- Patients with congenital long QT syndrome are at particular risk of torsades de pointes, ventricular tachycardia and sudden death when given drugs that prolong the QT interval. Nevertheless, the labeling recommendation for patients with congenital long QT syndrome has been changed from “contraindicated” to “not recommended,” because it is recognized that there may be some patients with this condition who could benefit from a low dose of citalopram and who lack viable alternatives. Similarly, the drug is not recommended for those who have bradycardia, hypokalemia or hypomagnesemia, recent acute myocardial infarction, or uncompensated heart failure.
- Although citalopram use should be avoided, if possible, in patients with certain conditions because of the risk of QT prolongation, ECG monitoring and electrolyte monitoring should be performed if citalopram must be used in these patients.
- The maximum recommended dose of citalopram is 20 mg per day for patients with hepatic impairment, adults older than 60, patients who are CYP2C19 poor metabolizers, and those who are taking cimetidine or another CYP2C19 inhibitor concurrently.
- Citalopram should be discontinued in patients who are found to have persistent QT measurements (corrected for heart rate) greater than 500 milliseconds.
Author: SupremeCmdr
The SEC Identifies Inadequate Disclosures in Sales of Structured Notes :: Investment Fraud Lawyer Blog
Structured notes are essentially bank bonds bundled with derivatives. Derivatives are contracts whose value is derived from stocks, bonds, currencies and commodities. Thus, structured notes are complex products with no pricing transparency.
Financial underwriting just got a whole lot more complicated.
More Financial Scammers Are Targeting Seniors :: Investment Fraud Lawyer Blog
As America ages, regulators are seeing more and more financial abuse of people 50 years of age or older. The North American Securities Administrators Association NASAA, the association of state securities regulators, reportedly filed 1,241 such enforcement actions in 2010, the latest year for which data has been compiled – more than double the 506 enforcement actions filed in 2009 “Financial Scammers Prey on Seniors,” by Anne Teresen, Wall Street Journal.
via More Financial Scammers Are Targeting Seniors :: Investment Fraud Lawyer Blog.
PodMed – Medical News Roundup Johns Hopkins 04.13.12
Life Underwriting Expert Witness Search Results on Google Alternatives
We get so focused on Google that it’s easy to forget there are alternatives to Google search. Granted, the alternatives are not nearly as popular. At 66% market share and 11.7 billion searches during the month of February 2012 alone, Google clearly is the leader. But other search engines are worth understanding — both from the perspective of when you are a searcher for information, and from the perspective of a site owner knowing that visitors may come from those other search engines.
via Google Alternatives.
I came across this article while catching up on news one Saturday morning. For fun I ran the search string “life underwriting expert witness” without quotation marks on all of the search engines listed in the article. I must admit that I was surprised at the search findings on all of the engines.
Let’s just say I’m a happy guy this morning.
The Conundrum Between Maturity and ADHD
A recent Canadian study showed that the youngest children in each grade (born in the earliest month of the Canadian grade cutoff: December) were 30% more likely to be diagnosed with ADHD than the oldest children (born in January). For girls, who overall have a lower incidence of ADHD, the difference was even more pronounced: 70%.
Interestingly, the overall rate of ADHD diagnosis in the sampling of children from this Canadian study (900,000 children) was 6.9% for boys and 2.2% for girls. Rates of diagnosis here in the United States are much higher, creeping up on 10% of all children.
via The conundrum between maturity and ADHD.
Medications are not without their side effects…
NEJM Resident eBulletin – Elevated PSA
Teaching Topic
Elevated PSA
Case Records of the Massachusetts General Hospital
Case 9-2012: A 67-Year-Old Man with a Persistently Elevated PSA Level
D.S. Kaufman and Others
At least 30% of clinically important prostate cancers may be missed during transrectal ultrasound-guided biopsy, and the results are not improved if more than 12 cores are taken (so-called “saturation biopsies”).
Clinical Pearls
What is a Gleason score?
The Gleason score is the sum of the two most common histologic grades in a prostate-gland tumor, each of which is rated on a scale of 1 to 5, with 5 being the most cytologically aggressive. It correlates with prognosis. A higher score is more likely to be seen with disease that is not confined to the prostate, and is also correlated with poorer response to treatment of localized disease.
What are the criteria for active surveillance in prostate cancer?
The authors report that criteria for active surveillance for prostate cancer include a PSA level less than 10 ng per milliliter. While the decision to carry out active surveillance is one that must be individualized, in general, in addition to having a relatively low PSA, patients with early clinical disease stage and a Gleason score indicating well or moderately differentiated tumor may be considered for active surveillance.
Morning Report Questions
Q. What is transperineal template-guided mapping biopsy (TTMB) of the prostate?
A. Traditional transrectal ultrasound-guided needle biopsy of the prostate allows excellent and convenient sampling of the posterior aspect of the prostate gland, where prostate cancers most commonly originate. On occasion, however, the cancer may arise either centrally or anteriorly and may be beyond the reach of a biopsy needle inserted through the rectum. However, the anterior gland can be reached through a perineal approach, a technique that is used to insert radioactive seeds into the prostate gland for the purpose of treatment (brachytherapy). Precision is needed to ensure that the needles are placed correctly. To achieve this, transrectal ultrasonography is used to visualize the needles, and the needles themselves are passed through holes in a template (grid) that is secured against the perineum. The perforations ensure that the needles are inserted in parallel and with a known relationship to one another. The “repurposing” of this brachytherapy technique for prostate biopsy is known as TTMB, or “grid” biopsy, and the template may be used to insert biopsy needles precisely to any location in the prostate gland.
Figure 3. Transperineal Template-Guided Mapping Biopsy of the Prostate.
Q. What are the indications for consideration of TTMB?
A. A PSA level higher than expected for the size of the gland should prompt consideration of TTMB for better sampling of the prostate. Biopsies performed with the use of templates are important for carefully selected patients in whom there is an unexplained discordance between PSA readings and findings on examination of biopsy specimens obtained via transrectal approach. One quarter of patients who undergo TTMB after at least one negative specimen obtained by transrectal ultrasound-guided biopsy will have positive results on TTMB. Up to half of these patients have cancers with a Gleason score of 7 or higher. In patients with two or more negative specimens from transrectal ultrasound-guided biopsies, the most common finding in specimens obtained by TTMB was cancer in the anterior lobes. The morbidity associated with TTMB is greater than that associated with transrectal ultrasound-guided biopsies; there is a higher incidence of acute urinary obstruction. Overall, the costs associated with TTMB (e.g., the costs of general anesthesia, the operating room, and the processing of a large number of tissue cores) render it far more expensive than transrectal ultrasound-guided biopsies.
For Freelancers, Landing A Workspace Gets Harder : NPR
For Freelancers, Landing A Workspace Gets Harder : NPR.
More than 30 percent of the nation’s workers now work on their own, and the research firm IDC projects the number of nontraditional office workers — telecommuters, freelancers and contractors — will reach 1.3 billion worldwide by 2015.
$1,248 to Cage a Bunny? City Officials Hopping Mad
The Case Against Passion – naked capitalism
But the real question is who this vogue for romantic attachment to one’s work really serves. Faking passion in job interviews seems to be as necessary as faking orgasms is in some relationships. On the surface, this long-lived fas appeals to the narcissistic tendencies that are ever more common in American society, that we all have some special talent or destiny and we are supposed to go forth and, to use that horrible New Age turn of phrase, manifest it.
But being emotionally invested in career success as the proof of one’s worth makes people exploitable. That’s the secret of elite firms like Goldman and McKinsey, which hire people who were not simply bright, but have a record of achievements that shows that they care deeply about external validation. When an organizational guru came in to give a look over McKinsey in the 1980s, he was famously told by the head of the firm, “Don’t mess with the insecurity.”
via The Case Against Passion « naked capitalism.
Passion is overrated. Love is perhaps too strong a term. I prefer extreme liking. Are you passionate about your work? Do you love what you do? Or do you simply like what you do?
Do or not do. There is no try.
Yoda
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