Friday, November 30, 2007

Invasive treatment not better than medical management for non-ST MI.

A randomized controlled trial published in the Lancet showed no benefit from early invasive treatment for non-ST elevation MI. Although it's true that they experienced fewer symptoms of angina, they did experience more MI's than their piers. This study seems to indicate that early invasive treatment in these cases is not indicated.
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Initial data indicated that routine invasive therapy was more effective than selective invasive treatment in reducing subsequent major cardiovascular events. More recently, large trials with up to five years' follow-up have had contrasting results.
The researchers enrolled 1,200 patients 18 to 80 years of age between 2001 and
Patients were randomly assigned to receive early invasive therapy or initial medical management with intervention only if clinically indicated...cumulative three-year results for the primary composite end point (death, recurrent myocardial infarction, or hospitalization) were 30 percent in the early invasive group and 26 percent in the selective intervention group (P = .09).
The authors conclude that early invasive treatment did not provide better outcomes over four years than the selective strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin.

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Monday, November 26, 2007

Sunday, November 11, 2007

Free clinics may help fill the gap

While the medical system has come under fire recently, thousands of free clinics around the country have been working to fill the holes. Seen as an acute stop-gap for something that is essentially a chronic problem, the cost of these clinics to their providers is generally a tiny fraction of the true value of care received by patients.

No potential medical system can successfully deliver universal coverage while at the same time controlling costs if it does not stimulate the delivery of low cost and free basic services to those most in need.
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The Free Clinic movement is living embodiment of many conservative principles: the principles of subsidiarity and voluntarism, the spirit of enterprise and of community self-reliance. As health care becomes more and more of a national concern, if people are truly concerned about the less fortunate, there should be a population explosion in the number of free clinics around the country.

All the good intentions in the world would not make a free clinic possible in our litigious society. But that problem has been solved in Virginia, whose example could easily be followed.

the help of the Virginia Association of Free Clinics, the state recently established the "VaRISK2" liability risk management program. Operating under the Division of Risk Management of the Department of the Treasury, of the Commonwealth of Virginia, the program indemnifies Directors, Officers, employees, and volunteers in a Free Clinic.

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