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May 2013 Archives

Surgery Deaths Higher on Fridays and Weekends

Elective surgery deaths occur at a significantly higher rate when surgery is performed on a Friday, Saturday or Sunday. Worse outcomes for patients admitted on weekends compared with weekdays measured by death and length of stay are explained as the "Weekend Effect". A recent study in the British Medical Journal confirmed the higher risk of death and complications for surgeries done at the end of the week and on weekends. The risk of dying from surgery on Saturday or Sunday was almost double the risk (82% higher) when surgery was performed on Monday. The risk of dying from surgery on a Friday was 44% higher than on a Monday. The elective surgeries that were looked at were colon resection, coronary artery bypass grafting (CABG), repair of abdominal aortic aneurysm, lobectomy or lung resection and a single combined group that included hip replacement, knee replacement, inguinal hernia repair, varicose vein stripping and ligation, tonsillectomy, femoral hernia repair and abdominal wall hernia repair.

Metallosis and Artificial Metal Implants for Hips and Knees

Metallosis occurs when the polyethylene lining that prevents the metal parts of artificial joints from creating friction and rubbing against each other wears out. The metal components come in direct contact and metallic fragments and ions become released into the surrounding tissue and blood stream. The metallic fragments and ions saturate the surrounding bone causing a painful soft tissue reaction and bone loss. Metal ions can also enter the blood and cause elevated levels of chromium and cobalt. Pain is caused by loosening of the prosthesis and the inflammatory reaction. When accompanied by elevated serum levels of chromium or cobalt, a metal hip joint likely has caused not only soft tissue reaction but a soft tissue mass or cyst as well. Artificial joints with have metal on metal components that cause pain or elevated levels of metal in the blood should be removed.

Need for Influenza Vaccine Questioned

Has the need for the influenza vaccine been "overhyped", and does belief in its safety and benefit rest on shaky scientific ground? Yes, says a recent article in the British Medical Journal, which points out that the enormous growth of this market has not been because of patient demand, but rather an intense public health campaign promoting it as a virtually risk free way to save lives and illness from influenza. These assertions may not be true, and yet annual flu vaccine doses  in the United States grew from 32 million in 1990 to over 135 million today. Flu shots are administered in clinics, pharmacies and even drive through centers. But not everyone wants to have one, but the pressure to vaccinate is high and the risks are minimized if acknowledged at all. Serious and life threatening injuries can occur from an flu shot. The risk of Guillian Barre Syndrome after vaccination  is estimated at 1 to 2 cases per million people. Is the market driven by patient benefit or by the benefit to manufacturers with the government support?

Ultrasound Best To Diagnose Ectopic Pregnancy

Ectopic pregnancies can cause catastrophic injuries to women when they go undiagnosed and massive hemorrhage results threatening future fertility and survival. Timely diagnosis in stable patients remains a challenge. Early detection lowers the morbidity and mortality associated with tubal rupture or spontaneous abortion. Unfortunately, approximately 40% of women with ectopic pregnancies are not diagnosed when they first present with symptoms of abdominal pain or vaginal bleeding. A recent study in the Journal of the American Medical Association (JAMA) looked at the clinical tools for assessing women with possible ectopic pregnancy at an early stage before life threatening hemorrhage occurs.

FDA Warns Against Valproate Drugs in Pregnancy

Valproate is not safe to treat pregnant women with migraine headaches, according to a new warning from the Federal Food and Drug Administration (FDA). There is a potential for reduced IQ in the offspring of women who take the drug while pregnant. Valproate is found in various anti-migraine medications such as Depacon, Depakote, Depakene and Stavzor. The FDA has determined that this drug is properly classified as "Category X" for drugs whose risks clearly outweigh their benefits.

Should Terminal Illness Be Disclosed

Physicians disagree whether terminal illness patients should be informed that they are dying. A recent study in the British Medical Journal highlighted the thinking on both sides of this controversial issue. On the one hand is the patient's right to know the truth about his or her condition. Not telling a patient about bad news undermines the physician patient relationship and deprives people of the opportunity to put their lives in order. Decisions about finances, guardianships, and funerals may not be made, because patients do not understand their inevitable close at hand demises.

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