Thursday, May 25, 2006

Top 10 Causes of Death Worldwide

Top 10 Causes of Death Worldwide:

"[F]or high-income countries:

1. Heart disease
2. Stroke
3. Lung cancer
4. Lower respiratory infections
5. Chronic obstructive pulmonary disease (COPD)
6. Colon and rectum cancers
7. Alzheimer's disease and other dementias
8. Type 2 diabetes
9. Breast cancer
10. Stomach cancer

Here is the list for low- and middle-income countries:

1. Heart disease
2. Stroke
3. Lower respiratory infections
5. Fetus/newborn (perinatal) conditions
6. Chronic obstructive pulmonary disease (COPD)
7. Diarrhea
8. Tuberculosis
9. Malaria
10. Road traffic accidents "

[Via WebMD Health Headlines]

Wednesday, May 24, 2006

Pennsylvania's Health Care Crisis has NOT 'turned the corner'

Our Governor is quoted as saying that Pennsylvania's health care crisis has turned a corner. It has not and as evidence I point you to the following article about a Cardiology group in Philadelphia that will no longer provide coverage at one health center there:

"Frankford Health Care System, which is already getting ready to discontinue maternity services at its Torresdale division, is losing another group of specialists at its Frankford campus in another departure tied in part to Pennsylvania's high medical malpractice insurance costs. --Philadelphia Business Journal"

Imagine you're, say, a plastic surgeon. There used to be fifteen of you on staff at a hospital so you took ER call only two days per months (as a precondition for maintaining staff privileges). Well, because of a malpractice crisis that has NOT turned the corner there are only three of you now. That's ten days of ER call each month. Kinda forces you to ponder whether maintaining staff privileges is worth is, doesn't it? And if you decide it's not, then patients loose access to yet another specialist at the hospital. See where this goes?

If it's not one virus, it's another

Bird flu has been very much in the news, but now another type of virus is also threatening: chikungunya virus (named with a Swahili word meaning 'bent up').

"The chikungunya virus has infected around one-third of the population (about 250,000 people) on the French island of Réunion since early 2005. It has also hit the neighbouring islands of Mauritius, Seychelles, Madagascar and Mayotte, and reared its head in India."

With only a little over 200 deaths it's not near as big a killer as H5N1 might be, but it would wreak havoc nonetheless. Fevers over 102 and arthralgias. Yuck.

Sunday, May 14, 2006

RangelMD on Tort Reform in Texas

Texas enacted caps on medical malpractice awards in 2003. The debate there on whether these caps are good or have been responsible for the drop in new malpractice cases by 60%-80% continues.

"Obviously the need is to reduce legal costs, increase ease and access to the system, increase efficiency and speed of proceedings so that justified compensation finds its way to the plaintiff with all deliberate speed, and establish much more consistency in finding fault and awarding compensation. One solution is the establishment of special health courts where neutral expert witnesses would be hired by the court, judges or panels would hand down judgments, and guidelines would be in place for the determining of fault and compensation.

It's easy to see why trial lawyers oppose special health courts because their roles would be significantly reduced. A system like this would be far less susceptible to such intangibles as the fickle mood of a jury or the charisma of the lawyer. We've been talking for years about reducing costs and improving access to health care. Maybe it's about time we started doing the same with our tort system. Proposition 12 may have been the first small step in that direction."


Friday, May 12, 2006

Wet taps and the number '3'

Wet taps are accidental dural punctures that happen while attempting to place a needle into the epidural space. The published frequency of wet taps is about 1 in 800 epidural placements, depending on the experience of the operator. If I'm placing an epidural catheter in a pregnant woman and get a wet tap, she has a greater than 50% chance of a dural puncture headache (unless, of course, she is morbidly obese, in which her risk is almost zero).

It seems my wet taps come in three's (hence the title of this post). I remember as a third year anesthesiology resident being on call on OB for the first time after spending three months on the transplant anesthesia service and getting three consecutive wet taps that night on OB. Bam, bam, bam (or should I say 'splash, splash, splash'). I felt terrible, of course, but could not recall doing anything different that would have caused them! My grandmother used to say that accidents happen in threes. She was referring to airplane crashes, but I have to wonder, is it true of wet taps?

In the last ten years of doing anesthesia I've had no accidental dural punctures that I know of. That all changed about a month ago. I did a lumbar epidural steroid injection on a co-worker's husband and must have scored the dura. That's one. I had a wet tap during a labor epidural on a patient who, in retrospect, had a non-union of the ligamentum flavum. That's two. I'm just waiting for number three. I'm on call on OB tonight. Is number three around the corner?

[here's a nice review, btw]

Tuesday, May 2, 2006

Don't Touch My Oxygen!

Most days are nice. Occasionally I get into a head-butting contest with a nurse or surgeon (but much less often than when I was younger). Of late, it seems to be an almost daily occurrence. Today's example? I arrived at a surgery center to start cases to find the oxygen failure alarm triggered on all our anesthesia machines. After telling colleagues and putting all rooms on hold, I figure out that a valve leak the day before had required a valve to be removed and the resulting system did not have enough oxygen pressure to keep the alarms from triggering. This was fixed in about 15 minutes and we proceeded.

Several hours later a nurse manager told me they were going to switch the oxygen system back to the way it was. I told her that, in my opinion, this should not be done until all cases for the day were finished. 'But it will only take a minute' was her reply. I told here once more that in my opinion as an anesthesiologist, no one should mess with a system that was presently working and that the safest thing to do was wait until rooms were down. She left and had the technicians make the switch.

She will now learn the hard way that you do not touch my oxygen while cases are under way. When it comes to patient safety, our opinions are not equal...



VeinViewer Shipped!

"The VeinViewer, a device that reveals the underlying venous anatomy for easy IV placement, is now being shipped, according to to nurses on the floor: call VeinViewer and not an on-call anesthesiologist.

Company website | Video of VeinViewer


[Via Medgadget]

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