Friday, July 27, 2007

Wednesday, July 25, 2007

Alcohol and drugs

Came across an interesting website with an online newsletter. Looks like it is the result of a collaboration between Boston University, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse. Check it out if you are looking for needs assessment data on alcohol and drug use/abuse. Physicians could probably also use it for self-directed learning! Some articles in the most recent newsletter:
  • Unhealthy Alcohol Use and the Preventive Paradox
  • Drug Use Disorders: Onset, Mental Health Impairment, and Comorbidity
  • Why Don't Primary Care Clinicians Screen Teens for Substance Abuse?
  • Coordinated Treatment for Hepatitis C in Injection Drug Users
There are also slide presentations available! Click here to access.

Tuesday, July 24, 2007

Low health literacy and mortality

From the Archives of Internal Medicine article "Health Literacy and Mortality Among Elderly Persons":
Conclusions Inadequate health literacy, as measured by reading fluency, independently predicts all-cause mortality and cardiovascular death among community-dwelling elderly persons. Reading fluency is a more powerful variable than education for examining the association between socioeconomic status and health.
Click here to access the journal abstract. Click here to access a lay article on this study.

Monday, July 23, 2007

Minnesota hospital suspends patient privacy violators

From the article:
More than 100 Park Nicollet Clinic employees have been suspended this year for violating federal laws on patient privacy -- mostly by tapping into electronic records of relatives or friends, according to clinic officials.

This week, the clinic notified its 8,300 employees about the suspensions as a reminder of what it calls its "zero tolerance policy" on confidentiality. Already, twice as many employees have been disciplined for privacy violations in 2007 than in all of 2006, officials say. They were suspended without pay for three days.
Click here to access the article.

Sunday, July 22, 2007

Physician shortage

From the New York Times article:
The government estimates that more than 35 million Americans live in underserved areas, and it would take 16,000 doctors to immediately fill that need, according to the American Medical Association. And the gap is expected to widen dramatically over the next several years, reaching 24,000 in 2020 by one government estimate. A 2005 study in the journal Health Affairs said it could hit an astonishing 200,000 by then, based on a rising population and an aging work force.
Click here to access the article (reg. req.).

Friday, July 20, 2007

Prescription for change?

Check out this Boston Globe article "Tests of ER trainees find signs of race bias in care"; from the article:
In the new study, trainee doctors in Boston and Atlanta took a 20-minute computer survey designed to detect overt and implicit prejudice. They were also presented with the hypothetical case of a 50-year-old man stricken with sharp chest pain; in some scenarios the man was white, while in others he was black.

"We found that as doctors' unconscious biases against blacks increased, their likelihood of giving [clot-busting] treatment decreased," said the lead author of the study, Dr. Alexander R. Green of Massachusetts General Hospital. "It's not a matter of you being a racist. It's really a matter of the way your brain processes information is influenced by things you've seen, things you've experienced, the way media has presented things."

Specialists predict that the novel study, appearing on the website of the Journal of General Internal Medicine, will result in considerable soul-searching in the medical profession, rethinking of medical school curriculum, and refresher courses for veteran doctors.
Click here to access the article.

Thursday, July 19, 2007

A bad bug

From the Archives of Surgery:
Main Outcome Measures The prevalence, case fatality, total mortality rate, and colectomy rate of C difficile colitis.

Results We found that the prevalence, case fatality, total mortality rate, and colectomy rate of C difficile colitis increased from 1993 through 2003. In our regression analysis, the year of diagnosis predicted an increase in prevalence, case fatality, total mortality rate, and colectomy rate after adjusting for potential confounders.

Conclusions The prevalence, case fatality, total mortality rate, and colectomy rate of C difficile colitis significantly increased from 1993 to 2003. These findings provide compelling evidence of the changing epidemiological features of C difficile colitis.
Click here to access the Archives of Surgery (subscription required for full article). Click here to read a Boston Globe article on this bad bug.

Wednesday, July 18, 2007

Physician impairment?

From the Miami Herald article:
Doctors' problems are usually closely held secrets in the healthcare industry and can persist for years before becoming public with any disciplinary action.
Click here to read more.

Tuesday, July 17, 2007

Check out the work of my fellow blogger, Rudy, over at This site is a great news feed on a wide variety of disability topics. Per Rudy, it is:
...intended both for people with disabilities and those who wish to learn about disability issues. The main goal of this web site is to raise disability awareness and understanding. It's a place where people can do research on disability issues. I also wanted it to be a place where people can share experiences and help each other.
CME Providers, bookmark it! Click here to access Rudy's blog. Blessings!

Monday, July 16, 2007

Gap in clot risk knowledge?

From the United Press International:
One out of three U.S. hospital patients is at risk for dangerous blood clots, but far fewer actually receive treatments to prevent the potentially life-threatening condition, according to a study released this week.

"Blood clots are the most common preventable cause of death in hospital patients. It is profound and puzzling: Why is there a preventable issue that people are dying from?" Frederick Anderson, a research professor in the Department of Surgery at the University of Massachusetts Medical School and director of the Center for Outcomes Research, told United Press International.

Deep venous thromboembolism, a blood clot in the deep vein of a leg or arm, can occur when people are immobilized for two or three days, such as after surgery. The condition is treatable but if ignored, may become deadly if the blood clot travels to the lung.

It is estimated that 5 percent to 10 percent of hospital deaths are due to blood clots that travel to the lungs, also called a pulmonary embolism.
Click here to access the article.

The patient's perspective

From the Boston Globe article:
When the ambulance arrived, the self-assured nurse was suddenly on the other side of her profession, depending on hulking EMTs to pound life back into her. She suffered a massive heart attack and it took 12 shocks of a defibrillator to stabilize her.

Eaton recently told her story to a rapt audience of doctors and nurses in a crowded conference room at Winchester Hospital. Over coffee and buzzing beepers, the point was to use Eaton's experience to review "best practices" and how to cope with trauma from a patient's point of view.
Click here to access the article.

Thursday, July 12, 2007

ACCME Annual Report 2006 available

Total hours of instruction:

2006: 712,163
2005: 678,528

Total commercial support:

2006: $1,199,405,519
2005: $1,115,597,071

Exhibit income:

2006: $244,913,684
2005: $235,721,224

Click here to access the report.

Wednesday, July 11, 2007


From the Wall Street Journal article:
With a steady decline in the number of doctors trained to perform such skills-intensive medical procedures in recent years, Cedars and other large academic medical centers are looking for ways to fill the gap. They are creating special procedure services and new procedure-training programs for medical residents. Teams of doctors known as proceduralists are now available at some centers with special expertise in tunneling a catheter into a vein, slicing an incision in the neck for an airway, or plunging a needle into a patient's back for a spinal tap.

While not a medical specialty in its own right, procedural medicine is emerging as an important new role for physicians with the manual dexterity and steady nerves to perform risky procedures. And hospitals say they see reduced complication rates when services are performed by physicians who are very well-versed in the procedures.
Click here to read the article (subscription required).

Tuesday, July 10, 2007

Thirteen horses and diphtheria

I love medical history; from the New York Times article, "Long Ago Against Diphtheria, the Heroes Were Horses":
The Claremont Riding Academy, on the Upper West Side of Manhattan, shut its doors for good a few months ago. As the oldest continuously operated stable in New York City, it reached back to an era when horses were as common as taxis are today, and it prompted thoughts of some of New York’s most heroic horses: the 13 beasts of burden used in 1894 to produce the miracle drug of their day, diphtheria antitoxin.

The horses and their successors were stabled for nearly two decades at the New York College of Veterinary Surgeons, on East 57th Street and Third Avenue. Initially joined by a few sheep, goats and dogs, the horses prevailed because they were larger and better antitoxin factories: when systematically injected with diphtheria toxin, their immune systems were prompted to develop neutralizing antibodies against the germ’s poison. (Most survived the injections with nothing more than a fever and loss of appetite, but over the years quite a few horses succumbed to even tiny doses of toxin.)
Click here to read the entire article.

Thursday, July 05, 2007

University of Pittsburgh Medical Center and gifts from indusry

From the article:
The University of Pittsburgh Medical Center has drafted a get-tough policy that would prohibit its physicians and other employees from accepting almost all freebies -- from sample medications to pens and notepads -- from drug and medical device companies.

Industry influence can result in "unacceptable conflicts of interest," the draft says, adding that financial support or gifts, even in modest amounts, "can exert a subtle but measurable impact on recipients' behavior."
Click here to access the article.

Tuesday, July 03, 2007

Palliative Care

I encourage every CME professional to read the Washington Post article "A New Focus on Easing the Pain"; an excerpt:
A 12-year-old boy, struggling to understand why dialysis could no longer keep his father alive, reflected on how fast he outgrew his sneakers. "I'm the size of a man -- size 11. I don't want my feet to grow any more," he said, unaware, perhaps, of how well his imagery called up his preparation to step into his father's shoes as the man of the family.
Click here to access.

Monday, July 02, 2007

Health Data Tools and Statistics

Have you ever wished there was one place on the web where you could access health statistics and public health data? Where there is, you'll find it at Partners in Information Access for the Public Health Workforce which is the result of a collaboration of U.S. government agencies, public health organizations and health sciences libraries. Click here to access; there's even an online tutorial and training manual.

A blow to DTC advertising?

Drug companies cannot escape liability for harmful prescriptions in West Virginia by laying all responsibility on doctors, the West Virginia Supreme Court of Appeals ruled Wednesday.

Three of five Justices denied a writ that would have kept Marshall Circuit Judge Mark Karl from holding trial against Janssen Pharmaceutica.

They upheld Karl's rejection of a doctrine that would define a doctor as a "learned intermediary" between a drug maker and a patient.

Chief Justice Robin Davis treated the doctrine as a useless 82-year-old relic.

"When the learned intermediary doctrine was developed, direct to consumer advertising of prescription drugs was utterly unknown," she wrote. "Pharmaceutical manufacturers never advertised their products to patients, but rather directed all sales efforts at physicians."

She wrote that the law created an exception to the duty of a manufacturer to warn consumers directly of risks.

"For good or ill, that has all changed," Davis wrote. "... we now hold that, under West Virginia products liability law, manufacturers of prescription drugs are subject to the same duty to warn consumers about the risks of their products as other manufacturers."
Click here to read the entire article.