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West Virginia State Medical Association Advocacy Day 2019

Advocating for Public Health and the Practice of Medicine at the WV State Capitol.

WV Senate President Mitch Carmichael and WVSMA members

At the AMA Interim Meeting 2018

YPSgram Issue #1: On Costumer Service and the ‘Good Doctor”

WVSMA Young Physician Section

Earlier this month, I was proud to help publish the first issue of the YPSgram, the newsletter of the Young Physician Section of the West Virginia State Medical Association. Here is a link to the newsletter titled: On Customer Service and the ‘Good’ Doctor

 

WV Medical Journal Guest Editorial- July August 2017

http://digital.graphcompubs.com/publication/?m=30875&l=1#{“issue_id”:419834,”page”:20}

Washing Your Hands

Adapted from BBC

Washing your hands- straightforward, or is it?

There’s plenty of evidence that washing one’s hands can reduce the spread of disease, only 5% of people wash their hands ‘properly’ ‘all the time’.

10% of 3000 people were witnessed leaving public toilets without washing their hands, and of those who did,33% didn’t use soap. While it is well established that we need to wash our hands properly, there are plenty of myths about what is proper.

Does the water need to be hot to get your hands clean?

In a survey of 500 adults, 69% believed that the temperature of the water has an impact on the effectiveness of hand-washing. Researchers found that water temperature made no statistically significant difference when other factors are controlled. Temperature still affects washing, though, because excessively cold or hot water lets people spend less time washing their hands than comfortable water temperature.

Is anti-bacterial hand wash better than soap?

A 2007 and a 2015 review both concluded that anti-bacterial hand washes  did not reduce the number of bacteria remaining on people’s hands after washing any more than soap did, nor was it any better than soap. Triclosan, a main ingredient on most antibacterial hand soaps, May increase anti-bacterial resistance and that and has been banned in the US and in the European Union.

Do you need to dry your hands afterwards?

Letting new hands air-dry is fine as long as he did not contaminated hands before they try out. Durkan’s transfer to your hands more easily if they’re wet.

Hand dryer or hand towel?

There’s a lot of debate surrounding this one. Most of us don’t want for as long as 45 minutes needed for the hands to dry using hand dry. New were hand dryers take 10 seconds hand and our equivalent to paper towels.

Making toilets nicer also makes a difference. One study observe 3,000 people in the US, found that if the toilets were clean and well-kept, people were more likely to stop and wash their hands properly. When the sinks were dirty, they just wanted to get out of there.

Whichever way you choose to wash and dry your hands, do it for longer than you think.

Hand and Upper Extremity Clinical Practice Guidelines

Presenting my findings on “Hand and Upper Extremity Clinical Practice Guidelines” at the Cleveland Clinic 16th Annual New Technology in Upper Extremity: The Cutting Edge, with Advancing Translational Research

Just received from the Evidence-Based Medicine Unit, American Academy of Orthopaedic Surgeons

“Congratulations on being nominated and selected for the Carpal Tunnel Syndrome Appropriate Use Criteria voting panel.”

No More Powdered Gloves

Adapted from Medscape

For several years, there has been a push to ban using powder in medical gloves. The US Food and Drug Administration (FDA) recently unveiled a proposal to ban powdered surgeons’ gloves and the absorbable powder lubricating them, as well as powdered gloves for patient examinations. Both synthetic gloves and those manufactured from natural rubber latex are covered.

Professional groups such as the American College of Surgeons, the American Academy of Allergy, Asthma and Immunology, and the American Nurses Association had already taken stands against powdered gloves. Government agencies such as the Centers for Disease Control and Prevention joined the chorus, as did the healthcare systems of Germany and the United Kingdom, as well as several healthcare organizations, such as Cleveland Clinic and Johns Hopkins, have either restricted or forbidden the use of these gloves.

Surgical gloves were first used in 1889, and soon, all sorts of lubricants were used to make them easier to don. Several studies has indicated respiratory complications.

 

 

Hospital Day at the Legislature 2016

The 2016 Hospital day at the Legislature was an opportunity to raise awareness to engage with the delegates, senators, and governor with regard to healthcare related matters. Several bills are under review with direct impact on hospitals and physicians. I had the chance to discuss and present input as a hospital advocate and a physician member of the WV State Medical Association.

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WV Governor, Earl Ray Tomblin

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Congress members Facemire, Romano, and Smith

2015 WV State Medical Association Healthcare Summit

The West Virginia State Medical Association Health Summit at the  Greenbrier Resort was memorable! I learned that there is a lot more to caring for patients than treating them.

I look forward to participate next year.
Source: 2015HealthcareSummitPhotos

Proposal for “WV Orthopedic Society Stance on Informed Consent” passed

During the WVOS board meeting today, past of the WV State Medical Association annual meeting, my proposal for “WVOS stance on Informed Consent” was approved by the Board.

Music and Surgery

Adapted from NRP

Music has always been suggested as a powerful tool to comfort patients recovery from surgery. The idea goes back to the days of Florence Nightingale. Music was used to ease surgical pain as early as 1914. Several studies have attempted to prove it, but those studies were small, and really didn’t find all that much.

Researchers in London started combing the medical literature for such studies and found hundreds of small studies suggesting some benefit. But once we put all the data together, they were able to find better evidence, that, yes indeed, surgery patients who listened to music, either before, during or after surgery, were reported less pain, less anxiety and more patient satisfaction.

On average, music helped the patients drop two points on the 10-point pain scale. That’s equal to pain relief reported with some pain medicines! And, unlike drugs,  music doesn’t seem to have side effects.

Struder Conference

The Struder Conference I attended end of last month covered medical leadership, hospital administration, and costumer service. It was one conference that was all about healthcare but none about medical care! It emphasized that there is a lot more about care than medicine; more to treating people well than prescriptions and injections. I left the conference the same medical doctor but a much better healthCARE provider.

Presenting at the WV Orthopedic Society Meeting

Title: written Informed Consent- Requirement or Interpretation?

Will A Transplanted Hand Feel Like One’s Own?

Adapted from National Public Radio

Hand transplants have been controversial for decades because, to prevent rejection, patients have to take powerful drugs that suppress the immune system and prevent it from attacking the transplant hand.

Until now, everyone who’s had a hand transplant got it because of an accident, or an illness. Would you request a transplant hand because of a birth defect?

The situation may be different, and Ethics specialist are looking into it.

Patients with birth defect had had lived their whole childhood with their defect and had adjusted well to it for the most part. Besides,  a hand transplant could end be a huge disappointment. The patient has to accept somebody else’s body part as their own, especially that the transplanted hand is visible, compared for heart and lung transplants. The first person to have hand transplant surgery couldn’t get used to having someone else’s hand; he ended up asking his doctors to remove it.

Besides no one knows whether the patient’s brain is even wired to use a new hand- there was never one on that side since before birth!

An apple a day does not keep the doctor away

Adapted from Becker’s Hospital Review.

The proverb “An apple a day keeps the doctor away,” dates back to the 1860s. (The Washington Post).

A recent study published in the April Fool’s issue of JAMA  found no significant difference regarding doctor’s visit between daily apple eaters compared to others.

Apple eaters were slightly more successful in avoiding prescription medications, suggesting the proverb should say, “An apple a day keeps the pharmacist away.”

Presenting at the Hand Surgery Specialty Day

Just presented: Pearls for Treating the Incarcerated- Can we Give Quality Care?

Patient Safety Awareness Week 2015

The National Patient Safety Foundation approaches patients and families to advance safety of patients as well as health care workforce, and promote strategies to prevent harm. This week is the Patient Safety Awareness Week for 2015.
One program targeted directly to patients is Ask Me 3, a patient education program whose goal is to improve communication between patients and health care providers, and encourage patients to become active members of their health care team. The program encourages patients to ask their health care providers three basic questions:

1. What is my main problem?

2. What do I need to do?

3. Why is it important for me to do this

Driving Safely Following Injury or Surgery

Adapted from NYTimes.com.

Driving is one of the many functions that we perform with little effort yet has a huge impact on our safety. It you think about it, though, you will notice  the many joints and muscles you must engage before you even start the car: fingers, wrist, elbow, shoulder, neck, head, ankle, knee, and hip.

Following injury or surgery, a natural question surfaces: When is it safe to resume driving?

The short answer is: There are no widely accepted timeline.

For patients who must wear casts, slings, neck collars or fracture boots, and for patients recovering from a sprain, fracture, or surgery,  the ability to steer, glance at mirrors and brake safely can be seriously impaired.

Immobilization of either arm in a splint or sling significantly impairs driving ability. Patients should not drive if the wrist, elbow, or shoulder are immobilized, be it  a cast, splint, sling, or an immobilizer.

Patients should not drive if they are in enough pain to impair their ability to steer or respond to sudden events while driving. Patients should also not be driving if they require narcotics for pain control as narcotics affect the patient’s ability to make proper and timely decisions, as well as execute them quickly.

A lot of studies focus on the ability to drive following lower extremity injury or surgery. They focus on how long it takes to make an emergency stop. Braking function returns to normal four weeks after right knee arthroscopy, nine weeks after surgery for an ankle fracture, and six weeks after the patient can walk unencumbered after a fracture of a major lower-body bone.

When the patient feels ready to resume driving, it’s best that to practice in a parking lot or low traffic area and determine how much comfortable he/she is to drive around other people. It is also a good advice to do resume driving in good weather and during daytime until the patient is comfortable handling emergent situations.

Unfortunately, many patients dismiss the advice and return to driving earlier than what is considered safe.

The International Orthopedic Surgery Fellow: The Beginning of the End

I am an international medical graduate (IMG) and I completed my  residency program outside the USA. The new fellowship eligibility requirement would have prevented me from pursuing fellowship training in the United States, and I would not have been practicing orthopedic surgery in the United States. For more details, check the original paper- The International Orthopedic Surgery Fellow: The Beginning of the End, published August 2014

E-cigs’ liquid nicotine causing poisonings – CNN.com

Adapted from CNN

As electronic cigarettes increase in popularity, calls to the nation’s poison control centers about exposure to the liquid nicotine used in many of the devices have surged. In February 2014, there were 215 poison center calls compared to one per month in September 2010. 51% of those calls involved children 5 and under. The total number of cases is likely even higher.

So far, E-cigarettes are not yet regulated by the FDA, and are not required to be childproof. They come in many different flavors like banana, candy and bubble gum, which make them appealing to children.

For this and other reasons, the FDA is starting to look into this. Last April, the agency proposed rules that call for strict regulation of electronic cigarettes, cigars, pipe tobacco, nicotine gels, water pipe tobacco and hookahs. Currently, only cigarettes, smokeless tobacco and roll-your-own tobacco come under the FDA’s regulatory authority.

FDA proposes first regulations for E-Cigarettes : News : CarolinaLive.com

http://www.carolinalive.com/m/news/story?id=1035346

FDA approves ‘rescue pen’ for painkiller overdose

Adapted from LA Times

LA Times - FDA approves 'rescue pen' aimed at curbing painkiller deaths

The Food and Drug Administration approved the sale, by prescription, of the pre-filled auto-injector of the drug naloxone that can reverse the effects of narcotics, which include prescription painkillers, such as Norco, Lortab, Percocet, OxyContin and Vicodin, as well as heroin.

Federal officials said they hoped a new “rescue pen” would help reduce the death toll from overdoses involving prescription painkillers.

Naloxone has been a workhorse drug in emergency departments battling the relentless rise in painkiller overdoses over the last decade.

A huge increase in the use of narcotic painkillers has been accompanied by a rise in addiction and overdoses, which are now responsible for more than 16,000 deaths each year. The surge in painkiller-involved overdoses has pushed drugs ahead of traffic accidents as a leading cause of death in the U.S. and prompted the U.S. Centers for Disease Control and Prevention to declare the problem an epidemic in 2011.

The rescue pen is part of a widespread campaign by public health officials, healthcare professionals and the pharmaceutical industry to find ways to promote the safe use of the drugs and reduce deaths.

A 2012 Times investigation of nearly 4,000 deaths involving prescription drugs in Southern California found that most victims overdosed at home, often with family members or friends nearby.

The rescue pen, to be marketed under the commercial name Evzio by the Richmond, Va., firm Kaleo Inc., is modeled on devices such as those that deliver epinephrine to patients with anaphylactic reactions, or insulin to diabetics.

The use of if is not without risks. Among the opioid-dependent patients, a shot of naloxone can prompt sudden and severe opioid withdrawal, which can cause nausea, vomiting, accelerated heart rate, increased blood pressure, seizures and cardiac arrest.

Anabolic Steroid: A High Price Tag

From In Motion: Active Living for All Ages

 

Anabolic Steroids

Anabolic Steroids: Performance Enhancing But at What Cost?

The temptations of winning and of becoming bigger and stronger can be quite powerful. Performance enhancing drugs, especially anabolic steroids, have become widespread, including usage by non-athletes who want to improve their physical appearance. Younger athletes see their role models using these substances, only adding to their appeal. Unfortunately, anabolic steroids have potentially dangerous and permanent side effects…. Complete Article.

Supplements for Joint Pain?

Adapted from New York Times

People have wildly conflicting opinions about the benefits of nutritional suppliments marketed for joint health. These include glucosamine, chondroitin, and MSM, short for methylsulfonylmethane. Vendors promise they lessen creaking and soreness of knees, backs, hips and other joints.

The results of scientific studies of the supplements are equivocal. In the largest study to date, published in 2006, more than 1,500 adults with knee osteoarthritis were randomly assigned to receive glucosamine, a painkiller or a placebo. After 24 weeks, only those participants taking the painkiller reported less knee pain. Glucosamine was no more effective than a placebo.

Two years later, 600 of the participants had continued to take glucosamine, painkillers or a placebo. There still was no obvious benefit from the glucosamine.

Oral suppliments are very different from viscosupplimentation, which is the scientific name for joint injections of similar nature to joint fluid. Those, although sometimes disputed, have a well documented record, and may help when other treatments, including steroids injections, have failed.

When asked about joint suppliments, I tell people that if they have already tried them and found some relief, it is OK to continue. I do not actively recommend nor suggest them to patients. The only serious side effects that I know of is spending money!

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