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“‘Physician Heal Thyself’ Isn’t Working” – Editorial by Dr. Adrian Park in Annals of Surgery

by jmiller on November 16, 2017

Congratulations to Dr. Adrian Park for having his second publication in one year in the top prestigious surgery journal, Annals of Surgery.  Dr. Park’s editorial is a commentary on the work of Dr. Chantal Alleblas, appearing in the same issue, which focuses on worker injury related to minimally invasive surgery in the abdominal cavity, including, general, gynecological, and urological surgery.  These surgeon related worker injuries are mainly the result of  ergonomic issues causing musculoskeletal disorder injuries, a topic that may be equally important as “physician burnout”, but with far less media attention.  Click here to read Dr. Park’s editorial and Dr. Alleblas’s  article “Prevalence of musculoskeletal disorders among physicians performing minimally invasive surgery: a systematic review”.

In the news: New ACC/AHA High blood pressure guidelines lower definitiion of hypertension

by jmiller on November 14, 2017

“High blood pressure should be treated earlier with lifestyle changes and in some patients with medication.  Blood pressure categories in the new guideline are:  Normal:  Less than 120/80 mm Hg; Elevated:  Systolic between 120-120 and diastolic less than 80Stage 1:  Systolic between 130-139 or diastolic between 80-89; stage 2:  Systolic at least 140 or diastolic at least 90 mm HG;  Hypertensive crisis:  Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage”.  Full guidelines are in Nov. JACC.  Click here for news summary.

In the news: Alcohol and cancer: a statement of the American Society of Clinical Oncology

by jmiller on November 14, 2017

“Alcohol is causally associated with oropharyngeal and larynx cancer, esophageal cancer, hepatocellular carcinoma, breast cancer, and colon cancer.  Even modest use of alcohol may increase cancer risk, but the greatest risks are observed with heavy, long-term use.”  (Journal of Clinical Oncology, November)  Click here to read full text.

“Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department” and editorial “Opioid vs nonopioid acute pain management in the emergency department”

by jmiller on November 14, 2017

Article concludes:  “For patients presenting to the ED with acute extremity pain, there were no statistically significant or clinically important differences in pain reduction at 2 hours among single-dose treatment with ibuprofen and acetaminophen or with 3 different opioid and acetaminophen combination analgesics.”  The editorial suggests that “evidence that nonopioid medications may provide similar pain reduction as opioid medications in selected ED patients.”  (JAMA, Nov 7)  Click here to read full text.

Ten steps the federal government should take now to reverse the opioid addiction epidemic; Reframing the opioid epidemic as a national emergency

by jmiller on October 25, 2017

Two “Viewpoint” papers (NEJM, Oct 24/31) on the opioid epidemic:  briefly, the ten steps are:  improving surveillance of possible opioid addiction; improving reporting of and response to opioid-related overdoses and fatalities; promoting more cautious prescribing for acute pain; changing labeling for chronic pain and greatly restricting or eliminating marketing of opioids for this indication; increasing insurance coverage of and access to non-opioid and non-pharmacological management of pain; interrupting the supply of heroin and illicitly produced synthetic opioids and improving coordination between legal and public authorities; identifying possible opioid addiction early and linking individuals to treatment; expanding low-threshold access to opioid agonist treatment,particularly with methadone and buprenorphine; implementing harm reduction measures for current users, including access to clean syringes and naloxone.; considering removing ultra-high-dosage-unit opioid analgesics from the market.  Click here to read both “Viewpoints”.

Urinary incontinence in women: a review

by jmiller on October 25, 2017

This Clinical Review (JAMA, Oct24/31) concludes:  “Urinary incontinence is common in women, although few seek  care despite many effective treatment options.  Clinicians should priotitize urinary incontinence detection, identify and treat modifiable factors, incorporate patient preference into evaluation and treatment, initiate conservative and medical therapy, and refer to specialists when underlying pathology is identified or conservative measures are ineffective.”  Click here to read full text.

Delirium in hospitalized older adults

by jmiller on October 25, 2017

Clinical Practice article (NEJM, Oct 12) focuses on delirium presenting the clinical problem; strategies and evidence; management; prevention; guidelines; and conclusions and recommendations.  “Agitation should be managed with non-pharmacologic strategies first.  Physical restraints should be avoided.  Antipsychotic agents should be reserved for unremitting symptoms that threaten patient safety; if required, haloperidol (initial dose, 0.25 mg), olanzapine (2.5 mg), or quetiapine (12.5 mg) would be reasonable first choices depending on the amount of sedation desired.”     To read full text, click here.

“Global Surgery” by Dr. Adrian Park is now in our electronic medical libary.

by jmiller on September 20, 2017

“Our intent in creating this book is to tell the story of global surgery, including its brief history and exciting future, and to provide important practical information for those who wish to engage in this most worthy of pursuits. Our hope is that this book will prove to be a trusted and well-thumbed resource for you at whatever stage of your global surgical journey you find yourself.”  With so many of our physicians providing international charitable surgical services, this book will provide a wealth of information to enrich this experience.  To access the book, click on the  “Medical Staff” icon  at the top toolbar; locate and click on “Medical Library” on the left sided toolbar.  The “Medical Library” is located on the right hand column, where the first entry is “AAMC Electronic Journal and Book List A to Z”.  If you click on and type “Global Surgery” in the search box, you will have access to Dr. Park’s new book.  If you have any questions, please call Joyce Miller, ext. 4877 or send an email to jmiller@ahhs.org

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