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A Primer on Summer Safety

From FDA.GOV: A Primer on Summer Safety.

Cholesterol lowering

Bandolier: Cholesterol lowering with statins [Mar 2004; 121-2]

Mercury not in vaccines

It's hard to miss the posts from Mercola.com on medlogs.com.

Dr Mercola's frequent posts are often enhanced with graphics - so they stand out from the crowd. He does a good job sharing his opinion .. but today's post on mercury in vaccines is quite misleading. He suggests that readers/parents "read more on the link between autism and vaccines before deciding whether to vaccinate your infants." 

Huh?

He may not know that thimerosal is not in any of the commonly used pediatric vaccines - nor has it been for several years. Dr Mercola: please update your weblog to reflect a more accurate picture of pediatric vaccines circa 2004. While there may be reasons for some parents to have questions about vaccines .. thimerosal is not one of them.

Billing for depression

The Primary Care Companion to the journal of clinical pscyhiatry has a good article called Billing for the Evaluation and Treatment of Adult Depression byt the Primary Care Clinician.  (pdf)

It's a good overview of a challenging topic.  It's well documented that primary care physicians are poorly reimbursed.  It's hard to be appropriately reimbursed for our time - which of course is are most valuable commodity.  Funy that I can remove a toenail in 10 minutes and earn several times what I can earn to listen to someone for 45.

 

For-Profit Hospitals Costlier

Published tomorrow: For-Profit Hospitals are Costlier Than Non-Profits. This is from the "duh" department. But while we would intuit that this is the case, this article provides clear evidence that profit clouds healthcare decisionmaking.

Make Saline Spray at Home

A year ago I posted about many commercial nasal sprays and how they may contain preservatives that can actually destroy neutrophils.
Since then, I've told patients to make it at home. Here's the secret formula:

• 1 Teaspoon of Baking Soda
• 1 Teaspoon of salt
• 1 Cup of warm water

The solution can be squirted up the nose from a squeeze bottle .. or you can just dip a teaspoon in the solution, place it under one nostril and hold the other nostrol closed ... and snort it up. Yep .. if feels like you just went bodysurfing on a big Atlantic wave .. invigorating. Nasal saline is now a mainstay of my treatment for nasal complaints. I rarely use antibiotics. This article reviews the use of nasal saline and concludes:

"Summary: Nasal irrigations should no longer be considered merely adjunctive measures in managing sinonasal conditions. They are effective and underutilized. Some of the persisting unanswered questions will only be answered by further research."

HubMed

Alan posts about a great find: HubMed. Hubmed is so good, I've added a Hubmed search form to the docnotes home page.

Zed Med

Zed Med in N. Zed is a wonderful weblog written by Chuck Zelnick. He's on sabbatical in New Zealand: I'm now in my 22nd year of practicing Family Medicine, and feeling its time for a change. So I'm taking my family (wife, youngest daughter) with me to New Zealand for 6 months, where I will be working in a small town medical clinic in the South of South Island

A Simple, Accurate Method to Confirm Placement of Intra-articular Knee Injection

PubMed Entry: A Simple, Accurate Method to Confirm Placement of Intra-articular Knee Injection Glattes RC, Spindler KP, Blanchard GM, Rohmiller MT, McCarty EC, Block J. Department of Orthopaedics and Rehabilitation and the Department of Radiology, Vanderbilt Sports Medicine Center, Nashville, Tennessee. BACKGROUND: Intra-articular knee injections are routinely performed in clinical practice without documenting intra-articular placement. HYPOTHESIS: A small amount of air to an intra-articular knee injection produces an audible "squishing" sound with range of motion. STUDY DESIGN: Prospective nonrandomized clinical trial. METHODS: The study group (20 knees from 20 patients) received an intra-articular injection with a mixture of local anesthetic, corticosteroid, contrast dye, and 1 to 2 cc of air. The control group (10 knees from 5 patients) received extra-articular injections of a mixture of local anesthetic, contrast dye, and 2 cc of air. All knees were examined immediately after injection for a squishing sound with range of motion. Postinjection arthrographic radiographs were taken to verify the actual placement. RESULT: All study group knees and no control group knees had intra-articular contrast by radiograph. Clearly audible squishing sounds were heard in 17 of 20 study knees (sensitivity of 85%). Squishing sounds were audible in none of the control knees (specificity of 100%). CONCLUSION: Adding 1 to 2 cc of air to knee injections provides a no-cost, reliable, sensitive, and specific method of confirming accurate placement. Clinical Relevance: This simple method is easily reproduced, can confirm accurate placement, and can eliminate extra-articular injection as the reason for clinical response failure. PMID: 15150053 [PubMed - in process]