I went to a Scottish dancing class last weekend, and now I am limping all over the hospital. Very funny. It gives me a new appreciation of the video I watched in orthopedics about the different gait phases, and how alterations in specific places indicate different pathologies. . .

That was the first time I ever actually understood the moves to Dashing White Sergeant (this is a complex figure which involves two groups of three – man and two women – facing each other; the man “sets to” with one woman, and they swing around; he repeats with the second, and then dances with each alternately; the two groups conclude by stepping back and forth to each other, and finally one group goes under the others’ arms to move on to another group of three, and repeat. . . take my word that it’s great fun when done in order). But as my sister said, the best thing about the class was the teacher’s Scottish accent. Definitely will have to repeat this again.

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I got out of the house a little late (my house has a snowball mechanism somewhere near the door: the later I am to start with, the more my family and the general environment will collaborate to help me be even later), and was watching the clock as I drove into the hospital parking lot. My beeper went off before I even parked – not late yet, by my clock. It was the attending. “You ready to give that presentation this morning?” “Definitely.” “All right, 8 o’clock in my office.” Uh, I was thinking more like noon, but ok.

Definitely didn’t help to find two attendings in the office, plus the residents; but the second one is the younger, friendlier one. It went fine. There were three studies on supplemental oxygen in surgery to prevent wound infections published in the last six years. The first one found double the rate of infection in patients who only received 30% oxygen, as opposed to 80%. The second one, using a much wider range of patients, including (presumably emergent) small bowel obstruction, than the previous study, and had a sloppier way of detecting/defining infection. (They had an unblinded investigator review the charts after discharge to see if there had been an infection – as opposed to actually going and evaluating the patients while they were in the hospital.) This one also, in my opinion, failed to adequately hide the patients’ randomization from the surgical team. They found double the risk of infection with 80% oxygen, exactly the opposite of the first study. The third study started off with a baseline infection rate in their hospitals of 25% (shocking, but they claimed it’s consistent with the literature), and found a 50% decrease with 80% oxygen. Their patient population and method of determining infection were similar to the first study (only elective colorectal resections, and a blinded investigator checking on the patients in-house.) Conclusion: supplemental oxygen is probably beneficial. We could stand to see another study, but if it does help, it does so significantly, so it’s worth doing.

I asked my father what he does, and he said, he does 100% oxygen all the time anyway, so as to be sure he doesn’t get the dials mixed up and give 90% nitrogen by mistake.

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