Wednesday, February 21, 2007
JAMA: Off-Pump vs On-Pump CABG and Cognitive Decline
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Five years after surgery, there is no difference in cognitive decline between on-pump and off-pump CABG.
Cognitive and Cardiac Outcomes 5 Years After Off-Pump vs On-Pump Coronary Artery Bypass Graft Surgery
"Results After 5 years, 130 patients were alive in each group. Cognitive outcomes could be determined in 123 and 117 patients in the off-pump and on-pump groups, respectively. When using a standard definition of cognitive decline (20% decline in performance in 20% of the neuropsychological test variables), 62 (50.4%) of 123 in the off-pump group and 59 (50.4%) of 117 in the on-pump group had cognitive decline (absolute difference, 0%; 95% confidence interval [CI], –12.7% to 12.6%; P>.99). When a more conservative definition of cognitive decline was used, 41 (33.3%) in the off-pump group and 41 (35.0%) in the on-pump group had cognitive decline (absolute difference, –1.7%; 95% CI, –13.7% to 10.3%; P = .79). Thirty off-pump patients (21.1%) and 25 on-pump patients (18.0%) experienced a cardiovascular event (absolute difference, 3.1%; 95% CI, –6.1% to 12.4%; P = .55). No differences were observed in anginal status or quality of life.
Conclusion In low-risk patients undergoing CABG surgery, avoiding the use of cardiopulmonary bypass had no effect on 5-year cognitive or cardiac outcomes."
[free full text]
Sunday, July 30, 2006
Risks of Epidural Analgesia for Labor
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Anesthesiology has a nice article which attempt to quantify some of the less common risks of having an epidural during labor: epidural hematoma, infection, and neurologic injury.
| Epidural hematoma |
1 in 168,000 |
6 per million |
| Deep epidural infection |
1 in 145,000 |
7 per million |
| Persistent neurologic injury |
1 in 240,000 |
4 per million |
Transient neurologic injury
[< 1 year] |
1 in 6,700 |
180 per million |
It contains an interesting tidbit others might find interesting, too. There are 4 million births in the United States each year and 2.4 million involve epidural analgesia. Wow. That's three fifth of all live birth get an epidural! (And some call nights, it seems every single one does...)
Sunday, July 23, 2006
Pennsylvania Showing Net Loss of Physicians Over Time
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The number of physicians in Pennsylvania has declined by approximately ten percent between 1999 and 2005. On its own that number may not sound like such a huge drop. Compare that number to the other 20 most populous states and it becomes obvious that the difference is very significant.
Almost all of have seen net increases of between 7% and 35% over the same period. I would find it very interesting to know how long the wait is for a new patient appointment in an internal medicine practice in Pennsylvania vs. these states that have seen an increase. A knee replacement? First visit to a Neurologist. Follow up visits? You get my drift. Pennsylvania has a population that is among the most aged. Medicare just announced plans for more cuts. New physicians are choosing not to practice in Pennsylvania and we've seen a net loss of 10% in our physicians with unique provider numbers over the last six years. Get the picture, Governor Rendel?
Data from State of Medicine in Pennsylvania--2005
Thursday, May 25, 2006
Top 10 Causes of Death Worldwide
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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
4. HIV/AIDS
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, January 4, 2006
Antibiotic Resistance In Terms I Can Understand
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Penicillin and Amoxicillin's days are numbered
"Researchers from the University of Rochester started with the analysis of data from 11,426 children who has suffered a common throat infection.
They found that 25 per cent of children given penicillin, along with 18 per cent given amoxicillin treatment needed further treatment within weeks.
The data, taken from 47 studies from the past 35 years looked at the effectiveness of various drugs on treating strep throat in children.
Additional results revealed that of those given older-generation cephalosporin antibiotics, 14 per cent had to return for more treatment, while just 7 per cent prescribed newer versions like cefpodoxime and cefdinir, given for just four or five days, had to go back to the doctor. "
Sunday, January 1, 2006
Prilosec and C.Diff?
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Reading a blog far afield of medicine, then to the Washington Post, I cam across an interesting nugget on C. Diff. The JAMA published an article on December 21, 2005 titled Use of Gastric AcidâSuppressive Agents and the Risk of Community-Acquired Clostridium difficileâAssociated Disease [abstract]. In two population-based case-control studies:
" The incidence of C difficile in patients diagnosed by their general practitioners in the General Practice Research Database increased from less than 1 case per 100 000 in 1994 to 22 per 100 000 in 2004. The adjusted rate ratio of C difficileâassociated disease with current use of proton pump inhibitors was 2.9 (95% confidence interval [CI], 2.4-3.4) and with H2-receptor antagonists the rate ratio was 2.0 (95% CI, 1.6-2.7). An elevated rate was also found with the use of nonsteroidal anti-inflammatory drugs (rate ratio, 1.3; 95% CI, 1.2-1.5). "
A teleconference is planned for January 18th to discuss these results as part of the new Author-in-the-room series.
Wednesday, December 28, 2005
Gastric Bypass Surgeries Soaring (HealthDay)
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Gastric Bypass Surgeries Soaring (HealthDay):
"HealthDay - TUESDAY, Dec. 20 (HealthDay News) -- The number of gastric bypass and other bariatric surgeries conducted in the United States more than quadrupled between 1998 to 2002, from 12,775 procedures to 70,256, researchers report."
And from 2002 to the present, I'm sure they've continued to go up. Would I have one? Ask me when I'm 400 pounds and have tried other methods of weight loss without sustained results...
[Via Yahoo! News: Health]
Thursday, December 22, 2005
More proof: people don't change (doctors are people)
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Disciplinary Action by Medical Boards and Prior Behavior in Medical School
"Conclusions In this case-control study, disciplinary action among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school. Students with the strongest association were those who were described as irresponsible or as having diminished ability to improve their behavior. Professionalism should have a central role in medical academics and throughout one's medical career."
Thursday, December 1, 2005
CDC MMWR: Severe Clostridium difficile
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Severe Clostridium difficile--Associated Disease in Populations Previously at Low Risk --- Four States, 2005
Friday, November 25, 2005
How much caffeine does that drink have?
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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.
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