Noncardiac Surgery Guidelines

From The NY Times:

The nation’s two leading heart groups issued new guidelines yesterday about what should be done for patients with heart disease before they undergo surgery on other parts of the body.

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Traveling Patch

From WebMD:

Researchers have developed a skin patch that prevents the curse of many trips abroad: travelers’ diarrhea.

In a study of more than 150 travelers to Mexico and Guatemala, the novel vaccine cut the risk of moderate to severe diarrhea by 75%. Those who did get sick had a shorter, milder course of illness, says researcher Herbert DuPont, MD, director of the Center for Infectious Diseases at the University of Texas School of Public Health in Houston.

The patch releases a low level of the toxins of E. coli that causes Traveler's diarrhea. This stimulates the immune system of the patient. Then, when they are infected by the bacteria, they already have some preformed antibody which is protective. Neat, huh?

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Keep the Lunch, Lose the Box

From San Jose Mercury News:

The state's public health department asked parents Thursday to toss certain Chinese-made lunchboxes potentially containing dangerous levels of lead - the same ones it distributed in a campaign to promote healthy eating.

The department distributed more than 350,000 of the canvas lunchboxes, only to find out that at least three that were tested in a batch of 56,000 contained "significant" levels of lead.

I think this is an argument to brown bag it.

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Diana's Death- Looking Back

From CBS News:

Glamorized in life, Princess Diana continues to be scrutinized 10 years after her death.

An early-morning traffic accident in a Paris tunnel killed Diana's companion, Dodi Al-Fayed, and the driver of their car. But Diana was conscious after the accident and did not appear to be seriously hurt. In truth, she was bleeding internally.

Had the accident occurred in the United States, Diana would have been rushed to a hospital. However, the French have a different system: They first try to stabilize the patient at the scene. Still, as CBS News correspondent Erin Moriarty reports, that difference doesn't explain the series of missteps and delays in Diana's medical care that experts say never should have happened.

After I watched this clip on the CBS News, I was in awe at the horrible care that the Princess had received. I had heard it was the custom to send the Doctor out to the scene of the accident in Europe, which is not usual in the states. An anxious trauma patient needs to have hemorrhagic shock excluded long before any sedation is even considered. They used up their "golden hour" long before she ever got to the hospital. Her care is a good argument for "scoop & run" in these types of situations.

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Skinny In Colorado

From MSNBC:

Coloradans are among the skinniest people in the nation, according to a new obesity report, but don't go celebrate with a slice of New York cheesecake.Colorado's waistline is expanding just like every other state's.

According to the Trust for America's Health, which compiled the report released Monday,Colorado has some of the lowest rates in the country of overweight residents, physical inactivity, hypertension and childhood obesity. Overall, it ranks as the leanest state in the study.

Is is any wonder? With all of those outdoor activities in that state, I know why they are thinner out there. Between mountain bike riding, skiing, hiking and climbing, those folks never sit still out West.

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Stay On the Right Side

From CNN:

An 86-year-old man has died three weeks after a surgeon operated on the wrong side of his head, and state health authorities were investigating whether the mistake contributed to his death.

The patient, whose name wasn't released, died Saturday. The state medical examiner was determining the cause of death, according to a spokeswoman for the state health department.

The man underwent emergency surgery at Rhode Island Hospital on July 30 to treat bleeding in his brain, according to a state report released Thursday.

There's really no excuse for not having consulted the CT scan before starting the case. Still, it can be quite easy in the "heat of battle" to proceed on the wrong side. I remember as a first year resident on call, the OR called me at around 5 am as they were getting ready to prep the patient for surgery that day, and he was an early case. The patient was going for a combined carotid/CABG operation, but they didn't have consent for the carotid portion. When I asked which side I should consent them for, the patient didn't know, but the nurse insisted on the right carotid. I looked in the chart, and the nurse assumed that because the right side was 100% blocked, that was the surgical side. Wrong! She didn't realize that once a carotid is occluded, it can't be operated on, and it was really the left side, which was 70% occluded. Now that it was becoming an issue, I called the attending vascular surgeon at home, and confirmed with them which side was the operative one, as by the time they arrived, the patient would be under anesthesia, and draped with the surgical side of the neck exposed. While I hope that the surgeon would have known which was the correct side, I can easily envision things proceeding less than perfectly. Thankfully, this is my only surgical side story, and it was a save.

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Minute Clinic Controversy

From MSNBC:

The growth of clinics in retail stores comes amid a shortage of family physicians that only promises to worsen.

Medical groups predict a shortage of 200,000 doctors in the United States by 2020. About 20 percent of Americans live in areas with a shortage of primary medical care, according to PricewaterhouseCoopers.

Wal-Mart operates 78 in-store clinics in 13 states, where the cost of a “get well” visit ranges between $40 and $65.

About half of those surveyed who visit Wal-Mart clinics have no insurance, according to spokeswoman Deisha Galberth. Another 15 percent said if there had not been a clinic, they would have gone to an emergency room instead.

As far as I'm concerned, if it offers an affordable alternative to the overloaded Emergency Rooms, than it is a good thing.

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Workplace Safety

From The Toronto Star:

Ontario's front-line health care workers will soon be better protected against job-related injuries and life-threatening infections.

The province announced yesterday it will provide nurses and other health care workers with new respirators and safety needles in an effort to make their workplaces safer.

One more reason to move to Canada. What are we doing again in the US?

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E-Prescriptions In the North

Electronic drug prescriptions can be delivered to pharmacists in all 50 states for the first time this week as Alaska became the final state to join the technological bandwagon.

In the past year, Georgia, South Carolina and West Virginia have all joined the national network, and the change in Alaska regulations means doctors' hieroglyphic handwriting and prescription pads could soon be a thing of the past.

Dick Holm, a member of the state Board of Pharmacy, said the process took so long to get to Alaska because "we're a small state and we address things as they come up." He said the change was not mandated by the federal government.

More.

It may be legal, but I've never seen it.

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Overhyped Antimicrobial Soap

Washing hands with an antibacterial soap was no more effective at reducing bacterial levels or preventing illness than washing with ordinary soap, researchers said.

Furthermore, the soaps, most of which contain the antimicrobial triclosan, produced worrisome antibiotic cross-resistance among different species of bacteria, according to a study reported in a supplement to the Sept. 1 issue of Clinical Infectious Diseases.

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It's going to take more than one study to change how people wash their hands after years of aggressive marketing by the soap industry.

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Crazy Coumadin

Widely used blood thinner warfarin will come with new instructions explaining that people with certain genes may need a lower dose to take the drug safely, U.S. health officials said on Thursday.

The change is part of a move toward personalized medicine in which doctors tailor treatment based on genetic makeup, the Food and Drug Administration said.

More.

I'm not sure of the cost effectiveness of a genetic test to figure out a dose of coumadin. When the medication is started in the hospital, with daily PT/INR monitoring, and reasonable dosing, patients really shouldn't become hypertherapeutic.

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Protecting Children

Parents shopping for school supplies probably haven't thought to include body armor on their lists, but after recent school shootings including April's Virginia Tech massacre, two companies are marketing armored backpacks and uniforms.

"Back in '99 following the Columbine shootings, me and my buddy Joe Curran — both of us are parents of two children — wondered if there was anything out there in the world to protect children in school if there was a shooting," Mike Pelonzi, co-inventor of My Child's Pack, a bulletproof backpack, told ABCNEWS.com.

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It's a sad day in America when this is what is needed to keep a child safe at school.

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The Video.

Laparoscopy HD

I have previously posted about my research on the use of high definition TV (HDTV) for surgical endoscopy. I am honored to have participated in the evaluation of the highest resolution surgical system ever created which I used to capture the footage showcased in the amazing upcoming National Geographic HD special “Inside The Living Body” which will be the first surgical procedure broadcast in HD.

What’s also new is that this system allowed me to record footage that will be seen by the lay public in their living room that is higher resolution and quality than virtually any surgeon has ever seen in the OR!

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I will say that most surgeons I know are quite pleased if their laparoscope isn't fogging throughout the procedure with no picture. Barely half the monitors at the hospitals I deal with are even LCD, and they are the older CRT's. Surgery HD is a long way off from the masses at this point unless someone can show the benefit.

Recall that everything used in a hospital costs a ton of money once it gets the medical moniker attached to it. A few years ago, the VCR that a radiologist was using to record barium swallows broke. For a Sony "Medical VCR" they wanted over two thousand grand for it. He kept fighting with administration over the price tag as they didn't want to go for it. After a few months, he finally got fed up, went down to the local Best Buy, and picked one up for a hundred bucks, and of course it worked just as well. I can only imagine how much surgery in HD is going to cost when we consider all of the equipment involved, going for ten times more than in the consumer market.

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Sugar High

Added sugars are the bane of our modern diet - and drinking sugar is arguably the easiest way to over-indulge.

What are the most sugary drinks?

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Some list...Red Bull isn't even on it.

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Endobarrier For Weight Loss

"This is again performed endoscopically with a device that goes down the esophagus into the stomach where the device is deployed. The theory is food goes on the inside of this endobarrier. The digestive enzymes are on the outside of the endobarrier and the food and digestive enzymes don't mix until two feet further down stream in the smaller bowel.”

While it is similar to the gastric bypass, it’s not a replacement for those who need the surgery just yet.

"For now, it's not instead of, it's prior too gastric bypass. Whether or not this becomes a procedure instead of gastric bypass remains to be seen," said Gersin.

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Ok, so let me get this straight. So we put this baggie inside the stomach, and it goes into the small intestine a ways. This keeps the food from getting digested. And no one thinks that this thing is going to move and cause an obstruction? Not for nothing, but this is making "Fat March" look like a better idea...

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