Blood Management Summit and App - Transfuse 2012

Announcement: Blood Management Summit - Transfuse 2012 will be held on April 19-20, 2012 at the JW Marriott in Scottsdale, Arizona.

This conference has been developed with collaboration between Mayo Clinic and Hartford Hospital, building upon the success of three previous national conferences. "Transfuse 2012" is a unique multi-disciplinary conference focused on exploring the current state-of-the-art techniques and programs to reduce allogeneic blood utilization in hospitals. This international conference will feature national and international blood management experts from China, New Zealand and Australia along with a unique iPad app launch and one-of-a-kind hands-on animal lab.

Mayo Clinic's Mark H. Ereth, M.D. introduces the conference and the iPad app in this 3-minute video:



This conference is designed for all physicians, including surgeons and anesthesiologists, perfusionists, nurses and leaders in quality and patient safety. The conference is a CME accredited activity for physicians, nurses and perfusionists.

The Conference Website is: http://www.mayo.edu/cme/anesthesiology-2012r780

One of the course directors is Dr. Ajay Kumar, Chief of Division of Hospital Medicine at Hartford Hospital, and a good friend of mine. Another friend from the time I worked at Cleveland Clinic is also on faculty, Dr. Moises Auron.

It should be a great conference. Go check it out.

Oral factor Xa inhibitor apixaban - more effective than enoxaparin for thromboprophylaxis after knee replacement

Low-molecular-weight heparins such as enoxaparin are preferred for prevention of venous thromboembolism after major joint replacement. Apixaban, an orally active factor Xa inhibitor, might be as effective, have lower bleeding risk, and be easier to use than is enoxaparin.

The primary outcome in this Lancet study was the composite of asymptomatic and symptomatic deep vein thrombosis (DVT), non-fatal pulmonary embolism (PE), and all-cause death during treatment. The primary outcome was reported in 15% of apixaban patients and 24% of enoxaparin patients (relative risk 0·62), absolute risk reduction 9·3%.

Major or clinically relevant non-major bleeding occurred in 4% of patients receiving apixaban and 5% of treated with enoxaparin.

The authors concluded that apixaban 2·5 mg twice daily, starting on the morning after total knee replacement, offers a convenient and more effective orally administered alternative to 40 mg per day enoxaparin, without increased bleeding.

References:

Apixaban versus enoxaparin for thromboprophylaxis after knee replacement (ADVANCE-2): a randomised double-blind trial. The Lancet, Volume 375, Issue 9717, Pages 807 - 815, 6 March 2010.

Image source: Apixaban, Wikipedia, public domain.

Eradication of nasal colonization with S. aureus associated with a decrease in postoperative surgical-site infections

Nasal carriers of Staphylococcus aureus are at increased risk for health care–associated infections with this organism.

Eradication of colonization with S. aureus by screening at admission and subsequent decolonization (with intranasal mupirocin and chlorhexidine skin washes) were associated with a decrease in postoperative surgical-site infections.

In a randomized, double-blind, placebo-controlled trial, S. aureus nasal carriers were treated with mupirocin nasal ointment and chlorhexidine soap.

A total of 6771 patients were screened on admission, 1270 nasal swabs from 1251 patients were positive for S. aureus. All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin.

The rate of S. aureus infection was 3.4% in the mupirocin–chlorhexidine group, as compared with 7.7% in the placebo group (relative risk of infection, 0.42). The effect of mupirocin–chlorhexidine treatment was most pronounced for deep surgical-site infections (relative risk, 0.21).

References:

Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus. NEJM, 1/2009.
GIANTmicrobes in Toys & Games section of Amazon.com http://goo.gl/gMrf

Anesthesia 2.0: Web 2.0 in anesthesia education

Educators in all specialties of medicine are increasingly studying Web 2.0 technologies to maximize postgraduate medical education.

Web 2.0 technologies include:

- microblogging
- blogs
- really simple syndication (RSS) feeds
- podcasts
- wikis
- social bookmarking and networking

Although direct practice and observation in the operating room are essential, Web 2.0 technologies hold promise to innovate anesthesia education and clinical practice such that the resident learner need not be in a classroom for a didactic talk, or even in the operating room to see how an arterial line is properly placed.

Web 2.0 and advanced informatics resources will be part of physician lifelong learning and clinical practice.

References:
Anesthesia 2.0: Internet-based information resources and Web 2.0 applications in anesthesia education. Chu LF, Young C, Zamora A, Kurup V, Macario A. Curr Opin Anaesthesiol. 2010 Jan 19. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/20090518

Image source: Wikipedia.

The 2010 Annual Perioperative Medicine Summit Starts Today

The annual Perioperative Medicine Summit 2010 starts on March 4 in Miami:

http://periopmedicine.org and @PeriopSummit

I maintain their website for the University of Miami and Cleveland Clinic, and help with the Twitter account, hosting of PDF handouts, videos, etc.

Dr. Jaffer, Chief of Division of Hospital Medicine and Summit Director will text his own tweets at http://twitter.com/PeriopSummit

Expect multiple free handouts posted on the front page of the summit website during March 4-6, 2010 and clinical pearls and discussions on Twitter: http://periopmedicine.org and @PeriopSummit

Program and Abstracts of the 5th Annual Perioperative Medicine Summit 2010

Summit Brochure



Summary

Dr. Amir K. Jaffer and Dr. Franklin Michota, the founding Summit Directors, in collaboration with Dr. David Hepner, will direct the 5th Annual Perioperative Medicine Summit in Miami, Florida.

The course is co-sponsored by the University of Miami Miller School of Medicine and the Cleveland Clinic in collaboration with the Society for Perioperative Assessment and Quality Improvement (SPAQI).

The goal of the Summit is to enable clinicians who are actively engaged in perioperative medical care to incorporate the latest findings from clinical research into their practices so that they can improve the quality and safety of their medical care.

Map of the Meeting Location


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Map of Eden Roc Resort

Perioperative Practice: Time to Throttle Back?

From the Annals of Internal Medicine:

The United States spends more on health care than other nations, yet our health outcomes remain inferior to those of many countries.

Many "accepted" perioperative practices conflict with the evidence, for example:

- Routine perioperative stress testing provides no diagnostic yield in patients at low risk for cardiac events
- Indiscriminate perioperative therapy with β-blockers can increase mortality in otherwise stable patients

Perioperative tests and treatments improve outcomes only when targeted at specific patient subsets. Implementation of the American College of Cardiology/American Heart Association perioperative guidelines ensures cost-effective management and promises the greatest benefit for patients.

References:
Perioperative Practice: Time to Throttle Back. Chopra, V., Flanders, S. A., Froehlich, J. B., Lau, W. C., Eagle, K. A. Ann of Int Med, 2009.
Image source: Wikipedia, public domain.