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Cartoon Caption Contest Winners!

Thanks for the many entries in Better Health’s first cartoon caption contest. Unfortunately, I accidentally deleted some of them several days after they’d been submitted (I was too aggressive with my anti-spam efforts). But they were all included in the contest. Our judges really struggled with choosing a winner… so they narrowed it to 2 and made them both winners!

Would you agree that it’s a toss up? Both authors will receive a Better Health t-shirt. I hope it makes them as happy as this guy. Thanks for participating!

Winner #1: Kerri Morrone Sparling “Please sign here and here and then I can write about you on my blog.”

Winner #2: Rob Falconer “Yes, we do normally weigh patients naked, Miss Saggar, but I think we’ll make an exception in your case.”

And just for a bit of trivia – the artist’s (Dr. Val’s) original caption read: “Mrs. Chen’s medical questionnaire was unremarkable except for her fine print at the end of page 3: ‘allergic to geodon.'”

Top Five Pediatric Stories of 2008

By Dr. Stacy Beller Stryer, M.D.

Reflecting on the past year’s successes and failures as a parent is an important and worthwhile exercise to do each January. In previous January blogs, I have published my own list of resolutions for the New Year to help you get your own creative juices flowing. This year, however, I have decided to talk about the top five news stories related to pediatrics in 2008.

The top news story in 2008 is the election of Barack Obama as our next President. President-elect Obama wants affordable, comprehensive and portable health care for everybody . His goal is for all uninsured children to be able to sign up for healthcare plans. He wants to expand Medicaid and state health insurance programs, and to develop a government-funded health insurance plan that will compete with other companies. President-elect Obama also wants comprehensive health education taught in schools.

A second important pediatric-related news story is the recall of cough and cold medicines, including decongestants, expectorants and antitussives, for children, particularly those ages 2 years and less. The reason for the recall is because studies have found that the risks of dangerous side-effects far outweigh the benefits. A study which came out last year from the Centers from Disease Control found that over 1500 children under age 2 visited the emergency room for serious side effects due to taking cold medicines in 2004 and 2005, and that 3 children died. In addition, insufficient studies have evaluated the efficacy and side effects in children. Actually, these medicines were previously developed based on studies done with adults.

Another important finding concerns the use of cigarettes. If you smoke and light up that cigarette only when you are outside your house or when your children aren’t home, you may still be harming them (OK – this was reported in the January issue of Pediatrics but I heard about it December 31st!). According to a recent study published in Pediatrics , this “third-hand smoke” causes toxins to remain everywhere, such as on clothes, hair, couch cushions, and carpets, for extended periods of time. The toxins include heavy metals, carcinogens, and radioactive materials that children may ingest, especially if they are crawling on the carpets. If this isn’t enough of a reason to quit smoking, I don’t know what is!

Unlike some other fatal illnesses, researchers have been able to decrease the risk of sudden infant death syndrome (SIDS) significantly over the years when they discovered that placing an infant to sleep on his back significantly reduced the risk. Another study published last October in the Archives of Pediatrics and Adolescent Medicine that placing a fan in an infant’s room during sleep decreased the risk of SIDS by 72%.

The last news story which made significant changes in pediatric practice this past year concerns the identification and treatment of elevated cholesterol levels in toddlers and children. In July, the journal Pediatrics published revised guidelines for pediatricians, including initiation of lipid screening in children, beginning at age 2 years, in those who have a family history of high cholesterol or early heart disease, or in those who are overweight, have diabetes, or smoke. The American Academy of Pediatrics has also begun to recommend a decrease in the fat content of milk in overweight children beginning at age 1 year. Finally, they now recommend medication as early as age 10 years in certain children with elevated lipid levels despite exercise and diet change.

There are many other important findings from 2008, but I thought that these were among the most important. Now stop reading and get back to your New Year’s Resolutions for 2009!

Realistic Expectations For Hand Sanitizers In Elementary Schools

Photo Credit: Dr. Crippen

Photo Credit: Dr. Crippen

I recently listened in to a Webinar related to infectious disease prevention strategies in elementary schools. The lead speaker (Dr. Thomas Sandora) was the principal investigator of a research study that was sponsored by Clorox and published in the Journal, Pediatrics a few months ago. I thought the results were interesting.


Study Design

This study was a randomized, controlled trial of 285 third to fifth graders in a school in Avon, Ohio. The study took place over a two-month period: from March to May, 2006. Half of the classrooms were randomized to the intervention group (which included having the kids apply hand sanitizer before and after lunch, and the teachers perform a sanitary wipe down of all their desks once/day), the other half were observed during their “business as usual” daily routine without sanitizers. The primary outcome measure was “days of school missed due to illness – either upper respiratory or gastrointestinal.” Swabs of surfaces in both the intervention and control groups were taken.

Results

Interestingly, there was no difference in the groups in terms of days of school missed due to upper respiratory type illnesses. There was a small but significant (9%) reduction in gastrointestinal-related illnesses absenteeism in the intervention group. Surface swabs picked up norovirus with higher frequency in the control group classrooms. No MRSA was detected during the study.

Discussion

Upper respiratory tract infections (URIs) are highly contagious, and are commonly spread by droplets in the air as well as surface contact (some viruses and bacteria can survive for 2 hours or more outside the body). Due to an infected child’s continuous contact with their own nasal secretions (sorry for the graphic photo), it is difficult to reduce the spread of URIs through the occasional hand washing or sanitizing. One would have to wash a child’s hands after each time they touched their mouth or nose.

On the other hand, gastrointestinal infections like norovirus are spread via the fecal-oral route, and are therefore not dripped and sneezed all over the place the way URI-causing viruses tend to be. Instead, GI infections are spread when hands are not washed thoroughly after a trip to the bathroom – and then food is touched and ingested.

So it’s not all that surprising that the transmission of GI-related infections were particularly susceptible to this study’s intervention: hand sanitizing before and after lunch, and a daily desk surface wipe.

An interesting point that Dr. Sandora made was that alcohol-based hand sanitizers don’t contribute to antibiotic resistance, because their killing mechanism is not related to antibiotics. I guess it’s like saying that humans don’t become resistant to knife injuries when exposed to attacks with greater frequency.

Conclusions

Hand sanitizer and surface disinfectant strategies may be more effective in reducing the transmission of gastrointestinal illnesses than respiratory tract illnesses in elementary school children. But since compliance is challenging – the total reduction in GI illness transmission remains modest though probably worth the hygiene effort. One glance at the photo above tells you all you need to know.


The Gordian Knot: Ensnaring Today’s Healthcare System

http://www.cs.berkeley.edu/~sequin/SCULPTS/CHS_miniSculpts/TangledKnots/PentafoilTangle4.JPGBy Steve Simmons, M.D.

Gordian Knot: 1: an intricate problem ; especially : a problem insoluble in its own terms —often used in the phrase cut the Gordian knot 2: a knot tied by Gordius, king of Phrygia, held to be capable of being untied only by the future ruler of Asia, and cut by Alexander the Great with his sword

Generations ago, the American Medical Association’s (AMA) Code of Ethics stipulated that allowing a third party to profit from a physician’s labor was unethical.  This tenet resides in a time when house calls were common place; when trust and respect helped forge an immutable bond between doctor and patient; and when it would have been unthinkable to allow anyone other than the doctor, family, or patient to have a role within the doctor-patient relationship.

The landscape of today’s healthcare system and its delivery methods make the authors of the AMA’s forgotten code look prescient.  Insurance companies, controlling the purse strings, have become an unwelcome partner within the doctor-patient relationship, frequently dictating what can and can’t be done, and are reaping a healthy profit from their oversight. Obscene salaries and large bonuses are awarded to the CEOs   of these companies for keeping as much money as they can from those providing health services, with the CEO United Healthcare being reported as receiving a $324 million paycheck during a five year period.  Thus, short-term business strategies are given priority, often at the expense of patients’ long-term medical goals, creating a Gordian knot so entwined that no one – patients, doctors, insurance providers, or government regulators – can see a way to unravel it.

A result of so much money being skimmed off the top is that no one seems to be getting what they need, let alone want.  Patients long for more time to discuss problems with their doctor and wish it were easier to get an appointment.  Yet physicians are unable to receive adequate reimbursement from insurance companies for their services, and if they do get reimbursement, it’s after months of waiting and often at the high expense of having a posse of back office staff needed to negotiate these payments. These physicians therefore are forced to overload their schedule and rapidly move patients through their office if they are to earn their typical $150,000 per year, pay off medical school debt, and afford the salaries of their office employees.  Finally, government agencies, looking for the elusive loop to tug on, ultimately burden physicians further with a myriad of onerous rules and regulations.

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ER Physician Dies In His Own ER

This is one of the saddest stories I’ve read in a while. H/t to GruntDoc.

Dr. Michael Sanchez, who in a few months as director of University Hospital’s busy emergency department slashed waiting times and reduced the number of patients turned away because of overcrowding, was struck and killed while jogging Sunday afternoon.

His own emergency department colleagues tried to save Sanchez without recognizing him because of the extent of his injuries. Only after he was pronounced dead did they learn it was Sanchez, hospital staff said.

Police said Sanchez was struck in the 11600 block of Bandera Road about 1:40 p.m. Sunday. The driver told police he was on his way to get the brakes on his SUV fixed when his cell phone rang. As he answered it, he said he spotted Sanchez on the side.

According to a police report, Smith said he hit the brakes and the car swerved onto the shoulder, striking Sanchez and sending him onto the hood of the car.

A witness said the driver swerved across two lanes before striking the victim. Police said no charges have been filed.

Rufe said Sanchez had so much enthusiasm and energy for the job, it made some of his colleagues skeptical about him. But it was that drive that allowed him to push the department beyond the way things had traditionally been done.

“He was telling me one day, ‘I love my job. I love what I do. I love my family. We have a wonderful home. I can’t ask for anything else. And now the possibility of a residency program. I’m just a fortunate person,’” Rufe said.

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