Archive for December, 2008

My head is killing me…

December 16, 2008

migraineHeadache is a common presenting symptom to the primary care office.  When accompanied by nausea or photophobia the headache is classified as a migraine.  For acute migrane abortion, I have used any antinausea medication — usually promethazine.  This is a habit I will soon break.  Last month Journal of Emergency Medicine reported a randomized control trial of prochlorperazine vs promethazine.  The results are convincing — prochlorperazine just blows promethazine out of the water (69% to 39%). It also had less sedating (H1) effect and then next day people felt less groggy.  Now the knock in prochlorperazine in the past was akathisia.  However if you remember your physiology, when your patient shows up with a bit of a parkinsonian-like tremor — just add a little (H1 blocker) like Benadryl.  It can even be oral.  But don’t take my word for it…look at the analysis yourself.

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Circumcision, Circumcision, Circumcision

December 8, 2008

circumcisionScore one for the descendants of Abraham, a new study of men in Africa concluded that circumcision reduced the HIV rate by 50-60% in heterosexual males.  Importantly it didn’t reduce the male to female transmission rate, but in addition to condoms or abstinence – circumcision has proven to be the only method to slow HIV infection rates.

Researchers hypothesize the HIV virus lives in the foreskin mucosa.  UNAIDS and the WHO have set up a joint website promoting the benefits www.malecircumcision.org.  Other effects include reduced transmission rates of syphillis, chancroid, HPV, and herpies simplex.

Resident work hours.

December 3, 2008

December 2 was the fifth anniverery of the 80-hour work week implemented by the ACGME in 2003.  Now the Institute of Medicine released the update on the findings.  They recommend further work restrictions, however they come with a cost of 1.7 billion dollars.  They say that residents are still too fatigued.  resident-work-suggestions

I’m not sure about these recommendations.  Of course they would need to be implimented by the ACGME to have any teeth, but I don’t think residencies will survive  with further restrictions.  One change might come to the residency I am in — night float.  We currently have a call system, but I am in favor of the night float system because I think it will reduce the 30 hours calls.

Abortion numbers

December 3, 2008

abortions

The CDC keeps track of many statistics, including the number of abortions preformed each year.  The article highlights the most recent data (from 2005).  Personally I hope that we can find ways to reduce the number of abortions, but this is a complex social problem requiring caring people, resources and information to the mother to allow her to make the best choice for her and family.