In the Doctor's Lounge - Anesthetic, heart disease, genetic testing | St. Louis Public Radio

In the Doctor's Lounge - Anesthetic, heart disease, genetic testing

Jul 29, 2008

This article first appeared in the St. Louis Beacon: July 29, 2008 - Anesthetic Accidents More Common in Afternoon 

A shortage of anesthesiologists is leading to longer working hours and more fatigue among the docs, according to an article in the July issue of the AORN Journal. And further, "Anesthetic adverse events have been found to occur more frequently in surgical procedures performed after 4 p.m."

Fatigue and even burn-out are not unfamiliar afflictions among physicians and other healthcare professionals; however, this study highlights these issues in an especially critical setting.

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Heart Disease Revealed in Many Adults Without Symptoms

A significant proportion of apparently healthy individuals can show signs of coronary artery disease on a specialized heart CT scan known as coronary computed tomography angiography, according to research published in the July 29 issue of the Journal of the American College of Cardiology.

In the study, overall risk of heart disease was assessed using traditional Framingham risk scoring and the patients were then assigned to high-, moderate- or low-risk groups. Twenty-five percent of those found to have significant coronary artery disease had been classified as low-risk.

But hang on ... before we are quick to recommend, or request, such a screening for everyone across the board, there are issues related to radiation exposure and likelihood of false positives, among other concerns. Accordingly, "We are far away from recommending CT screening in asymptomatic individuals and abide by the recommendation statement of the U.S. Preventive Services Task Force against routine screening ... in adults at low risk," concluded the authors of an accompanying editorial.

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EditorialNon-invasive Test Detects Heart Disease in Women

And more from the frontlines of heart imaging suggests that another non-invasive test can accurately diagnose coronary artery disease in women, according to research published in the July issue of the Journal of the American College of Cardiology: Cardiovascular Imaging. The exam is known as multi-component cardiovascular magnetic resonance stress perfusion testing.

Heart disease is the number one killer of women, although only 13 percent of women in America polled in 2003 by the American Heart Association believed it to be the greatest health threat. In addition, diagnosis of heart disease in women can present a challenge due to the oftentimes "atypical" symptoms they have.

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Physicians to Get Bonus for Electronic Prescribing

The old joke about doctors' handwriting isn't so funny after all: 1.5 million patients are injured by drug errors every year. "That's a lot of people needlessly hurt and a lot of time spent trying to sort out bad handwriting. E-prescribing will help deliver safer or more efficient care to patients," said a U.S. Department of Health and Human Services official in July.

Medicare will pay a bonus to doctors who stop using handwritten prescriptions and, after five years, those who are not using electronic prescribing will likely be reimbursed at lower rates than those who do.

Incentives to use the system are predicted to increase the use of electronic prescribing and lower the risk of medication errors while increasing overall efficiency.

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Genetic Information Nondiscrimination Act Could Have Unforeseen Consequences

The Genetic Information Nondiscrimination Act, which was recently signed into law, may be creating a troublesome distinction between those at genetic risk for a disease and those with other characteristics that predispose them to a condition, according to a perspective article in the July 24 New England Journal of Medicine.

"An insurance company can discriminate against [those with characteristics that predispose them to a medical condition] in coverage and pricing because of the increased risk they represent, yet they bear no more responsibility for their increased risk than people whose genes predispose them to illness. If we are willing to spread the costs associated with genetic risk across the population, why shouldn't we do the same for all health risks?" the authors ask.

It is also a concern that insurance companies may focus more on current health while setting rates, making affordable insurance harder to obtain for many.

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This column by HealthDay's Dr. Cindy Haines, managing editor of the Physician's Briefing news service, will run each week in the St. Louis Beacon.