Faculty Bibliography

10th Anniversary Congress on Women's Health & Gender-Based Medicine, May 18-21, 2002, ... Hilton Head, SC

There is an obvious need to measure low-density lipoprotein cholesterol in all patients with acute myocardial infarction and coronary artery disease. The recent guidelines of the National Cholesterol Education Program have established the desired level for low-density lipoprotein cholesterol for such patients at <100 mg/dL. However, several studies have demonstrated a lack of low-density lipoprotein cholesterol measurement and lipid-lowering therapy with statins in patients with acute myocardial infarction and coronary artery disease. These findings point to a need for quality of care improvement efforts to foster both lipid measurement and statin use in such patients. Many studies have demonstrated the numerous beneficial effects of statin use. In addition to lipid lowering, these include plaque stability and ant platelet, ant macrophage, and antiatherothrombotic activities as well as enhanced endothelial activity. As a class of drugs, the statins have been shown to offer significant benefits with little in the way of associated risks

Because the vaccine has never been used to prevent anthrax after people have been exposed to spores, its effectiveness in such circumstances is unknown and it is classified as experimental. The Centers for Disease Control and Prevention had to receive permission from the Food and Drug Administration to test this use of the vaccine. Recipients must sign a five-page form that explains the experimental nature of the use and states that they should not consider the vaccine a treatment for anthrax. In the case of anthrax, if workers do not take antibiotics beyond 60 days, with or without a vaccine, they face a small theoretical risk that they could still get the disease. But taking either antibiotics or the vaccine also poses risks. And the F.D.A. has not approved the use of any antibiotic for longer than 60 days for anthrax. Earlier this month, the F.D.A. allowed the disease centers to vaccinate workers after exposure to spores. The C.D.C. bought 220,000 doses of anthrax vaccine from the military. On Dec. 15, the disease centers hastily convened a forum at the National Academy of Sciences in Washington to review information about anthrax vaccine and its possible use in exposed workers

In addition to saying the surgical site should be marked, the commission made these two other recommendations: In the operating room before starting surgery, all members of the surgical team should confirm that they have the correct patient, surgical site and procedure. The operating room team should take 'a timeout' to check medical records and X-rays, discuss among themselves what they are about to do, and corroborate information with the patient. Other types of surgical mishaps also occur. Earlier this month in Seattle, the University of Washington accepted responsibility when one of its surgical teams left a 13-inch instrument in a patient after removing a large cancer from his abdomen. [David Byrd], who was on vacation, immediately called [Donald Church] to deliver the bad news, apologize and offer free corrective surgery, Church said. Instead, Church went to another hospital where a surgeon, who happened to have been a former student of Byrd's, removed it

Participants like Dr. Ross Brechner of the Maryland State Health Department said defining a big outbreak was difficult. One hundred cases could be a big one, ''but 1,000 would be a monster,'' Dr. Brechner said. The items include rugs, sets of china, jewelry, hundreds of envelopes, even wads of hundred-dollar bills, said two health officials, Dr. James Pearson of the Virginia Division of Consolidated Laboratory Services in Richmond and Elizabeth Franko, director of the Georgia Department of Health Laboratory. In the investigation, the C.D.C. collected blood from patients and people exposed to spores, to validate whether blood tests could help in detecting anthrax infection. For such testing, blood has to be collected at intervals of at least two weeks

Traditionally, the agency has deferred to state and local health officials to disclose health information. But that strategy was not effective in the recent anthrax attacks. As cases were detected in several states, there was a critical lack of a national voice to prevent confusion, said Dr. John Agwunobi, the Florida secretary of health. State health officials also praised the disease control centers for providing their expertise on anthrax. One Postal Service official, Suzanne Medvidovich, senior vice president for human resources, praised the agency's experts for their willingness to make decisions and for their availability to inform workers about anthrax. During the outbreak, medical investigators were trying to gather data and conduct tests like nasal swabs and blood tests to see if they might be effective in detecting anthrax, Dr. Agwunobi said, although their usefulness had not been proved

No new case of anthrax has been reported since Otillie Lundgren, 94, of Oxford, Conn., developed a fatal case in mid-November. But, [James M. Hughes] said, whoever spread the anthrax 'has a dangerous weapon and a willingness to use it, so we have to maintain vigilance and be prepared to detect additional cases.'

Dr. Arnold Kaufmann, who has investigated anthrax at the disease centers, said that studies were needed to determine whether adding a second bacteria, even one that usually did not cause illness, to Bacillus anthracis in a bacterial cocktail could create a more severe disease than anthrax, and thus an even more dangerous weapon. The little experience American doctors have had with anthrax involved cases in mills and tanneries that imported goat hair and animal hides contaminated with Bacillus anthracis. Many mill workers were known to have been exposed to spores small enough (less than 5 microns) to pass into the air sacs of the lungs and produce inhalation anthrax. But scientists do not know why so many workers who were exposed to large numbers of spores every day did not become ill. Perhaps continuous exposure led to some type of immunity, participants said. Dr. Philip S. Brachman, an epidemiologist at Emory University who investigated anthrax cases for the disease centers from the late 1950's to the 1970's, said the presence of any anthrax spores ''in an office environment is dangerous.''

Because the first alert failed to stop the errors, Dr. Dennis S. O'Leary, the commission's president, said his organization tried ''a different tack, this time directed at patients,'' urging them to demand that their surgeons mark the surgical site before going to the operating room. Or, Dr. O'Leary said, patients should do it themselves. In addition to saying the surgical site should be marked, the commission made these two other recommendations: In the operating room before starting surgery, all members of the surgical team should confirm that they have the correct patient, surgical site and procedure. And the operating room team should take ''a timeout'' to check medical records and X-rays, discuss among themselves what they are about to do, and corroborate information with the patient. If Dr. O'Leary's public appeal fails to stop wrong-site surgery, he said he expected that his certifying organization would require hospitals to document the steps its staff took to pen initials and talk to patients before surgery. Any violations detected in an unannounced spot check would jeopardize a hospital's accreditation, Dr. O'Leary said