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PrairiEDocs e-newsletter #29 Other archived PrairiEDocs e-newsletters Surveying the
land (and web) for news (and more)
Motorcycle Fatalities Increase 17% from 1997 to 1999 Defibrillator Debate--Sell Without Prescription? Broselow Tape Accuracy Reviewed Are Infections Risk Factors for Strokes? How Prudent is a Prudent Layperson? Possible Cure for Diabetes Begins Safety Trials Audio Cassette Tape on Bioterrorism Quotable Quotes Adding B-12 to Heart Disease Prevention Strategies? While research continues to implicate folic acid in the prevention of heart disease, a new study suggests that adding B-12 may strengthen the protection even further.
Motorcycle Fatalities Increase 17% from 1997 to 1999 Two National Highway Traffic Safety Administration (NHTSA) studies cite dramatic increases in motorcycle-related fatalities, with the single biggest increase found in the over 40 age group and with motorcycles with bigger than 1,000 cc engines. Additionally, the report in the February issue of Annals of Emergency Medicine noted that while these riders were less likely to speed and more likely to wear a helmet, they also consumed more alcohol than any other age group except the 30-39 year-old group. Further investigation is called for in identifying effective strategies in reducing this trend. Defibrillator Debate--Sell Without Prescription? The National Press Club sponsored debate at the end of January, focusing on whether a prescription should remain necessary for the members of the public interested in acquiring an AED.With planners hoping that defibrillators someday be as common as fire extinguishers, and others predicting they could save 75 percent of all sudden cardiac arrest victims, debate proved lively as to whether the federal law requiring a prescription be overturned. Lance Becker, the director of the Emergency Resuscitation Research Center at the University of Chicago, stated the survival rate for sudden cardiac arrest is 2 percent, and it jumps to 50 percent when a defibrillator is available in a public area, and it may jump to 75 percent if AEDs are in homes.'' One of the panelists, Gust Bardy, a cardiologist at the University of Washington Medical Center, discussed a project he recently conducted with a group of sixth graders. Bardy gave the children brief instructions on how to use a defibrillator on a mannequin. ``They performed it correctly,'' he said. ``It took them 90 seconds and it takes paramedics an average of 60 seconds.'' Broselow Tape Accuracy Reviewed A recent study in the British Journal of Anesthesia looked at the Broselow tape that has become a standard in pediatric resuscitation in the U.S. The tape uses body length to help estimate body weight and endotracheal tube size. Researchers used pediatric anesthesia records at a city hospital in 1999 as a basis for their review. Researchers found a good correlation was found between the Broselow estimated weight and the actual measured weight. The Broselow weight was within 10% error of the measured weight in 65% of children. Researchers concluded that it was more accurate with younger children. Tracheal tube selection by the Broselow tape method was adequate in 55% but underestimated the actual tube size in 39%. An alternate technique, using an age-based formula, matched the actual tracheal tube size in 41% of children but overestimated it in 57%. http://bja.oupjournals.org/cgi/content/abstract/88/2/283 Melanoma is expected to strike 51,400 Americans this year and kill 7,800. While melanoma accounts for only about 4 percent of all skin cancer cases, it causes almost 80 percent of skin cancer deaths. So it is with great anticipation that scientists are looking at a possible breakthrough cancer vaccine, courtesy the results from Dr. Donald Morton at the John Wayne Cancer Institute in Santa Monica, Calif., reports that preliminary results from tissue samples and records of 30,000 patients prove that there is a doubling of survival when using the latest of his four attempts at a vaccine. The American Cancer Society reminds us all that the following are the ABCD warning signs in evaluating moles or other spots on the skin that are changing in size, shape, or color. The warning signs of melanoma are often called the ABCD's: A - asymmetry.
One half of a mole or pigmented spot doesn't match the other half; The main preventable cause of melanoma is excessive sun exposure. So doctors advise avoiding or limiting sun exposure from 10 a.m. to 4 p.m., and using protective clothing and sunscreen with an SPF rating of at least 15. Severe sunburns in childhood may particularly increase the risk of melanoma in later life, so children in particular should be protected, doctors say. Are Infections Risk Factors for Strokes? Influenza vaccination and lowered stroke risk----French researchers speculate on whether it's a case of correlation or causation--in their report in the February's Stroke: Journal of the American Heart Association. They collected data on 90 consecutive patients hospitalized for strokes that were also 60 years of age and older, comparing them with 180 population-based controls. They found there were significantly fewer subjects who had a recent influenza vaccination among those who had a stroke than among controls (46.7% versus 59.4%, p = 0.036. This effect was particularly strong among those under 75 years of age. Adjustments were made for age, other risk factors for stroke and recent antibiotic use, stroke risk was reduced among patients who had been vaccinated in the year of the study (odds ratio0.50, p = 0.033). Risk was also reduced for those vaccinated during the preceding 5 years (odds ratio 0.42, p =0.009) compared with those who had not been vaccinated. The French
researchers are now increasing their study to 1000 patients and
2000 controls and hoping to perform a randomized control trial
to confirm a protective effect of influenza vaccination against
stroke. An interesting new application for jet engine sensor technology is being investigated for use in animals, with human testing slated to begin this spring. The sensors are smaller than a dime, no wires are involved, and powered by a handheld transmitter/receiver. They are called micro-electro mechanical systems (MEMS) and were developed by Mark Allen, PhD, a professor of electrical engineering at the Georgia Institute of Technology. The MEMS sensor is made from a flexible plastic and is paper-thin. It can be attached to a catheter to monitor pressure changes. Projected uses included blood pressure monitoring and pressure fluctuations in the areas of vessel aneurisms. Researchers are investigating yet another weapon to discourage the restenosis in angioplasty patients. A newer variation, called cryoplasty uses pressurized nitrous oxide injected into the balloon catheters. The nitrous oxide expands as it turns into a gas, cooling surrounding tissue dramatically. Researchers claim this procedure is gentler; than conventional balloon angiography. The inventor, James Joye, DO, recently reported on results from 15 patients. Twelve of the fifteen were successfully opened up using only this procedure. None of these 12 have had restenosis. These results exceed expectations with conventional balloon procedures. The other three people in the study required additional treatment initially. The cryoplasty test is scheduled for 70 more patients early this year. How Prudent is a Prudent Layperson? Since state and federal several legislative initiatives in recent years have been predicated on such terminology, a study was conducted to identify what the "prudent layperson" was likely to identify as "emergency medical conditions." After a comprehensive tabulation of symptom classifications from the diagnostic coding manual (the International Classification of Diseases, aka as ICD-9), a survey of non-medical laypersons was then conducted. Researchers reported using analysis that included descriptive statistics, proportional calculations, and 95% confidence intervals. Only 25 out
of 87 signs and symptoms listed as such by the ICD-9 were considered
"emergency medical conditions" by more than half of
those surveyed who were self-defined as prudent laypersons. Most
often listed as emergencies by them were loss of consciousness,
Researchers concluded that "use of the prudent layperson standard for reimbursable emergency health services may not reflect the actual scope of symptoms necessitating emergency care." Possible Cure for Diabetes Begins Safety Trials Having successfully "cured" diabetes in lab animals, human trials have begun with INGAP (neogenesis-associated protein) peptide---a chemical messenger capable of triggering ransformation of pancreatic tissue into islet cells. The discovery
of INGAP began accidentally. Working to develop a laboratory model
of pancreas disease, Rosenberg and Vinik wrapped an animal pancreas
in cellophane. To their surprise, the isolated pancreas began
to grow new islet cells. Further research showed that this happened
because the pancreas was making INGAP. Later studies showed that
only a small portion of INGAP -- INGAP peptide -- was needed to
stimulate growth of new islet cells. Eventually, the researchers
discovered the INGAP gene and learned how to make large quantities
of the INGAP peptide. INGAP peptide was invented by Lawrence Rosenberg, MD, PhD, of Canada's McGill University and Aaron I. Vinik, MD, of East Virginia Medical School, Norfolk, patented by the two universities and licensed to GMP Companies Inc., Ft. Lauderdale, Fla. An earlier licensing agreement with Eli Lilly and Company expired. Islet cell transplantation is another alternative being explored. Tissue rejection does not seem to be a significant problem, but supply of donor tissue may be. There is a major study underway focusing on islet cell transplantation. Currently, it takes two donors to provide enough islet cells for a single transplant. It is estimated that 3,000 donor organs become available each year and there are some 800,000 people with type 1 diabetes. Audio Cassette Tape on Bioterrorism (from the web site for American College of Physicians--American Society of Internal Medicine): The audio recording of the Distinguished Lecture by Richard P. Wenzel, FACP on Bioterrorism is now available. Recorded at the 2000 ACP-ASIM Annual Session, the speaker, Dr. Wenzel, addresses the following three clinical questions: What are the
likely pathogens that bioweaponeers would use? To order, call toll-free 1-800 776-5454 and ask for audiotape #DL 56, Bioterrorism or order online at http://www.cmeunlimited.org/acp/dl56 (associate member $12, member $13, nonmember $14) Eighty-two
percent of California hospital emergency rooms (ERs) lost money
in 2000, says a report recently issued by the California Medical
Association (CMA). CMA calculates that California ERs in National Library of Medicine presents… http://www.sis.nlm.nih.gov/Tox/biologicalwarfare.htm Biological
pathogens released intentionally or accidentally, or naturallyoccurring,
can result in disease or death. Recent terrorist attacks in theUnited
States and elsewhere have prompted widespread and justified societal
concerns about the hostile use of biological agents and their Human exposure to these agents may occur through inhalation, skin (cutaneous) exposure, or ingestion of contaminated food or water. Following exposure, physical symptoms may be delayed and sometimes confused with naturally occurring illnesses. Biological warfare agents may persist in the environment and cause problems some time after their release. The selective list of agents below fall into four major groups, three classes of microorganisms - bacteria, rickettsia, and viruses, plus bacterial toxins, which are poisonous chemicals produced by bacteria. Incubation period, duration of illness, symptoms, means of transmission, treatment, and prognosis include the following: Anthrax, Smallpox, Plague, Brucellosis, Botulism, Tularemia Q Fever, and Viral Hemorrhagic Fevers Malpractice
Reform Lists state
by state legislative efforts at tort reform, as well as Learn the
difference between Hepatitis A, B, C at: You can
see photos of vaccine-preventable diseases at: A fun personality test based on color sequence selection: http://www.colorgenics.com/intro.html
J Norman Mailer (1923-____) US novelist, journalist: When considering regulations, half of what is published is probably 50% incorrect. The rest is 75% wrong. Will Rogers (1879 - 1935) US humorist, author: Even if you're on the right track, you'll get run over if you just sit there. Robert Benchley US author: Drawing on my fine command of the English language, I said nothing. 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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