Friday, June 29, 2007
CDC: 2007 Influenza Vaccine Update
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The CDC has just released Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2007
"The 2007 recommendations include new and updated information. Principal updates and changes include 1) reemphasizing the importance of administering 2 doses of vaccine to all children aged 6 months--8 years if they have not been vaccinated previously at any time with either live, attenuated influenza vaccine (doses separated by >6 weeks) or trivalent inactivated influenza vaccine (doses separated by >4 weeks), with single annual doses in subsequent years; 2) recommending that children aged 6 months--8 years who received only 1 dose in their first year of vaccination receive 2 doses the following year, with single annual doses in subsequent years; 3) highlighting a previous recommendation that all persons, including school-aged children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others should be vaccinated; 4) emphasizing that immunization providers should offer influenza vaccine and schedule immunization clinics throughout the influenza season; 5) recommending that health-care facilities consider the level of vaccination coverage among HCP to be one measure of a patient safety quality program and implement policies to encourage HCP vaccination (e.g., obtaining signed statements from HCP who decline influenza vaccination); and 6) using the 2007-2008 trivalent vaccine virus strains A/Solomon Islands/3/2006 (H1N1)-like (new for this season), A/Wisconsin/67/2005 (H3N2)-like, and B/Malaysia/2506/2004-like antigens."
MedlinePlus Works Well on Small Device Browsers like N95
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My Nokia N95 runs the Symbian OS. Epocrates only runs on Palm and PocketPC devices. Epocrates online seems not to know what to do when a small device browser accesses it. I can log in, but the site is really unusable on a small screen (I've written to Epocrates to suggest they consider adding support for small devices/screen). So where do I get drug information? From the government!
I just discovered that the National Library of Medicine's Medline Plus
does play well with small screens/browsers. Below is a screenshot of the Medline Plus page on Opera for Handheld Devices:
Compare this to the page view on the N95's built-in browser:
Makes the $29 for Opera worth it, don't you think?
Thursday, June 28, 2007
Cingular Doesn't Play Nice With Midlets
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I have cell phone service with Cingular/ATT and have been quite happy with them. One reason is that I can move my SIM card between different phones and am not locked in to using only one cell phone. Another was that they didn't tend to hobble their devices the way Verizon did. For example, new Verizon phones would let you use bluetooth for wireless headsets, but not for syncing. Well, I just discovered one problem with Cingular...
My new Nokia N95 (which I had to purchase for full retail since Cingular doesn't offer any Symbian smart phones) is awesome. I was trying to get Widsets to work but failed. (Widsets are small web applications that can run on the phone much like the iPhone will supposedly use Web 2.0 technology to extend its application capability.) The reason? Cingular won't let most midlets have socket connections. Hmph.
I didn't make the Google Health Advisory Council :-(
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Well, I've checked my old e-mails to be sure I didn't miss something important. I didn't make the cut for the Google Health Advisory Council. (sigh)
Pennsylvania CRNA Scope of Practice Bills Withdrawn
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The two House bills dealing with CRNA scope of practice have been withdrawn by their sponsors due to 'lack of support' in the House Professional Licensure Committee. Good news for now but I'm sure we'll see these efforts again...
The Ether Way on the Preop Interview
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Right on, brother:
"Long ago, my preop interview became less pre-flight check-list and more gut-check and sniffing for smoke. (I'll write more about sniffing for smoke in another post) Paradoxically perhaps, the most important thing to me is to bond to the patient; it's the second part of that WCW observation. I might do eight or ten cases in a day; the consequence of treating my work as a technical exercise is the risk of inattention and the sort of boredom that drives the desperate discontent that I see in so many of my colleagues."
[The Ether Way]
Sermo: Finally a good online forum for physicians
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I just stumbled upon Sermo, a web community for physicians only:
"Here, physicians aggregate observations from their daily practice and then - rapidly and in large numbers - challenge or corroborate each others opinions, accelerating the emergence of trends and new insights on medications, devices and treatments. You can then apply the collective knowledge to achieve better outcomes for your patients."
Now, if they'd only have RSS feeds....
Saturday, June 23, 2007
Google Personalized Home Page for Anesthetists
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I made a tab on my iGoogle page for just my anesthesiology-specific widgets. Take a look...
Thursday, June 21, 2007
Viagra for Bone Cement Impaction Syndrome?
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In sheep, the phosphodiesterase inhibitor sildenafil (Viagra) prevents the catastrophic changes in pulmonary artery pressure that fat embolism can cause:
Sildenafil Prevents Cardiovascular Changes after Bone Marrow Fat Embolization in Sheep.
Tuesday, June 19, 2007
Sicko: Socialism in a capitalist society?
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This is the best summary I've read of the barriers to implementing significant change to our current health care system:
Sicko: Socialism in a capitalist society?:
"Bang the Drum with some analysis of whether a government-run health care system is possible in America:
To accomplish any meaningful reform, Americans will have to dismantle the insurance and pharma lobbies at a minimum, and begin to tackle the question of how to deliver universal health care without tying it to employment, marital status, or other qualifiers (and figure out how to put all those unemployed pharma and insurance reps to work, too). Once those lobbies have been set aside, the questions of how to implement a healthcare system which avoids the pitfalls faced by Canada, the UK and France, embraces the positives in the Cuban system, and essentially folds a socialist system into a capitalist society will have to be addressed.
"
[Via Kevin, MD - Medical Weblog]
Tuesday, June 12, 2007
AHRQ: Overall Health Care Quality Performance in Pennsylvania
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Sunday, June 10, 2007
Pennsylvania Doctor Trap Number Two Proposed
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Pennsylvania has chosen an interesting strategy to keep doctors from leaving the state. Rather than fix the current jackpot medical malpractice system they've decided to try to trap doctors that are already here.
The first example of this was something called the MCARE abatement program. The Medical Care Availability and Reduction of Error (MCARE) Act replaced an existing catastrophic coverage fund with a new fund to cover awards which exceeded the primary coverage provided by professional liability policies. Each physician must pay into the fund a percentage of their primary premium to sustain the fund.
The MCARE abatement program (or Health Care Provider Retention Program) provides some financial relief from paying premiums to the fund. How much relief a physician gets depends on the practitioners specialty. And here we come to trap number one. If you accept the abatement, you agree to practice in the state for the year in which you receive the abatement AND the next year. If you leave early, you have to pay back the full amount of the abatement.
The legislature is now working on trap number two--a physician loan forgiveness program. For a period of ten years, for every year a physician practices in Pennsylvania after completing training the state will pay off ten percent of their student loan debt. If they leave early (say, after five years), they have to pay the state back ALL of the money the state paid toward their loans.
Saturday, June 9, 2007
Why I'm Not Buying The (First) iPhone
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With only three weeks to go until the release of the iPhone the frenzy is peaking. What features will it have? What is the twelfth icon? Will it have a SIM tray? Where will be the best place to buy one? I decided to today that I don't care. Let me explain why I won't be buying Apple's iPhone.
I've learned not to buy the first of anything Apple puts out. Though I love the company and have been buying their computers and other devices since the beginning, I think that (especially recently) there's good reason to be patient and let other people help Apple work out the kinks.
I ordered the MacBook on the day it was announced....and had the heat-sink problem. I ordered the 24" iMac the day it was announced...and had it up and die on day four of owning it. There are other examples of released hardware that was flawed initially but improved with each revision that, thankfully, I didn't experience myself. The bottom line is that being first has a price and that it's worth giving Apple a chance to learn from the initial release and improve the hardware with subsequent revisions. That doesn't mean waiting for the next model. Apple revises hardware between new releases, too.
The second reason for waiting is that the device you really wanted is usually the second one in the model line, not the first. But you compromise, tell yourself it's still worth getting the first one, but it's not. Because as soon as the second version comes it, you decide you should have waited. That's what happened to me with the Newton. I bought each new model as it came out (and still have a 2100).
What do I expect in the second version of the iPhone that I think makes it worth waiting for? Better-than-EDGE speed, for one thing. A camera that's better than 2 megapixels for another. GPS for a third. And many fewer problems.
Today, I put down my own good money for a Nokia N95. Five megapixel camera, built-in GPS, and a mature OS that has lots and lots of third-party apps. With iSync and the release of Nokia Media Transport yesterday (nice write-up here), adding contacts, calendars, iTunes music, photos, and videos just got a lot simpler.
ReaderMini: Google Reader On-The-Go
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I track about one hundred news sources with Google Reader. By subscribing to a site's RSS feed, I can see updates as they happen without having to visit the web page itself. Very efficient.
Google has a mobile version, too. Thought this stripped-down version is excellent for cell phones, the interface is too simple for someone with a more capable internet device such as a PDA, UMPC, smartphone, or Nokia N800 internet tablet.
From reading the forums at internettablettalk.com I just found ReaderMini:
"Reader Mini is a light-weight alternative to Google Reader. Reader Mini uses the Google Reader API to access your feeds. It is a compromise somewhere between the power of the main interface and the too-limited mobile version."
Friday, June 8, 2007
Pennsylvania's Lawmakers Could Learn From Texas
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Texas enacted tort reform in 2003, capping damage awards at $250,000. In an article titled "Insurance companies, doctors flock to Texas" David Hendricks passes along some facts I hope Pennsylvania legislators take to heart:
- Malpractice insurance rates have fallen an average of 21%
- The number of companies offering malpractice insurance in the state has risen from four to thirty
- Malpractice lawsuits have fallen 50%
- Doctors are coming to Texas, as evidenced by 2,250 pending applications for medical licensure
[Kevin, MD]
Thursday, June 7, 2007
At risk: vaccines - The Boston Globe
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The Boston Globe
"Certainly there is plenty of evidence to refute the notion that vaccines cause autism. Fourteen epidemiological studies have shown that the risk of autism is the same whether children received the MMR vaccine or not, and five have shown that thimerosal-containing vaccines also do not cause autism. Further, although large quantities of mercury are clearly toxic to the brain, autism isn't a consequence of mercury poisoning; large, single-source mercury exposures in Minamata Bay and Iraq have caused seizures, mental retardation, and speech delay, but not autism.
Finally, vaccine makers removed thimerosal from vaccines routinely given to young infants about six years ago; if thimerosal were a cause, the incidence of autism should have declined. Instead, the numbers have continued to increase. All of this evidence should have caused a quick dismissal of these cases. But it didn't, and now the courthas turned into a circus. The federal and civil litigation will likely take years to sort out."
[Via PointofLaw.com]
