However, much has happened since it went up, including the Blogger outage.
The medical literature does not support the utility of the above tests for screening, diagnosis, or management of CHD. Homocysteine Testing Aetna considers homocysteine testing experimental and investigational for assessing CHD or stroke risk and for evaluating women with recurrent pregnancy loss see CPB - Recurrent Pregnancy Loss.
Homocysteine testing may be medically necessary for the following indications: Measurement of Carotid Intima-media thickness Aetna considers measurement of carotid intima-media thickness experimental and investigational for assessing CHD risk because its effectiveness has not been established.
Noninvasive Measurement of Arterial Elasticity Aetna considers noninvasive measurements of arterial elasticity by means of blood pressure waveforms e. Peripheral Arterial Tonometry Aetna considers peripheral arterial tonometry e.
The Corus CAD is considered experimental and investigational for all other indications. Stress Echocardiography Aetna considers stress echocardiography experimental and investigational for cardiovascular disease risk assessment in asymptomatic low risk individuals. Venous Ultrasound Aetna considers venous ultrasound experimental and investigational for screening of persons without signs or symptoms of peripheral venous disease.
Background Cardiovascular disease CVD risk testing is utilized to indicate the chances of having a coronary event. The most common tests to determine cardiac risk are high-density lipoprotein HDLlow-density lipoprotein LDLtotal cholesterol and triglycerides often referred to as a basic or standard lipid panel.
Non-traditional risk factors for coronary heart disease CHD are used increasingly to determine patient risk, in part because of an assumption that many patients with CHD lack traditional risk factors e. The authors conclude that current evidence does not support the notion that non-traditional risk assessment adds overall value to traditional risk assessment.
Follow-up ranged from 21 to 30 years. The assessment explained that the strongest evidence of the value of such a test is direct evidence that its measurement to assess cardiovascular disease risk results in improved patient outcomes.
In the absence of such evidence, the assessment of the potential clinical utility of a test lies in understanding a chain of logic and the evidence supporting those links in the chain.
The potential for clinical utility of a test for assessing cardiovascular disease risk lies in following a chain of logic that relies on evidence regarding the ability of a measurement to predict cardiovascular disease beyond that of current risk prediction methods or models, and evidence regarding the utility of risk prediction to treatment of cardiovascular disease.
In order to assess the utility of a test in risk prediction, specific recommendations regarding patient management based on the test results should be stated. In a report on the use of non-traditional risk factors in CHD risk assessment, the U.
Treatment to prevent CHD events by modifying risk factors is currently based on the Framingham risk model. Risk factors not currently part of the Framingham model i. They said there is insufficient evidence to determine the percentage of intermediate-risk individuals who would be re-classified by screening with non-traditional risk factors, other than hs-CRP and ABI.
For individuals re-classified as high-risk on the basis of hs-CRP or ABI scores, data are not available to determine whether they benefit from additional treatments.
In addition, there is not enough information available about the benefits and harms of using non-traditional risk factors in screening.
Potential harms include lifelong use of medications without proven benefit and psychological and other harms from being mis-classified in a higher risk category.
C-reactive protein CRP is produced by the liver.
An elevated CRP level may be indicative of inflammation nonspecific location. It has been theorized that certain markers of inflammation -- both systemic and local -- may play a role in the development of atherosclerosis. Of current inflammatory markers identified, hs-CRP has the analyte and assay characteristics most conducive for use in practice.
For these patients, the results of hs-CRP testing may help guide considerations of further evaluation e. The Writing Group noted, however, that the benefits of such therapy based on this strategy remain uncertain.
The Writing Group stated that hs-CRP also may be useful in estimating prognosis in patients who need secondary preventive care, such as those with stable coronary disease or acute coronary syndromes and those who have underdone percutaneous coronary interventions.
The Writing Group posited that this information may be useful in patient counseling because it offers motivation to comply with proven secondary preventive interventions.
However, the Writing Group noted that the utility of hs-CRP in secondary prevention is more limited because current guidelines for secondary prevention generally recommend, without measuring hs-CRP, the aggressive application of secondary preventive interventions.
Patients with an average hs-CRP level greater than 3. The Writing group recommended against the measurement of inflammatory markers other than hs-CRP cytokines, other acute-phase reactants for determination of coronary risk in addition to hs-CRP. Cook et al compared risk-prediction models that include or do not include hs-CRP.
During a mean follow-up of 10 years, women developed CVD. For accurately predicting CVD events, hs-CRP was out-matched only by older age, current smoking, and high blood pressure among traditional Framingham variables. Homocysteine and several lipid and lipoprotein fractions including apolipoprotein A-I, apolipoprotein B, lipoprotein atotal cholesterol and HDL cholesterol were measured.
Overall, hs-CRP showed the strongest univariate association with all markers studied. Although several other markers studies were univariate predictors of CVD, hs-CRP was the only novel plasma marker that predicted risk in multi-variate analysis.
Total cholesterol-to-HDL ratio also predicted risk in multi-variate analysis.The Medical Racket. By Wade Frazier. Revised June Disclaimer.
Timeline to Timeline from Introduction.
Masculine, Feminine, and "Modern" Medicine. An Electronic Medical Record is a computer generated record created in the healthcare setting.
They tend to be a part of a local stand-alone health information system that allows storage, retrieval and modification of records%(1).
Electronic Health Record An Electronic Health Record (also known as EHR) is an official health record for a patient that is stored with multiple facilities and agencies.
The main purpose of this electronic system is to improve efficiency, quality of care, and reduce costs. Back to Sam's Gadget FAQ Table of Contents. Introduction Getting Into Troubleshooting This document attempts to provide an entry to the world of consumer electronics troubleshooting and repair.
An electronic health record (EHR), or electronic medical record (EMR), is the systematized collection of patient and population electronically-stored health information in a digital format.
These records can be shared across different health care settings. Running head: INPLEMENTING THE EMR IN CLINICS 1 One of the many benefits of implementing an electronic medical record system, is the simplicity of computerized decision support systems as part of the electronic health record.