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PrairiEDocs e-newsletter #20 Other archived PrairiEDocs e-newsletters Surveying
the land (and web) for news (and more)
Drug May Stop Progression of Parkinson's Disease Popular Prescription Allergy Meds Recommended for Over-the Counter Status Medical Residents Seek OSHA Intervention to Limit Hours per Week Hip Fracture Intervention Initiative Pediatric Automatic External Defibrillator Antidepressant Use in Children Dramatically Increases Quotable
Quotes A free online CME course on EMTALA basics for physicians is now available on the ACUTE CARE, INC. web site. With options for text-based or streaming audio narration, you can log on to the internet site, take a pretest, complete the program, and forward your posttest and evaluation-- receiving up to one category 1 CME---all online and in a paperless fashion. Your CME certificate is sent via e-mail; you can print this out if you wish, for your records. The program is the first in a series of EMTALA-related topics and is jointly sponsored by ACUTE CARE, INC. and Steven Frew, JD, a nationally-known EMTALA consultant and expert. Other topics of interest for emergency care providers are planned, as well. One CEH for prehospital emergency care providers successfully completing the program, was recently approved by Mobile Intensive Care Services, Mary Greeley Medical Center, located in Ames, Iowa. Please plan to attend the Symposium on Domestic Abuse on Friday, May 18. New CNN Headline News anchor, Andrea Thompson, is going to speak at 8:15 am about "four generations of domestic abuse" that occurred in her family. Over 1,000 people have already registered. This is free to the public with continuing education credits approved for physicians, nurses, clergy, law enforcement, lawyers, and judges. Go to http://www.iowamedicalsociety.org for further information (you can register online). Drug May Stop Progression of Parkinson's Disease Currently available medications and treatments are used to treat the symptoms of Parkinson's disease; there is no known cure. One, it seems, may do much more---actually slowing the ailment's progression. In preliminary laboratory tests, researchers found that the drug pramipexole trade name Myrapex) may protect brain cells from dying. Until now, it has been primarily used to manage symptoms such as tremors. The neuroprotective qualities may reperesent a significant breakthrough in a disease that is destined to strike one out of every 500 people. The evidence was presented at a meeting of the American Academy of Neurology in Philadelphia. The study was funded by Pharmacia, maker of pramipexole. Popular Prescription Allergy Meds Recommended for Over-the Counter Status On May 10th, a government advisory panel voted overwhelmingly to advise the Food and Drug Administration that Claritin, Allegra and Zyrtec should be available over-the-counter. The decision will likely pit drug manufacturers (currently taking in some $5billion a year) against health insurers, in determining the final outcome. Legal experts warn that the issue could potentially be tied up in courts for years. Officials from Aventis S.A. (Allegra), Schering-Plough (Claritin), Pfizer Inc. (Zyrtec) expressed concerns over the proposal, while Dr. Robert Seidman, chief pharmacy officer of Wellpoint Health Networks, which brought the issue to the FDA, said the recommendations were history making. Advocates of the move point to Canada, Germany, Britain and other countries where Claritin has been sold without prescriptions for more than a decade at much lower prices. An example - the current price of Claritin is about $2.13 a pill ($192 for 90 pills), in the United States. In Canada, where it is available over-the-counter, it costs about 70 cents per pill before taxes. Medical Residents Seek OSHA Intervention to Limit Hours per Week Medical residents are pressing the Occupational Safety and Health Administration to set limits on the hours they may have to work each week. They regularly clock 95 hours a week and sometimes as many as 136 hours. The petition asks OSHA to:
The petition was filed by the consumer and health advocacy group Public Citizen; the Committee of Interns and Residents; the American Medical Student Association; Dr. Bertrand Bell, author of a New York state health code restricting resident work hours; and Dr. Kingman P. Strohl, director of the Center for Sleep Disorders Research at Case Western Reserve University. The medical residents' petition cited various surveys and studies, finding: The average resident reported going as long as 37.6 hours without sleep. A fourth of respondents reported being on call in the hospital more than 80 hours a week. Six out of seven surgical residents reported falling asleep while driving. Nearly a third of residents experienced depression. A potential problem for the petitioners lies ahead-the law by which OSHA regulates (the Occupational Safety and Health Act) does not address the issue of work hours. New York is the only state to legislatively limit resident work hours, and has appropriated $168 million for enforcement. Similar attempts in California and Massachusetts have failed. The American Medical Students Association has been working with Representative John Conyers, D-Mich., to introduce federal legislation in coming months. In the past 15 years, six countries and jurisdictions have limited work hours for medical residents: Australia, to 70 hours; Denmark, fewer than 45 hours; United Kingdom, 56 hours; the European Union, 48 hours by 2003; Germany, 56 hours; and the Netherlands, 48 hours. The Accreditation Council for Graduate Medical Education has created voluntary guidelines to help restrict work hours in the United States, but most hospitals have not implemented them. Hip Fracture Intervention Initiative More than 340,000 times a year an elderly person falls, breaking a hip. One in four such patients die within a year. About 4 percent don't survive the first hospital treatment, usually dying of pneumonia. For those who make it to rehabilitation, almost half will be unable to ever walk alone without assistance and about 40 percent must move into long-term care facilities. The American Academy of Orthopedic Surgeons is spearheading an effort involving some 40 national health organizations in putting together a multidisciplinary action plan to improve prevention, recognition and treatment of hip fractures. The direct and indirect costs of hip fractures in the United States are about $12.6 billion a year, today. By the year 2050, the number of fractures is expected to reach more than 650,000 and the cost will more than double. Major points to be covered in the consensus recommendations: 1. Establish a national campaign to treat and control osteoporosis. 2. Establish routine screening tests for the elderly to identify those at riskof falling. Assistance devices (canes, walkers, etc.) should be implemented earlier to lower their risk. 3. Determine the appropriate length of hospital stays for these patients. Federal Medicare funding now severely limits the stay a hip fracture patient; they often are discharged with no continuing care plan. 4. Establish a critical care pathway that would encompass a coordinated program of treatment, from the initial hospital stay to rehabilitation. 5. Address the psychological changes that may result from the hip fracture trauma. Pediatric Automatic External Defibrillator The first children's automatic external defibrillator, has been cleared for marketing by the Food and Drug Administration. It was announced recently that it was approving the device made by Agilent Technologies Inc. of Palo Alto, Calif. The device is for use on infants and children up to the age of eight, or up to 55 pounds. Before Friday's clearance, automatic external defibrillators were approved for use only on adults and on children over the age of eight, and over 55 pounds. The new children's device, using pediatric pads (instead of paddles), will deliver about 50 joules of energy. The FDA statement on the device said it was cleared for use on young children after the company performed laboratory and animal tests and after successful tests on children and adults. The FDA said Agilent will conduct additional studies on 50 children worldwide to evaluate how the device performs in actual use. Antidepressant Use in Children Dramatically Increases The use of antidepressants soared among children and teen-agers between 1988 and 1994, a study says.A study presented at a meeting in New Orleans of the American Psychiatric Association, looked at 900,000 youths ages 2 to 19 and found three- to fivefold increases over the seven-year span the study looked at, based on data from two state Medicaid systems and a health maintenance organization (one state was Midwestern, the other mid-Atlantic). In 1994, about 1.8 percent of children in the Medicaid programs and about 1.3 percent in the HMO were taking antidepressants (some of the prescriptions were for depression, others for attention-deficit/ hyperactivity disorder). The rates increased with age, ranging from about 0.2 percent in children ages 2 to 4, to 3 percent or 4 percent for youth ages 15 to 19. Looking at the results has caused some to speculate on overuse and overprescribing, while others believe the increase reflects better recognition of depression and ADHD in young people. Depression is the most common serious psychiatric disorder in youth and adolescents, Dr. Joseph Coyle, chairman of psychiatry at Harvard Medical School stated. In children ages 7 to 13, some 2 percent to 3 percent have severe depression at any one time, he said, and the rate rises in adolescence. A high tech version of the age-old condition known as hypochondria is emerging. Dubbed "cyberchondria" ---people are logging on to learn more about symptoms, then turning to their physicians for attention to their imagined medical conditions. Others air their problems on the internet itself, getting attention and empathy online. Developers say Indianapolis is the perfect location for the hub of the high-speed research network Internet2, because it is at the center of many nationwide fiber-optic networks. Internet2 allows researchers to transfer data across the Abilene network at speeds of 9.6 Gbps, 45,000 times faster than a standard 56K connection and fast enough to transfer the entire contents of the Library of Congress in seven seconds. Because many of the projects currently being hosted on Internet2, such as the human genome project, will eventually have commercial uses, the administrators of Internet2 have sought to develop corporate partnerships to support the network. Although this has resulted in high-profile sponsors such as Cisco Systems, Bill Stephan, assistant vice president of IT at Indiana University, said he must constantly convince potential partners to consider long-term benefits, not short-term profits. He explained, "One of the most important lessons learned from the Internet is to make sure there's a clear understanding of who owns what. I run into, 'When do we get our money back?'" (Net Economy, 16 April 2001) Adolf Hitler (1889-1945): "The broad masses of a population are more amenable to the appeal of rhetoric than to any other force." "What luck for rulers that men do not think." "The broad mass of a nation . . . will more easily fall victim to a big lie than to a small one." "The art of leadership. . . consists in consolidating the attention of the people against a single adversary and taking care that nothing will split up that attention. . . ." "All propaganda has to be popular and has to accommodate itself to the comprehension of the least intelligent of those whom it seeks to reach." Anatole France (1844-1924) French author, Nobel Prize, Literature, 1921: "An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." ERDOCS e-mail group (listserv) As a Clinician
providing acute and emergency medical care, you are invited to
visit and participate in our new ERDOCS group at eGroups, a free,
easy-to-use email group service! You have plenty of experiences
to share, questions to ask, concerns and opinions to voice, suggestions,
news to post, tips to offer, etc. and can do so within this framework.
this is a versatile system for posting things to be sent to a
group to peruse, respond to, or simply be aware of. It eliminates
conventional mail delays and allows you to review and post at
your leisure. (We still have the more open-ended [any visitor
can observe/post] discussion group at the
ACUTE CARE, INC. web
site). Our goal is to give you a variety of feedback and communication
tools. This
e-newsletter is available through the generous unrestricted
support of
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| P.O. Box 4130, Des Moines, IA 50333 | 800.729.7813 | e-mail: staff@acutecare.com |