Dollars for Docs

Source: AVTimes.com

Concerned about an ethical conflict of interest in a given doctor?  


Here is a website that tracks payments made to physicians by pharmaceutical companies.


Drug companies make payments to doctors and health professionals for the promotion of their drugs and products.The medical-industrial complex industrial complex can have a strong influence on medical practice. 


As always, there is a quid pro quo. Remember, there is No Free Lunch.

The Positive Effects of Double Gloving- Revisited

Here is a paper on double gloving in the OR, published in AORN.

Source: Infection Control Today

The primary reason to double glove is to limit the risk of percutaneous injuries to operator, thereby reducing the risk of transmission of blood borne pathogens such as HIV, Hepatitis B and C.


Double gloving or double gloving with an indicator glove system may provide greater protection to the surgeon. During a 24 month survey, the investigators utilized a  comparative design to examine the effect of double gloving with inner indicator gloves on the durability of inner gloves and the detection of glove tears or perforations during surgery. The study was conducted in 2 major medical centers and a shock-trauma center. Twenty one surgical specialties were included and 8,723 pairs of double gloves were analyzed


The detection of blood on the hand after surgery was greater with single gloving (75%) than with double gloving (75% vs 25%) and the frequency of changing gloves during surgery was significantly higher among those who double gloved with an indicator glove system (70%) versus double gloving alone (59%). The majority of health care providers studied expressed favorable views about double gloving


In brief, double gloving results in fewer blood exposures and results in early detection of a perforated outer glove if a colored, indicator underglove is donned.


Of course, these finding are not all that new, but, they do add to the body of literature in support of double gloving as a safety measure. 


So why isn't uptake universal? Some surgeons are skeptical about practice changes and some have a disregard for evidence based practice. However, across healthcare systems, there are active resistors and organizational constipators blocking infection prevention and safety efforts. This is likely at play too.


 The evidence is mounting. Time to hop on the safety-wagon.

Sexual Health: The Importance of Taking a Sexual History

Source: NYC Department of Health and Mental Hygiene

Today I am invited to give a lecture on the importance of taking a sexual history in the clinic. Sexually transmitted infections (STIs) are on the rise so the timing seems relevant. Click here for an excellent pictorial summary of STI rates from the CDC.


The benefits of taking a proper sexual history seem self evident. The purpose is to diagnose and treat sexual dysfunction AND STIs. Here is an informative full text review on the matter.


Many physicians do not delve into the sexual history as part of a patient encounter. Obstacles include inadequate training, lack of confidence, time pressure and perceived patient discomfort. I have always felt that a professional, non-judgmental, confidential, matter of fact discussion on sexual habits as a part of routine patient care facilitates the process. A certain way to make a patient uneasy is for the physician to appear uncomfortable while taking a sexual history. 


In addition, a discussion on sexual health serves to counsel and promote safe sex. Condom use cannot eliminate and prevent all STIs, however, the risk reduction can be significant (up to 90+%). The New York City Department of Health and Mental Hygiene has a novel and aggressive program for condom promotion. Learn about the NYC Condom by clicking on the corresponding hyperlink. 

Barefoot Running- Orthopedic Benefit?

Source: Runningquest.net

Barefoot running has received increased attention and gained popularity. 


For those of you interested in an enjoyable and thought provoking read, I suggest Born to Run by Christopher McDougall.


A disclaimer: I am an infectious diseases physician and not an orthopedist or sports medicine specialist. 


After my perusal of the peer reviewed medical literature, there is reason to suggest that running barefoot can result in gait alteration, shorter strides, decreased impact and strengthening of the feet musculature(relieving stress on the arches). There is no credible, peer reviewed data confirming that barefoot running has actually resulted in fewer, orthopedic running injuries. High quality studies to address this last point apparently have not (yet) been done. 


For a thorough, scholarly and scientific review on the matter, I refer you to this paper in the Journal of the American Podiatric Association.


Well, I am off for my morning run now, with my feet still properly shod......

Sudden Cardiac Death in Athletes

Well it is no secret to those that know me that I still have a boyhood obsession for football (soccer),  


I get a little nervy when a cardiac event occurring on the football pitch makes international headlines, raising the question about cardiac risks in athletes. Here is an article in the BBC on the case of a recent English Premier League footballer who collapsed during a match.


Fortunately, sudden death in young athletes is a rare event. Most deaths in young athletes are not secondary to conventional coronary artery disease. Genetic abnormalities, such as hypertrophic cardiomyopathy,  are usually associated with arrhythmias - irregular heart beats and sudden death. Having a genetic abnormality and playing a sport at a high level may increase the risk. These abnormalities may be difficult to detect, despite comprehensive testing.


For a more complete medical review on the matter, I defer you to this article, published in Current Opinion in Critical Care.

Backpack and Pain in the Back

Source: Wellcommons.com

I live down the street from a private school and regularly see young boys and girls carrying backpacks of gargantuan size. I don't recall having a backpack that big as a schoolboy.


Fortuitously, I came across this recent article in Archives of Disease in Children on my daily review of medical titles.


In an analysis of 1403 children,  61 % were carrying backpacks that exceeded 10% of their body weight. This was significantly associated with back pain but not back pathology. The long term effects of heavy backpacks is not known, however, I suspect that it is not significant.


Assuming that the packs are filled with books, perhaps as the use of i-Pads and e-readers proliferate, the heavy textbooks will take a digital format and lighten the load.


As for me, I will pass on the backpack, and opt for the over-the-shoulder 'man bag'.

Hepatitis C: On the Rise

Source: PhoenixCME.org

Hepatitis C, a bloodborne viral infection which can lead to chronic liver disease, cirrhosis and liver cancer, has now surpassed HIV as a cause of death in the USA. An eye opening article, published in the Annals of Internal Medicine, can be found here.


Much like HIV, these findings call for a more comprehensive public health strategy that focuses on a) early detection (screening and testing) and b) treatment. This would take a coordinated healthcare system, which we do not have, and resources, which are in short supply. 

It is Monday, back to the grind.