The Sea at Le Havre

Impressionist painter Claude Monet (1840-1926), was born in Paris, but spent his childhood near the coast of Le Mer de la Manche in the north of France.  In Le Havre he met a seascape painter Eugene Boudin and from that time he started painting and showing nature full of in light.  Monet painted The Sea at le Havre in 1868.  Small waves caused by the breeze travel on the surface of the sea, which color, is a reflection of the sky.  Impressionists painted nature having as an objective to express light patterns and depict the hues and luminance of the out-of-doors. Monet with his use of light and color created moments of loveliness and serenity understood only by those who have spent time with loved ones near the water.

Claude Monet (1840-1926), The Sea at Le Havre, 1868, French. Oil on canvas. 60.01 × 81.60 cm. Courtesy of the Carnegie Museum of Art (http://www.cmoa.org/), Pittsburgh, Pennsylvania; purchase, 53.22.

Excerpt from the article by Jeanette M. Smith, MD  JAMA. 2015;313(9):878-879

Top Three Posts

A year has passed since this blog started and 50+ articles have been reviewed.  It is interesting that the post regarding iPad accuracy remains the most popular while that on Circulating Tumor Cell Culture is still among the three top while in the second most popular is now the article on the Risk of Stroke due to Intracranial Atherosclerosis.

1.    iPad is accurate in the diagnosis of bone fractures

http://radiologyweekly.blogspot.com/2014/08/ipad-is-accurate-in-diagnosis-of-bone.html

2.    Risk of Stroke due to Intracranial Atherosclerosis

http://radiologyweekly.blogspot.gr/2014/05/risk-of-stroke-due-to-intracranial.html

3.    Circulating Tumor Cells  Culture Promises Individualized Testing and Treatment

http://radiologyweekly.blogspot.com/2014/07/circulating-tumor-cells-culture.html

Rising Utilization of CT in Adult Fall Patients

Brinjikji et al in an article published by the AmericanJournal of Roentgenology report on the CT utilization for adult patients secondary to falls in the United States.

Using the National Hospital Ambulatory Medical Care Survey, they identified all visits from 2001 to 2010 of adult patients presenting to EDs after falls. This database surveys approximately 500 EDs annually for 4 weeks, providing national estimates on ED resource utilization and outcomes. They studied trends in CT utilization and proportion of visits with life-threatening conditions (intracranial hemorrhage, organ laceration, axial skeletal fractures) after falls.

Their study looked at 22,166 cases representing 73,241,368 visits in Emergency Departments. The proportion of adult fall patient visits during which CT was performed increased from 11.4% in 2001 to 28.0% in 2010 (p < 0.0001), whereas the proportion of adult fall visits with life-threatening conditions increased from 5.7% to 8.2% (p < 0.0001).  The odds of CT utilization in 2010 compared with 2001 were 2.62 (95% CI, 2.61–2.62).

They concluded that there was a significant increase in CT utilization among adult fall patient visits from 2001 to 2010.  Their findings suggest that CT is overused among adults who have fallen.

Hypertension initiative

 The U.S. Department of Health and Human Services announced an initiative the Million Hearts®2014 Hypertension ControlChallenge that aims to prevent 

1 million heart attacks and strokes over five years.

Some of its key blood pressure control tips include:

·       Using a standardized checklist approach to measure blood pressure. 

·       Implementing a self-measured blood pressure program- (sometimes called     home blood pressure monitoring).  

·        Common problems that can account for inaccurate and higher blood      pressure measurements are:

A full bladder                     10-15 mmHg

An unsupported back           5-10 mmHg

Unsupported feet                 5-10 mmHg

Crossed legs                         2-8 mmHg

Cuff over clothing              10-40 mmHg
Wrong size cuff                    high or low

Unsupported arm                   10 mmHg

A conversation                  10-15 mmHg 

Three questions doctors, nurses and other health care provides should ask patients when measuring their blood pressure are:

•  “Were you rushing to get here or were you physically active right before this appointment?”  Patients should have time to rest before their blood pressure measurement and they should be sitting quietly.
• “Have you been taking your medication?” Although it self-evident it’s important to make sure if patients take their medication as it was prescribed.
• “What’s your diet and physical activity regimen like?” If a patient doesn’t eat a healthy diet or abstains from physical activity, find out why. 

The American Medical Association and Johns Hopkins School of Medicine call for physicians and care teams to measure accurately, act rapidly and partner with patients to promote patient self-management.

References: Pickering et al Circulation 2005, O’Brien et al Blood Press Mon 2002