Archives for November 2005

MSSP Nexus Blog Proposes: The Bloscars

As a refinement to the Medgadget MedBlog Awards, Rita at MSSP has an idea:

MSSPNexus Blog: Academy of Blogging Arts and Sciences

The Bloscars

Since MedGadget started this, the onus is on them to create, manage, and of course fund the Academy of Blogging Arts and Sciences.

Nominations shall be restricted to select members of the Academy. I’m not sure how they’ll be selected, that would be Medgadget’s problem to figure out. (That’ll teach you for coming up with a good concept!) Once the field has been narrowed to no more than five nominees in each category, all members of the Academy of Blogging Arts and Sciences shall be permitted to vote for one Bloscar winner in each category.

I think it’ll get somebody a nice cease-and-desist letter from the Oscar folks, but as there’s only about 30 of us, what are the chances of that?

Emergency bypass surgery on angioplasty patients drops 90%

I can go two weeks and not find anything stimulating to comment on, then there’s a day like today.

Emergency bypass surgery on angioplasty patients drops 90% Cardiac Stent: original from

Decline seen at Mayo Clinic even as physicians expanded angioplasty to sicker patients

When life-threatening problems occur during angioplasty procedures, doctors may perform emergency coronary artery bypass graft surgery, but data from the Mayo Clinic indicates that need to send patients to emergency surgery has dropped sharply, according to a new study in the Dec. 6, 2005, issue of the Journal of the American College of Cardiology.
‘Our review of almost 25 years of data on angioplasty suggests that there has been a dramatic reduction of almost 90 percent in the incidence of coronary artery bypass graft surgery following angioplasty; and this is despite the fact that more recently we are performing angioplasty on very high risk patients,’ said Mandeep Singh, M.D., F.A.C.C., from the Mayo College of Medicine in Rochester, Minnesota.

‘We knew there had been a reduction, but the magnitude of the reduction was a surprise to us,’ Dr. Singh said. ‘The bypass surgery rates, which were close to 3 percent, came down to 0.3 percent in the most recent time period.’

Dr. Singh said the fact that angioplasty is being offered to sicker patients now makes the reduction even more remarkable. Patients requiring emergency surgery in the most recent study period had a higher prevalence of high blood pressure and heart failure, and they were more likely to have undergone previous procedures, compared to patients in the earlier study periods.

Dr. Singh said he believes stents may be responsible for much of the reduction in the rate of life-threatening problems during angioplasty procedures.

However, among patients who did suffer serious problems during angioplasty and had to be sent into emergency surgery, the researchers did not see an improvement in survival. Death rates were statistically similar in all three study periods, ranging between 10 percent and 14 percent. Dr. Singh pointed out that there were only 41 deaths among patients who underwent emergency bypass surgery, including just two during the 2000 to 2003 study period. He said such small numbers make it difficult to calculate useful statistical comparisons.

‘The assessment of elective PCI without on-site bypass surgery underway in some states is a step in the right direction. But, choosing the right metrics is challenging. The only meaningful comparison between hospitals with and without on-site surgery is the rate of death or urgent transfer to another facility within a pre-specified period of time after PCI. One proposal that mixes acute events with late endpoints like repeat revascularizations is manipulative and misleading,’ he added.

This is really good news for everyone, cardiac surgeons included (they don’t want to be operating emergently anyway, and especially not on people who are already super-sick with vessels so bad they can’t be opened in the cath lab). I, for instance, really hope that when I have my MI (family probability) they can get me opened and stented in the lab, and not spend an hour in the lab then go and have my chest cracked for a bypass.

Also, this study going on with emergency caths in hospitals without in-house emergency bypass surgery is going to be very interesting to watch. Personally I hope it’s shown to have an acceptable risk/benefit ratio, but that study is only starting.

Good news, and progress, all around.

Stent picture from St. Michael’s Hospital, Tononto, Canada.

From Medscape: Are We Really Better Off With HIPAA?

From Medscape, an editorial by their founder: Are We Really Better Off With HIPAA? There’s a video of Mr. Frishauf reading his editorial, slowly, if you want to watch, but the entire text is under the video box. Original Image from PrawfsBlawg

Are We Really Better Off With HIPAA?

Whether you’re an American clinician or patient, there’s no escaping the Health Insurance Portability and Accountability Act (HIPAA). Republicans and Democrats assured us it would make healthcare better.

But has it?

Unless you’re a HIPAA consultant, a compliance officer, or some other bureaucrat, the answer is generally no.

The thing that bothers me most about HIPAA is its expensive, annoying, and — in the end — meaningless implementation. Clinicians have to get all patients to sign forms, which they then file, or they get into trouble, and could face huge fines. Insurance companies must do the same, but then require patients to forget about their privacy if they want insurance. So most do.

Hospitals cringe at the thought of HIPAA fines. Their well-paid consultants design elaborate, expensive systems to ensure compliance.

I will concede one good thing about HIPAA, and that’s the health insurance portability.
Title I protects health insurance coverage for workers and their families when they change or lose their jobs — and this part of the law is working.

But the much ballyhooed “privacy” parts of the law are a failure that could easily be repealed with financial savings to healthcare and no adverse effects that I can think of. In fact, US medicine without these provisions could be better, as information sharing would be easier. And that usually helps patients a lot more than it hurts them.

That’s my opinion, and I’m Peter Frishauf, founder of Medscape.

That’s my opinion as well. Mountains of paperwork, which serve only to further erode public trust in government (another meaningless form you HAVE TO SIGN, thanks for watching out for my rights) and put one more impediment in the wheels of progress.

Also, let’s not forget that the first (and as far as I can tell by Googling, only) use of HIPAA was to convict a hospital employee of identity theft. He should have gone to jail, but there’s already laws against identity theft.

And, it’s here to stay. The continuous creep of government intrusiveness into our lives continues no matter which part is in power in Washington. There’s no chance this will be overturned, politicians lack the “Oh, that was a mistake, and we’ll fix it” gene.

Image from PrawfsBlawg. Don’t want to tick off the lawyers.

MedBlogs Grand Rounds 2:10

It’s Time For Grand Rounds

Just when you thought you couldn’t stomach anymore Thanksgiving goodness, it’s the Thank-You-Kindly edition of Grand Rounds! (Version 2.10, but who’s counting.) Publicized in part by Medscape, thanks!

A nice job, and a lot of links!

New York EM Docs Sacked

I think this is entirely wrong, unless actual wrongdoing is alleged:
this pink slip's for you!

NUMC to fire ER staff

November 29, 2005

Nassau University Medical Center officials yesterday announced plans to replace nearly all their veteran emergency room doctors within six months, saying the physicians’ training and credentials are not up to today’s standards.

Union leaders who represent the doctors immediately accused administrators of violating a deal to forgo layoffs at the public hospital in East Meadow. They said the firings are the first step in an effort to privatize the emergency room. The hospital entered into an affiliation agreement with the nonprofit North Shore-Long Island Jewish Health System in the summer.

[ Interesting local hospital politics, only partially hinted about, removed ]

The hospital has decided to hire doctors with national medical board certification and residency training in emergency medicine, who could handle a wider array of cases, Kane said.

Dr. Joan McInerney, who was asked to step down as chairwoman of emergency medicine, broke into tears and declined to comment on her job yesterday, saying she had to call her lawyer.

But McInerney said she disagreed with the decision to replace all the doctors at once, and advocated hiring emergency specialists gradually. “None of them deserve that,” McInerney said of the doctors.

Officials said their move would create more flexibility in a department that sees 80,000 patients a year.

The hospital’s 20 full-time emergency room doctors specialize in non-emergency fields, including internal medicine, surgery, gynecology or pediatrics. Only two doctors have the training and certification in emergency medicine that would now allow them to stay.

Asked whether the doctors would be offered other jobs in the hospital, Kane said, “I don’t know that there will be vacant positions elsewhere that they would qualify for.”

McInerney was asked to step down by Kane and Dr. Steven Walerstein, the senior vice president for medical affairs but she has not yet done so, said Ron Gurrieri, the union’s first vice president. McInerney is board certified in emergency medicine, but does not have residency training in that area.

The field of emergency medicine developed in the 1960s. The first certification was not until 1980, and there were few residency training programs then. About 62 percent of practicing doctors are board certified or residency trained in emergency medicine, according to the American College of Emergency Physicians. Older emergency room doctors often specialized in another area.

At Nassau University Medical Center yesterday, the emergency room doctors said they could not comment, for fear of retribution.

“We’re outraged,” said one doctor who spoke on condition of anonymity. “Obviously we feel that we’ve provided good services to the hospital, and now they’re changing our terms of employment, and they want to get rid of us.”

For the record, I believe new hires in ED’s should be EM Residency Trained, and Board Eligible / Certified, with an expectation that those who are eligible will get themselves certified. That having been said, I’m not in favor of sacking an entire ED physician cadre based on ‘changing standards’. If they’ve been credentialled at their hospital, then they shouldn’t be removed unless some cause is shown. (I don’t have that protection, by the way, most EM docs don’t. I’m speaking of the Ideal World here).

Have a look at their ED’s site. I’ve never worked in an ED that had this level of division, and wonder if this isn’t what the move is about. [Speculation alert] Consolidating the operations of 7 separate EDs into one (or two, Surgeons are notorious turf-defenders) could possibly save some money, and EM trained docs can staff all the areas they describe. [/Speculation].

A bunch of CVs are getting polished tonight and faxes will be flying tomorrow.

You’d think the name would have been a warning…. – MacDonald charged in Wendy’s heist – Nov 28, 2005

MANCHESTER, New Hampshire (AP) — He works at a Wendy’s, and his name is Ronald MacDonald — but now he may be known as the Hamburglar.

Two workers at a Wendy’s in Manchester, New Hampshire, have been charged with taking money from the safe. One of the suspects is Ronald MacDonald.

MedGadget 2005 Medical Blog Awards

Well, it’s that time:

Welcome to the second annual Medical Weblog Awards! These awards are designed to honor the very best in the medical blogosphere, as decided by you–the readers of these fine medical blogs.

It’s been another year filled with explosive growth, stirring debate, and excellent writing — in a number of fields. Our categories reflect this diversity. The categories for this year’s awards will be:

— Best Medical Weblog

— Best New Medical Weblog (established in 2005)

— Best Literary Medical Weblog

— Best Clinical Sciences Weblog

— Best Health Policies/Ethics Weblog

— Best Medical Technologies/Informatics Weblog

Nominations are now accepted in the comment section of this post. [Ed. Not here! Follow the link!] Nominate your favorite medical weblog, even if it’s your own. A blog can participate in more than one category.

The following timeline will be observed:

— Nominations will be accepted until Friday, December 30, 2005.

— Polls will be open from Tuesday, January 3, 2006 and will close at midnight on Sunday, January 15, 2005 (PST).

— Awards will be announced on Wednesday, January 25, 2006.

I will take this opportunity to remove myself from voting for this year. I’ve enjoyed being the Inagural winner, and the speaking tour, while exhausting, was educational and fun. I’ll be nominating blogs, and encourage you to, as well.

New CPR Recommendations

More CPR news!

A couple of weeks ago it was announced CPR could be taught more quickly and effectively, and today the American Heart Association announced changes to the CPR recommendations that should make the actual performance of CPR easier:

Nov. 28 (Bloomberg) — New guidelines for resuscitating people whose hearts suddenly stop emphasize more and faster chest compressions, with fewer stops to breathe oxygen-rich air into the patient’s mouth.

“The 2005 guidelines take a `back to basics’ approach to resuscitation,” said Robert Hickey, chair of the American Heart Association’s Emergency Cardiovascular Care programs. “The association believes the new guidelines will contribute to more people doing CPR effectively,” he said in a statement.

Rescuers should give 30 chest compressions then two breaths to all adults, children and infants needing CPR. That’s double the previously recommended 15 compressions for every two breaths in adults in the previous guidelines published in 2000. It also simplifies the technique for children and infants, who previously received one breath for every five compressions.

The emphasis on chest compressions carries over to the use of automated external defibrillators, the devices now found in airports, schools and other public places to shock an erratically beating or stopped heart back into a normal rhythm.

CPR is an effective lifesaving technique, and the survival rate is clearly higher the earlier good CPR is started. That having been said, a whole lot of people aren’t crazy about that whole ‘mouth to mouth breathing thing’, and I don’t blame them. This makes that less frequent, but still recommends rescue breaths.

Okay, and now the caveat: none of this is based on really bulletproof science, it’s consensus guidelines to do the best we can. This is why they’re recommendations.

Tinfoil Hats and You

Well, I think we all suspected this…


Among a fringe community of paranoids, aluminum helmets serve as the protective measure of choice against invasive radio signals. We investigate the efficacy of three aluminum helmet designs on a sample group of four individuals. Using a $250,000 network analyser, we find that although on average all helmets attenuate invasive radio frequencies in either directions (either emanating from an outside source, or emanating from the cranium of the subject), certain frequencies are in fact greatly amplified. These amplified frequencies coincide with radio bands reserved for government use according to the Federal Communication Commission (FCC). Statistical evidence suggests the use of helmets may in fact enhance the government’s invasive abilities. We speculate that the government may in fact have started the helmet craze for this reason.

Just so you know.

via InstaPundit

Self-Parodying Headlines

BBC NEWS | Business | Condoms used to measure inflation:

“Condoms and the anti-impotency drug Viagra might be joining the shopping basket of items used by the Cypriot government to measure inflation.
Most nations have a list of products whose prices they track, but such items are traditionally more bread and butter – both literally and metaphorically.

Cyprus’ state statistics department is also proposing to add hunting licences and vodka to its new list of items.

The UK’s Office for National Statistics added champagne to its list this year.

Adding anything here would just be impotent.

Yeah, I know, the original headline was meant to be humorous, but I really liked it.


I have a lot to be thankful for. I just spent some time trying to enumerate my blessings, and decided, instead, to wish you a Happy Thanksgiving of your own.

See you both tomorrow!

Doc Around the Clock has moved

Doc Around The Clock

Well I did it. After hours upon hours of tinkering, editing, changing, re-changing and re-changing my changes, I have settled on a design for my new blog site. I had a blast setting it up, despite a few scary moments. The most distressing moment came when I thought I lost my entire old Doc Around The Clock. After a few distressing hours, many tears, an episode of tachycardia, diaphoresis and crushing substernal chest pain I had reclaimed my blog. I am not sure how, but it was a miracle on par of Moses parting the Red Sea, seeing the Virgin Mary on burnt toast, and getting an XboX at its release last night. So here it is and I hope you enjoy it.

Tinkering with the blog and the software is half the fun of blogging, so I completely identify with his desire to change. Add him to you blogrolls, if you haven’t already.

And his RSS feed is:

MedPundit answers the Question of the Day

Question of the Day: From an email:

If we had a Medicare-for-all system where the reimbursements were higher than they are today, and at least fair, would you support this over the current for-profit system with 1500 insurance companies?

You’ll have to read her answer. I think it’s much better than the one I would have given, as there’s no swearing. And better thought out.

And certain to twist Graham’s nickers.

MedBlogs Grand Rounds 2:9

code blog: tales of a nurse: Grand Rounds 2.09

Welcome to this edition of Grand Rounds! I haven’t hosted since last year, but this is codeblog’s 3rd time around.

Third time’s a charm! And, I believe Geena is the first three-time host. Way to go!

Panexa: Ask Your Doctor for a Reason to Take It

via HIPAA Blog:



PANEXA is a prescription drug that should only be taken by patients experiencing one of the following disorders: metabolism, binocular vision, digestion (solid and liquid), circulation, menstruation, cognition, osculation, extremes of emotion. For patients with coronary heart condition (CHC) or two separate feet (2SF), the dosage of PANEXA should be doubled to ensure that twice the number of pills are being consumed. PANEXA can also be utilized to decrease the risk of death caused by not taking PANEXA, being beaten to death by oscelots, or death relating from complications arising from seeing too much of the color lavender. Epileptic patients should take care to ensure tight, careful grips on containers of PANEXA, in order to secure their contents in the event of a seizure, caused by PANEXA or otherwise.

Hehe. Drug companies are amazing.