Thursday, May 26, 2005
Face-Lift Played Major Part in Woman's Death
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Face-Lift Played Major Part in Woman's Death, City Finds - New York Times:
You may remember the story several weeks ago about an Irish citizen who died the morning after a face lift in a plastic surgeon's office in New York. I've kept a Google Alert on this subject and this popped up today:
" An investigation by the New York City Medical Examiner's Office has concluded that the death of a 42-year-old Irish woman earlier this year was caused in significant part by face-lift surgery she underwent in the Manhattan office of a doctor who has repeatedly been sued for malpractice. "
Not much (any) detail. Maybe more will come out soon.
[Via ]
Thursday, May 19, 2005
Neuromuscular blocker binders around the corner?
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Organon is working on the first of a new class of drugs called selective relaxant binding agents (SRBA). The first drug, called Org 25969, is about to enter phase three trials in the US. These drugs can supposedly reverse neuromuscular blockade at any depth of neuromuscular block by binding the neuromuscular blocker.
Though this news release and the Organon website are short on details, this site has the scoop:
"The novel concept of using a ring-shaped cyclodextrin to engulf a neuromuscular blocking drug is fascinating.2 Cyclodextrins are cyclic oligosaccharides which are recognised to encapsulate lipophilic molecules such as steroids. They are water soluble and well tolerated biologically. Org 25969 consists of eight such sugar molecules in a ring, the outside of which is hydrophilic, and the inside, hydrophobic. The size and shape of the ring is designed to produce a cavity into which a neuromuscular blocking drug such as rocuronium will tightly fit. Org 25969 is capable of forming a binary host – guest complex of high affinity with rocuronium, for two of its externally charged side-chains react with the quaternary nitrogen groups of the muscle relaxant. It is able to encapsulate all four steroidal rings of rocuronium within its lipophilic cavity. This encapsulation or chelation reverses the effect of rocuronium, by preventing its access to the nicotinic receptor and promoting its dissociation from it."
[via Medical News Today]
Saturday, May 7, 2005
25 Years and a 1288% Increase in Malpractice Premiums
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"...losses paid out per doctor rose much faster than premiums paid per doctor (1288% vs. 312%), or medical care inflation (480%), from 1975-2001 (see this graph). After 2001, when med-mal insurers were exiting the market in response to this reality, insurance regulators permitted substantial premium price increases that began to correct for these imbalances (though far from fully -- really returning medical malpractice paid-loss ratios to 1995 levels, which were still 150% higher than they were in 1975). It is an unavoidable fact that the exceptional growth in losses paid per doctor over time explains medical malpractice premium growth..."
[via PointofLaw.com]
Wednesday, April 27, 2005
IBM To Launch Electronic Medical-Record-Sharing Project
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InformationWeek: IBM To Launch Electronic Medical-Record-Sharing Project > April 27, 2005:
"IBM wants to help pave the way for the free exchange of electronic health-care records that today are trapped in hundreds of disparate hospital, physician, and health insurance systems.
By the end of the year, IBM will launch a pilot system, the Interoperable Health Information Infrastructure, that will link IBM sites in San Jose, Calif.; Rochester, Minn. (home of the Mayo Clinic); and Haifa, Israel, to demonstrate how electronic medical records based on open standards could move from one health-care provider to another and follow a patient around the world. "
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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Apr Jun
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