Search

After five years of teaching in two San Francisco independent schools, the author returned to Stanford University to pursue an MBA and a Master's in Education. While it is true that some of the topics he studied, such as the weighted average cost of capital, have little, if any, use in the independent school world, throughout his two years at Stanford, he found numerous lessons that can be applied directly to school leadership. Classes on organizational leadership and interpersonal dynamics, the latter known as "touchy feely," have been the most helpful in his roles as admission director and middle school head. In this article, the author details how the economic, statistics, and financial concepts he learned in business school apply to work in independent schools.

Objectives: We wanted to estimate the frequency and describe the nature of emergency department (ED) procedural sedation restrictions in the State of California. Methods: We surveyed medical directors for all licensed EDs statewide regarding limitations on procedural sedation practice. Our primary outcome was the frequency of restrictions on procedural sedation, defined as an inability to administer moderate sedation, deep sedation, and typical ED sedative agents in accordance with American College of Emergency Physicians (ACEP) guidelines. Our secondary outcomes were the nature of these restrictions, who has imposed them, why they were imposed, and the perceived clinical impact. Results: We obtained responses from 211 (64%) of the 328 EDs. Ninety‐one (43%) reported conditional or total limitations on their ability to administer one or more of the following: moderate sedation, deep sedation, propofol, ketamine, or etomidate. Thirty‐nine (18%) reported total restriction of at least one of these—most frequently a prohibition of deep sedation (18%). Local anesthesia directors were the most frequently cited creators and enforcers of these restrictions. Some respondents reported that, due to these restrictions, they used less effective sedatives, they performed procedures without sedation when sedation would have been preferred, and they observed inadequate sedation and pain control. Conclusions: In this statewide survey we found a substantial prevalence of practice limitations—mostly created by local anesthesia directors—that restrict the ability of emergency physicians to provide procedural sedation for their patients in accordance with ACEP guidelines. Deep sedation was prohibited in 18% of responding EDs. Our respondents describe adverse consequences to patient care. [ABSTRACT FROM AUTHOR]

A 55-year-old man with history of chronic hepatitis B cirrhosis presented to an emergency department in California with abdominal pain, constipation, and jaundice. The patient developed methicillin-susceptible S. aureus bacteremia with a concurrent transient E. coli. This organism carried mcr-1 in a plasmid similar to other mcr-1-carrying plasmids from the USA. The spread of mcr-1 into carbapenem-resistant isolates is of great concern and monitoring of this resistance mechanism is important., (Copyright © 2017 Elsevier Inc. All rights reserved.)