Dr. Kevin has posted the top 10 medical blog posts.  Not surprising, the top post is about none other than swine flu.  But the others are interesting, and cover a span of topics:

How do I prevent and treat swine flu, and, is a pandemic imminent?

2. The Craigslist Killer is a Boston University medical student

3. Is the nursing shortage overblown?

4. Most hospitalists are good, but some, like these ones, aren’t

5. Is the bipolar child and ADHD a purely American phenomenon?

6. A pediatrician takes the anti-vaccine movement head on

7. Which television doctor shows do the medical profession like best?

8. How the primary care doctor shortage threatens Obama’s health reform plan

9. Does consensual doctor-patient sex actually harm the public?

10. What would happen if every doctor chose to specialize?

I really wanted to take a break from the swine stuff, but here’s one more for you, and then its on to other things–unless this swine bug really picks up.

From the blog of Dr. Joseph Kim:

The World Health Organization (WHO) is raising the pandemic alert to phase 5 (and phase 6 is the highest level).

“Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.”

I guess it is, and definitely not good for the Mexican tourist industry.According to NewsDaily, The United States, Canada and the European Union advised people to avoid non-essential travel to Mexico, and Cuba suspended all flights to and from Mexico for 48 hours.

Carnival Cruises said it canceled stops at Mexican ports for three of its ships on Tuesday and the Canadian tour operator Transat AT postponed flights to Mexico until June 1 due to the swine flu alert. Private companies also adopted their own travel restrictions not just to Mexico but also to countries where cases have been confirmed.

Is all this necessary? Well, ideally, it would be good to contain it until more is known about the outbreak, but it seems sort of past that point. It has spread around the globe, albeit in tiny numbers. There are now 65 cases in the U.S., Canada announced six more infections and new cases were also confirmed in Israel and New Zealand. So it is hitting all corners, undoubtedly due to travelers taking it from here to there.

But it is important to note that  Mexico City is at the center of the outbreak, a huge overly crowded metropolis of 22 million in the metro area. About 2,000 people have been hospitalized with symptoms of swine flu, and there may be many more infected although those numbers are unavailable. However, most of these cases are unconfirmed, which is important to keep in mind. A total of 26 patients have actually been confirmed as having swine flu, with 7 deaths.  Mexico has also reported 152 fatalities in flu-like cases in recent days, but those are unconfirmed as having been caused by swine flu.

In the event that those deaths are confirmed, then the swine flu floating around Mexico does appear to cause a higher death rate than elsewhere. But again, there are so many factors involved, which may have nothing at all to do with the virulence of the virus.

Stay tuned…I’m sure we’re going to be seeing a lot more news.

Full fledged frenzy over the swine flu, reports the Chicagoist.

What started as a buzz late last week has grown into full-on shrieking as this year’s SARS has stepped up to the plate. With confirmed cases coming in from all over the country – including two in Kansas – the panic over the swine flu is rising. Which is fair enough: so far, 100 people are reported to have died in Mexico from the disease and it seems to be spreading fast. The threat of a pandemic even has the European Union urging cancellation of “nonessential travel” to North America.

It’s difficult to figure out exactly how many people in the continental US have actually come down with it, and more importantly, if it is really any more virulent than the ordinary winter time flu. Is it? I don’t know.

We also don’t know how serious and large the outbreak will get. Does it spread like normal flu? Is there more reason to worry? It’’s hard to say with so many mixed reports and so much misinformation.

It’s not to say that we’re overreacting this time, and certainly, one has to be prudent. But the hysteria that some tried to whip up about the avian flu has been unfounded. Every now and then, there’s still a case reported, but please, the projected pandemic remains just that–projected.

But in 1976, there was another bout of swine flu, which led to a decision to mass vaccinate the public. What happened was that in 1976, 2 recruits at Fort Dix, New Jersey, had an influenzalike illness. Isolates of virus taken from them included A/New Jersey/76 (Hsw1n1), a strain similar to the virus believed at the time to be the cause of the 1918 pandemic, commonly known as swine flu. Serologic studies at Fort Dix suggested that >200 soldiers had been infected and that person-to-person transmission had occurred. A 19 year old private died of the infection.

However, it seemed that the vaccine was more deadly than the flu. According to the LA Times, “More than 500 people are thought to have developed Guillain-Barre syndrome after receiving the vaccine; 25 died. No one completely understands the causes of Guillain-Barre, but the condition can develop after a bout with infection or following surgery or vaccination. The federal government paid millions in damages to people or their families.”

So it seems that another bout of swine flu is brewing. Time magazine has an interesting article on how to avoid the mistakes of 1976, when dealing with the current outbreak.

For ER nurses, are you seeing more patients coming in with symptoms of cold/flu, and panicking over having swine flu? Are they coming in with symptoms that they might normally just ignore or treat at home, but instead, showing up in the ER because they are afraid that they have contracted swine flu?

I just want to clarify, that unlike some of the nurse police haunting the Internet, I don’t have anything against nurses being presented as less than savory characters. Nurses do not have to be portrayed as wonderful, eager, helpful, saintly, flawless, and utterly perfect little creatures who can outperform any physician they tango with. I have nothing against presenting nurses as flawed human beings–in other words, like real people.

The Nurse Jackie show is supposed to be a comedy, but I have a problem with presenting the lead character of a show about a nurse as a complete stereotype. And that’s what it sounds like. Can we try another form of humor, please?

Can Jackie the nurse be funny without being a drug addict, a miracle worker, or the wisecracking hardboiled battleaxe? Yes, many nurses and physicians do have substance abuse problems, which includes smoking, drinking, abusing prescription drugs and illegal drugs. But please, does the main character have to have a drug problem, at least initially? Couldn’t one of the other nurses or docs have that problem? Does the young naive doctor have to touch Jackie’s boob? In a big, busy, NY ER, its not likely that very many of these stereotypes would be tolerated.

Anyway, I have no intention of watching the show. If and when it actually airs, it will be interesting to hear the feedback from nurses and healthcare workers.

And now, another bout of silliness from Hollywood, as reported by our own Dr. Jollywood.

It a new “nurse show” from Showtime cable. That means that they are free to use profanity and show nude butts all they want, free from the censors of regular television. So with that in mind, Nurse Jackie premieres. It is the story of a nurse working in the Emergency Department, who “walks the line between saint and sinner.”

Are we nauseous yet?

To their credit, Jackie is rather plain looking with short blond hair, small boobs, and looks like she’s been around the block a few times. She also looks like she’s in her 40s, which is novel in and of itself. For a television program, that is. Not for a nurse, where the average age in the US is 47.

But while the show hasn’t yet premiered, there are serious warning signs in the previews. Jackie is a wisecrack a minute kind of gal, and a young doctor can’t help but fondle her breast in public. It also seems that Jackie is a drug addict, and asks God to “make me good but not yet.”

I guess Jackie is going to be the sinner with the heart of a saint. A new take on the sleazy prostitute with the heart of gold. Jackie tells one nurse that “when it gets easy, its time to go.” Wow, those are fighting words. Everyone working in the ER should have a rough time everyday, and come home in tears or beaten up. And of course, have to work overtime without being paid. Life is rough in the ER and keep it that way. No nurse should expect to get used to it.

Now, if you’re done puking, back to our regular scheduled programming.

Is there any reason why a medical themed show can’t feature a nurse with a strong personality who is just normal?

Not that I’m trying to deter tourism away from Florida, but there has been an outbreak of meningitis caused by a rare viral strain–W135.

So far, only 12 cases, primarily in Dade County (Miami area). But 4 of the 12 infected died, so it is a virulent bug and one not to mess around with. The W135, which accounts for about 3 percent of all meningitis strains, can kill within hours of symptoms–which include  severe headache, fever, nausea, vomiting and a stiff neck. If that applies to you, stop reading my blog and get to the ER pronto.

The troubling part is that it doesn’t seem to be confined to one geographic location. The people infected were all over the place. But since the W135 strain is so rare, health officials believe there is some connection by which it was passed on from Patient Zero to the other 11 victims.

In case you missed, bird flu has been upstaged by swine flu. And unlike the few, albeit highly lethal, cases of bird flu in humans, the swine flu has made a major jump from pigs to people.

From MSNBC:

A new swine flu strain that has killed as many as 68 people and sickened more than 1,000 across Mexico has “pandemic potential,” the World Health Organization chief said Saturday, and it may be too late to contain the sudden outbreak.

Now, lest you think that this is just “south of the border” and of no importance to those of us living in the northern regions, its important to note that microbes have no knowledge of national borders. Or state borders. And they can travel very quickly, especially when airborne.

The disease has already reached Texas and California, and with 24 new suspected cases reported Saturday in Mexico City alone, schools were closed and all public events suspended in the capital until further notice — including more than 500 concerts and other gatherings in the metropolis of 20 million.

So it’s here. Watch out.  KevinMD has a nice report about it on his blog.

Apparently, in spite of all the dire reports of a sudden drying up of nursing  jobs in choice spots like NY, Boston and San Francisco, Texas apparently needs nurses. Of course, this can be due to the fact that nurses are not well paid, well treated, non-unionized, etc. I don’t know. There are several very prestigious medical centers throughout Texas, so perhaps the prestige doesn’t spill over to either attracting or keeping nurses on the job.

But at any rate, the shortage is alive and well according to the Houston Chronicle:

Texas nursing’s in a fine fix. The statewide shortage of nurses moved beyond industry standards for “critical” several years ago, says veteran University of Texas School of Nursing Dean Patricia Starck . These days, it’s acute. In her 25 years in nursing education, Starck says she’s never seen anything like today’s situation. Job openings are going begging because we don’t have enough nursing educators. That is mostly because the high salaries offered to nurses in the workplace are luring away those who might otherwise opt to teach. To their credit, hospital administrators here are allowing nurses to take time away from the job with pay to fill teaching slots and ease the shortage.

On April 22, 2009, Earth Day in fact, the U.S. Food and Drug Administration issued a statement stating that it has “notified the manufacturer of Plan B that it may, upon submission and approval of an appropriate application, market Plan B without a prescription to women 17 years of age and older.” This follows a March 23 federal court order.

Plan B is already available to women 18 and over. I blogged on this before, and this whole Plan B circus is one of the most shameful in the history of the FDA. It represented the rather insidious joining of Bush pseudo-Christian politics and medicine/science–a rather unpalatble combination.

But now it seems that 17 year olds, who have the misfortune to experience unprotected sex, will be able to stop conception and not have to worry about an unwanted pregnancy, and if so, what path to choose.

Universal health insurance, which is one of the health reform ideas being tossed around, may not be a lifesaver afterall. That is, according to one study at least.

The press release on this says the following:

A new analysis suggests that universal health insurance might not save many adult lives — or any — if the United States actually puts it into place.

A previous estimate by the influential Institute of Medicine is too optimistic, said Richard Kronick, a former health care adviser to President Clinton who crunches numbers in a study appearing online in the journal Health Services Research.

In contrast to the Institute’s estimate that universal coverage would save 18,000 adult lives per year, Kronick thinks the number is substantially smaller and possibly around zero.

“It’s quite counterintuitive and it’s not a message that most people, including myself, want to hear,” said Kronick, a professor of family and preventive medicine at the University of California at San Diego. However, “the evidence we have concerning the relationship between lack of insurance and mortality is not very good, and a reasonable reading of that evidence is that the number of deaths in the United States probably wouldn’t change a lot if everybody gets health insurance.”

In 2002, the Institute of Medicine, which advises politicians and the public, estimated that uninsured people are 25 percent more likely to die than the insured. The Institute estimated that 18,000 adults in the United States would survive each year instead of dying if they had insurance. An updated 2006 estimate using the same approach boosted the number to 22,000.

In his analysis, Kronick examined a national study that tracked 643,001 people who responded to health surveys from 1986 to 2000, with researchers following them through 2002.

After adjusting figures to account for factors such as income and “health status,” Kronick found that having insurance made little or no difference to the overall mortality rate for people ages 18 to 64.

He estimates that no more than 9,000 people die each year who would otherwise survive if they had health insurance.

Willard Manning, who worked on the 2002 Institute of Medicine report, said different studies can result in different conclusions because there are so many ways to look at the numbers.

Kronick’s study and the 2002 report, for example, take different approaches to accounting for high-risk patients who get insurance because they’re sick, said Manning, a professor of health studies at the University of Chicago. Overall, however, Manning still believes that more insurance will lead to fewer deaths.

“To me, that’s going to have some consequence for mortality,” he said, because the sick who can’t afford care will cut back on seeing doctors.

Christine Stencel, spokesperson for the Institute of Medicine, said the authors of the 2002 report carefully considered research when they made their estimate.

There is one “inarguable conclusion,” she said. “Lack of coverage is a health hazard. Lack of insurance raises people’s risk of illness, complications and, yes, premature death…The point is that it is no longer possible, in the face of all the evidence, to say that lack of health insurance does not negatively impact Americans’ health, lives, and well-being. It clearly does.”

Today is April 23, the greatest day on earth. Why? Well, because its my birthday.

And I happen to share it with William Shakespeare, who was not only born on this date, but died on it as well (different years, of course).

Back to regular programming tomorrow.

Another Earth day. Have we made any progress since the first Earth Day way back when in those ancient times, circa 1970?

A few interesting tidbits. First, it seems that Earth Day had its humble beginnings in Seattle. Yes, Seattle of all places, during its pre-Microsoft days, when the waterfront was a bawdy spot for drunken sailors looking to get laid, and Starbucks just a mere twinkle in the eye of a caffeine lover. The city was green, because of all the rain, so perhaps that was the idea behind the green revolution.

Second, the person who first announced that there would be an Earth Day, in September 1969 at a conference in Seattle, was  U.S. Senator Gaylord Nelson of Wisconsin. Note, he has the same last name as me, so that must be some kind of omen that I was meant to be a radical veggie savior of the environment.  Anyway, at this meeting in rainy pre-Microsoft pre-Starbucks and pre-grunge Seattle, he  announced that in spring 1970 there would be a nationwide grassroots demonstration on the environment. This occurred during a time of great concern about overpopulation–that concern gets less press these days, but never fear, reproduction is alive and well and an out of control population still remains the greatest environmental threat.

Nelson viewed the stabilization of the nation’s population as an important aspect of environmentalism and later said:

“The bigger the population gets, the more serious the problems become … We have to address the population issue. The United Kingdom, with the U.S. supporting it, took the position in Cairo in 1994 that every country was responsible for stabilizing its own population. It can be done. But in this country, it’s phony to say ‘I’m for the environment but not for limiting immigration.’”

Senator Nelson first proposed the nationwide environmental protest to thrust the environment onto the national agenda.” “It was a gamble,” he recalls, “but it worked.”

Finally, the third most vital point is that the date chosen was April 22. No accident or coincidence, I assure you. That is today, and it is the day right before my birthday. So Earth Day is sort of the opening ceremony to my birthday, and then the real celebration is tomorrow.

Just two ordinary folks, working to improve healthcare. Its an interesting story on NPR, about people organizing and trying to organize the public, to improve healthcare. That’s how it starts, one step at a time. One person at a time..

I’ve been at the Association for Healthcare Journalists conference since Thursday, so not much time for blogging. However, I have been tweeting about it. So if you want to read my little tweets, come on over to twitter. @nabeep

Anyway, I got home a little while ago and am pooped. Going to bed late, lots of socializing, and getting up early–makes for one sleepy person. At least I don’t have to commute to the office tomorrow, and even better, the conference was in Seattle so I was able to drive and didn’t have to deal with airlines or changing time zones.

Amazing as it may seem, there are actually people opposed to this bill. People in the medical community who think that education is dangerous. And that women are better off ignorant about their bodies.

Fight Pink aka HR 1740.

This is about an benign as it gets, so you really have to wonder who would be opposed to legislation they will introduce to highlight the breast cancer risks facing young women under the age of 40 to empower these women with the tools they need to prevent and fight this deadly disease.

As an addendum to my earlier post, about a nurse being laid off by an “extremely remorseful” manager while in the middle of a surgical procedure…I’m just glad that they didn’t decide to lay off the surgeon as well. That would have been cute. Ooops, sorry doc, you’re laid off and it begins right now! Too bad about the patient.

Or laid off the anesthesiologist. I guess they would have had a hard time waking up the patient then.

This situation is so ludicrous, so uncalled for, and just so…so…just so representative of everything that is wrong with our healthcare. Like the nurse working an extra hour or two to finish up the surgical procedure was going to break the finances of the facility. Like having an imbecile as a manager, who thinks that “immediate layoffs” means to throw employees out the door regardless of what they are doing. What if the nurse was on the toilet? Would they have let her wipe before the threw her out?

Anyway, if the state of Wisconsin has any sort of state oversight, they should be coming down hard on this place.

You just gotta love healthcare. I thought I’d seen and heard almost everything, but this really racks up as one of the best moments in the annals of moronic managers and dim-witted organizations

A managed at the Dean Health System in Madison, WI, laid off a nurse who was in the middle of a surgical procedure.Yes, she was in the middle of surgery and a manager pulled her out of the procedure and told her to pack up her stuff. Did you ever?

From the LaCrosse Tribune:

The abrupt removal, which spokesman Paul Pitas said posed no danger to the patient, came after the Madison-based health-care provider announced Wednesday it planned to “immediately” lay off 90 employees.
Pitas, director of corporate communications, labeled the action “clearly … an error in judgment on the part of the manager conducting the layoff.” He declined to name the manager but described her as “an otherwise good employe with more than 30 years of nursing experience who made a regrettable decision.”

“This person is very upset and is extremely remorseful over this,” Pitas said, adding that the layoffs created “extraordinary circumstances.”

Yeah, I’m sure that the person is “extremely remorseful” over the incident. What about using basic common sense in the first place? Would someone with 30 years of nursing experience go and pull a nurse out of surgery to lay her off? And even if her boss told her to do it, she should have stood her ground–another hour or so is not going to make or break the hospital.

If the manager took it upon herself (or himself) to interpret immediately as meaning to pull people away from doing essential jobs, then this person should have been booted out the door. Really, would she/he pull a nurse away from starting an IV, or who was changing a dressing, or helping a patient get out of bed? Just drop the patient and get out.

Of course, what makes it worse is the equally dim-witted sound-bytes from the spin doctors about this.

Pitas said Dean plans to pursue the matter, but he declined to say what the possible outcomes could be.

“Dean will continue to reiterate to its staff the importance of following all patient-care policies,” he said. “Out of respect for the (manager), we cannot discuss specifics. However, we can tell you we are looking into this and appropriate action will be taken.”

That’s reassuring, isn’t it. That comment sounds like it came from Sarah Palin–incoherent and pointless. And the bottom line is that they will do nothing. Just shrug and pat their pet manager on the head for good behavior. Because you know, a manager who does something this dumb must have been doing equally dumb things all along. This type of stupidity just doesn’t spring up out of nowhere.