Dr. Justin Davies discusses value of using physiology-guided PCI
If you’ve been wondering what iFR (Instant wave-Free Ratio) is, how it works, how it compares to FFR (Fractional Flow Reserve) and, most importantly, how it affects clinical outcomes, then click here to register for a free, online, interactive live case being done on Monday, April 13, 2:30pm-3:30pm London Time, 9:30am-10:30am New York Time).
Interactive: that means you can ask questions!
Dr. Justin E Davies, interventional cardiologist at Imperial College NHS Trust, and developer of iFR, will be performing and guiding the worldwide audience through a live complex PCI multivessel case, using physiology to guide his procedure. Continue reading
Consumer Reports regularly publishes health information to aid the consumer/patient in making decisions. And that’s a good thing. But also important is having the most current information, which their January 27, 2015 article, titled “The surprising dangers of CT scans and X-rays,” does not.
All of the cautions about imaging tests that are listed in the Consumer Reports article are valid: ask why the test is necessary; check the credentials of the imaging specialist; ask for the lowest effective dose; avoid unnecessary repeat scans.
But one important piece of data is almost a decade old and, as a result, is potentially misleading. I’m talking about the radiation dose from a Cardiac CT scan. The article states that a Cardiac CT Angiogram (CTA) exposes the patient to 12 mSv of ionizing radiation, or 120 times that of a chest X-ray. This was true years ago, when CTA was first being used to diagnose coronary artery disease. But it is not true today. Continue reading
Lutonix and IN.PACT drug-coated balloons
Last week saw the U.S. Centers for Medicare and Medicaid Services (CMS) approve reimbursement for the two drug-coated balloons that recently were approved by the FDA: C. R. Bard’s Lutonix and Medtronic’s IN.PACT.
C. R. Bard’s Lutonix drug-coated balloon (DCB) was approved in October 2014, while Medtronic’s IN.PACT Admiral was approved in January of this year. Both devices have shown superior results when compared to uncoated balloons (a.k.a. “plain old balloon angioplasty” or POBA). Continue reading
The lyrics of the 1923 song go like this: “Who’s sorry now, who’s sorry now? / Whose heart is achin’ for breakin’ each vow?”
And today, it was the American Board of Internal Medicine (ABIM) who said they were sorry for breaking the hearts of all the cardiologists in the U.S. of A.
They wrote specifically: “We got it wrong and sincerely apologize. We are sorry.” Continue reading
Today’s the day that The National Board of Physicians and Surgeons (NBPAS) officially launches. Briefly stated, it’s an alternative certification organization, set up by Dr. Paul Teirstein and a group of physicians, mostly cardiologists, who strongly objected to the Maintenance of Certification assessment track established by the American Board of Internal Medicine (ABIM).
You can read more about it in my post from last week, “Scalpel…Suture…Suction…Pencil?” and in Dr. Teirstein’s New England Journal of Medicine article, titled “Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients.”
I’ll be following the progress of this initiative, but a few recent articles and developments bring up some interesting points. Continue reading
The buzz going around the medical community this week is Dr. Paul Teirstein’s article in today’s New England Journal of Medicine, titled “Boarded to Death — Why Maintenance of Certification Is Bad for Doctors and Patients,” in which he skewers the imposition of the Maintenance of Certification (MOC) requirement put into place a year ago by the American Board of Internal Medicine (ABIM).
The concept of the MOC was to ensure that physicians who had been certified in their specialty kept current with medical practice and the current guidelines. It’s not that concept that Dr. Teirstein objects to, but its heavy-handed implementation by, as he puts it, “people not directly involved in patient care who have lost contact with the realities of day-to-day clinical practice.” Ouch!
And Dr. Teirstein is not alone in his objections. An online petition he created has garnered almost 20,000 signatures. It asks the ABIM to recall the changes in MOC and institute a simple pathway consisting of a recertification test every ten years; a corollary petition, pledging non-compliance (read “boycott”) has over 6,000 signers – a more difficult pledge since many physicians are employed by hospital systems that require the ABIM MOC. And this certification is a monopoly, but more on that later…. Continue reading
Dr. Charles Dotter in LIFE Magazine (1964)
Who is that mad scientist in the 1964 issue of LIFE magazine? Oh, just the man who invented the concept of angioplasty; in fact he’s the man who actually coined the word “angioplasty!” And he’s the doctor who performed the first angioplasties in the leg, in order to save limbs from amputation without resorting to surgery.
Like many innovators, he had a crazy idea: to open blocked arteries from the inside out. No cutting, suturing, or stitching. Less trauma, lower morbidity, quicker recovery. His name was Charles Dotter and he was a radiologist in Portland, Oregon who, 51 years ago next week, performed an angioplasty on the blocked leg artery of an 82-year-old woman. Continue reading