Pornography and Condoms

This article caught my eye this article. 


This June, in Los Angeles, citizens will vote on whether actors in pornographic movies will be required to wear condoms, by law. The ballot is a result of intense lobbying by the AIDS Healthcare Foundation.


Under current regulations by the California Division of Occupational Safety and Health, actors are required to use condoms.  Enforcement, however, is tricky as the agency can only act after it receives a complaint. Sexually transmitted infections, including HIV, are seen as an occupational hazard in this industry. Wearing a condom in an adult movie is akin to mandating that construction workers wear personal protective equipment (hard hats, protective eyewear, protective footwear). 


As I am an infectious diseases physician, you can likely guess my thoughts on the matter.

Patient Interest in Sharing Personal Health Record Information-A New Trend?

Here is an article in the Annals of Internal Medicine that explores sharing the electronic medical record with patients.

The investigators explored preferences about sharing electronic health information among users of the U.S. Department of Veterans Affairs (VA) PHR (personal health record) system, My HealtheVet.  The study was Web-based survey of a 18,471 users of My HealtheVet. 

Almost 4 of 5 respondents (79%) were interested in sharing access to their PHR with someone outside of their health system (62% with a spouse or partner, 23% with a child, 15% with another family member, and 25% with a non-VA health care provider).  

As a consultant, it would be of tremendous assistance to access electronic records from referring providers. At the least, it would make my job easier. The digital age and electronic medical records  should, in theory, reduce information asymmetry between patients and providers. Access to the one's electronic health record should, in theory, engage patients in their care by instilling a sense of ownership and should allow for easier provider to provider communication, thereby making care more efficient and reducing redundancy in testing and treatment. Provided that HIPPA (health information privacy) standards are upheld, a technical breakthrough may be at hand.

All of the proposed benefits, however, remain largely theoretical given that no real body of literature exists to prove the tangible, long term benefits or hazards of a shared, electronic patient record. This must be a focus of research as the use of shared electronic records proliferate.  

My Own Country- My Own Thoughts

I spent the last several days engaged in reading some not so light material, Abraham Verghese's My Own Country, a first person account of an infectious diseases physician's experience with HIV/AIDS in rural Tennessee, in the mid-1980's.


What fascinated me most about the book was not so much the details of the evolving HIV epidemic in the 1980's, but rather, the inherent challenges of managing an infectious disease without primary treatment (pre-antiretrovirals), and the stigma associated with the diagnosis. In Tennessee, much as in other parts of the country during the mid 1980's, to be HIV positive was to suffer in secrecy, lack familial and social support, confront blatant homophobia, and be faced with disdain and refusal of medical care from some physicians and nurses. 


Anyone with an interest in HIV/AIDS epidemiology should give the book a proper perusal.  

Hand Hygiene Surveillance a la George Orwell- Video Surveillance

It seems like a cannot stray too far from the subject of hand hygiene as of late. Apologies to those that find it boring. Here is a related article published in Clinical Infectious Diseases. 

The investigators evaluated healthcare worker hand hygiene with the use of remote video surveillance with and without feedback. The study was conducted in an 17-bed intensive care unit from June 2008 through June 2010. 


Cameras were placed with views of every sink and hand sanitizer dispenser to record hand hygiene of healthcare workers. Individual patients were not visualized. Sensors in doorways identified when a healthcare worker entered/exited a patient room.  Trained, remote video auditors utilized for review of the surveillance data.  Hand hygiene was measured during a 16-week period of remote video auditing without feedback and a 91-week period with feedback of data. Performance feedback was continuously displayed on electronic boards mounted within the hallways, and summary reports were delivered to supervisors by electronic mail.

During the 16-week prefeedback period, hand hygiene rates were shockingly less than 10% (3933/60 542) and in the 16-week postfeedback period it was 81.6% (59 627/73 080). The increase was maintained through 75 weeks at 87.9% (262 826/298 860).

Hand hygiene surveillance by video audit works. The process is not cheap and has associated start up (technology) costs, training of video auditors and, likely, ongoing auditor validation for quality assurance. Of course, conservatives and libertarians will bemoan such Orwellian surveillance tactics. However, as video surveillance is not punitive, respects patient privacy (patients are not visualized),  and is done for the sake of patient safety, their argument is flimsy, at best.


Newer technologies for hand hygiene surveillance seem promising. I have blogged about this before.

Voltaire on Medicine

Voltaire

The other day I was reviewing a power point slide of mine and came across this quote by Voltaire:



“The art of medicine consists in amusing the patient while nature cures the disease.”

Infection Prevention Without Emotional Zealotry: Michael Edmond

With Mike Edmond, in 2006, as he ponders infection prevention

Kudos to my close friend and colleague, Dr. Michael Edmond, for recognition as one of the 20 most influential health leaders in the USA by the Health Leaders Media Council. 


Under his guidance, our focus is common sense, evidence based, infection prevention efforts that target all pathogens.


Infection prevention policies devoid of ''emotional  zealotry'', an approach welcomed here. It may be a polarizing stance on the issue of MRSA control and infection prevention, but the progressively lower infection rates substantiate the process.

The 2011 Richmond City FC Copa Navidad- Passion and Purpose on the Pitch

Football for a medical charity with passion and purpose on the pitch.


The 7th annual  Richmond City FC Copa Navidad, our charity football match, took place on Sunday, December 11th, at SCOR. All proceeds go the the Fan Free Clinic, caring for Richmond's medically under served. 


The event was one of our most successful to date with Richmond City FC White defeating Richmond City FC Blue 6-5 in a hard fought, drudge match.


Thank you to all the footballers, the volunteer referees from CVSA and to SCOR.


Event photos below- click to enlarge.

RCFC Blue Copa Navidad 2011

RCFC White Copa Navidad 2011

RCFC 2011 Copa Navidad Participants

The Blogger, with footballing friends at the 2011 Copa Navidad