Hands -- Guidance and Germs

Updated 3/2017-- all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

Some interesting items this week involving hands.  The one which has gotten much news coverage is the issue of hand washing.  Take a look at some of the headlines:

High five! Hand washing on rise (Chicago Sun-Times)

For Many, 'Washroom' Seems to Be Just a Name (New York Times)

93% of women wash their hands vs. 77% of men (USA Today)

All the above are reporting on the same study, but the difference in presentation is amazing to me.

The above study doesn’t involve hand washing in a hospital or doctor’s office setting.  The JAMA article (2nd reference below) does, but this article focuses on whether public reporting of hand washing compliance is helpful or not.  Do we inflate our numbers to make ourselves look better?

Public reporting creates an incentive to maximize performance but does not specify the manner in which this is achieved. Broadly speaking, 2 approaches are possible. Hospitals can adopt evidence-based strategies designed to improve patient outcomes that will also improve the publicly reportable indicator, or they can adopt indicator-based strategies designed to improve the reported indicator that may not improve outcomes and may even cause harm. Evidence-based improvement strategies would be favored in an environment in which organizations focus on improving patient outcomes—when such strategies exist and are easy to implement. Conversely, indicator-based improvement strategies would be favored in an environment in which the hospital focuses on protecting its reputation, when evidence-based improvement strategies are unproven or resource intensive, or when measurement of the indicator is easily manipulated to show improvement. …

I wish copyright laws would allow me to reproduce the entire essay from a recent issue of JAMA (first reference below).  The essay is written by Ariela Zenilman about her father’s hands. 

Between the scrapes from paper cuts, the finger on which a ring is worn, and the color of nail polish, the hands of the human body tell a story. They are the most mysterious reflection of character. The hands ….. Surgeons are blessed with steady hands for a reason: they reduce the trembling in the hands of worried family members, counteract pain and destruction, and alter creation for the better by fixing fault and disease within the body. A surgeon has the remarkable gift of a set of multifunctional and dexterous hands.

I have always admired my father's hands. From a very early age I could tell his grace and dedication to detail were apparent in how he moved and touched, felt and experienced the world around him. …... His hands seemed inexplicably and effortlessly linked to his every thought: as a young child I always dreamed of having hands like his.…….

When I see my father's hands ……. His hands are a mere reflection of his heart, an attribute I hope to see in my hands as I follow in his footsteps.

…. Hands reflect ability, accomplishment, and passion. …………., I have learned to trust my instincts, follow my heart, and, most of all, not to underestimate the power of my own hands.

I love hands.  I have been in love with the anatomy and mechanics of hands since medical school.  Before then I just loved to watch them work (my mother making biscuits, my teacher’s writing, basketball players shooting baskets, pianists, etc). 

For the general public, wash your hands – flu season is upon us.

For us involved in patient care, wash your hands before and after each patient.  This is one (if not the best) of the best lines of defense in preventing the spread of infection.

REFERENCE

The Hands That Guide Me; Ariela Zenilman; JAMA. 2010;304(10):1049. doi:10.1001/jama.2010.1291

Public Reporting of Hospital Hand Hygiene Compliance—Helpful or Harmful?; Matthew P. Muller; Allan S. Detsky; JAMA. 2010;304(10):1116-1117.

Finger and Wrist Exercises (April 19, 2010)

Reprise – Pigmented Birthmarks

Updated 3/2017 -- photos and all links removed as many no longer active. and it was easier than checking each one.

When I wrote this piece (July 14, 2007), it was due to this lovely one by TBTAM and this one by Intueri. I was literal in looking at the picture. They wrote wonderful literary pieces.

You should check out all the other literary ones from that challenge:

• Emergiblog
• All Sounds to Silence Come
• Musings of a Dinosaur

Birthmarks fall into two categories: pigmented or vascular (I'll deal with those in the future). Birthmarks (both types) are present at birth or develop shortly after birth. Pigmented birthmarks can be brown, tan, black, or bluish/bluish-gray. The cause of pigmented birthmarks is unknown. Most birthmarks are not inherited. There is no known way to prevent birthmarks. People with birthmarks, just like everyone else, should use a good quality sunscreen with a high SPF when outdoors in order to help prevent skin cancer. In most cases, health care professionals can diagnose birthmarks based on the appearance of the skin. Many folk tales and myths exist about the causes of birthmarks, but none of these stories have been proven to explain the true causes of birthmarks. Photo credit

Types of Pigmented Birthmarks

• Cafe-au-lait spots are light tan or light brown spots that are usually oval in shape. They usually appear at birth but may develop in the first few years of a child's life. Cafe-au-lait spots may be a normal type of birthmark, but the presence of several cafe-au-lait spots larger than a quarter may occur in neurofibromatosis (a genetic disorder that causes abnormal cell growth of nerve tissues).
• Congenital nevi are moles that are present at birth. These birthmarks have a slightly increased risk of becoming skin cancer depending on their size. Larger (covers an area larger than the size of a fist) congenital nevi have a greater risk of developing skin cancer than do smaller congenital nevi. All congenital nevi should be examined by a health care provider and any change in the birthmark should be reported.
• Pigmented nevi (moles) are growths on the skin that usually are flesh-colored, brown or black. Moles can appear anywhere on the skin, alone or in groups. Moles occur when cells in the skin grow in a cluster instead of being spread throughout the skin. Moles may darken after exposure to the sun, during the teen years and during pregnancy.
• Mongolian spots usually are bluish and appear as bruises. They often appear on the buttocks and/or lower back, but they sometimes also appear on the trunk or arms. The spots are seen most often in people who have darker skin. They usually fade (often completely) by school age without treatment.

Treatment of Pigmented Birthmarks
Pigmented birthmarks are usually left alone, with the exception of moles and, occasionally, café-au-lait spots. Moles, particularly large or giant congenital nevi, often are surgically removed, though larger ones may be more difficult to remove. Café-au-lait spots can be removed with lasers (highly concentrated light energy) but often return. If a mole exhibits potentially cancerous changes, a biopsy may be performed. Large or prominent moles that affect appearance and self-esteem may be covered with special cosmetics.

Warning Signs Since there is an increased risk of skin cancer in congenital nevi, see a doctor if you notice a change in color, size, or texture of a mole or other skin lesion. Also, see a doctor right away if there is any pain, bleeding, itching, inflammation, or ulceration of a congenital mole or other skin lesion.