Thursday, December 27, 2007

NIH-Funded Research to Be Free (After One Year)

I was browsing the Wall Street Journal Health Blog and ran across this item regarding the new federal budget:

"The results of NIH-funded research must be made available for free online one year after they’re published in an academic journal. That’s a big deal, because the NIH is one of the biggest funders of medical research and subscriptions to the academic journals where that research is published can cost thousands of dollars a year.

Some researchers and academic institutions have been pushing for this for years, and the multibillion-dollar journal-publishing industry hired a PR guy known as “the pit bull of public relations” to fight the change."

Medscape CME: An Introduction to the Surgical Care Improvement Project (SCIP)

Surgical Care Improvement Project (SCIP) Module 1: Infection Prevention Update

Maximum of 1.5 AMA PRA Category 1 Credit(s)™ for physicians

Medscape CME: Systemic Lidocaine Good

Annals of Surgery: Systemic Lidocaine Shortens Length of Hospital Stay After Colorectal Surgery: A Double-blinded, Randomized, Placebo-controlled Trial.

1.0 AMA PRA Category 1 Credit(s)™ for physicians

Tuesday, December 18, 2007

Health Care Reform Distilled

GruntDoc has an excellent distillation of the choices to be made in health care reform:


Pick any two"

Sort of a permutation of C. Everett Koop when he said that Americans want the best medical care in the world, they want it for free, and they want it now.

Sunday, December 16, 2007

Patients pay only 14% of health care costs? Wow.

Free the market; Government interference hampers healthcare reform

"In a system in which medical care seems free or is artificially inexpensive, with someone else paying for one's healthcare, medical costs spiral out of control because we are encouraged to demand medical services without having to consider their real price. For every dollar's worth of hospital care a patient consumes, that patient pays only about 3 cents out of pocket; the rest is paid by third-party coverage. And for the healthcare system as a whole, patients pay only about 14%."

This article has several nice pieces of data.

Saturday, December 15, 2007

Saving 2660 Megabytes On Your New MacBook

A friend asked me to set up a new Macbook he bought for his wife. With recent Apple laptop sales being what they are, I bet many people will be doing the same thing, so I thought I'd pass along one thing I've learned: always erase the hard disk and re-install OS X.

As loaded by Apple, a new MacBook running Leopard has a hard drive that contains 18.4 gigabytes of software. That 18.4 GB includes language translations and fonts you will probably never actually need. Reinstalling OS X and not installing language translations saves 1.9 GB. Skipping foreign language fonts saves another 141 MB. Not installing X11 saves more, so that skipping all these things saves 2.6 GB (or 2660 MB) of disk space.

NYT: Google Gets Ready to Rumble With Microsoft

If you're long GOOG (or even if you just like Gmail), read this in the New York Times.

Pennsylvania's Ed Rendell Playing Games With Mcare Abatement

The Governor of my state, Ed Rendell, has decided he wants to spend any surplus from the catastrophic malpractice insurance fund (which pays awards and settlements over $500,000) on providing insurance for uninsured adults in Pennsylvania. He wants this so much that that he's threatened not to renew the Mcare program unless he gets what he wants. Thought he State Senate has voted to extend the abatement, the House adjourned before voting.

Here's an interesting quote from Rendell:

"We're not going to go through the pain initially of having the doctors send in their checks, and then having to return them if we continue the (subsidy)," Rendell said after speaking at a nurses' conference in Hershey."

What about the pain of the physicians who will have to figure out how to get the money to pay the full amount in January rather than April? Does the Governor think it's harder for the State to issue a refund than it is for doctors to get their hands on that kinds of money?

There should be no linkage between renewal of Mcare abatement and funding of the Cover All Pennsylvanians insurance program. Mcare funds should be used to cover the program's unfunded liability and make it easier to privatize later. The Governor's Cover All Pennsylvanians should get funding in a way that does not impact Mcare's ability to retire unfunded liability and he should stop playing political games to fund it otherwise.

Schneier: How to protect your laptop and portable disks

Bruce Schneier writes an excellent security newsletter called Crypto-Gram. This week there's something especially important for physicians who keep patient data on portable computers or drives: How to Secure Your Computer, Disks, and Portable Drives.
"The reason you encrypt your entire disk, and not just key files, is so you don't have to worry about swap files, temp files, hibernation files, erased files, browser cookies or whatever. You don't need to enforce a complex policy about which files are important enough to be encrypted. And you have an easy answer to your boss or to the press if the computer is stolen: no problem; the laptop is encrypted."

Wednesday, December 5, 2007

On 'Waking'

Haven't seen it. Will probably wait for the DVD. My national society, the America Society of Anesthesiologists, has a very nice patient education page on anesthesia awareness here and the referenced video is on YouTube here. No, I don't think Congressional hearing would solve anything. Aspect stock has not done as well as I thought it would in the last five days....

Saturday, December 1, 2007

Anesthesiology: Predictors of Postoperative Acute Renal Failure

Predictors of Postoperative Acute Renal Failure after Noncardiac Surgery in Patients with Previously Normal Renal Function

"Background: The authors investigated the incidence and risk factors for postoperative acute renal failure after major noncardiac surgery among patients with previously normal renal function.

Methods: Adult patients undergoing major noncardiac surgery with a preoperative calculated creatinine clearance of 80 ml/min or greater were included in a prospective, observational study at a single tertiary care university hospital. Patients were followed for the development of acute renal failure (defined as a calculated creatinine clearance of 50 ml/min or less) within the first 7 postoperative days. Patient preoperative characteristics and intraoperative anesthetic management were evaluated for associations with acute renal failure. Thirty-day, 60-day, and 1-yr all-cause mortality was also evaluated.

Results: A total of 65,043 cases between 2003 and 2006 were reviewed. Of these, 15,102 patients met the inclusion criteria; 121 patients developed acute renal failure (0.8%), and 14 required renal replacement therapy (0.1%). Seven independent preoperative predictors were identified (P < 0.05): age, emergent surgery, liver disease, body mass index, high-risk surgery, peripheral vascular occlusive disease, and chronic obstructive pulmonary disease necessitating chronic bronchodilator therapy. Several intraoperative management variables were independent predictors of acute renal failure: total vasopressor dose administered, use of a vasopressor infusion, and diuretic administration. Acute renal failure was associated with increased 30-day, 60-day, and 1-yr all-cause mortality.

Conclusions: Several preoperative predictors previously reported to be associated with acute renal failure after cardiac surgery were also found to be associated with acute renal failure after noncardiac surgery. The use of vasopressor and diuretics is also associated with acute renal failure."

Saturday, November 24, 2007

Catalogs Clogging Your Mailbox?

I am convinced that the fact that two of our letter carriers have gone on disability is in large part due to the number of mail order catalogs we receive each day at home. For a while I was actually calling companies to ask we be taken off their list. Now I've found something

"The mission of Catalog Choice is to reduce the number of repeat and unsolicited catalog mailings, and to promote the adoption of sustainable industry best practices. We aim to accomplish this by freely providing the Catalog Choice services to both consumers and businesses. Consumers can indicate which catalogs they no longer wish to receive, and businesses can receive a list of consumers no longer wanting to receive their catalogs."

I've declined twenty catalogs so far and can't wait for today's mail to arrive so I can decline some more!

Friday, November 16, 2007

Find Big Files in OS X

I just found a nifty freeware application for OS X to help scan my hard disk and graphically represent the file sizes present. It seems to run well on OS X, too. From the developer:
"GrandPerspective is a utility application for Mac OS X that graphically displays the disk usage of a file system."
I asked it to look at my documents folder and found a 1.5 GB file associated with an app I tried out but then deleted:

Though it's a free app, donation are appreciated, I'm sure.

Saturday, November 10, 2007

Sums up my experience regarding tight glycemic control in non-diabetics

"A stupid man's report of what a clever man says can never be accurate, because he unconsciously translates what he hears into something he can understand."

--Bertrand Russell

Sunday, October 28, 2007

Up the Creek Without an OS X 10.5 Paddle

The new version of Mac OS X has been released. Yea! And, although it will be delivered to my door at home Monday, I'm at a conference on a small island in a state that doesn't have a single Apple Store (South Carolina--who knew?). Poor planning on my part.

Note to self: always check conference dates for conflict with major apple announcement dates or OS update releases. Stupid. Stupid. Stupid.

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