TECHNOLOGY CAN LEAVE MANY PATIENTS BEHIND
Amid the Covid-19 pandemic, more doctors are turning to telemedicine. That’s a problem for tens of millions on the wrong side of the digital divide.
SPEAKING ON A landline, the patient complained of an itchy eye. On the call’s other end, physician Carla Harwell considered the possibilities, from seasonal allergies to vision-damaging herpes. Luckily, the elderly patient’s daughter was visiting during the phone consultation, so Harwell asked her to text a picture of her mom’s eye. The photo shocked Harwell. It was the worst case of bacterial conjunctivitis the doctor had ever seen.
Without the picture, Harwell would have told the octogenarian patient to call back in a few days or come to her office, risking an in-patient visit during the Covid-19 pandemic. She certainly wouldn’t have prescribed the antibacterial eye drops needed to treat the infection. “I probably would not have prescribed anything,” Harwell says. “That’s a scary thought.”
COMMENTARY
Telehealth is here, will remain after the pandemic, and is useful in many situations.
Being older, poorer, minority, Linguistically challenged, rural, less informed and less Tech-savvy reinforce each other in comprising Barriers to proper Medical care of ANY kind, especially Telemedicine. These handicaps will hopefully improve with time, and should be A societal priority.
Special internet-connected roving Aid-mobiles in afflicted areas is one feasible idea that would help. Responding to a lesser “911” number, the health-van could go to the calling persons location, help the person to the van, take pictures and other data for a Telehealth Doctor to evaluate, and facilitate treatment.
A neighborhood Telehealth site is also workable, and was a precondition to Rural Telehealth access, pre-pandemic.
If you are reading this message, congratulations! You are increasing your information, technical facility and your access to better Healthcare.
—Dr. C.
PODCAST: “MEDDIET” ALTERS GUT MICRIOBIOME IN OLDER PEOPLE, IMPROVES FRAILTY, COGNITION, INFLAMMATION
We observed that increased adherence to the MedDiet modulates specific components of the gut microbiota that were associated with a reduction in risk of frailty, improved cognitive function and reduced inflammatory status.
Dr Philip Smith, Digital and Education Editor of Gut and Consultant Gastroenterologist at the Royal Liverpool Hospital interviews Professor Paul O’Toole; who is Professor of Microbial Genomics, Head of School of Microbiology and Principal Investigator in APC Microbiome Ireland, an SFI funded centre at University College Cork, Ireland, on “Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status: the NU-AGE 1-year dietary intervention across 5 European countries” published in paper copy in Gut in July 2020.
COMMENTARY
Diet is one of the 3 pillars ( or 4, if you don’t consider intellectual stimulation a form of exercise) of health. And there are 3 prime dimensions to diet: Quality, Quantity, and Timing. This excellent study addresses the Quality of the diet. Vegetables, fruits and whole grains are the foundation.
Dietary Fiber is the main difference between the healthful Mediterranean diet and the highly processed diet so common in America.
How can you be sure you are eating enough fiber? Read on.
On almost all cans and boxes, you will find a nutritional statement, by law. Assuming that the contents are “real food”, and preferably “organic”, look for the “fiber” in grams, and the “calories” in 100’s, and mentally divide the grams of fiber by 100s of calories, and you get a number. Let’s say that your fiber for the day totals “25” gms. and your calories for the day Totals 2500; that is “25” hundred calories. Divide the 25 grams by the 25 hundred calories, and you get “1”. Anything less than 1 is low in fiber.
25 grams of fiber is about the daily recommendation for fiber. 25 hundred calories is a ballpark figure for an average diet.
PORTION SIZE DOESN’T MATTER, since your dividend is a ratio.
The bacteria in your MICROBIOME feed on the fiber, and the higher and more diverse the fiber ( within reason. Hay is high in fiber) the healthier the food.
Blueberries are good for a fruit at 4-5 gms. of fiber per hundred calories. Broccoli is a good vegetable at 10 gms fiber per hundred calories, carrots about 3, and so on.
Sugar is the perfect “bad” food, at no fiber for as many calories as you can pack in. It makes you Want more, and “desensitizes” your taste buds to the natural sweetness of fruit, or even vegetables.
HIGH FIBER foods are MORE FILLING, leading you to eat less.
Civilization and Capitalism pushes too much food and too many calories at us. Overeating , obesity, and many of the modern illnesses is the result.
Generally, fresh fruits and vegetables are preferred, though cooking doesn’t do much harm, other than some vitamin loss that can be replaced.
Whole grain cereals have fiber in addition to other nutrients. Also, the complex carbohydrates in whole grains are released more slowly than wIth refined cereals. This floods your blood less rapidly with glucose, and elicits a Less precipitous insulin response. This results in a lower, healthier “glycemic Index”.
Vegetables, fruits Legumes, seeds, nuts and their oils are the mainstay of the Vegan diet, which is healthful If enough protein and essential fats are ingested.
Fish, eggs, milk and cheeses are other components of the Mediterranean diet.
I take many of my daily Vegetable and fruits and liquefy them in a food blender. Drinking my daily vegetables and fruits is a tasty and convenient way to improve my diet. I Savor individually those items I find most tasty, like nuts, apples, avocado, And fruit in season. This exercises my jaws, which is probably healthy.
YOUR MICROBIOME helps you in many ways that science is just beginning to understand. A healthy Microbiome is a DIVERSE Microbiome. FIBER is the food of the Microbiome, and a diversity in dietary fiber leads to a diverse Microbiome. A diverse, happy Microbiome produces many biological substances, like neurotransmitters, and probably communicates with the brain directly through the gut-brain Axis.
The Podcast on the 1 year Meddiet showed how directly a diet can BENEFIT HEALTH STATUS.
-Dr. C.
PODCAST INTERVIEWS: DIAGNOSIS AND EARLY TREATMENT OF COVID-19
In this audio interview conducted on June 3, 2020, the editors discuss two new studies: one comparing test swabs collected by health care workers with swabs collected by the patients themselves and one assessing hydroxychloroquine treatment in people who had been exposed to Covid-19 but weren’t yet ill.
The continuing spread of SARS-CoV-2 remains a Public Health Emergency of International Concern. What physicians need to know about transmission, diagnosis, and treatment of Covid-19 is the subject of ongoing updates from infectious disease experts at the Journal.
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.
Doctors Without Waiting Rooms 