Cast & Curious

Tag: Medicine

  • Praying before undergoing a heart surgery?Think again.

    Okay, this one really is stretching man’s EBM-ish about any form of health care treatment. Trying to determine if prayer is a factor for patient’s recovery is one very interesting study to make, even on patients undergoing heart surgery! Here’s the abstract of one such study taken from American Heart Journal.

    Am Heart J. 2006 Apr;151(4):934-42. Click here to read Links

    Study of the Therapeutic Effects of Intercessory Prayer (STEP) in cardiac bypass patients: a multicenter randomized trial of uncertainty and certainty of receiving intercessory prayer.
    Benson H, Dusek JA, Sherwood JB, Lam P, Bethea CF, Carpenter W, Levitsky S, Hill PC, Clem DW Jr, Jain MK, Drumel D, Kopecky SL, Mueller PS, Marek D, Rollins S, Hibberd PL.

    Mind/Body Medical Institute, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. hbenson@bidmc.harvard.edu

    BACKGROUND: Intercessory prayer is widely believed to influence recovery from illness, but claims of benefits are not supported by well-controlled clinical trials. Prior studies have not addressed whether prayer itself or knowledge/certainty that prayer is being provided may influence outcome. We evaluated whether (1) receiving intercessory prayer or (2) being certain of receiving intercessory prayer was associated with uncomplicated recovery after coronary artery bypass graft (CABG) surgery.

    METHODS: Patients at 6 US hospitals were randomly assigned to 1 of 3 groups: 604 received intercessory prayer after being informed that they may or may not receive prayer; 597 did not receive intercessory prayer also after being informed that they may or may not receive prayer; and 601 received intercessory prayer after being informed they would receive prayer. Intercessory prayer was provided for 14 days, starting the night before CABG. The primary outcome was presence of any complication within 30 days of CABG. Secondary outcomes were any major event and mortality. RESULTS: In the 2 groups uncertain about receiving intercessory prayer, complications occurred in 52% (315/604) of patients who received intercessory prayer versus 51% (304/597) of those who did not (relative risk 1.02, 95% CI 0.92-1.15). Complications occurred in 59% (352/601) of patients certain of receiving intercessory prayer compared with the 52% (315/604) of those uncertain of receiving intercessory prayer (relative risk 1.14, 95% CI 1.02-1.28). Major events and 30-day mortality were similar across the 3 groups.

    CONCLUSIONS: Intercessory prayer itself had no effect on complication-free recovery from CABG, but certainty of receiving intercessory prayer was associated with a higher incidence of complications.

    Take note of their conclusions. In a predominantly catholic country like ours, I think our bishops would not be very happy with this. Unless they come up with another similar randomized multicenter study disproving this same results!

    Uh what the!

  • 3G iPhone and what physicians can do with this gadget

    I’m not about as techie doc as anyone here, but for those physicians ogling for the new 3G iPhone, here’s what you can possibly do with this gadget according to Dean Giustini, at Open Medicine Blog

    1. Listen to medical podcasts or videocasts;
    2. View patient charts;
    3. Search PubMed; Google scholar; the web
    4. Phone 911 for emergencies; ‘code’ response in hospitals;
    5. Monitor patients; using PocketTweets (Twitter for your iPhone)

    Here’s the big list (Grand Rounds Vol 4 number 40) of what physicians can do (or not do) with 3G iPhone and medical softwares for it compiled by Dr. Penna!

    All seem to be dependent on the availability of highspeed, reliable, uninterrupted net service and access to an electronic healthcare database in the hospitals. None of these two however is within a mile of my practice.

    The recent introduction of Apple‘s newest baby to the Philippine market (via Globe Telecom), purportedly half the original price, made me think my Nokia 7250 and Palm Pilot is prehistoric. On second thought, Mr. Gunn, made a comment in this same article that struck me more stupid than dumb. Or was I?

    Read here!

  • Ensuring e-mail security in clinical practice

    Tired of deleting spam on your email’s inbox? That’s nothing compared to what happens when confidential information is “fished” out from those email messages sent over the net!

    No one is more horrified of this than physicians who use emails to send confidential information across the net. Yes, losing confidential information tru e-mail is as devastating as losing patients. Or worse, losing our careers.

    That is what Dr. David Kreindler is trying to avoid when he wrote this article “Email security in clinical practice: ensuring patient confidentiality” published in Open Medicine Vol 2 No 2 2008.

    And since it is impossible to strip the email of confidential personal (or patient’s) information (the primary reason your sending that email in the first place) he gave a step by step advice on how to thwart email piracy and help keep email information secure with an encryption software.

    Read his article here!

    One commenter disagreed though and thought email privacy is overblown! And he has a point. But I’m not just about to “lay away” my emails out in the open net without some form of security. On the overall, this is just one component of a security policy aimed at reducing confidential information phishing and making it hard for spammers to get into my inbox!

    (It is just ironic too, that Dr. Kreindler published his email, openly in that article, and with a link too, which is actually a mine for email harvesters!)

  • Wrong side of surgery: Which site?

    Although rare, wrong site surgery happens even to the most able and busy OR team such as in this hospital. Imagine the horror of both the OR team and the patient discovering the closure stitches in the normal side after the procedure. But thats another story.

    What I’m a bit surprised is how the hospital administration managed to “rectify” the error and came out with better policies to prevent future incidents like this to happen. Their CEO even blogged about it, so the whole community would know about the lapses, the steps taken to correct it, and prevent further “errors” to happen in the same way.

    I can help but wonder if most of our health institutions here in our country have the same attitude towards wrong site surgery and medical errors. A universal protocol for wrong site surgery has been existing and updated regularly for quite sometime already. The American Academy of Orthopedic Surgeons (AAOS) also had its recommendations to reduce surgical sites error in orthopedics. Most of the stories I hear in our country from the gossip tree end up in long, expensive court duels. And even with the pay off, none of the parties learned anything (but money and pride) from the mistakes which should have been preventable in the first place!

    Not to be over simplistic about this but parallelisms can be drawn between mistakes like this one and that of mistakes done on people you care of. Admission is a braved act. Facing the consequences is an even braver act. But taking actions to prevent such errors from happening is a mark of a true caring physician. That is how we deal with people we care. To us physicians, that would be our patients.

  • Sex in the Clinics (Doctor’s Cut)

    Nope, it’s not what you think! But The Blog Rounds Fifteen Edition will tackle gender sensitive issues in medicine, on being a physician and on one’s specialty!

    Head on to Manggy‘s blog, No Special Effects, host to this interesting round of blog posts, to get a clear idea of what I’m talking about. His call for articles is already up here.

    For those unaware yet, The Blog Rounds is a biweekly compilation of the best in Philippine’s medical blogosphere, written by physician bloggers (or medically inclined bloggers) and hosted on a participating blogger’s weblog. Archives and edition schedules ( plus the host blogger) are listed here. The next edition of TBR will be up this Tuesday, July 8, 2008 7am PST.

    Physicians and medically inclined bloggers interested in joining this blog carnival, please contact me through my email kokegulper[at]yahoo[dot]com or any of the participating TBR bloggers. Guidelines and updates are posted here in my website, The Orthopedic Logbook.