The ACC/AHA have just released updated guidelines on perioperative cardiac evaluation and management for non-cardiac surgery patients.

…recommendations in the updated guideline address elective non-cardiac surgery, which should be delayed 14 days after balloon angioplasty, 30 days after bare-metal stent implantation, and optimally 365 days after drug-eluting stent implantation

A total knee replacement is a very common operation and more than 700,000 of them are performed each year in the United States. With a mean cost of about $16,000 each, in 2011 we spent over eleven billion dollars paying for knee replacements. Projections are that, by 2030, we’ll be doing 3.5 million per year. The operation has great results and patients generally do well during and after their surgery.

Anesthetic care has improved dramatically over time. Whereas initially patients who had a knee replaced would be given large doses of narcotic pain medicines (morphine) to deal with their pain, over time anesthesiologists figured out that treating pain in different ways at the same time was better. Continue reading

Changing careers is scary! As I contemplate my move out of the clinical practice of anesthesia into information security consulting I have good days and bad days. And days that are both bad and good. Preparing myself mentally is key. I have had three books recommended to me that are all terrific primers for what’s ahead. I wanted to share them here.

Are there any others you recommend?

Perhaps because of Snowden, perhaps because of HIPAA, I’ve been thinking about secure e-mail a great deal. I’ve used Pretty Good Privacy and agree that it is the most secure solution as no third party holds to keys for decryption. You have someone’s public key. They alone have their private key. And that’s all that’s needed to encrypt and decrypt the message. The only problem is that the other party needs to be using PGP, too. Easy for a geek or nerd. Not so much for the average user. In Glenn Greenwald’s book No Place to Hide, he details how he ignored initial attempts at contact by Snowden because he, Greenwald, didn’t have the right software. Products like GPG Tools are terrific and make setup a breeze, but, again, it takes two to tango. Continue reading

The following idea really struck a chord with me:

The problem:  We all want accountability in healthcare. Physicians and other providers face the ultimate accountability: they are personally liable for their professional negligence. They cannot hide behind a corporate shield – that’s been the law, well, forever. But hospital and other healthcare executives are not personally liable for the misconduct that they, personally, whether by omission or commission, engage in.The fix: Extend personal liability based on negligence standards to all administrators with direct or indirect control over any healthcare related decision. The lack of skin in the game is what leads to many careless decisions.

via Reforming Healthcare Reform » Wisdom. Applied..

I love this post on Health Care Renewal on what wrong with Health IT today. We are about to begin using a new system in the operating room and I’ve been struggling to express why I hate it. This sums it up”

The reality is the train has left, those of us addicted to patient care watch in dismayed horror as our productivity plunges and we struggle to restructure not our workflows but our clinical thought processes to badly designed, logically flawed, and obscenely overpriced documentation tools that distract the expert clinician from a high quality clinical encounter.

via Health Care Renewal: From a physician and former USAF air traffic controller/pilot on the state of healthcare IT.