January 16th, 2009 by Dr. Val Jones in Friday Funny, Humor
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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.'”
January 14th, 2009 by Dr. Val Jones in Expert Interviews, News
2 Comments »
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.
January 13th, 2009 by Dr. Val Jones in Announcements, Medblogger Shout Outs
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Dr. Val is hosting the historic inauguration day Grand Rounds at MedPageToday. Please send your submissions to this email address: valjonesmd AT gmail dot com. Put “Grand Rounds Submission” in your email title and please use this format for the body of your email:
- Post title
- Post url
- Short description of the post
- Blog title
- Blog url
Although I have never done a themed Grand Rounds before, it would be terribly remiss of me not to acknowledge healthcare reform on the very inauguration day of our new President, Barack Obama. So please send me your best posts about the change you’d like to see in healthcare. If we do a really great job of this, maybe Tom Daschle will take a looksie? Don’t laugh, but DC is a small world – I share a hair stylist with Tom’s wife, Linda!
Please send me your submissions by midnight, ET, Sunday January 18th. I will include all submissions, but will give more weight to those that are about healthcare reform.
For those of you who are reading this and wondering what on earth I’m talking about – please read about Grand Rounds here. It’s the weekly summary of the best blog posts from the medical blogosphere.
My inaugural Grand Rounds will be published at MedPageToday at 8am, Tuesday, January 20th. (This link will work from that time on). I hope that we’ll reach an unprecedented number of readers on this platform.
I look forward to receiving your submissions!
Warmest Regards,
Val
P.S. Please enjoy Barbara Kivowitz’s Grand Rounds this week – it has a Sci Fi theme! The January 27th edition of Grand Rounds will be hosted by: Chronic Babe.
January 12th, 2009 by Dr. Val Jones in Audio, Expert Interviews
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Well today was quite a role reversal for me – instead of interviewing someone for my blog, I was interviewed by another blogger. Dr. Philippa Kennealy of the Entrepreneurial MD, asked to speak to me about my new company, Better Health LLC. She summarized the interview here, calling me “The whole-brained physician who won’t ‘stay in the box.'” Quick, someone send for the men in white with butterfly nets!
You may listen to our podcast interview below (just click on the play button):
[Audio: http://blog.getbetterhealth.com/wp-content/uploads/2009/01/entrepreneurialmd.mp3]
January 8th, 2009 by Dr. Val Jones in Friday Funny
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By Steve Simmons, MD
In order to solve the increasing shortage of primary care doctors many experts have proposed a plan to fill the void with nurse practitioners (NPs). This acknowledges the necessary role primary care plays in our health care system while ignoring the actual qualifications for the job. Furthermore, by failing to address why doctors are leaving primary care these experts unwittingly will ensnare us further in the same trap we currently find ourselves in today. Independent of whether or not nurse practitioners are qualified to practice medicine without a supervising doctor is the following fact: they are avoiding primary care medicine for the same reasons as doctors.
As we determine who will take the lead on providing primary care, we should consider what is best for our patients. Nurse practitioners fill an invaluable role by taking on many of the day-to-day problems and there is little doubt that our patients benefit from their skill and experience. Anyone suggesting that nurse practitioners can replace physicians should understand that the nurse practitioners’ training program teaches them to provide care within the structure of a healthcare team led by a supervising doctor.
What can doctors provide their patients that nurse practitioners cannot? Depth of knowledge. Seven years of study in medical school and residency provide a doctor with the depth to understand complex medical conditions more difficult than the average day-to-day medical problem. With experience, many nurse practitioners can provide excellent care for patients suffering a difficult or unusual problem; yet without that experience this lack of depth can be the difference between a good and bad outcome.
A very good nurse practitioner I work with once said, “I am only as good as the doctor backing me up, when I am working with a good doctor, I’m great.” This helps exemplify how nurse practitioners can rely on physician supervision to help prevent unnecessary tests, procedures, and misdiagnoses.
When a patient needs the care of a specialist, a nurse practitioner might find it difficult to advocate for the patient without the necessary parity of experience with the specialist. In my training, it was unthinkable to give absolute control of a patient to a specialist. Specialists need to focus often leaves them unable to best serve the overall interests of the patient. While no primary care doctor can perform a highly technical procedure on their patient, they can advise as to whether the procedure is necessary or not. Every patient needs someone to coordinate their care plan while keeping in mind his overall best interests. An unsupervised nurse practitioner may find it intimidating to tell the enthusiastic specialist “no” while advocating for what is best overall for the patient.
The idea that you can replace a doctor with a nurse practitioner does not address the underlying problems that will continue to drive all healthcare providers away from primary care medicine. I hope that anyone suggesting a solution for the shortage of primary care doctors tries to understand why the shortage has occurred in the first place. Then and only then will there be enough primary care providers to care for us all.
Until next time, I remain yours in primary care,
Steve Simmons, MD
