Archive for September 17th, 2008

McCain’s Gaffe

September 17th, 2008 | No Comments | Source: Washington Post

Already this year we’ve seen meltdowns in the housing and mortgage markets, skyrocketing foreclosure rates, the collapse of major investment banks and federal bailouts of Fannie Mae, Freddie Mac and AIG. And it’s only September!

Into these headwinds, John McCain spits “the fundamentals of our economy are strong!” It seems everybody but Top Gun knows what happens when you spit into the wind.

The crises have devastated millions of US households. 86% of those polled by ABC News last week said the economy was “not good.” GDP growth, anemic as it has been, is artificially propped by last spring’s one-time fiscal stimulus.

Now, unemployment is starting to accelerate. There are worrisome declines in retail and automotive sales, and there’s more debt out there than people can count.

Maybe Top Gun means we won’t crash and burn like the Great Depression? That’s true because modern economic shock absorbers do work. The recent surge in commodity prices helped US mining and agriculture interests, for example. The weakening dollar contributed to a hike in exports. Now these trends have faded and inflation worries have faded with them.

Maybe we’re not headed towards Great Depression II, but it’s time for some real Straight Talk from McCain: if current policies continue, we’re looking at years of little or no growth at best.

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Ring Out the New, Ring In the Old

September 17th, 2008 | No Comments | Source: NY Times

A study published in today’s American Journal of Psychiatry concludes that when it comes to treating schizophrenia in children, older, less expensive antipsychotic drugs are just as effective as the new ones and they don’t cause certain side effects.

Investigators carried out a multicenter, double-blinded, randomized trial of 119 youth with psychotic symptoms. The children received either Zyprexa (Eli Lilly), Risperdal (Janssen) or molindone, an older drug. The primary outcome was response to treatment at 8 weeks as judged using standard assessment tools.

They saw improvement in 34% of the Zyprexa group, 46% of the Risperdal group, and 50% of the molindone group. These differences were not significant.

Importantly, youths receiving the new drugs experienced marked weight gain-13 pounds in the Zyprexa group and 9 pounds in the Risperdal group. The Zyprexa group also had increased total cholesterol, LDL (bad) cholesterol, and liver enzymes. These changes were not seen in the molindone group, although as expected many of them experienced disordered movement.

(more…)

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Lap Choly and the 80h Workweek

September 17th, 2008 | No Comments | Source: WSJ Health Blog

Ever since surgical resident workweeks started getting shaved (it’s now 80 hours), there has been debate about how the change impacts quality in teaching hospitals. Proponents of the shorter workweek believe less fatigued residents make less errors. Skeptics fear that frequent shift changes increase the risk of errors in information transfer.

To date, studies of the matter have failed to silence the debate one way or the other.

The same can be said of the latest study of laporoscopic cholecystectomy in the era of the 80 hour workweek. The problem isn’t its finding that quality improved after the workweek became shorter, but that it’s not possible to attribute the improvement to residents sleeping more.

Using a retrospective trial design, the investigators compared complication rates at their hospital before and after the change to an 80 hour workweek. After accounting for age, gender and presence of acute cholecystitis, they found that the incidence of bile duct injury and total complications was lower after the rule change.

But why?  It may be that rested residents make all the difference. But it also could be that attending physician supervisors got more involved for whatever reason, or that the manpower alteration caused risky patients (where complications are most likely) to get procedures other than laporoscopic cholecystectomy.

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