Health, United States, 2004 with Special Feature on Drugs
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Health, United States, 2004 with Special Feature on Drugs
""Health, United States, 2004, is the 28th annual report on the health status of the Nation and is submitted by the Secretary of the Department of Health and Human Services to the President and Congress. It assesses the Nation’s health by presenting trends and current information on selected determinants and measures of health status in a chartbook followed by 153 trend tables organized around four major subject areas: health status and determinants, health care utilization, health care resources, and health care expenditures.""
Guidelines: Coronary Artery Bypass Grafting
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Guidelines updated for Coronary Artery Bypass Grafting (CABG):
" "Key Points
- Off-pump CABG, which avoids aortic cannulation and cardiopulmonary bypass, is now available in many hospitals. However, three randomized trials comparing neurologic outcomes after off-pump and on-pump CABG provide insufficient evidence to warrant the conclusion that the off-pump procedure is better for limiting neurologic complications.
- The authors note that long-term data from trials of angioplasty versus CABG (most notably the BARI trial) continue to show significant advantages with CABG for preventing death and repeat revascularization in diabetes patients.
- Since 1999, both stent use and left internal mammary-artery grafting have become more common. The most recent randomized trial data show that rates of death, MI, and stroke remain similar for CABG recipients compared with stent recipients. The authors also mention that CABG's advantage over stenting for preventing repeat revascularization has narrowed, but remains significant.
- In a class I recommendation, the authors write that aspirin is "the drug of choice" for prophylaxis against early saphenous-vein graft closure and should be continued indefinitely.
- There is a new class I recommendation for statin therapy in all CABG patients, unless contraindicated.
- Hormone replacement therapy should no longer be initiated in women after CABG.
- The new guidelines emphasize the importance of understanding how newer antithrombotic and antiplatelet therapies affect bleeding risk in acute coronary syndrome patients who undergo CABG. For example, the authors have made a class I recommendation that clopidogrel be withheld for 5 days before CABG, if clinical circumstances permit.
- Several new sections have been added, including those about off-pump techniques, robotic coronary bypass, and the value of clinical guidelines and pathways for guiding postoperative care and improving outcomes." "
[Via Medscape Headlines]
What Is the Rhythm?
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Medscape: What Is the Rhythm? Part of their ECG of the week series.
Big Red Palm
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""The Big Red Book comes to your Palm with the release of AHFS DI (AHFS Drug Information) by Skyscape
 First published in 1959, the 'Big Red Book,' as it's come to be known, has gone the extra mile for pharmacists and healthcare professionals seeking answers to the most detailed questions. It provides more extensive evidence-based data than any other drug reference and is now available for the PDA.
|
""
[Via The Palmdoc Chronicles]
I prefer this text for looking up drug information and find the information it contains much more useful. It seems as though the PDR contains every possible complication as a CYA for the drug maker. The AHFS book doesn't give me that impression.
BMJ--Lessons from the withdrawal of rofecoxib
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British Medical Journal: Lessons from the withdrawal of rofecoxib:
""Suggested measures to ensure drug safety before definite licensing of a drug:
- Legal requirement for drug companies to register all randomised controlled trials prospectively
- Legal requirement for drug companies to make all data on serious adverse events from clinical studies publicly available immediately after study completion
- Continuously updated systematic reviews of adverse events based on published and unpublished data from randomised controlled trials and observational studies
- Phased introduction of new interventions in independent, large scale, randomised trials before definite drug licensing
- Clear cut financial firewalls between pharmaceutical companies and researchers performing systematic reviews and clinical studies
""
NEJM -- Controlling Health Care Costs
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Just released by the New England Journal of Medicine--Controlling Health Care Costs (no registration required for this article):
""Every year, without fail, spending for services covered by private health insurance increases. Sometimes health care spending grows slowly, as it did in the mid-1990s during the managed-care boom. But more often, it increases rapidly, as it is doing now--in part because of the managed-care bust. Presidential candidates do not want to venture beyond platitudes concerning costs because they risk being accused of taking things away from people. Both President George W. Bush and Senator John F. Kerry have served up proposals designed to ease voters' angst about the affordability of health care, but neither proposal, as it has been elaborated through September, gets at the core issues involved in controlling the growth of health care costs.""
Pennsylvania Medical Society | FAQ: Act 13 Physician Self-reporting Rules
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Pennsylvania Medical Society | FAQ: Act 13 Physician Self-reporting Rules:
- How did the physician reporting provisions come to be included in the law?
- What tort and insurance reforms were created by Act 13?
- What patient safety elements were included in the law in exchange for these reforms?
- What are the physician reporting requirements under Act 13, and should physicians be alarmed by these or by the State Board’s investigation process?
- How does the State Board determine which cases warrant an investigation?
JCAHO Sentinel Event Alert: Intraoperative Awareness
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Sentinel Event Alert, Issue 32 - October 6, 2004: Preventing, and managing the impact of, anesthesia awareness
" "Anesthesia awareness is under-recognized and under-treated in health care organizations. The Joint Commission recommends that health care organizations which perform procedures under general anesthesia do the following to help prevent and manage anesthesia awareness:
1) Develop and implement an anesthesia awareness policy that addresses the following:
- Education of clinical staff about anesthesia awareness and how to manage patients who have experienced awareness.
- Identification of patients at proportionately higher risk for an awareness experience, and discussion with such patients, before surgery, of the potential for anesthesia awareness.
- The effective application of available anesthesia monitoring techniques, including the timely maintenance of anesthesia equipment.
- Appropriate post-operative follow-up of all patients who have undergone general anesthesia, including children.
- The identification, management and, if appropriate, referral of patients who have experienced awareness.
2) Assure access to necessary counseling or other support for patients who are experiencing post-traumatic stress syndrome or other mental distress."
"
Medscape Bioterrorism Resource Center
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Medscape maintains an excellent Medscape Bioterrorism Resource Center. Registration does not appear to be required for access to this resource, either.
""This Resource Center provides clinicians with the latest news, reference material, literature selections and continuing education about potential bioterrorism agents. It is designed to help healthcare professionals identify the signs and symptoms of such agents and thus be better prepared to respond in the event of a bioterrorism outbreak.""
Topics covered include:
Anthrax
Smallpox
Plague
Botulism
Tularemia
Viral Hemorrhagic Fevers
Biotoxins
The question I have to answer is:
a) should I have myself re-vaccinated and
b) should I approach my wife about having our two sons vaccinated.
Any informed opinions are
.
MGHAnes
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MGHAnes:
""Skyscape has released MGHAnes™ which is the Skyscape version of Clinical Anesthesia Procedures of the Massachusetts General Hospital, 6th Ed.
| The best-selling handbook, Clinical Anesthesia Procedures of the Massachusetts General Hospital, Sixth Edition, is now available in PDA format. This easy-to-navigate handheld reference provides instant access to current, comprehensive, concise, consistent, and clinically relevant guidelines for anesthesia procedures throughout the preoperative, intraoperative, and postoperative periods. Coverage includes a comprehensive, alphabetical drug appendix, adult and pediatric resuscitation guidelines, malignant hyperthermia protocols, an anesthesia machine checklist, and information on complementary and alternative medicine and end-of-life issues |
""
[Via The Palmdoc Chronicles]
