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PrairiEDocs e-newsletter #4
Other archived PrairiEDocs e-newsletters
Surveying the
land (and web) for news (and more)
for the emergency medicine practitioner…
Issue #4 "fasten your
seat belt and adjust your headrest as this
electronic ed-venture gets underway" July 9, 2000
In this
issue:
An Update
Online Helpful Sites----Free CME Programs Online
Prepared for Biological Terrorism?
Financial
sponsorship statement & How to contact us
We are pleased to announce that back issues
of this e-newsletter are now available By going to:
http://www.acutecare.com/narchive.htm There is also an Emergency Care
Discussion Forum now available at http://www.acutecare.com
that you can post questions, offer comments, or seek/offer informal advice.
If you know of others that may be interested in receiving this e-newsletter,
have them contact us at prairiedocs@aol.com
At a press conference in Washington D.C. on June 26, 2000, Dr. Francis Collins, the Director of the International Human Genome Project; and Craig Venter, president of Celera, a private biotech company, announced their completion of the "working draft" of the human genome. It immediately began to raise a host of scientific, medical and ethical questions.
The announcement also was deemed somewhat unusual in some scientific circles in that it precedes anything published in peer-reviewed journals (simultaneous announcement and publication are the norm). For several years the two separate research entities have been racing to complete a sequence of the human genome. The race dissipated when both groups joined together to announce that 85-90% of the human genome has now been mapped.
The public group took credit for creating a 'working draft' of the genome, while Celera took credit for the first complete assembly of the genome. The assembly process identified 3.12 billion base pairs to the human chromosomes. It has been compared to having a map of the United States where only the major freeways and a couple of major landmarks are identified. Having roughly mapped the location of the genes, researchers now face the daunting task of identifying the protein produced by each gene and what the gene does alone and in concert with other genes.
The public Human Genome Project is an ongoing international collaborative project that includes input from the US National Institutes of Health, the Department of Energy, universities around the world and the Wellcome Trust in England. During the past year, this consortium has been producing 1000 bases per second of raw sequence - 7 days a week, 24 hours a day, surprising everyone by bringing in the project ahead of schedule and under budget.
Much of the success of the project has been attributed to the policy of free access to the sequence information to researchers around the world as soon as it becomes available. The "working draft" is well on the way to the "finished" form that will eventually result. About half of the genome sequence is in "near-finished" form or better, and another 24 percent of it is in completely "finished" form. It all seems likely to be completed ahead of the self-imposed previous deadline of 2003.
The working draft of the human genome will help in finding clues in identifying the genes associated with major human diseases including cancer, heart disease as well as genetic disorders. Once genetic proteins are decoded, it may be possible to devise new diagnostic and therapeutic approaches.
Human genetic variations - called single
nucleotide polymorphisms or SNPs are a major area of research. SNPs provide
a tool for studies of human disease and human history The Human Genome
Project had set a goal of discovering 100,000 SNPs by 2003. Already, with
today's assembled sequences and other data accumulated by The SNP Consortium,
scientists have now found more than 300,000 SNPs and will likely have
discovered some one-million SNPs by the end of the year 2000.
In a study recently completed by an Israeli hospital pediatric department, it appears that intranasal midazolam is a safe and effective treatment for febrile seizures in children. The year-long study looked at 47 children (ages six months to five years) who had febrile seizures lasting at least 10 minutes. Intranasal midazolam (0.2 mg/kg) was compared with intravenous diazepam (0.3 mg/kg).
Overall, midazolam controlled 23 of 26 seizures, and diazepam controlled 24 out of 26 seizures. Seizures were controlled more quickly with diazepam but midazolam was as judged safe and effective. Time to cessation of seizure was shorter with intranasal midazolam (it was noted that the mean time from hospital arrival to start of treatment was significantly shorter with the patients who received intranasal midazolam).
Because seizures could stop spontaneously, clinicians decided to choose ongoing seizures of at least 10 minutes as the entry point for the study. Most of the children had upper respiratory tract infections, and follow-up speculation centers around the role excessive nasal secretions may play in delaying and the absorption of the midazolam.
This study also points out that acute seizures are treated with oral diazepam and lorazepam, sublingual lorazepam, rectal solutions of lorazepam and diazepam and diazepam suppositories. However, oral or sublingual techniques can be a problem if a child is convulsing, and absorption of rectal solutions can be slow. A gel form of rectal diazepam was recently introduced and can be administered at home.
The authors concluded that intranasal midazolam appears to be a safe and useful adjunct in medical centers and (if given proper instruction) may be another useful means for parents treating febrile seizures at home. Larger scale studies were recommended, expanding to other types of seizures. BMJ 2000;321:83-86 ( 8 July )
In a Letter to the Editors of the BMJ, it
was also pointed out that in addition to the medications and routes described
historically in this study, midazolam has also been effectively administered
buccally (back lower gumline and tonsilar area) to unconscious children
(but not to conscious children due to the bitterness of the medication.
For the past 20 years, injuries have continuously claimed more lives of children in the United States than all diseases combined. When compared to other western countries, children in the US have the highest mortality rate of all, especially in numbers of children claimed by suicide.
Each year one in every five children require medical attention for injuries which translates into 16 million ER visits by those aged 1-19. Of these--- 600,000 require hospitalization; 30,000 have permanent disabilities and 22,000 die.
The top ten injuries among children which are the most severe/most frequent: 1.Motor vehicle vs.pedestrian collisions
2. Drowning
3. Bike accidents
4. Falls from heights
5. Scald burns
6. Flame burns
7. Suicides
8. Assaults
9. Choking
10. Smoke inhalation
Bike helmets alone, can reduce the risk of
injury by 85%, and brain injury by 88%. Yet only an estimated 8% of bicyclists
use them.
Online Helpful Sites----Free CME Programs Online
http://cmecenter.medscape.com/Home/CMEcenter/CMECenter.html
Medscape offers both free and fee-based continuing education activities. The free programs are learning modules developed by Medscape under unrestricted educational grants and accredited by an approved sponsor.
The fee-based program
is available on select medical journal articles developed by Medscape
and other publishers and accredited by an ACCME approved sponsor.
CME Tests: multiple choice, submitted online, or by mail or fax.
CME Certificate: via mail, within 4 to 6 weeks. Certificate is defined
as a record of participation.
How to do it:
1. Find the modules available for CME credit.
2. Read the Learning Objectives.
3. Read the Program.
4. Click the "Take the Test" hyperlink.
5. Answer the questions on the test and click "Submit".
6. After passing the test you must complete the course evaluation.
7. When finished, click "Submit."
8. If an instant certificate is available for the Program, you'll be presented with your certificate. Print the certificate.
9. If an instant certificate is not available for the Program, upon request, the certificate will be mailed to you within 4-6 weeks.
Don't want to take the CME course online? If you do not have time to take the course online, you may go to the bottom of the Table of Contents page and click on the "Click here to get a printable version of the module and then click print on your browser." You may complete the test and evaluation form and either mail or fax the answers and evaluation form to the address given.
(Note: NPs and PAs can also obtain credit by taking the course and requesting a letter of completion of having taken and passed the course and submitting the letter directly to their licensing body.)
Find Free CME Programs by Specialty: They include--Cardiology, Critical Care, Diabetes & Endocrinology, Gastroenterology, Hematology-Oncology, HIV/AIDS, Infectious Diseases, Molecular Medicine, Neurology, Orthopedics, Pediatrics, Psychiatry and Mental Health, Respiratory Care, Rheumatology, Surgery, Transplantation, Urology, and Women's Health.
Prepared for Biological Terrorism?
In a Cyberounds program entitled, "Bioterrorism and the Emergency Department" by Martin Carey, M.D., the ability of a physician to suspect, identify and appropriately respond to a biological agent exposure is explored.
In narrowing possible agents, Carey quotes Col. Gerald Parker, commander of the US Army Medical Research Institute of Infectious Diseases, as having stated "An effective biological weapon has to be able to be produced in large enough quantities; it has to have the ability to infect large numbers of individuals; it has to remain stable when stored; and it has to retain virulence after aerosol dissemination." (made at a bioterrorism symposium in Arlington VA, February 1999).
While NATO has identified some 31 biological agents that could have the potential for use as biological weapons, Dr. Carey lists the top four (based on the likely ease of production and distribution): smallpox, plague, anthrax and botulism. Carey further narrows possible candidates to anthrax and smallpox, which can be produced reliably, are reasonably easy to aerosolize and are relatively resistant to destruction. This makes them ideal candidates to be used as biological weapons (other agents high on the list of possibilities include tularemia, glanders, typhus, Q fever, Venezuelan equine encephalitis, Marburg and influenza viruses).
How much do you know
about these? In future of editions of this e-newsletter we'll explore
recognition, treatment and precautions in dealing with some of these entities
as potential biological terrorism agents.
Pinworms afflict up
to 42 million Americans, mostly children.
Centers for Disease Control
A law still on the
books in Waynesboro, Virginia prohibits women from driving a car unless
the husband walks in front waving a flag.
www.dumblaws.com
More babies are born
in July in the US than any other month.
National Center for Health Statistics
The Internet began
on October 1, 1969 with two computers. One sent the first email message
containing the word 'log' to the other, which promptly crashed.
ARPA
Major league baseball
teams buy 182 pounds of special baseball rubbing mud each year from a
farmer in Millsboro, Delaware.
MLB
From Ben Jonson (1572-1637) English poet
and dramatist:
"Weigh the meaning and look not at the words."
"Hope is such a bait, it covers any hook."
"Talking and eloquence are not the same: to speak and to speak well are
two things. A fool may talk, but a wise man speaks."
"Success produces confidence; confidence relaxes industry, and negligence
ruins the reputation which accuracy had raised."
This
e-newsletter is available through the generous unrestricted support of
ACUTE CARE, INC.
You can find out more about ACUTE
CARE, INC.
by going online to http://www.acutecare.com
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at that site.
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