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By Dr. Paul Kivela

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Month: February 2017

Medically Sound

With Dr. Paul Kivela

Testosterone Replacement Therapy is Safe and Improves Cardiovascular...

  February 25, 2017

This JAMA Intern Med. Published  February 21, 2017 study finds that testosterone treatment in androgen(testosterone)-deficient men was safe and was not associated with an increased risk of cardiovascular outcomes. In fact with long-term follow-up, the study concluded that the risk of cardiovascular morbidity and mortality outcomes (acute myocardial infarction (AMI/heart attacks), coronary revascularization (blocked coronary… Read More


Testosterone treatment improves bone strength and density

  February 25, 2017

This February 21, 2017 JAMA Internal Medicine article concludes that testosterone improves bone density and bone strength in men with low testosterone.  Although they couldnt determine if there was lower fracture risk, the investigators found that the treatment of older men with low testosterone increased volumetric trabecular bone mineral density of the lumbar spine.  They… Read More


Review Finds California Healthplan Provider Directories Unusable

  February 20, 2017

The California Department of Managed Health Care found ninety person ( 36 out of 40) healthplan/insurance company department compliance reports for 2015 contained data inaccuracies significant enough to render them essentially usable and certainly not consumer friendly. This story originally appeared in California Healthfax and then reported on in HealthLeaders.  From HealthLeaders . A state… Read More


There is no advantage of Mechanical over Manual...

  February 20, 2017

This January 1, 2014 JAMA article studies Mechanical Chest Compressions and Simultaneous Defibrillation vs Conventional Cardiopulmonary Resuscitation in Out-of-Hospital Cardiac Arrest  There are clearly many factors that affect the chances of survival after a cardiac arrest, including early recognition of arrest, effective cardiopulmonary resuscitation (CPR), timely defibrillation, and postresuscitation care. One important link is thought… Read More


Inaccurate Provider Panels A Major Problem

  February 20, 2017

A  July 2016 Health Affairs article  looked at the adequacy of provider networks for plans sold through insurance Marketplaces established under the Affordable Care Act by conducting a “secret shopper” survey of 743 primary care providers from five of California’s nineteen insurance Marketplace pricing regions in the Summer of 2015.   They found less than 30%… Read More


A Downside of Gluten Free Diet – Heavy...

  February 19, 2017

A study in the the February 2017 issue of Epidemiology discusses one of the untoward side effects of gluten free diet. The downside is increased blood levels of heavy metal toxicity primarily arsenic and mercury.  An initial thought was increased intake of fish but the the hypothesized cause is thought to be increased rice which tends… Read More


Tick-borne Disease in Northwestern California, USA likely underidentified.

  February 19, 2017

This March 2014 CDC report shows a high incidence of tick borne pathogens causing including the usual Borrelia burgdorferi, the spirochete that causes Lyme disease and also a relatively new B. miyamotoi, which causes a similar syndrome and relapsing fever.  B. miyamotoi has also been found in the Midwest and East Coast U.S.  This CDC… Read More


Majority of Americans Favor Childhood Vaccines

  February 19, 2017

Most Americans support requiring the measles, mumps and rubella vaccine for public school children in order to protect public health. They see high preventive health benefits of such vaccines, and low risk of side effects, and they consider the benefits of the vaccine to outweigh the risks.Yet, public concerns about childhood vaccines linger in the… Read More


Ottawa Chest Pain-Cardiac Monitoring Rule Validated

  February 19, 2017

This article from the January 30, 2017 issue of Canadian Medical Association Journal looks at which patients with chest pain can be safely discontinued from telemetry/cardiac monitoring after an initial evaluation.  Although this article may not persuade me from discontinuing patients when we have enough monitors in the Emergency Department, but this study in conjunction… Read More


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