Abdominal Aortic Aneurysms (AAA)

Abdominal aortic aneurysms affect 77/100,000 of those aged 60-64 years and this incidence increases with age. As a result the mortality rates also show an increase.  For ease, think of it as 3% of adults over 50 years having some kind of aneurysm.  Of this number 30% are destined to rupture if left undetected. Surgery to repair is recommended for aneurysms > 5cm. 

Recent articles in the BMJ and Lancet have recommended screening men (more at risk) over 65 for possible aneurysms and repeating screening in those with an aneurysm ~3cm. This is to monitor its expansion and to eventually decide when the patient is fit for elective surgery.  Any introduction of screening does raise some interesting questions.

AAA rupture is dramatic (as is a massive MI or stroke/CVA) and in older patients, surgery may not be appropriate. Or more bluntly put, the risks are too great and survival is unlikely. (This is not a judgement, merely fact) Even elective surgery of an asymptomatic (unproblematic) AAA is 5%.  Pros and cons need to be explained clearly, perhaps even on several different occasions to ensure informed consent. 

Also, an important issues when considering the introduction of any type of screening:

Wilson's criteria-

1.) Condition screened should be an important one. (It is)

2.) There should be acceptable treatment for the disease. (elective surgery)

3.) Diagnostic and treatment facilities should be available. (abdominal ultrasound, non-invasive, painless)

4.) Recognisable early symptomatic stage. (abdominal pain radiating to the back, pulsating {expanding & contracting abdominal mass}...see link above)

5.) Opinions on who to treat as patients need to be agreed. (AAAs >5cm are suitable for elective surgery)

6.) Test must be discriminatory, valid, reproducible and safe. (Ultrasound is all these things)

7.) Examination must be acceptable to the patient. (Again it is, unlike a prostate or other intimate examination)

8.) Untreated natural history of the disease is known. (Unfortunately, this is the case.)

9.) Inexpensive test. (US- ultrasound is inexpensive, portable and reliable)

10.) Continuous screening should be available for at risk groups. (Proposal is that for those with aneurysms >3cm they will be recalled for screening to monitor any increase or complications)

*Lancet. 2002;360:1531-1539

*BMJ. 2002;325:1123-1124, 1135-1138

*Radiology- Abdominal Aortic Aneurysm

4:13:15 PM    

Looking at medicine: art or science?

I came across an interesting article in the Medical Humanities online journal.  Since the time of Hippocrates and I'm sure well before him, there has always been debate over whether medicine is a science or an art. 

I sit in the middle myself; feeling it is a 'scientific extension of art'.  I don't feel that expressing it the other way round would be correct but that's my POV.  Approaching patients from this perspective keeps them in focus.  The lure of 'glory' and the paternalism so often (rightly) attributed to the attitude of doctors is not limited to any pont of view whether it be artistic, scientific or my own hotch potch amalgam. 

The reference is - A Warsop Art, science, and the existential focus of clinical medicine Journal of Medical Ethics: Medical Humanities 2002;Vol. 28: pg 74-77.

The abstract is as follows:

"The continuing debate over the status of medicine as an art or a science remains far from resolved. The aim of this paper is to clarify what is meant by the art of medicine. In the following interpretation I contrast two current perspectives of the medical art. I argue that the art of medicine is best understood in terms of the Aristotelian notion of techne. It consists of listening skills directed to the lived experience of the patient in such a way that knowledge (principally scientific knowledge) can be applied in a therapeutic way. This constitutes what I call medicine’s existential focus. The art of medicine is prior to and independent of medical science which plays an important but subordinate role."

4:07:56 PM    

Insurance and despair

I never wonder why the public is ill-informed on health matters. Not when what really needs to be reported isn't.  Case in point is Short thigh length linked to diabetes risk.  It was front and centre (ok a little to the right) on Google News in March (taken from my old blog).  What should be reported are issues such as insurance and the level of damages awarded in personal injury claims. For starters.

I got my monthly mailshot from the Medical Protection Society (MPS) and had no idea the problem was so worldwide.  To qualify my statement, negligence is inexcusable and a priori for all I am about to say. The culture of increasing compensation claims has led to an exponential growth in the cost of litigation and in insurance costs.  The soft target for examples is of course the U.S.A. with recent threats and walkouts from doctors.  What I got in the mail today was the role insurers have been playing.

In Australia, 30,000 doctors were left without cover when Ace Europe decided to withdraw medical malpractice cover and OBGYN doctors went on strike. OBGYN is one of the most litigated specialities. (so gross & lots of trouble in my POV) The Cost of Compensation Culture - report This report shows how compensation across the different sectors (not limited to health care) accounts for 1% of the U.K. G.D.P. A .pdf version is also available. The M.P.S. calls for government action to contain the cost of litigation. I heartily agree. There are already more NHS managers than beds (ratio is 1.7:1)

4:03:24 PM    

Tobacco facts

Anything you'd ever want to know about tobacco from all over the world. Tobaccofactfile Given from a health perspective; there aren't any jolly old fashioned cowboy adverts here.

4:00:40 PM    

Strip cartoons

Kudelka

3:59:22 PM    

CT Scans

CTs are as old as I am (28).  They were created by the EMI laboratories in London by engineer Godfrey Hounsfield using the royalties from Beatles records. (absolutely true)

CT- Computed Tomography

3:57:07 PM