Friday, August 21, 2009

No Dinner 'til You Wash Your Hands

No double dipping for me, please.

The media is certainly hitting the swine flu topic hard and from many angles.
Here is a new one for all to wring their hands over.

The Australasian Society for Infectious Diseases has seen fit to warn the Australian Commonwealth Chief Medical Officer that they are worried about the flu vax being in multi-dose vials.
Multi-dose vials means multiple needles piercing the little grey diaphragm on the bottles top.
The concern is that syringes or needles will be reused leading to you sharing fluids with that guy in front of you in the jab line.

Seems pretty ridiculous, doesn't it?

But then, two years ago the UKs Chief Medical Officer advised hospital patients to bring hand sanitizer and keep it by their bed.
They were to demand that every doctor or nurse that entered the room use the sanitizer.
Less than 60 per cent of doctors wash their hands between patients, according to the CMO, so it's up to patients to scold them into better hygeine, and have that sanitizer ready so they can't weasel out of it. Daily Telegraph, July 19, 2007

Infection rates in hospitals are tracked, but "because of the sensitive nature of the data, the NNIS system has been granted a guarantee of confidentiality for the identities of both the patients and the reporting hospitals under Section 308(d) of the Public Health Service Act."

Can't let the people see the real dirt, apparently. Why, hospitals may no longer cooperate with data gathering, and patients may lose confidence in the hospitals!
However, in California last year there was a proposal to make such information transparent.

Lest you think the simple task of handwashing is to be laughed off, it is such a serious issue that hospitals have hand-washing surveillance monitors. (Search on: hospital hand washing)
Sounds pretty grade-school, pretty junior-won't-take-his-Sunday-bath.

There is even a Journal of Hospital Infection, printed by The Hospital Infection Society.
You laughing or crying yet?

I will now make the point.

So, if a group of caregivers in a contained setting (hospital), with staff dedicated to monitor and encourage the simple, basic, universally recognized and proven task of handwashing to prevent the spread of disease-- which these very caregivers are ethically bound to prevent-- can't be bothered to behave as responsible adults by washing their hands, then I'm perfectly willing to believe there is some doctor or nurse (the talk is of pharmacists and dentists providing jabs as well) out there who will double dip.

Lastly, what is the simplest, most basic, least expensive and dangerous recommendation for flu prevention?
Handwashing, correct?
If you go for the jab don't forget to bring your own hand sanitizer. And hypo. And demand the first dose from the bottle.

Bonus round:
Brilliant one pager on hospital acquired infection that mentions the above and the 50% reduction in nosocomial infection in one hospital that instituted this "don't touch me with those filthy hands" policy and also touches on reused hypos as sources of infection.

Friday, June 26, 2009

Of Bugs (or Arachnids), Cats, Dogs

Worst Summer Job EVER

Guy I knew in udergrad school was doing research in the ag college.
He signed up for a summer research project. Paid him minimum wage and all the glory of furthering important research.
Be a part of something bigger than yourself.
Do your little bit to make the world a better place.

The research was on corn. (Taxonomy for the geeks:
His job was to catalog and count spiders living on the underside of the leaves of the stalks of corn.
This necessitated lying on his back in a corn field with a big magnifying glass in hand and scouring each leaf.
All day.
Mid-July to harvest.
The hottest time of year.
In Nebraska.

Do you know how hot it gets at ground level in the middle of a corn field, under a summer sun, with no wind, and all that moisture from plants and the mud you are lying in, while counting spiders on the underside of leaves of corn stalks, in Nebraska?
Neither do I.
But I bet it gets plenty hot.
Like a sauna only smellier.
And buggier.

But this isn't about those lazy days of youth.

This is all about what happens late at night.
When the lights are off.
And nature calls.

Falls from tripping over the family pet are responsible for around 90,000 injuries each year treated in ERs.

At night, with the lights off and my chocalte-coated pointer lying in my path like some 65 pound viet cong tripwire is how I picture my neck-breaking fall.
But walking the dog is apparently a real hazard as well.

From Morbidity & Mortality Weekly Report, which is an awesome journal for the name alone, comes:
Nonfatal Fall-Related Injuries Associated With Dogs and Cats -- United States, 2001-2006.

Falls are the leading cause of non-fatal injuries in this country, they say.
Highlights: dogs 7.5x more likely to trip you up than cats.
Women 2.1 times more likely to be injured than men.
Years 0-14 and 35-54 are the most dangerous.

So now you know.
A 37 year old women with a boxer doesn't stand a chance.

Just doing my lttle bit to make the world a better place.

Beyond Healthy Comments

You Tube has a vid posting under "Corn Spider".
I strongly recommend you DO NOT WATCH IT.
On the other hand, it may be instructive as to the value of youtube, and/or affirm your belief in the emminent collapse of the republic.
There is profanity.

This corn biz is serious.

How to walk the dog. YouTube again.

Lightning strikes twice

I've noticed a pervasive cynical attitude when it comes to the subject of research+pharma funding.
A wheezing out of "follow the money" like Redford/Woodward's source in All the President's Men plays background.

Can't we all just show a little trust of these many committed academics and researchers?
These selfless individuals are dedicating their lives to making yours better/longer.

Well, apparently not.

In April the Institute of Medicine called on doctors to disclose funding sources in order to protect against conflict of interest.NEJM 360:2160-2163 May 21, 2009 # 21

And then there are those pesky Harvard med students protesting big pharma money influence on their education:
(Whoop, whoop. A protest I can get behind.) CONTAINS NO GOOD PICTURE CONTAINS ONE GOOD PICTURE

Now we have Senator Charles Grassely co-sponsoring a bill, the "Physician Payments Sunshine Act".
"According to Grassley, the American Medical Student Association had surveyed 149 medical schools, requesting their financial disclosure policies. Only 126 complied."
The senator wants to know why.
'"There's a lot of skepticism about financial relationships between doctors and drug companies," Grassley said in a statement. "Disclosure of those ties would help to build confidence that there's nothing to hide."'
From: Reuters Health Information US Senator Seeks Med Schools' Disclosure Policies

Good on you Mr. Grassely.

Sadly, the same Medscape page on which I found the senator's quotes had the link waaay down page.
While at the top under "Top Stories", Michael Jackson's death was link four.

Get it?
Michael Jackson is more important than research integrity.

Sure how it looks anyway.

To avoid any confusion, this is the now deceased Michael Joseph Jackson (August 29, 1958 – June 25, 2009) mentioned above:

And this is a picture of that other Michael Jackson:

Which brought more joy to the world?
You decide.

What? Me worry?

No need to worry.
Over 5,000 patient records were scrutinized, and the discovery?
An average of seven percent of abnormal findings were ignored.
Doesn't sound too bad, right?
Only 0.07 ignored. Only one of every fourteen.
Just an abnormal finding. Don't get all excited. Move along.

So, why did I have that test performed if you weren't going to act on the result anyway?
Arch. of Int. Med., 2009. 169: 1123-9.

Conversely, 93% were acted upon. So perhaps this is actually pretty good news.
What it really gets me thinking is a trusted second opinion is golden.
And as always, don't leave any questions you have concerning your health go unanswered.
Insist upon a full explanation of test results.

More to worry about. Or not.
Discussion on dangers of dose from radiography seem to me to have been building over the past few years.
Could just be I'm paying more attention, of course...

Lovely quote:
'Joseph M. Price, M.D., of Carsonville, Mich., wrote, "I believe that it is a rare physician ordering standard-type CT scans (such as abdominal studies) who has the slightest idea of the actual level of total radiation to which the patient is being exposed."'

And why be concerned?

Because of his further quote:
'...what particularly caught my attention was that the median dose-length product (DLP) of CCTA examinations was a little greater than the dose of an abdominal CT study, or the equivalent of 600 chest x-rays."
The above printed in JAMA, 2009. 301: 2324

Whether or not your CT is being ordered appropriately, do you really, really, really have to be exposed to the median level of radiation discussed above?

And the study says:
"As a result of the dose reduction program, patients' estimated median radiation dose decreased by 53.3% (P<0.001), href="">

Sourced from: Raff G, et al "Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques" JAMA 2009; 301: 2340-48.
Price J "Radiation doses associated with cardiac computed tomography angiography" JAMA 2009; 301: 2324.

Did that just say dose went down by half?
Yes. Yes it did.

Sure hope my radiologist follows these discussions.
And acts on them.

Why get a lame Joke of the Day, or LOL Cat of the Day, or Some-other-crappy-thing-of-the-day, when you could be enjoying
-the exciting-
Radiology Picture of the Day

Diagnostic radiation fears driving you to drink?:

Masochistic teetotaller and need more to worry about but won't drink?:

Thursday, April 16, 2009

Aspirin On The Brain

When did an aspirin-a-day replace the apple for keeping the doctor away?

Millions of Americans are on a daily aspirin regime in the hopes of preventing a cardiovascular event.
The ones I see tell me, "It's just a little baby aspirin".
Kudos to the marketers for that. Turning a drug responsible for significant morbidity and mortality into harmless just a little baby aspirin was genius.

2003: The FDA Cardiovascular Advisory Committee rejects approval of aspirin for use to reduce the risk of a first heart attack.
Apparently, the risk of haemorrhagic stroke and gastrointestinal bleeding were trade-offs the committee found weighing heavily against an approval.

Bloody Brains

That haemorrhagic stroke bit comes to mind today as I read findings published in an online report of the Archives of Neurology on April 13th.
seen here:

Finding: Aspirin increases risk of bleeding in the brain 70%. Low doses (BABY ASPIRIN) taken daily were more likely than larger doses taken infrequently to cause bleeds.

good review of the research on a simplistic level:

I fear the steam behind the aspirin-a-day train will lead to this research being run over flat.
Already I see the seemingly dispassionate and reasoned swipes at the findings.
If you read enough commentary on the topic, you too will begin to see a pattern of down-playing the study. And all quite reasonable.

My concern is this, from the nhs link above: "Anti-clotting drugs are known to increase the risk of bleeding and when prescribing them, clinicians should carefully consider both the risks and benefits of treatment on an individual basis."

Clinicians should carefully consider?
Aspirin is OTC.
People are self-medicating.
They have been sold on aspirin-a-day.
Clinicians have been prescribing the regime for years.
What risk?
It's just a little baby aspirin.

From THE aspirinwonderdrug people, an interesting history of the drug
An aspirin alternative page from 1970, only really interesting for the Q and A on priapism

Friday, February 27, 2009

Meeting Expectations

Ran across this from the OGL yesterday.

Yes. It says "behavior-incompetents" there on the end.

Makes the Cornell scientists clueless-researchers.

Do read the article.
It may explain much.
If it doesn't...that might explain much.

Thursday, January 29, 2009

Sweet, Sweet, Hg

Hg is, of course, the shorthand alphabetical representation of mercury, element number 80.
Why "Hg"? Latin hydrargyrum.
Don't really get that. The hydr- part, sure. But -gyrum?
Haven't studied enough Greek and Latin.

But all that is neither here nor there.
The headlines read

Mercury in High-Fructose Corn Syrup

"The Minneapolis-based nonprofit Institute for Agriculture and Trade Policy (IATP), shows detectable levels of mercury in 17 out of 55 tested products rich in high-fructose corn syrup."

Here is the list provided (with the above quotation) at
Check the url. /food-recipes?
Ummm. A little mercury. Some arsenic. Voila.
Haute chem cuisine.

Quaker Oatmeal to Go bars
Jack Daniel's Barbecue Sauce
Hershey's Chocolate Syrup
Kraft Original Barbecue Sauce
Nutri-Grain Strawberry Cereal Bars
Manwich Gold Sloppy Joe
Market Pantry Grape Jelly
Smucker's Strawberry Jelly
Pop-Tarts Frosted Blueberry
Hunt's Tomato Ketchup
Wish-Bone Western Sweet & Smooth Dressing
Coca-Cola Classic: no mercury found on a second test
Yoplait Strawberry Yogurt
Minute Maid Berry Punch
Yoo-hoo Chocolate Drink
Nesquik Chocolate Milk
Kemps Fat Free Chocolate Milk

Notice any commonality in the foods listed?

"“Mercury is toxic in all its forms,” said IATP’s David Wallinga, M.D., and a co-author of both studies. “Given how much high fructose corn syrup is consumed by children, it could be a significant additional source of mercury never before considered. We are calling for immediate changes by industry and the FDA to help stop this avoidable mercury contamination of the food supply.”"

Love that quote.
Mercury is toxic. Poison.
What is a safe level of mercury in your body?

Mercury has a very, very long history of use in medicine.
My favorite is its use as an anti-syphilitic. It was replaced by salvarsan (the original medicinal "magic bullet"?) because of its toxicity.
Of course, salvarsan/arsenic wasn't all that kind on a body either.
But hey, when the spirochetes come a knockin' 'cause the house was a rockin'....
[Addition 3/13/09:]

Mercury is still in use in medicinals.
I particularly enjoyed the hubbub several years ago over mercury in childhood vaccines.
Wasn't supposed to be a problem, right? All the experts said so, right?
But away it went, kinda, to placate parents.

Still in flu vaccine.

I rather expected this report to get more press and create general upset.
Doesn't look like that will happen.

And so, mad milliners, on we go with institutionalized poisoning.

Why is a raven like a writing desk?
Mr. Dodgson's answer:
Other notable answers:
Uncle Cecil's take on the riddle:

Monday, January 19, 2009

Change Alright

This new CIC certainly is sweeping in change.
There has been an upsurge in plastic surgery procedures ahead of the inauguration.

"My normal load for cosmetic procedures has doubled, except for hyaluronic acid fillers — Perlane and Restylane — which have almost tripled," reports cosmetic and laser surgeon Hema Sundaram, who runs two offices in the Washington, D.C., area.
Cosmetic procedures pick up prior to Obama inauguration MB Marcus, USA TODAY

Reconstructive surgery, the idea of it anyway, delights.
Rebuild ears, noses, breasts post mastectomy, correct cleft palates. Brilliant.

Jabs of botulinim toxin, dermabrasion, collagen injection, sacks 'o saline under the breast? Depressing.

For an interesting brief history of breast augmentation:

Is there a difference between having your nose rebuilt after it was bitten off in a bar room brawl and Jaggerizing your lips to look younger than you are?

I think so.
And I wonder what it means that so many are turning to this change in their outward appearance ahead of (and due to) the change of administration.

side note: botox is also used with anal fissures to relax the sphincter