Update on secondary prevention of stroke from this month’s NEJM. Check out the resources hub.

Doing percutaneous coronary intervention – without a surgical backup

In the early days of percutaneous intervention – stenting and so on – you’d always want to have cardiothoracics around to crack the chest in case of emergency bypass surgery. As the population gets larger, and further away from major centres, more places are doing diagnostic angiography, and some of them are starting to stent.  This month’s NEJM has a look at the safety of doing PCI without surgical backup.

review | pulmonary embolism and deep venous thrombosis

Prof. Goldhaber from Harvard gives a review in this month’s Lancet on DVT and PE. The review touches on a few key areas in particular, including prophylaxis in hospitalised patients, advanced therapies (such as thrombolysis or embolectomy), and the use of newer drugs.

A overview on transcatheter aortic valve implantation

Transcatheter aortic valve replacement, or TAVI, had a lot of publicity over the past few years. Prior to TAVI, when faced with those elderly patients with multiple co-morbidities, who were really very restricted symptomatically from aortic stenosis, there really wasn’t much choice. But with any new advent, people question every complication. So now, the NEJM has got a few different articles looking at the TAVI situation.

BMD testing interval and transition to osteoporosis

So, you’re suspecting osteoporosis, you get a bone mineral density test…and you manage it. When do you do the next test? How long do you wait?

review | silicosis

When you auscultate the chest and hear crackles consistent with pulmonary fibrosis, the first thing that should go through your mind is the differential list – which usually gets broken up into upper and lower lobe causes. Although ankylosing spondylitis, radiation, and even tuberculosis are familiar – but silicosis isn’t usually. So luckily, here’s a review from the Lancet to update you.

New guidelines for migraine prevention

For those in the medical profession, you’ll realise that migraines are one disorder that we ourselves suffer a great deal  - and if you’ve had one, you’ll develop a great deal of empathy very quickly for your patients. The American Academy of Neurology has reviewed the evidence and provided some great recommendations in a short guideline update in regards to the best pharmacopreventive strategy.

In older patients with non-urgent multivessel coronary disease, CABG (probably) has a better long term survival than PCI

It’s been a decade long argument between cardiologists and cardiothoracic surgeons – when it comes to single lesions, PCI is often opted for, and when there are multiple diffuse lesions, CABG is often the choice. It’s not like this hasn’t been looked at before – a few RCTs have suggested different results – but many say these studies are underpowered or too selective. This registry based study from the NEJM aims to end the argument.

An update on cervical cancer screening

No one likes getting a Pap smear done. It can be quite daunting and frightening the first time, but we all know that early detection offers the best chance of cure. Over in the US, a joint group including the American Cancer Society have released some brand new guidelines in screening for cervical cancer. 

The explosion in the cloud

A while back we talked about using the cloud in medicine – and for when you’re working in a group on a presentation, or trying to write a research paper, cloud based collaborative tools are really useful. Saves the fifty emails back and forth, and it’s easy to track changes and see who suggested what. It also means you don’t have multiple copies of the same thing that you need to merge. Also, we’re all carrying several internet connected devices, like our laptop, smartphone, home desktop and tablet, and you don’t want to be sending stuff back and forth. Cloud based tools are the future – or really, the present – what are you signed up for?