CDC MMWR: Severe Clostridium difficile
Severe Clostridium difficile--Associated Disease in Populations Previously at Low Risk --- Four States, 2005
Thursday, December 1, 2005
Greg Pierce: Pragmatic Security
- Categories: Software, Technology
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Greg's "Pragmatic Security," for the Rest of You ;-):
" Greg has just published a very pragmatic set of instructions to help "friends and family of geeks" deal with security issues on the internet. Very good recommendations, all of them, and so I'd like to ask all of my friends and family to go check them out. He obviously spent a lot of time writing that essay, and I believe that most will find it an 'easy read'.
He admits it's not a complete solution to everyone. It's a plan to get started. I think it's a good plan.
The most important issue he left out, in my opinion, is the huge number of "phishing" email messages being sent out these days (these are attempts to trick you out of your username and password). Nobody is safe from these, many of them are just too good. I wrote up a little blurb and posted it in a reply to Greg's message, so please include it in your reading. "
He admits it's not a complete solution to everyone. It's a plan to get started. I think it's a good plan.
The most important issue he left out, in my opinion, is the huge number of "phishing" email messages being sent out these days (these are attempts to trick you out of your username and password). Nobody is safe from these, many of them are just too good. I wrote up a little blurb and posted it in a reply to Greg's message, so please include it in your reading. "
[Via Truer Words - A Journal]
How do you mark a surgical site?
- Categories: Medical errors, Anesthesia practice
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The American Academy of Orthopaedic Surgeons has a policy on marking surgical sites titled Guidelines for Implementation of the Universal Protocol for the Prevention of Wrong Site, Wrong Procedure and Wrong Person Surgery. It's worth reviewing and comparing to your institutions policy. For example:
- Make the mark at or near the incision site. Do NOT mark any non-operative site(s) unless necessary for some other aspect of care.
- The mark should be unambiguous (e.g., use initials or "YES" or a line representing the proposed incision; consider that "X" may be ambiguous).
- The person performing the procedure should do the site marking.
There's much more to the guideline, but your current policies are most likely to be at variance with the above three points. One of the surgery centers I work at, for instance, marks the surgical site with an 'X'. I've explained to them that 'X' is ambiguous (does X mark the spot, or does X mark 'not this one'?) and even explained the details of a malpractice case in which marking with an X came into play. Another hospital was in the habit of marking both sides ('L' and 'R'). Also confusing. Finally, several centers have the nurse preparing the patient for surgery to mark the site. Also not a good idea.
Wednesday, November 30, 2005
NYT: Gimme an Rx! Cheerleaders Pep Up Drug Sales
Interesting New York Times article on pharmaceutical reps:
"Exaggerated motions, exaggerated smiles, exaggerated enthusiasm - they learn those things, and they can get people to do what they want."
Approximately two dozen Kentucky cheerleaders, mostly women but a few men, have become drug reps in recent years.
While there are no statistics on how many drug representatives are former or current cheerleaders, demand for them led to the formation of an employment firm, Spirited Sales Leaders, in Memphis. It maintains a database of thousands of potential candidates."
Approximately two dozen Kentucky cheerleaders, mostly women but a few men, have become drug reps in recent years.
While there are no statistics on how many drug representatives are former or current cheerleaders, demand for them led to the formation of an employment firm, Spirited Sales Leaders, in Memphis. It maintains a database of thousands of potential candidates."
This reminds me of the drug rep on the TV show Scrubs (played by Heather Locklear).
Friday, November 25, 2005
How much caffeine does that drink have?
- Categories: Data, Anesthesia Tips
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I've written before about caffeine addiction in surgical patients. In recent years there's been an explosion of caffeine-containing beverages. Having some idea of the caffeine content of the major ones can help you choose an appropriate dose.
The Energy Fiend web site has a nice Caffeine Database. I found it via a recent NYT article.
Thursday, November 24, 2005
NEJM: The Origins of Pandemic Influenza--Lessons from the 1918 Virus
- Categories: Medical Articles, Influenza
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The Origins of Pandemic Influenza--Lessons from the 1918 Virus [free full text]
"...monitoring of the sequences of viruses isolated in instances of bird-to-human transmission for genetic changes in key regions may enable us to track viruses years before they develop the capacity to replicate with high efficiency in humans. Knowledge of the genetic sequences of influenza viruses that predate the 1918 pandemic would be extremely helpful in determining the events that may lead to the adaptation of avian viruses to humans before the occurrence of pandemic influenza. We could then conduct worldwide surveillance for similar events involving contemporary avian viruses. "
How To: Awake Fiberoptic Intubation
- Categories: Anesthesia Tips
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This definitely falls in the "don't try this at home" category, but if this technique is different than the one you use, give it a try. It will surely result in a net gain in style points.
How To Do An Awake Fiberoptic Intubation
Technorati Tags: Anesthesia
Wednesday, November 23, 2005
C-section rate in USA reaches 29.1% in 2004
" Despite the evidence of risks associated with cesarean section, the rate of birth by cesarean section in 2004 in the USA registered at 29.1 percent, the highest ever recorded. According to the Centers for Disease Control and Prevention (CDC) in a recent report, this figure is an 8 percent increase from 2003, and a 41 percent increase since 1996. "
One of the OB practices at our hospital has a policy that they will not do vaginal births after C-section (VBAC)...largely due to concern about lawsuits.
[Via UK Medical News Today]
MMWR Available Via Really Simple Syndication (RSS) Feeds
- Categories: Anesthesia resources
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"MMWR now offers RSS feeds, a free, automated method to receive all MMWR publications. Through RSS, new reports and publications are fed to your desktop or browser-based news reader when they are posted online. Headlines are presented in the RSS feeds, with links to the full reports and publications on the MMWR website. RSS feeds to MMWR publications are available at http://www.cdc.gov/mmwr/rss/rss.html"
[CDC]
Tuesday, November 22, 2005
Translations of phrases often seen in dissertations and scholarly articles
- "It has long been known" ... I didn't look up the original reference.
- "A definite trend is evident" ... These data are practically meaningless.
- "While it has not been possible to provide definite answers to the
- questions" ... An unsuccessful experiment but I still hope to get it published.
- "Three of the samples were chosen for detailed study" ... The other results didn't make any sense.
- "Typical results are shown" ... This is the prettiest graph.
- "These results will be in a subsequent report" ... I might get around to this sometime, if pushed/funded.
- "In my experience" ... Once.
- "In case after case" ... Twice.
- "In a series of cases" ... Thrice.
- "It is believed that" ... I think.
- "It is generally believed that" ... A couple of others think so, too.
- "Correct within an order of magnitude" ... Wrong.
- "According to statistical analysis" ... Rumor has it.
- "A statistically-oriented projection of the significance of these findings" ... A wild guess.
- "A careful analysis of obtainable data" ... Three pages of notes were obliterated when I knocked over a glass iced tea.
- "It is clear that much additional work will be required before a complete understanding of this phenomenon occurs" ... I don't understand it.
- "After additional study by my colleagues" ... They don't understand it either.
- "Thanks are due to Joe Blotz for assistance with the experiment and to Cindy Adams for valuable discussions" ... Mr. Blotz did the work and Ms.
- Adams explained to me what it meant.
- "A highly significant area for exploratory study" ... A totally useless topic selected by my committee.
- "It is hoped that this study will stimulate further investigation in this field" ... I quit.
Sunday, November 20, 2005
Trial lawyers blocking avian flu bill
ATLA blocking avian flu bill:
" The Washington Post's Jeffrey Birnbaum reports: "Legislation that would pour billions of dollars into the production of vaccines against avian flu and other pandemic diseases is threatened by the trial lawyers' lobby, which objects to proposed limits on lawsuits against drug manufacturers. "
All in the name of protecting patients, I'm sure.
[Via PointOfLaw Forum]
EFF: Legal Guide for Bloggers
- Categories: Anesthesia resources
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Electronic Frontier Foundation: Legal Guide for Bloggers
"The goal here is to give you a basic roadmap to the legal issues you may confront as a blogger, to let you know you have rights, and to encourage you to blog freely with the knowledge that your legitimate speech is protected."
[Via O'Reilly Radar]
More on pre-emptive positioning
- Categories: Anesthesia Tips
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A fellow anesthesiologist wrote a reply to my post about pre-emptive positioning with the following:
"We've started doing the same thing at my surgicenter. At first I thought it was pretty ballsy when one of my colleagues suggested that we do simple one level laminectomies under LMA general and induce in the prone position. But now that we've started it I am very comfortable with the idea."
I'm not ready to try this yet (do you want to be my first patient?). Lateral or semi-sitting to supine is a matter of seconds. Prone to supine would take significantly longer I believe. Other experiences?
Sunday, November 6, 2005
You Anesthesiologist Today Was...
- Categories: Anesthesia practice, Anesthesia Tips
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I finally ordered my own business cards. I've had generic one available but always had to write in my own name (despite being with the group for well over two years) so decided it was time for an upgrade.
Picking the pattern was tough, but I decided on a tranquil image (that happens to be one of the MacOS X desktop images):
Rejected images included a dark tunnel with a light at the end, and anything with pearly gates.
This decision was evidence based (of course). Giving patients a business card before anesthesia increases their recall of your name to about 50% rather than the 10% that remember it without. It should also help them see they are being cared for by a physician. There's room on the back for 'anesthetic' and 'comments', too.
Thursday, November 3, 2005
Pre-emptive Patient Positioning
- Categories: Anesthesia practice, Anesthesia Tips
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Many surgeries require the patient to be in a position other than supine (flat on their back) for the surgery to be done. Shoulder surgery, for example, is often done with the patient in a semi-sitting or 'beach chair' position. Certain hip surgeries are done with patients on their side as well. General anesthesia is induced with the patient supine, then people have to move the patient (who is now akin to a very heavy sack of potatoes) into the right position. It's time consuming, risks staff injury, and jeopardizes the airway. The few accidental extubations I've had have occurred when the patient was being moved. Does it have to be this way? If the case is amenable to an LMA, I think the answer is 'no.'
If I'm caring for a patient who will require a general anesthetic and an LMA would be suitable, I've taken to positioning the patient before induction of anesthesia. I then pre-oxygenate, perform an IV induction, and place the LMA. The OR staff and surgeons like it because a) it saves time and b) it saves their backs. I like it because there's no move during which my airway can potentially be compromised (and because it saves time and saves my back). There's a benefit to the patient, too. Namely, they can tell us while awake whether our positioning is comfortable for them. Is the axillary role in the right place? Do they need a pillow under their knees in? Is their bottom up against the back of the table in beach chair? Is their ear properly padded in the lateral position? Think Different (but always, Think Safe).
Saturday, October 15, 2005
Bird flu virus reported to resist Tamiflu
More popular press stories on drug resistance in bird flu:
"An avian influenza virus isolated from an infected Vietnamese girl has been determined to be resistant to the drug oseltamivir, the compound better known by its trade name Tamiflu, and the drug officials hope will serve as the front line of defense for a feared influenza pandemic. [Science Blog - Science News Stories]"
The New England Journal of Medicine has a recent free article summarizing our current state of knowledge titled Avian Influenza A (H5N1) Infection in Humans:
"High-level antiviral resistance to oseltamivir results from the substitution of a single amino acid in N1 neuraminidase (His274Tyr). Such variants have been detected in up to 16 percent of children with human influenza A (H1N1) who have received oseltamivir. Not surprisingly, this resistant variant has been detected recently in several patients with influenza A (H5N1) who were treated with oseltamivir."
This is not to say, however, that we have no other neuraminidase inhibitor tricks up our sleeves.
