US Lacrosse, the lacrosse governing body, set out a few years ago to reduce eye injuries among female players one of the fastest growing sports in the country. And a new study appears to show the effort was successful.

Protective eyewear was mandated at the youth, scholastic and collegiate levels in 2005. The study, funded by US Lacrosse and published in the American Journal of Sports Medicine, shows that the rate of eye injury of injury dropped from .1 injuries per 1,000 athlete exposures in 2000-2003 to .016 in 2004-2009.

Head/face injuries also decreased and there was no change in overall body injuries, showing that players likely didn’t become more aggressive after the eyewear mandate. Concussions went up, but researchers believe that was because of increased awareness and diagnosis in more recent years.

“The findings suggest the mandated protective eyewear in girls’ lacrosse achieved the desired goals of reducing eye injury,” said Andrew E. Lincoln, from the MedStar Sports Medicine Research Center in Baltimore, a member of the US Lacrosse Sports Science and Safety Committee and coauthor of the study.

He said one of the “major concerns involved with introducing protective equipment,” increased aggressiveness, was also addressed.

The study looked at female scholastic lacrosse players in 25 public high schools in Fairfax County, Va., during the 2004-2009 spring seasons. The data was compared to earlier data from the same source.US Lacrosse said such studies help them establish and adjust safety policies.

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The Johns Hopkins Armstrong Institute for Patient Safety and Quality has been awarded $10 million for a project designed to reduce surgical-site infections and other major complications of colon surgery.

The money comes from the Agency for Healthcare Research and Quality (AHRQ), part of the Department of Health and Human Services. The project is in partnership with the American College of Surgeons (ACS).

Armstrong Institute Director Dr. Peter J. Pronovost, says the work will build modeled on the five-step checklist approach Hopkins developed to reduce bloodstream infections associated with central line catheters in intensive care units.

Checklists are now in place in nearly every state, the District of Columbia, Puerto Rico and many nations around the world and is believed to have saved thousands of lives and millions of health care dollars.

"This work will build on our knowledge of how to prevent central-line infections and apply it to the task of preventing surgical-site infections, pneumonia, deep-vein thrombosis and other common surgical complications," Provost said in a statement. "We should be able to repeat that success in other areas." The surgical safety program will begin in 10 states, in at least 10 hospitals in each state. 

 AHRQ has also awarded the Armstrong Institute over $700,000 for an 18-month program to develop and implement the check list system in two states to prevent ventilator-associated pneumonia. Once the pilot program shows positive results, the hope is that it, too, could be implemented nationwide.

The Armstrong Institute was established in May with a $10 million gift from C. Michael Armstrong, the chairman of the board of trustees of Johns Hopkins Medicine and retired chairman of Comcast, AT&T, Hughes Electronics and IBM World Trade Corporation. The goal of the institute is to advance the science of reducing preventable harm and to improve health care quality.

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The movie Contagion debuts at No. 1 at the box office this weekend. And while we’d like to think of a fast moving and deadly virus as all fiction, public health officials say it’s not totally out of bounds – the Department of Homeland Security list pandemic and plague as one of 15 likely national emergencies that the country should prepare for.

Infectious disease and disaster preparedness experts at Johns Hopkins say they are doing just that and are better prepared than a decade ago.

But hospitals, health care workers and public health agencies need to take more steps because they’ll be on the front lines of a lethal outbreak, said Dr. Gabor Kelen, director of the Johns Hopkins Office of Critical Event Preparedness and Response.

They’ll need well-trained scientists and research to rely on. And practically, they’ll need to be able to isolate infectious patients and workers will need clear policies to make urgent ethical decisions on equipment, medicine and manpower,  he said.

Dr. Trish Perl, an epidemiologist and infectious disease expert and a professor in the Hopkins departments of medicine, pathology and epidemiology, noted the enormity of the possible situation: The Spanish Flu of 1918 killed an estimated 50 million worldwide.

She said officials will need to do more work to be prepared to prevent and contain new infections – and protect the workforce, as well as the general public. And officials says, as the movie illustrates, officials need to be prepared for fear.

So, does Contagion scare you?

Handout photo via Reuters

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For those who lost power during the hurricane, Baltimore City has opened 10 emergency cooling centers. They'll have cool air and free water.

The Community Action Program will operate four centers around the city, open from 9 a.m. to 7 p.m.:

+Northern Community Action Center at 5225 York Road

+Southern Community Action Center at 606 Cherry Hill Road (inside the shopping center 2nd floor)

+Southeastern Community Action Center at 3411 Bank St.

+Eastern Community Action Center at 1400 E. Federal St.

The Health Department’s Office of Aging and CARE Services will operate six additional cooling centers, open from 9 a.m. to 7:00 p.m.:

+Waxter Center at 1000 Cathedral St.

+Oliver Center at 1700 Gay St. +Sandtown-Winchester Center at 1601 Baker St.

+Hatton Center at 2825 Fait Ave.

+John Booth at 229 1/2 S. Eaton St.

+Zeta Center at 4501 Reisterstown Road

“We encourage those without power, especially our seniors and those with underlying chronic conditions, to seek relief from the mildly warm temperatures we expect in Baltimore today,” said Deputy Commissioner of Health Jacquelyn Duval-Harvey, in a statement.

In general, the Baltimore City Health Department recommends people drink extra water or juice, avoid alcohol and caffeine, wipe skin with cool water as needed, minimize outside activities, wear light-weight and light-colored clothing, stay inside from 11 a.m. to 4 p.m., stay in air-conditioning, check on older, sick, or frail neighbors, don't leave children or pets in closed vehicles at all and watch out for signs of heat exhaustion and heat stroke such as confusion and nausea.

Call 311 for help with neighbors or for information about cooling centers, and call 911 for emergencies. Go to www.baltimorehealth.org/coderedinfo  for more information.

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Here is some more information from officials at the state Department of Health and Mental Hygiene for before and after the hurricane.

--On carbon monoxide: This is generated by gas-powered appliances such as generators and charcoal and gas grills. It’s invisible, odorless, tasteless and highly poisonous.

Signs of trouble include fatigue, weakness, chest pains for those with heart disease, shortness of breath, nausea, vomiting, headaches, confusion, impaired vision and loss of consciousness.
Officials recommend not using the appliances inside the home or close to windows outside. Sparks may also cause fires.

--On emergency kits: When you get a kit together make sure to include all regularly taken prescription medications and first aid items. Officials point to the Federal Emergency Management Agency (FEMA) for advice on packing the rest of the kit:

+one gallon of water per person per day for at least three days, for drinking and sanitation
+at least a three-day supply of non-perishable food
+battery-powered or hand crank radio and a NOAA Weather Radio with tone alert and extra batteries for both
+flashlight and extra batteries
+first aid kit
+whistle to signal for help
+dust mask to help filter contaminated air and plastic sheeting and duct tape to shelter-in-place
+moist towelettes, garbage bags and plastic ties for personal sanitation
+wrench or pliers to turn off utilities
+can opener for food (if kit contains canned food)
+local maps
+cell phone with chargers, inverter or solar charger

--For after the storm: If the electricity goes out, remember food is likely to spoil, according to the state Office of Food Protection and Consumer Services.

Perishable foods from the refrigerator and freezer that climb above 40 degrees Fahrenheit for two hours should be discarded. That’s all meat, milk, yogurt, eggs, mayonnaise and dressings, pastas and deserts.

Food that keeps for a limited time without refrigeration includes hard process cheeses (cheddar, Swiss, provolone, Romano and Parmesan), butter and margarine, opened canned fruits and fruit juices, peanut butter, jellies, jams, mustard and vinegar based dressings, rolls, muffins, bagels, waffles, and herbs, spices and raw vegetables.

It is okay to refreeze food that still contain ice crystals and feels cold and hard to the touch.
Toss anything that comes in contact with floodwaters including canned goods. Give a good washing to utensils, pots, plates and other items with hot soapy water and sanitize them by boiling in clean water or immersing them in a solution of 1 teaspoon of chlorine bleach per quart of water for 15 minutes.

Spoiled good should be double bagged in plastic, tied and put in animal proof cans.

A well functioning freezer half full will usually stay cold enough for food for 24 hours. Fully stocked and unopened, the freezer will keep food safe for 48 hours. If in doubt, throw it out.

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The city's Office of Emergency Management is monitoring Hurricane Irene, which could bring heavy rains, flooding and possible power outages across Maryland over the weekend. And city officials are asking residents to be prepared.

They suggest getting a three-day supply of water, a battery operated AM/FM radio and a flashlight. Some non-perishable food and some non-electric entertainment might not be a bad idea to have on hand too.

“As we have learned from previous hurricanes, just because we are not in the eye of the storm does not mean we are free from danger,” said Mayor Stephanie Rawlings-Blake, in a statement. “High winds, rain, and a storm surge can cause flooding and downed power lines. It is absolutely vital that we prepare for whatever Mother Nature throws our way.”

For the latest updates, go to Frank Roylance's weather blog.

UPDATE: More tips on getting ready are at http://www.ready.gov/america/getakit/index.html. It suggests gathering prescriptions, glasses, cell phones and chargers, pet food, baby supplies, a first aid kit and other items that could last a week.

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Well-known patient safety expert Dr. Peter Pronovost has been named director of the new Armstrong Institute for Patient Safety and Quality at Johns Hopkins, where researchers aim to discover new ways to cut down on preventable harm.

Pronovost, a professor of anesthesiology and critical care medicine at Hopkins, is known widely for developing a checklist to prevent central-line bloodstream infections in ICUs. It’s been adopted in most Maryland hospitals and facilities around the nation and has shown to wipe out the potenetially deadly infections.

The U.S. Centers for Disease Control and Prevention recently reported that such infections are down 58 percent nationally.

But there are many other kinds of harm, from medication mistakes to misdiagnoses to health disparities. Pronovost will oversee all efforts and will focus on research that will benefit Hopkins and the greater medical community.

"Our team has proved you can take one safety problem and nearly eliminate it by bringing science to the delivery of health care and by using our hospital as a laboratory," said Pronovost in a statement. "Now we want to scale up for all other types of preventable harm using this model of research, practice and evaluation and share that with the world too. We have an amazing team of interdisciplinary researchers and safety leaders to guide the way. I am honored and humbled to be given the opportunity to do just that."

Baltimore Sun file photo of Dr. Pronovost/Kenneth K. Lam

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It’s the third day of the extreme heat, and state Department of Health and Mental Hygiene officials are warning everyone to take precautions.

There is a heat advisory today from noon to 8 p.m. in Maryland’s capital region, as well as the central and southern regions.

“Each consecutive day of severe heat increases the health risks for our most vulnerable Marylanders, especially seniors, children and anyone with serious underlying health conditions,” said Frances Phillips, the state health department’s deputy secretary for public health services, in a statement. “We urge everyone to take precautions for their families, pets and any neighbors who might be at higher risk because of their health or home conditions.”

State officials said 51 people went to emergency rooms in Maryland because of dehydrations but there have been no confirmed heat-related deaths so far this season. Last summer, there were 32 deaths. In 2009, there were 6, in 2008 there were 17 and in 2007 there were 21.

Local health departments, including Baltimore’s, have opened cooling centers. To find one, click here.

Officials say to keep a closer eye on the vulnerable, including infants and young children, young athletes, seniors and those with health conditions. They also recommend asking your doctor if you need to take extra care in hot weather if you are on prescription medication.

For everyone else, stay inside as much as possible, on lower floors if possible. If you go out, try and aim before 10 a.m. or after 6 p.m. Wear light colored and loose fitting clothes, drink plenty of water and take frequent breaks if you are outside. Don’t leave the kids or pets in the car.

Baltimore Sun file photo/Jed Kirschbaum

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Radar, like the kind used by police to target speeders, could be used to diagnose concussions suffered by athletes and service members, according to some Georgia Tech researchers.

The researchers at the Georgia Tech Research Institute said radar can detect movements of body parts in a way that shows if they are not normal. As long as the walking test is performed along with a cognitive test, such as saying the months of the year backward, the radar was good at screening. Brain injuries make it hard to walk and think at the same time.

They tested the device on people wearing goggles that simulate drunkenness because concussions produce similar impairment as brain injury.

If they can shrink the size of the radar (and get U.S. Food and Drug Administration approval) the device could be used at sporting events and on the battlefield to help those in charge decide if a person is ready for more activity.

“When a person with a concussion performs cognitive and motor skill tasks simultaneously, they have a different gait pattern than a healthy individual, and we can identify those anomalies in a person's walk with radar,” said GTRI research engineer Jennifer Palmer, in a statement.

She and others presented the findings at the SPIE Defense, Security and Sensing conference this week. Others have found changes in gait can help diagnose concussions, but measuring has been done slower and more intrusive clothing and cameras. 

Diagnosing a concussion has been difficult because symptoms are not always easily detectible. Mostly, cognitive abilities are assessed. Early detection can prevent further injury and long-term problems. More than a million concussions and other mild traumatic brain injuries are reported every year in the United States.

Baltimore Sun file photo/Elizabeth Malby

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 Considering the number of people in the state and nationally who use oxygen therapy, the Maryland fire marshal has put out some tips to avoid a catastrophe by fire.

“All Marylanders need to be aware of the potential hazards involving medical oxygen use,” said State Fire Marshal William E. Barnard in a statement. “Oxygen itself is not flammable, however, an oxygen enriched environment can cause materials to ignite more readily and burn at a faster rate than normal.”

Hair, plastic, skin oils, clothing and furniture catch fire at lower temperatures when there is extra oxygen. The fires burn hotter and faster.

Cooking and candles were heat sources in many fires, but smoking was the leading factor in fires in home where oxygen is used, said the fire marshal citing according a National Fire Protection Association report. The heat enabled the ignition of about six in 10 of such fires.

In total, from 2002-2005, oxygen equipment was involved in 209 home fires. They caused an average of 46 deaths and 62 injuries a year. Even more people were treated for burns each years -- 1,190.

Continue reading "Fire marshal: take care around oxygen equipment" »

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The Veterans Administration reports that it has reduced MRSA infections by 50 percent in its intensive care units around the country during the first three years of a special initiative.

MRSA, or methicillin resistant Staphylococcus aureus, is an antibiotic-resistant bacteria that can be life threatening, especially in the ICU – and the results of the initiative, now in its fourth year, could help other hospitals design programs to cut down on the infections.

“This is a landmark initiative for VA and health care in general,” said Dr. Robert Petzel, VA’s under secretary for health, in a statement. “No one should have to worry about acquiring an illness or infection from the place they trust to deliver their care. I am proud that VA is leading the way.”

The VA implemented four infection control practices, including patient screening, contact precautions for patients found to have MRSA and extra hand sanitizer stations and hygiene reminders. The initiative also involved changing the culture so everyone felt infection control was a personal responsibility.

The VA has more than 1,000 U.S. facilities that serve more than 6 million veterans a year. More than 1.7 million screening tests for MRSA were conducted as part of the new initiative.

The Baltimore VA Medical Center was one of the five test sites for the first phase of the initiative, the VA reports. The city has rate of community infection, rather than those who become infected in the hospital, twice the national average and that helped local clinicians develop an expertise.

They had been doing their own research and helped establish protocols to reduce the local rate over the years. Now there are systemwide declines, and the results were published in the New England Journal of Medicine.

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April 4-10 is National Public Health Week and state health officials are highlighting injury prevention.

They say injuries are a serious and costly public health problem for Maryland – they are the No. 1 killer of children and young adults up to age 24 and the fifth leading killer of all ages. State data also shows they cost more than $217 million in emergency department charges and $855 million in hospitalizations.

And while anyone can get an injury, they are often preventable, officials say.

“It takes only a moment for an injury to happen,” Dr. Joshua M. Sharfstein, secretary of the state’s Department of Health and Mental Hygiene, said in a statement. “Avoid that moment by doing the little things to protect yourself, your loved ones, and your community.”

He is encouraging people to learn how to prevent injuries and adopt this motto: “Safety is NO Accident: Live Injury-Free.”

Some steps include using seatbelts on every trip, not using cell phones while driving and wearing a bike helmet.

More tips from state officials include checking your home for hazards such as poor lighting and uneven surfaces that can cause falls, understanding workplace safety regulations, putting kids in properly installed car seats, working with schools to implement school violence and bullying programs and changing smoke alarm batteries and installing carbon monoxide detectors.

For more information, click here or go to the state Department of Health and Mental Hygiene website.

Baltimore Sun file photo/John Makely

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The nuclear plant crisis in Japan has so far posed no risk to the food supply in the U.S., according to the Food and Drug Administration.

But the agency which regulates and monitors food safety standards said last week it is closely monitoring food coming from the country as a precaution.

The stepped up concern comes as radiation has been found in spinach and milk at farms near a Japanese plant that is fighting a meltdown after this month's earthquake.

As part of its investigation, the FDA is tracking data on food from Japan, including where it is grown, harvested and manufactured to monitor potential risk in the future.

Food from Japan make up less than 4 percent of all imported foods, the FDA said.

The agency said it does not track where fields and farms are located in other countries, so it is unclear if any are near the Fukushima nuclear reactor. But FDA officials said production was stopped at fisheries and farms because of damage from the tsunami and earthquake.

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Johns Hopkins patient safety guru Dr. Peter Pronovost says hospitals and industry need to collaborate so electronic equipment in emergency rooms and intensive care units are giving medical staff the right signals.

In a commentary published in the Journal of the American Medical Association, Pronovost, a professor of anesthesiology and critical care medicine, and medical student Simon C. Matthews, say clinicians are overloaded with raw data but no single smart system to integrate the information.

The results could be diagnostic mistakes, miscommunication and missed problems with patients.
Improvements could improve safety and save money, they concluded. They pointed to the aviation industry as an example.

“When a major airline wants an aircraft for its fleet, it does not painstakingly assemble it by deciding which seats, control systems, engines, communications systems, oxygen masks and other components to use,” they wrote.

“The airline does not try to determine the best way for these and hundreds of other components to fit together; rather, it relies on an industry integrator (such as Boeing) to build a low-cost, high-quality aircraft that is safe and meets the needs of its end users. The result is a lower-cost, higher-quality airplane with components that work together. Health care needs a similar systems-integration approach.”

Read the full commentary, “The Need for Systems Integration in Health Care,” at JAMA.

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Bloodstream infections in intensive care patients with central line dropped by 58 percent in 2009 from 2001, according to a new report from the U.S. Centers for Disease Control and Prevention.
Over time, that means 27,000 lives and $1.8 billion in health care costs saved.

Bloodstream infections kill up to one in four patients who get them, the CDC says. So keeping the central line, a treatment delivery tube usually placed in a large vein in the neck or chest, free of germs is crucial.

The infections are often the result of improper procedures while the line is placed or maintained, and studies in recent years show that health care providers can prevent most infections by following CDC infection control guidelines, officials at the CDC say. That means, for example, removing lines as soon as possible. 

“Preventing bloodstream infections is not only possible, it should be expected,” said Dr. Thomas R. Frieden, CDC director, in a statement. “Meticulous insertion and care of the central line by all members of the clinical care team including doctors, nurses and others at the bedside is essential. The next step is to apply what we've learned from this to other health care settings and other health care-associated conditions, so that all patients are protected.”

Chicago Tribune photo of a medical student preparing to perform a central line procedure

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HealthGrades, a rating organization, has named “America’s 50 best hospitals,” and Baltimore appears to have done well:

Franklin Square Hospital Center, Greater Baltimore Medical Center and Good Samaritan Hospital all made the list. Hospitals were located in 28 cities in 19 states. West Palm Beach, Fla., had the most hospitals with six. Cleveland and Chicago were next with four.

I’m always a little unsure about these lists, especially when some of the top-rated hospitals in the country aren’t ranked -- though, some city hospitals don’t make lists like these because they have way higher Medicare/Medicaid population and way more sickly patients and complicated cases.

But HealthGrades says this ranking used risk-adjusted mortality and complication rates, which means they took into account the different levels of patient illness. The hospitals also needed to meet minimum patient volumes and range of services provided.

They said patients at these hospitals had a nearly 30 percent lower risk of death and 3 percent lower rate of complications. HealthGrades study found that if all U.S. hospitals had performed at this level, more than a half million Medicare deaths could have been prevented between 1999 and 2009.

See the full list of hospitals at HealthGrades.com.

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Doctors at Union Memorial Hospital Curtis National Hand Center have sent out a warning: Take care with that snowblower.

Shovel safety is a constant topic in winter, but the doctors say they just received another patient in the emergency room with a snowblower trauma – four fingers and a possible amputation of one. Hand surgeons can’t say if it can be reattached.

Rescue workers reported in a Sun story that it was a 50-year-old Laurel man who got his hand stuck in the snowblower.

So, the hand doctors want to remind everyone who uses a snowblower of some ways to prevent injury. First, if your snowblower jams, turn it off.

Never put your hand down the chute or around the blades, disengage the clutch, wait five seconds after shutting machine off to allow impeller blades to stop rotating, always use a stick or broom handle to clear impacted snow and never use your hand and keep all shields in place. Do not remove the safety devices on the machine.

Keep hands and feet away from all moving parts. And keep a clear head, concentrate and do not drink before using your snowblower.

They say if you do cut your finger or hand, bleeding from minor cuts will often stop on their own by applying direct pressure to the wound with a clean cloth. You may need to go to the emergency room if that doesn’t stop the bleeding after 15 minutes. You may also need to go to the ER if you are due for a tetanus shot or to check for tendon or nerve injury if motion or feeling is lost in the finger.

Reuters photo

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