Surgery News - January 2009 - (Page 6) THE JANUARY 2009 • SURGERY NEWS 20/20 COMMENTARY VISION Health Care ‘Paradigm Shift’ Needed continue that effort with President-elect Obama’s staff, focusing on a vision of health care reform. First, we have to consider this task as one that will require a cultural transformation of our nation. Our current health care system is a “sick care” system with perverse incentives. We have scores of billing codes to pay providers to make you better once you get sick, but there are very few billing codes they can use to make a living if they want to keep you healthy. We need a paradigm shift that moves our nation to one that embraces health and wellness through appropriate prevention strategies. That’s not to say we still won’t need surgeons, internists, gastroenterologists, and nephrologists. But we need to start this paradigm shift because the business case has been made: The disease and economic burden that we have upon us—we currently spend more than $2 trillion per year on health care, or 16% of our gross domestic product—is largely preventable. Chronic diseases account for 75% of our health care costs. Smoking, for instance, is the No. 1 preventable cause of death, yet we continue to sell cigarettes. Currently, 9 million children are overweight or obese, some of them with diabetes and hypertension. As these youngsters get older and manifest cardiovascular disease and cancers at an earlier age, the economic burden of obesity and its effect on quality of life will be significant. We have many well-respected thought leaders in this country who understand the factors that contributed to our predicament. We need to bring them together and have them figure out a way to accomplish the goal of ensuring that all Americans have access to a set of basic health services. We also need to restructure our health care payment system, which is starting to look like our tax system. It’s almost impossible for the average person to navigate. We have to start educating Americans about their responsibility. We can’t afford to BY RICHARD have adolescents CARMONA, M.D. start smoking, because if they develop the habit, they will shorten their lives by 14 years and increase their lifetime health care costs astronomically because of pulmonary disease, cancer, and other related illnesses. Every American can contribute by taking steps to improve his or her own health. The best mentors for our children are their parents. If children are routinely counseled about health, wellness, and prevention, they will grow up with those values. Our dysfunctional health care system is not a Democratic problem. It’s not a Republican problem. It’s an American problem, and we have to face it as Americans. Rather than arguing about who should pay for health care, let’s start focusing on how to remove the preventable disease burden and related economic burden from society. Let’s ensure that everybody has access to true health care, including prevention and wellness services. ■ DR. CARMONA served as the 17th Surgeon General of the United States. He is currently vice chairman of Canyon Ranch, CEO of Canyon Ranch’s health division, and president of Canyon Ranch Institute. He is also a Distinguished Professor of Public Health at the University of Arizona, Tucson. s the 17th Surgeon General of the United States (2002-2006) and chairperson of the Partnership to Fight Chronic Disease (www.fightchronicdisease.org), I have been working for nearly 2 years with the presidential candidates’ policy teams to help ensure that health and health care were among their top policy considerations. Today, I BRIEF SUMMARY Please see package insert for full prescribing information. ® INDICATIONS AND USAGE: To reduce the development of drug-resistant bacteria and maintain the effectiveness of AZACTAM® (aztreonam for injection, USP) and other antibacterial drugs, AZACTAM should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. Before initiating treatment with AZACTAM, appropriate specimens should be obtained for isolation of the causative organism(s) and for determination of susceptibility to aztreonam. Treatment with AZACTAM may be started empirically before results of the susceptibility testing are available; subsequently, appropriate antibiotic therapy should be continued. AZACTAM is indicated for the treatment of the following infections caused by susceptible gramnegative microorganisms: Urinary Tract Infections (complicated and uncomplicated), including pyelonephritis and cystitis (initial and recurrent) caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Enterobacter cloacae, Klebsiella oxytoca,* Citrobacter species * and Serratia marcescens.* Lower Respiratory Tract Infections, including pneumonia and bronchitis caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Haemophilus influenzae, Proteus mirabilis, Enterobacter species and Serratia marcescens.* Septicemia caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus mirabilis,* Serratia marcescens * and Enterobacter species. Skin and Skin-Structure Infections, including those associated with postoperative wounds, ulcers and burns caused by Escherichia coli, Proteus mirabilis, Serratia marcescens, Enterobacter species, Pseudomonas aeruginosa, Klebsiella pneumoniae and Citrobacter species.* Intra-abdominal Infections, including peritonitis caused by Escherichia coli, Klebsiella species including K. pneumoniae, Enterobacter species including E. cloacae,* Pseudomonas aeruginosa, Citrobacter species* including C. freundii * and Serratia species* including S. marcescens.* Gynecologic Infections, including endometritis and pelvic cellulitis caused by Escherichia coli, Klebsiella pneumoniae,* Enterobacter species* including E. cloacae * and Proteus mirabilis.* AZACTAM is indicated for adjunctive therapy to surgery in the management of infections caused by susceptible organisms, including abscesses, infections complicating hollow viscus perforations, cutaneous infections and infections of serous surfaces. AZACTAM is effective against most of the commonly encountered gram-negative aerobic pathogens seen in general surgery. Concurrent Therapy: Concurrent initial therapy with other antimicrobial agents and AZACTAM is recommended before the causative organism(s) is known in seriously ill patients who are also at risk of having an infection due to gram-positive aerobic pathogens. If anaerobic organisms are also suspected as etiologic agents, therapy should be initiated using an anti-anaerobic agent concurrently with AZACTAM (see DOSAGE AND ADMINISTRATION). Certain antibiotics (e.g., cefoxitin, imipenem) may induce high levels of beta-lactamase in vitro in some gram-negative aerobes such as Enterobacter and Pseudomonas species, resulting in antagonism to many beta-lactam antibiotics including aztreonam. These in vitro findings suggest that such beta-lactamase inducing antibiotics not be used concurrently with aztreonam. Following identification and susceptibility testing of the causative organism(s), appropriate antibiotic therapy should be continued. CONTRAINDICATIONS: This preparation is contraindicated in patients with known hypersensitivity to aztreonam or any other component in the formulation. WARNINGS: Both animal and human data suggest that AZACTAM is rarely cross-reactive with other beta-lactam antibiotics and weakly immunogenic. Treatment with aztreonam can result in hypersensitivity reactions in patients with or without prior exposure. (See CONTRAINDICATIONS.) Careful inquiry should be made to determine whether the patient has any history of hypersensitivity reactions to any allergens. While cross-reactivity of aztreonam with other beta-lactam antibiotics is rare, this drug should be administered with caution to any patient with a history of hypersensitivity to beta-lactams (e.g., penicillins, cephalosporins, and/or carbapenems). Treatment with aztreonam can result in hypersensitivity reactions in patients with or without prior exposure to aztreonam. If an allergic reaction to aztreonam occurs, discontinue the drug and institute supportive treatment as appropriate (e.g., maintenance of ventilation, pressor amines, antihistamines, corticosteroids). Serious hypersensitivity reactions may require epinephrine and other emergency measures. (See ADVERSE REACTIONS.) Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including AZACTAM and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile. C. difficile produces toxins A and B, which contribute to the development of CDAD. Hypertoxin-producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated. Rare cases of toxic epidermal necrolysis have been reported in association with aztreonam in patients undergoing bone marrow transplant with multiple risk factors including sepsis, radiation therapy and other concomitantly administered drugs associated with toxic epidermal necrolysis. PRECAUTIONS: General: In patients with impaired hepatic or renal function, appropriate monitoring is recommended during therapy. If an aminoglycoside is used co http://www.fightchronicdisease.org http://www.fightchronicdisease.org
Table of Contents Feed for the Digital Edition of Surgery News - January 2009 Surgery News - January 2009 Contents The 20/20 Vision Intent to Prevent News From the College: The Year Ahead Thoracic: Tracheal Triumph Practice Trends: Making the Grade Surgery News - January 2009 Surgery News - January 2009 - Contents (Page 1) Surgery News - January 2009 - Contents (Page 2) Surgery News - January 2009 - Contents (Page 3) Surgery News - January 2009 - Contents (Page 4) Surgery News - January 2009 - Contents (Page 5) Surgery News - January 2009 - The 20/20 Vision Intent to Prevent (Page 6) Surgery News - January 2009 - The 20/20 Vision Intent to Prevent (Page 7) Surgery News - January 2009 - News From the College: The Year Ahead (Page 8) Surgery News - January 2009 - News From the College: The Year Ahead (Page 9) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 10) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 11) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 12) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 13) Surgery News - January 2009 - Thoracic: Tracheal Triumph (Page 14) Surgery News - January 2009 - Practice Trends: Making the Grade (Page 15) Surgery News - January 2009 - Practice Trends: Making the Grade (Page 16)
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