The pharmaceutical industry certainly got off easier this week (see last week’s shortcuts) and the New York Times focused instead on the “industrialization” of the art of medicine. A hospital group in central Pennsylvania is offering insurers and patients bypass surgery for a flat fee with a 90 day guarantee. They’ve put 40 measures in place to make sure patients receive evidenced based care. If the any of the 40 measure are not met prior to the surgery it is cancelled until the measure is met. It’s a fascinating study of modern medicine taking some tips from the manufacturing industry.
How often do we really see atypical pathogens when we treat a patient with a community acquired pneumonia? An article in this months American Journal of Respiratory and Critical Care Medicine attempts to answer this question. Mycoplasma pneumoniae (12%), Chlamydia pneumoniae (7%) and Legionella pneumophila (5%) were identified as pathogens during a multinational industry sponsored study of antibiotics for community acquired pneumonia. Overall, atypicals were identified in 22% of cases in North America. They also found that 91% of patients in North America receive coverage for atypicals when treated for community acquired pneumonia. After adjustment, they were also able to show that covering for atypicals resulted in improved outcomes. Thus we should all feel a little better about adding the atypical coverage when appropriate.
There was more good news about the HPV vaccine which has certainly seen it’s share of controversies. Lancet’s lead article (http://sfx.med.nyu.edu/sfxlcl3?genre=article&id=pmid:17387782 &_char_set=utf8) showed that prophylactic administration of Gardisil was effective in preventing high-grade vulval and vaginal lesions associated with HPV16 or HPV18 infection in women who were naive to these types before vaccination. The May 10th New England Journal of Medicine had 3 articles discussing the vaccine to be effective in preventing high grade cervical lesions and anogenital diseases in women. In a companion piece, HPV was found to be associated with oropharyngeal cancer among subjects with or without the established risk factors of tobacco and alcohol use.
This week’s Annals reminds us about the effectiveness of AAA screening in male smokers between the ages of 65-75. Doing a cost effective analysis the authors conclude that AAA screening costs $19,500/life year saved when looking at AAA mortality and $7600/life year saved when looking at all cause mortality.
Finally, in a story that got picked up by just about every media outlet, a high school student investigated whether Ipods had any effect on pacemakers. He presented his results at the Heart Rhythm Society 2007 Scientific Sessions. His findings from 100 patients: 13% showed oversensing events, 37% showed some interference and there was 1 instance of pacing inhibition. So be careful kids the next time your grandfather wants to pick you up, make sure you first turn off that damn music…The Heart.org Link
-Neil Shapiro, MD Editor-in Chief NYU Clinical Correlations
Image of a footbridge in Sri Lanka, courtesy Anuradha Ratnaweera, Wikimedia Commons