RedScrubs
The Resource for Medical Professionals

Quite a bit of attention has been paid to the prevention of surgical site infections over the past few years — and this is one area that CMS/Medicare is targeting in its ever expanding “never event” list (I have ranted a bit about this before). From the CMS web site detailing a July 31, 2008 press release:
In last year’s final rule, CMS listed eight preventable conditions for which it would not make additional payments. In this year’s proposed rule, CMS identified nine potential categories of conditions, but based on public comments, is finalizing three of these. The new additional conditions in this year’s final rule include:
* Surgical site infections following certain elective procedures, including certain orthopedic surgeries, and bariatric surgery for obesity
* Certain manifestations of poor control of blood sugar levels
* Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures

Cancer patients who have failed to respond to other treatments have responded to a new anti-cancer compound that works by blocking a part of the cell’s machinery that is crucial for cell division. Having passed the Phase I of the clinical trials, the drug BI 6727 is now headed for a Phase II clinical program where the compound will be tested in combination with other anti-cancer drugs to see whether combined therapies could be even more effective than treatment with BI 6727 alone.
Results so far indicate that BI 6727 is well-tolerated without serious side-effects and encouraging anti-tumor activity. BI 6727 works by inhibiting the action of a protein called Polo-like kinase (Plk1) of which high levels are found in cancerous tumors. The main side-effects are neutropenia and/or thrombocytopenia – both treatable and reversible events.

A 45 minute video that explores the three most common psychosomatic conditions in the elderly is presented here. Dementia, delirium and depression are the 3 most prevalent mental conditions in geriatrics. The criteria for each of these disorders are explored and treatment options discussed. Sub-types of dementia are also discussed, including the Lewy body variant. Dr. James Bourgeois, professor of Clinical Psychiatry at UC Davis, explores the work up and management of elderly persons presenting with these mental disorders. This program is certified for CME by UC Davis Office of CME.

In a strange twist of evolutionary fate, rejection may sensitize us to genuineness in others making us better able to spot fake or artificial emotions. In a very small study, perhaps to be taken with a grain of salt, researchers studied 32 subjects. They found that subjects who were manipulated to feel rejection were able to distinguish a fake smile from a real one 80% of the time. This is an intriguing finding open to future studies of validation. Applications of this information may be pertinent to employment situations, recruiting, and just plain interpersonal relationships involving social situations that might affect employment status, promotions or demotions.

There is a wide practice gap between optimal and actual care for patients with acute myocardial infarction (MI) in hospitals around the world. A 12 member panel was convened in 2007 to develop an updated set of quality indicators for acute M.I. Consensus was reached on 38 quality indicators: 17 that would be measurable using chart data and 21 that would be measured administratively. Of the 17 chart reviewed indicators, 13 address pharmacological and non-pharmacological care. In-hospital mortality was a key outcome measure. It was recommended that hospitals strive for a minimum target benchmark of 90% or greater on process-of-care indicators. Implementation of strategies by clinicians and hospitals to meet target benchmarks on these quality indicators could save the lives of many individuals with acute MIs.

Performance measures are not an end unto themselves, but a crucial step in improving the quality of patient care. These measures were developed by the Canadian Cardiovascular Outcomes Research Team (CCORT) and the Canadian Cardiovascular Society (CCS). This study was published in the October, 2008 issue of CMAJ.

Dr. Barkley, PhD. discusses the recent advances in the diagnostic criteria and treatment of ADHD (Attention Deficit Hyperactivity Disorder). Sustained, or persistence of attention is focused on as a primary concern in the disorder. Response, or reactions to reality, or sustainment of reaction to reality, is another problem addressed in ADHD. Resistance to distraction is also an issue. Recent discoveries in the causes and medications that might help ADHD are also explored in detail. The video is approximately 59 minutes long. Series: M.I.N.D. Institute Lecture Series on Neurodevelopmental Disorders.

Diagnosed cases of ADHD, or Attention Deficit Hyperactivity Disorder, are estimated to be 4.4 million children in the US between the ages of 4-17. Boys are three times more likely to be diagnosed with this condition than boys. And, 60% of those diagnosed with it as children will still have it as adults.
Last week a study done on a mere 17 individuals concluded that they had the “perfect” treatment for ADHD. Besides the small sample size, this poorly designed test used an assessment test that was not well founded in research as their sole method of measurement when other good and more reliable tests were available.
This blog covers the background of this “state of the art” study and tears it to shreds. The concluding remarks were focused on the fact that the researchers had to throw out 3 of the 4 measures they were using to measure their results. The dropout rate was 32% meaning this perfect technique will be useless in 1 out of 3 children it’s tried on.

Nanotechnology, sometimes shortened to nanotech, refers to a field of applied science whose theme is the control of matter on an atomic and molecular scale. Generally nanotechnology deals with structures 100 nanometers or smaller, and involves developing materials or devices within that size.
Nanotechnology is an extremely diverse and multidisciplinary field, ranging from novel extensions of conventional device physics, to completely new approaches based upon molecular self-assembly, to developing new materials with dimensions on the nanoscale, or the scale of nothing, even to speculation on whether we can directly control matter on the atomic scale. It is predictive that nanomedicine, fueled by nanotechnology, will enable more personalized medical care that is both predictive and preventive.
The launch of the Mattel UCLA NanoPediatrics Program will explore the future of personalized medicine for children and represents one of the first of the world’s first dedicated program to nanomedicine and pediatric patients.
Projects currently underway at the state-of-the-art program include the development and application of nanodiagnostic tools such as DNA-based newborn screening tests for genetic abnormalities, the development of a new generation of nanodevices for the treatment of pediatric genetic disorders (including cancer) and the investigation of the use of nanoparticles for diagnostic imaging both during pregnancy and after birth.

Twice as many women as men suffer from depression and mood disorders – but only between puberty and menopause. This burden on women in the reproductive years suggests a powerful link between female hormones and brain function. Dr. Ellie Williams, MD, associate director of the Center for Neuroscience in Women’s Health discusses this role of hormones in women’s mental health.