FOR SOME, TOO MUCH TO DRINK ISN’T ENOUGH.

"How many times in the past year have you had X or more drinks in a day?" A study in the Journal of General Internal Medicine found that this single screening question, which is recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), accurately identifies patients with an unhealthy use of alcohol. With males the X factor is five, with females it is four, and if the response is more than one time per year, 82% were found to have a drinking problem. The point is simply that in the primary care medical office this diagnosis is often missed, and including this question could be very useful as well as save time.

OOPS! NURSE, DID THIS PATIENT SIGN THE ORGAN DONATION CARD?

By reviewing the records of more than 5,000 randomly selected patients ages 50 to 69 years in 23 primary care practices scattered in the midwest and west coast, investigators found a shocking failure to report abnormal test results of one in fourteen events. This study from Weill Cornell Medical College appeared in a recent Archives of Internal Medicine and should get the attention of everybody in the active practice of medicine. The reports included ultra-sound, x-ray, blood chemistries, mammography, biopsies, etc., and sometimes included failure to report cancer findings. One office actually missed informing 26% of their patients with test results. Interestingly, practices with electronic records systems fared no better than those with paper systems. Failure to communicate such reports is a malpractice threat of major proportions.

POUR ME A DOUBLE CAFFEINE MOCHA LATTE TO GO, PLEASE

The January 2009 Journal of Alzheimer’s Disease reported a study out of Helsinki, Finland, where researchers looked at the medical records of 1409 patients over a period in excess of two decades. It was found that those who drank four or five cups of coffee each day during mid-life were much less likely to develop Alzheimer’s or other dementia than those who eschewed the caffeinated beverage. Data were collected at five year intervals beginning in 1972 when average participant age was 50. Findings at ages 65 to 79 showed that heavy coffee drinkers (five + cups/day) had the highest level of cholesterol and highest rate of tobacco use, but were 65% less likely to have dementia than those who drank little or no coffee. Moderate coffee consumers at three or four cups/day appeared to have nearly 70% less dementia. Non-coffee drinkers not only showed higher rates of mental deterioration, but also scored higher for depression. Tea drinking was included in the study, but appeared to have no effect. Interesting to note that other studies have found that coffee drinkers performed better on cognitive testing and have less risk of Parkinsonism.

EVENTS ARE JUST MORE ANNOYING WHEN YOU ARE STERILE INSTEAD OF VIRILE.

Every year an estimated one-third of older adults take a tumble. In 2005, 15,802 persons age 65 and beyond died as a result of injuries sustained from a fall. CDC surveyed and analyzed data from their 2006 Behavior Risk Factor Surveillance System (BRFSS). The report indicated that approximately 5.8 million adults over age 65 had fallen at least once in the preceding three months. 31% of those who fell required a doctor’s visit or restricted activity for at least one day. The gender frequency was nearly the same with women at 15% and men at 16%, but women at 35.7% reported significantly more injuries than men 24.6%. No analysis was attempted of risky activity, or osteoperosis, or ancillary physical conditions. Once again Hawaii proves a safer place to live with the lowest fall rate at 12.8% of respondents while Vermont had the highest report at 20.1%.

EVEN IF YOU ARE ON THE RIGHT TRACK YOU CAN STILL GET RUN OVER.

The administration’s American Recovery and Reinvestment Act of 2009 provides incentives for health care providers who demonstrate use of EHR (electronic health records). Supposedly, qualifying physicians will be eligible for additional Medicare payments of as much as $44,000 over a five year course. Problems however, are that there are no provisions in the package to cover the out-of-pocket cost of adopting EHR, and the bill would dock Medicare pay for physicians who fail to use EHR by 2015. Penalties would begin at 1% of Medicare fee schedule and increase each year to a maximum of 5%. The Health IT (information technology) Policy Committee, the advisory group charged with defining principles, has just released its first draft recommendation to CMS (Centers for Medicare and Medicaid Services), and it is not known what type of system will qualify for incentives. A basic EHR package may be obsolete in the near future.

YOU WERE WRONG, MOM. CHEATERS DO PROSPER.

Baseball owners and administrators want to rid the sport of the abiding specter of steroid use which has corrupted the sport. The current program includes a lifetime ban for players who test positive for steroids on three occasions. The weakness in that policy is that research at Umea University in Sweden established that the muscle changes from steroid use remain even after the drug is discontinued. The study affirmed something a handful of scientists, athletes and strength coaches have long believed that steroids change you forever. Citing the data collected in Senator Mitchell’s report on the 52 hitters who admitted using steroids, there was a 5.4% improvement in OPS (on base percentage plus slugging) from ages 28 to 34. If baseball truly wanted to clean up the steroid problem they would impose a lifetime ban on every athlete who tested positive even once – a highly unlikely event. An added bonus for the cheating athlete is a longer professional career when compared with the non-user. Still, the overall effect on life expectancy and other organ systems remains unanswered.

THE SKIES ARE NOT ALWAYS SO FRIENDLY.

The Obama presidency almost didn’t happen. Recent information released by the National Transportation Safety Board (NTSB) related an emergency situation in Barack Obama’s campaign plane in July 2008. Shortly after take-off, the pilot was aware of powerful pressure forcing the nose of the Boeing MD-81 up. By applying heavy stick force and trim, the flight officers were able to keep the aircraft from stalling – a potentially catastrophic event. At the time the FAA (Federal Aviation Administration) stated that there was no emergency and the flight was never in peril, but cockpit tapes recorded the captain declaring an emergency to air traffic controllers and requesting the longest runway at Lambert-St. Louis International Airport. Improper storage of the tail cone ladder and slide are believed to have restricted the elevator cables which run the length of the aircraft. The captain nursed the plane to the ground without incident and everyone walked away. He is no less a hero than the US Air pilot who successfully debarked his passengers in the Hudson River.

THE BIG DIFFERENCE OF SEX FOR MONEY AND SEX FOR FREE IS THAT SEX FOR MONEY IS USUALLY A LOT CHEAPER.

The Journal of Sexual Medicine conducted a survey of 33 qualified Canadian and U.S. sex therapists and found some parameters for "good sex." Two minutes is not sufficient, three minutes may be adequate, but most satisfying time seems to be about seven to thirteen minutes. Thirty minutes is too long, and marathon or prolonged all night stuff of the entertainment industry is absurd. All therapists agree that couples should not keep a stopwatch in the bedroom, and 25% of therapists said there is no such thing as normalcy for sexual pleasure.

DIDN’T I TELL YOU TO TURN OFF THE BURNER?

The crew of firefighters at the Waipahu station responded quickly to provide assistance and direction at the scene of an automobile crash. As they were wrapping up at the collision site, another emergency call came in. Holy Zippo!! The second call was for a fire at their own firehouse! Apparently the first call came in at meal time and when the team responded no one remembered to turn off the range. Damage estimate – $25,000.

ADDENDA –

Aloha, and keep the faith. ----------rts

Contents of this Newsletter do not necessarily reflect the opinion, policy or position of the Hawaii Ophthalmology Society or the Hawaii Medical Association. Editorial comment is strictly that of the writer