The U.S. healthcare reform law will worsen a shortage of physicians as millions of newly insured patients seek care, the Association of American Medical Colleges said on Thursday. The group's Center for Workforce Studies released new estimates that showed shortages would be 50% worse in 2015 than forcast.
"While previous projections showed a baseline shortage of 39,600 doctors in 2015, current estimates bring that number closer to 63,000, with a worsening of shortages through 2025," the group said in a statement.
"The United States already was struggling with a critical physician shortage and the problem will only be exacerbated as 32 million Americans acquire health care coverage, and anadditional 36 million people enter Medicare."
Medicare is the federal health insurance plan for people over the age of 65, and census projections show that group growing as the giant baby boomer generation born from 1946 to 1964 hits retirement age. The U.S. healthcare reform plan signed into law by President Barack Obama in March is designed to provide insurance to 32 million Americans who now lack it. The AAMC projected a shortage of 33,100 physicians in specialties such as cardiology, oncology and emergency medicine in 2015. It calls for Congress to increase funding to train new doctors.
"The number of medical school students continues to increase, adding 7,000 graduates every year over the next decade," the AAMC said.
It said at least 15 percent more were needed. Other groups, such as the nonprofit Rand Corporation and the Institute of Medicine, have also projected various physician shortages.
Source: Reuters
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Thursday, September 30, 2010
Monday, September 27, 2010
New Research Leads To Cardiac Imaging Breakthrough
A recent investigation at the University of Western Ontario has resulted in a new imaging technique to enhance the effect of pacemakers, bypass surgery or angioplasties for patients.
Sunday, September 26, 2010
Study Predicts Clinical Outcomes With Cardiac Imaging
Recent study has revealed that, imaging along with noninvasive angiography, helps provide significant information to physicians caring for patients with coronary artery disease (CAD).
The research was presented yesterday at the 15th Annual Scientific Session of the American Society of Nuclear Cardiology.
The outcome from the Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in CAD (SPARC), Single Photon Emission Computed Tomography (SPECT or SPET), Positron emission tomography (PET), and 64-slice coronary CT Angiography (CCTA), suggests that, valuable pre-imaging data can be provided for the prediction of clinical trials.
3,019 patients, that had either, had already suffered from CAD or high-risk were examined in order to compare the incremental prognostic value of SPECT, PET, and CCTA. 932 patients underwent SPECT, PET was performed in 1,170 patients, and a CCTA study for 917 patients was assigned. Another 390 patients were not included in the final investigation owing to early revascularization or voluntary withdrawal.
Out of the final 2,629 patients, included in the examination, 84 events occurred during the first year of follow-up (42 all-cause deaths, 16 myocardial infarctions, and 26 revascularizations). Analysis of pre-imaging data revealed age, diabetes, prior myocardial infarction, and academic centers were most closely associated with the events. The addition of imaging result and modality to this pre-imaging data was shown to be significant, and the authors conclude that SPECT, PET, and CCTA can help physicians stratify patient risk and predict one-year adverse events.
Dr. Rory Hachamovitch will present this study, "Predicting Clinical Outcomes with Noninvasive Cardiac Imaging: One-Year follow up results from the SPARC study" Saturday, September 25, 2010 at 12:00 p.m. in the Grand Ballroom, Salon H of the Marriott Downtown Philadelphia.
Source: American Society of Nuclear Cardiology
The research was presented yesterday at the 15th Annual Scientific Session of the American Society of Nuclear Cardiology.
The outcome from the Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in CAD (SPARC), Single Photon Emission Computed Tomography (SPECT or SPET), Positron emission tomography (PET), and 64-slice coronary CT Angiography (CCTA), suggests that, valuable pre-imaging data can be provided for the prediction of clinical trials.
3,019 patients, that had either, had already suffered from CAD or high-risk were examined in order to compare the incremental prognostic value of SPECT, PET, and CCTA. 932 patients underwent SPECT, PET was performed in 1,170 patients, and a CCTA study for 917 patients was assigned. Another 390 patients were not included in the final investigation owing to early revascularization or voluntary withdrawal.
Out of the final 2,629 patients, included in the examination, 84 events occurred during the first year of follow-up (42 all-cause deaths, 16 myocardial infarctions, and 26 revascularizations). Analysis of pre-imaging data revealed age, diabetes, prior myocardial infarction, and academic centers were most closely associated with the events. The addition of imaging result and modality to this pre-imaging data was shown to be significant, and the authors conclude that SPECT, PET, and CCTA can help physicians stratify patient risk and predict one-year adverse events.
Dr. Rory Hachamovitch will present this study, "Predicting Clinical Outcomes with Noninvasive Cardiac Imaging: One-Year follow up results from the SPARC study" Saturday, September 25, 2010 at 12:00 p.m. in the Grand Ballroom, Salon H of the Marriott Downtown Philadelphia.
Source: American Society of Nuclear Cardiology
Sunday, September 12, 2010
Whole-Heart Magnetic Resonance Angiography for Detecting CAD
Non-contrast enhanced whole-heart coronary magnetic resonance angiography (MRA) involves a high sensitivity and moderate specificity for detecting coronary artery disease (CAD), with a negative predictive value suggesting that it can rule out CAD, reveals a recent published research in the Sept. 14 issue of the Journal of the American College of Cardiology.
Shingo Kato, M.D., of the Mie University Hospital in Tsu, Japan, and colleagues analyzed data from patients with chest pain and suspected coronary artery stenosis; 138 underwent coronary MRA, and image acquisition was successful in 127.
The researchers found that the sensitivity and specificity for detecting patients with significant CAD were 88 and 72%, respectively, according to patient-based analysis. Positive and negative predictive values were 71 and 88%, respectively, and accuracy was 79%.
Source: HealthDay
Shingo Kato, M.D., of the Mie University Hospital in Tsu, Japan, and colleagues analyzed data from patients with chest pain and suspected coronary artery stenosis; 138 underwent coronary MRA, and image acquisition was successful in 127.
The researchers found that the sensitivity and specificity for detecting patients with significant CAD were 88 and 72%, respectively, according to patient-based analysis. Positive and negative predictive values were 71 and 88%, respectively, and accuracy was 79%.
Source: HealthDay
Saturday, September 11, 2010
CTA and IVUS confirm that vulnerable plaques congregate in the proximal LAD
Stockholm, Sweden - Confirmation that thin-cap fibroatheromas (TCFAs) are focally distributed in the proximal left anterior descending (LAD) coronary artery is good news, according to the authors of a study using both computed tomography angiography (CTA) and virtual histology intravascular ultrasound (VH IVUS)
Dr Joëlla Van Velzen (Leiden University Medical Center, the Netherlands) and colleagues evaluated 168 patients with chest pain with coronary CTA to assess the frequency and distribution of mixed-composition plaques, which previous studies have shown are the most likely to rupture. All of the patients were then examined with VH IVUS to determine the frequency and distribution of high-risk plaque features, including the amount of necrotic core and presence of TCFAs.
The study results, presented as an abstract at the recent European Society of Cardiology (ESC) 2010 Congress, show that most TCFAs are located in the proximal segments of each vessel, primarily in the proximal LAD (p=0.03), and the average volume of necrotic core per vessel is greatest in the LAD (0.59 mm2), followed by the right coronary artery (0.55 mm2) and left circumflex artery (0.35 mm2) (p<0.001).
The VH IVUS exams found 602 plaques with 84 TCFA plaques, most of which were in the LAD, clustering mainly in the proximal part of the LAD. CTA found 984 plaques with 401 mixed-composition plaques, mostly located in the proximal segments of each vessel (p<0.001). Just under half of the mixed plaques were in the LAD.
Prior to this study, most of the existing information on the natural history and location of potentially high-risk plaques is retrospective autopsy data, according to the study authors. Van Velzen told heartwire that these results should be considered "encouraging," because plaques located proximally are more accessible to local invasive imaging techniques and local treatment options, such as PCI, than downstream plaques or diffuse disease.
Because CTA is a noninvasive technique and IVUS is invasive, a CTA technology that could identify vulnerable plaques would be helpful; however, Van Velzen cautioned that current CT technology cannot detect as many TCFAs as VH IVUS.
Commenting on the study, Dr Armin Zadeh (Johns Hopkins University, Baltimore, MD) agreed that "it's fairly well established that CTA is not as sensitive as VH IVUS to detect TCFAs; thus, [IVUS's] role does not seem to be diminished quite yet." On the other hand, the spatial resolution of VH IVUS is insufficient to detect TCFA as defined by pathology (<65-µm cap thickness), so VH IVUS "is not really a good standard to compare with" for the true assessment of TCFA, Zadeh said.
Many unanswered questions
Despite the encouraging findings, researchers have a long way to go before detection and treatment of vulnerable plaques can be routine. Commenting on the study, Dr Jonathan Lindner (Oregon Health and Science University, Portland) pointed out, " Right now, there is no specific therapy—drug or intervention—that has ever been shown to preventively treat [coronary disease] on the basis of [a] high-risk plaque phenotype."
Zadeh told heartwire that although this study confirms that problematic lesions are most common in the proximal LAD, "We don't know how troublesome these TCFAs really are. In reality, many of them eventually rupture clinically silently—evidence from pathology—and don't cause ACS." Further, Zadeh agrees with Lindner that "we don't know how to treat them even if we knew that they were troublesome—that is, we do not have any evidence yet that doing anything based on this information is associated with better outcomes. Particularly, it is unclear if doing anything beyond standard measures—cholesterol control, other risk-factor interdiction, etc—is helpful, let alone coronary stenting, which is associated with significant risks itself."
The future of research on identification and treatment of high-risk lesions before they become culprit lesions is "only conjecture at this point," Lindner said. "There is a parallel development of new treatment paradigms that will require new identification methods. The two are not happening in a vacuum independently of each other," he said.
Zadeh suggests that "we need outcome studies showing that identifying 'vulnerable plaques' significantly adds to our ability to predict risk over assessments with established track records," such as coronary atherosclerotic plaque burden, stenosis severity, stenosis location, and simple plaque characteristics. "More important, we need outcome studies showing that there is additional treatment in response to identifying 'vulnerable plaques' that improves outcome. Thus, we are quite a bit away from implementing some of these concepts into clinical practice."
Source:
Van Velzen JE, Schuiff JD, De Graaf FR, et al. Frequency and distribution of the vulnerable plaque in the coronary arteries: evaluated invasively by virtual histology intravascular ultrasound and non-invasively by multislice computed tomography. European Society of Cardiology 2010 Congress; August 29-September 1, 2010; Stockholm, Sweden. Abstract P4631.
Wednesday, September 1, 2010
ERASIR study | theheart.org
ASIR technique reduces radiation from CT angiography
AUGUST 20, 2010 |Vancouver, BC - Adaptive statistical iterative reconstruction (ASIR, GE Healthcare), an addition to the growing list of techniques for reducing radiation exposure from computed tomography (CT), has been validated in a large clinical trial [1].
Wednesday, August 18, 2010
New Imaging Method Helps Plan Implantable Cardiac Defibrillator Placement
A study published in the August Journal of Nuclear Medicine (JNM) finds that molecular imaging - a non-invasive imaging procedure - can identify high-risk patients with potentially life-threatening cardiovascular conditions and help physicians determine which patients are best suited for implantable cardioverter defibrillator (ICD) therapy.
"If the molecular imaging techniques are used for appropriate selection of ICD candidates, not only overuse but also underuse of ICD could be avoided and the assessment may be shown to be more cost-effective," said Kimio Nishisato, M.D., a physician in the cardiology division of Muroram City General Hospital, Muroram, Japan, and corresponding author for the study.
According to researchers from Sapporo University, Sapporo, Japan, the study shows that molecular imaging can play an important role in diagnosing and guiding the treatment strategy for arrhythmia, coronary artery disease and heart failure.
"This research holds significant potential for the detection, diagnosis and treatment of many common cardiovascular conditions," said Tomoaki Nakata, M.D., Ph.D., an associate professor at the Sapporo Medical University School of Medicine and director of the Hokkaido Prefectural Esashi Hospital, Japan. "With molecular imaging, physicians can improve patient care by pinpointing the precise location of the disease in order to eliminate the need for invasive medical devices and unnecessary surgical techniques." Nakata adds that molecular imaging can also reduce unnecessary medical costs by better targeting treatment for each individual patient.
In this study, researchers hypothesized that both the impairment of myocardial perfusion and/or cell viability and cardiac sympathetic innervations are responsible for heart arrhythmia and sudden cardiac death. However, there was no established reliable method, including a molecular imaging technique which is highly objective, reproducible and quantitative. The researchers investigated prognostic implications of cardiac pre-synaptic sympathetic function quantified by cardiac MIBG activity and myocyte damage or viability quantified by cardiac tetrofosmin activity in patients treated with prophylactic use of ICD, by correlating with lethal arrhythmic events which would have been documented during a prospective follow-up. Based on these aspects, the study is the first to show the efficacies of the method for more accurate identification of patients at greater risk of lethal arrhythmias and sudden cardiac death (SCD).
"Sudden cardiac death due to lethal arrhythmia represents an important health care problem in many developed countries," said Ichiro Matsunari, M.D., Ph.D., director of the clinical research department at the Medical & Pharmacological Research Center Foundation, Hakui, Japan, and author of an invited perspective also published in the August JNM. "While implantable cardioverter defibrillator therapy is an effective option over anti-arrhythmic medications to prevent SCD, the balance of clinical benefits, efficacy and risks is still a matter of discussion."
Matsunari adds that better, more precise strategies such as the molecular imaging technique used in this study are needed to identify high-risk patients for SCD, who are most likely to benefit from ICD therapy. SCD is often the first manifestation of an underlying disease - but one that current treatments such as ICD cannot always detect. Molecular imaging helps guide diagnosis and treatment as well as helps avoid unnecessary ICD treatment.
Authors of "Impaired Cardiac Sympathetic Innervation and Myocardial Perfusion Are Related to Lethal Arrhythmia: Quantification of Cardiac Tracers in Patients with ICDs" include: Kimio Nishisato, Division of Cardiology, Muroram City General Hospital, Muroran, Japan; Akiyoshi Hashimoto, Tomoaki Nakata, Takahiro Doi, Hitomi Yamamoto, Shinya Shimoshige, Satoshi Yuda, Kazufumi Tsuchihashi and Kazuaki Shimamoto, Sapporo Medical University School of Medicine, Sapporo, Japan; Daigo Nagahara, Obihiro-Kosei General Hospital, Obihiro, Japan.
Authors of "123I-Metaiodobenzylguanidine Imaging in the Era of Implantable Cardioverter Defibrillators: Beyond Ejection Fraction" include Ichiro Matsunari, Medical and Pharmacological Research Center Foundation, Hakui, Japan; Junichi Taki, Kenichi Nakajima and Seigo Kinuya, Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan.
Source:
Amy Shaw
Society of Nuclear Medicine
"If the molecular imaging techniques are used for appropriate selection of ICD candidates, not only overuse but also underuse of ICD could be avoided and the assessment may be shown to be more cost-effective," said Kimio Nishisato, M.D., a physician in the cardiology division of Muroram City General Hospital, Muroram, Japan, and corresponding author for the study.
According to researchers from Sapporo University, Sapporo, Japan, the study shows that molecular imaging can play an important role in diagnosing and guiding the treatment strategy for arrhythmia, coronary artery disease and heart failure.
"This research holds significant potential for the detection, diagnosis and treatment of many common cardiovascular conditions," said Tomoaki Nakata, M.D., Ph.D., an associate professor at the Sapporo Medical University School of Medicine and director of the Hokkaido Prefectural Esashi Hospital, Japan. "With molecular imaging, physicians can improve patient care by pinpointing the precise location of the disease in order to eliminate the need for invasive medical devices and unnecessary surgical techniques." Nakata adds that molecular imaging can also reduce unnecessary medical costs by better targeting treatment for each individual patient.
In this study, researchers hypothesized that both the impairment of myocardial perfusion and/or cell viability and cardiac sympathetic innervations are responsible for heart arrhythmia and sudden cardiac death. However, there was no established reliable method, including a molecular imaging technique which is highly objective, reproducible and quantitative. The researchers investigated prognostic implications of cardiac pre-synaptic sympathetic function quantified by cardiac MIBG activity and myocyte damage or viability quantified by cardiac tetrofosmin activity in patients treated with prophylactic use of ICD, by correlating with lethal arrhythmic events which would have been documented during a prospective follow-up. Based on these aspects, the study is the first to show the efficacies of the method for more accurate identification of patients at greater risk of lethal arrhythmias and sudden cardiac death (SCD).
"Sudden cardiac death due to lethal arrhythmia represents an important health care problem in many developed countries," said Ichiro Matsunari, M.D., Ph.D., director of the clinical research department at the Medical & Pharmacological Research Center Foundation, Hakui, Japan, and author of an invited perspective also published in the August JNM. "While implantable cardioverter defibrillator therapy is an effective option over anti-arrhythmic medications to prevent SCD, the balance of clinical benefits, efficacy and risks is still a matter of discussion."
Matsunari adds that better, more precise strategies such as the molecular imaging technique used in this study are needed to identify high-risk patients for SCD, who are most likely to benefit from ICD therapy. SCD is often the first manifestation of an underlying disease - but one that current treatments such as ICD cannot always detect. Molecular imaging helps guide diagnosis and treatment as well as helps avoid unnecessary ICD treatment.
Authors of "Impaired Cardiac Sympathetic Innervation and Myocardial Perfusion Are Related to Lethal Arrhythmia: Quantification of Cardiac Tracers in Patients with ICDs" include: Kimio Nishisato, Division of Cardiology, Muroram City General Hospital, Muroran, Japan; Akiyoshi Hashimoto, Tomoaki Nakata, Takahiro Doi, Hitomi Yamamoto, Shinya Shimoshige, Satoshi Yuda, Kazufumi Tsuchihashi and Kazuaki Shimamoto, Sapporo Medical University School of Medicine, Sapporo, Japan; Daigo Nagahara, Obihiro-Kosei General Hospital, Obihiro, Japan.
Authors of "123I-Metaiodobenzylguanidine Imaging in the Era of Implantable Cardioverter Defibrillators: Beyond Ejection Fraction" include Ichiro Matsunari, Medical and Pharmacological Research Center Foundation, Hakui, Japan; Junichi Taki, Kenichi Nakajima and Seigo Kinuya, Department of Nuclear Medicine, Kanazawa University Hospital, Kanazawa, Japan.
Source:
Amy Shaw
Society of Nuclear Medicine
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