Saturday, April 23, 2005
When can nursing mothers resume breastfeeding after surgery?
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When can nursing mothers resume breastfeeding after surgery?:
" the very small amount of propofol eliminated in breast milk within the first 24 hours after induction of anesthesia represents such minimal infant exposure to the drug that it provides insufficient justification for interruption of breastfeeding, Avram said. "
Studies are under way by the same group for other commonly used drugs. My advice to nursing patients is to pump and discard once, then resume normal breast feeding.
An Anesthesiologists Thoughts on the Early Epidural 'News'
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The New England Journal of Medicine just published The Risk of Cesarean Delivery with Neuraxial Analgesia Given Early versus Late in Labor and it has gotten national attention, including a segment on the Today show on NBC on February 17th. There's nothing here which was not known before. It's a nice study nonetheless, but readers should be aware of several other issues.
There's really nothing here that's new or that we haven't known before. I've been using neuraxial narcotic in women not yet sufficiently dilated for local anesthetic for ten years. I don't like doing it because I find the incidence of prolonged decelerations in the fetal heart rate trace that sometimes occurs makes people very, very nervous. By 'people' I mean patient, family, nurses, obstetricians,......and yours truly. This study in fact confirms that tendency:
" There was a higher incidence of prolonged and late decelerations in heart rate in the intrathecal group after the initiation of analgesia. "
To be specific, the incidence of prolonged decels was 3.9% vs. 0.6% (p < 0.003). I'm not saying this is a reason to avoid the technique, only that the obstetrical service needs to be prepared for it when it happens and know how to deal with it.
Wednesday, April 20, 2005
House Bill Would Fund Special Health Courts
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"Known as the Medical Liability Procedural Reform Act of 2005, HR 1546 would authorize grants to as many as seven states to establish special health courts to restore reliability to medical justice. The hallmark of the courts would be full-time judges with health care expertise, whose sole focus would be on addressing medical malpractice cases. Each participating state would be required to report on the effectiveness of the health courts, and the U.S. Attorney General would be required to hire a research organization to evaluate them."
Via [Common Good]
Sunday, April 17, 2005
Malpractice Insurance Summary for PA
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The Coalition for Affordable and Reliable Health Care, an advocacy group supporting medical liability reform, has a has an accurate summary of the malpractice insurance situation in Pennsylvania (and other states in the Union).
"A full 80% of medical students who come to Pennsylvania for a world-class education ultimately choose to practice elsewhere, according to the Pennsylvania Medical Society. (PA Medical Society, June 17, 2003)"
[Via PointOfLaw Forum]
Wednesday, April 6, 2005
Dear Journal Editor
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Orac has written a public letter to scientific journal editors that is a must read for anyone who has ever published (or tried to publish and been rejected--me!). The post is part of Tangled Bank XXV (Like Grand Rounds, but with an emphasis on science):
"We have again rewritten the entire manuscript from start to finish. We even changed the goddamned running head! Hopefully we have suffered enough by now to satisfy even you and your bloodthirsty reviewers. Besides the fact that we included five new figures of brand new data (with six panels each, yet), we still cannot believe that you were unable to see the merit of our work..."
Saturday, April 2, 2005
Crossing the Digital Divide...And Continuing the Ascent
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Crossing the digital divide is a phrase often used to describe what sets apart those that have computers with internet access and those that do not. It is as if, once the divide is crossed, that's it. You've arrived. Joined the enlightened hoards in digital nirvana. You've got a Dell, a cable modem, Internet Explorer, and a Yahoo account. You can now start looking for the last page on the internet.
The far greater reward waits for those who consider crossing the Great Divide the first step in a journey, and look for ways to travel more easily and extensively (and safely). To do that, you need to read, learn from others, and explore new things. One such facet to be explored is the Firefox web browser. Once you have that, you'll need this one book: Firefox Hacks: Tips and Tools for Next Generation Web Browsing. Nine chapters. 100 Hacks. Let me give you some examples:
- Find stuff
- Identify and Use Toolbar Icons
- Flush and Clear Absolutely Everything
- Make Firefox go fast
- Play with the preference system
- Installing complementary tools
- Take Firefox with you
- Modify tabbed browsing (by Seth!)
- Govern image and ad display
- Add stuff to your toolbars
- Create your own search plugin
Learn this stuff and your own hospital IT staff will bow to your superior knowledge...and what could be better than making their smug look disappear?
DOJ Subpoenas Issued to Orthopedic Companies
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Via Medgadget: DOJ Subpoenas Issued to Orthopedic Companies:
" A press release by
Stryker
Stryker Corporation (NYSE: SYK - News) announced today that it has received a subpoena from the United States Department of Justice requesting documents for the period January 2002 through the present as follows: "any and all consulting contracts, professional service agreements, or remuneration agreements between Stryker Corporation and any orthopedic surgeon, orthopedic surgeon in training, or medical school graduate using or considering the surgical use of hip or knee joint replacement/reconstruction products manufactured or sold by Stryker Corporation."
Based on an initial conversation with a Department of Justice representative, the Company understands that similar requests have been or will be directed to other companies in the orthopaedics industry. Stryker intends to fully cooperate with the Department of Justice regarding this matter.
Something major is going on. Any ideas?"
Only the rampant attempts to influence orthopedic surgical residents and their attendings with dinners, trips to 'schools' to teach techniques, golf games, and on, and on.
Friday, April 1, 2005
Crossing the Digital Divide...And Continuing the Ascent
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Thursday, March 31, 2005
Malpractice Payouts in Pennsylvania Rose in 2004
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Malpractice Payouts in Pennsylvania Rose in 2004:
"In 2004, insurers reported paying out $448 million, a 13.5 percent jump from $394.5 million reported in 2003, according to the U.S. Health Resources & Services Administration. The 2004 figure broke the previous record, which had been set in 2001.
The increase in 2004 came after two years of decline. One researcher said he thinks payouts are climbing steadily, but that the steep increase in 2004 also was bumped up by delayed reporting of some payments made the previous year."
[Via Point of Law Forum]
Saturday, March 26, 2005
CMJ Review: Clostridium difficile-associated diarrhea in adults
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The Canadian Medical Journal: Clostridium difficile-associated diarrhea in adults (free full-text)
Thursday, March 24, 2005
CDC: Disinfectants and Their Properties
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The CDC published (as an appendix to another report) a guide on which disinfectant work for what organisms:
"All surfaces should be cleaned thoroughly before disinfection. For basic disinfection, a 1:100 dilution of household bleach (i.e., 2.5 tablespoons/gallon) or a 1:1,000 dilution of quaternary ammonium compounds (e.g., Roccal-D® or Zephiran®) may be used. This appendix includes instructions for disinfection when a particular organism has been identified. All compounds require a contact time of >10 minutes."
Wednesday, March 23, 2005
C. difficile Outbreaks, Anyone?
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Our hospital has pulled all 3M Avagard hand disinfectant from the operating rooms, preferring instead that surgeons go back to the old fashioned surgical hand scrub. At the same time, we are apparently seeing more nosocomial Clostridium difficile infections. C. diff. is not a reportable pathogen, and this was felt to contribute to the outbreak Canada experienced recently. Avagard does not inactivate C. diff. spores. Co-incidence? I don't think so.
The CDC page for healthcare providers on C. diff. provides an interesting nugget:
"If your institution experiences an outbreak, consider using only soap and water for hand hygiene when caring for patients with Clostridium difficile-associated disease; alcohol-based hand rubs may not be as effective against spore-forming bacteria."
Has anyone else seen this at their facilities?
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