April was a light month: an opinionated take on NEJM highlights for April 2017

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Calendaring care

The length of our sidereal year is an accident – we happen to be circling a G2 star from which the habitable zone where free surface liquid water can exist lies at around 150,000,000 km; by Newton’s laws this in turn corresponds to an orbital period that is our year.  Even if it is not particularly strongly connected to the underlying human biology, a lot of healthcare cycles are aligned to the Earth Year for convenience but is it effective and efficient?

Individuals with diabetes are at risk for diabetic retinopathy which can cause blindness and for which ophthalmologic mitigating treatment exists at the late stages. It is therefore accepted practice to screen those patients yearly with an ophthalmological exam with a view of intervening quickly at the final stage of the disease.  But is this optimal? The authors used the data from a cohort of patients with type 1 diabetes followed for 20 years, to formally calculate the optimal screening intervals depending on the stage of each patient.  What they find is that the screening interval ought to vary from 4 years to 3 months depending on the risk of the patient; that making such a change would reduce the delay to intervention and at the same time decrease the average total number of screening visits needed by more than half.  This is obviously more complicated to track than a yearly visit schedule, but points to an interesting opportunity – personalized health calendaring. Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes; Screening for Diabetic Retinopathy (subscriber access)

 

Pictures of a triumph of cardiovascular medicine

The NEJM has a section called IMAGES IN CLINICAL MEDICINE which is usually grim or gross (sometimes both), but this one made me smile. It shows serial cardiac imaging of a patient diagnosed with heart disease in his 40s. In the first set of pictures, one can clearly see coronary disease. This was treated aggressively with cholesterol lowering medications. Four years later, the patient had an episode of chest pain (which turned out to be non-cardiac) and was imaged again – the regression of atherosclerotic plaque is striking.  Regression of Coronary Atherosclerosis with Medical Therapy (free access)

 

The New England Journal of Medicine is a premier weekly medical journal covering many topics of interest to the health sector. In this monthly series we offer an opinionated perspective on selected highlights that might be of interest to our clients and others.