Category: Financial & Investing
Keywords: 457b, retirement, investing (PubMed Search)
Posted: 1/29/2012 by Dan Lemkin, MS, MD
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Many physicians have the opportunity to invest in a variety of retirement funds. The most common commercial vehicle is a 401k. Academic and non-profits have access to an analogous 403b. Many physicians also have access to a 457b.
It is important to understand what it is, and most importantly how it differs from a conventional 401k or 403b. Like its' peers, it permit pre-tax contributions of a finite amount. They are offered through your employer and are bound to a specific vendor(s). These vendors provide a select number of investment choices specific to the employer contract. The maximum contribution for 2012 is $17,000.
The 457b is different from the other investment vehicles because of who and where your funds are held:
Non-governmental 457 plans have a number of restrictions that governmental ones do not. Money deferred into non-governmental 457 plans may not be rolled into any other type of tax-deferred retirement plan. It may be rolled only into another non-governmental 457 plan. Also, money deferred into non-governmental plans is not set aside in a trust for the exclusive benefit of the employee making the deferral. The Internal Revenue Code requires that money in a non-governmental 457 plan remains the property of the employer and is thus available to general creditors of the employer in legal or bankruptcy
If you work for a private entity, or a non-profit and they offer a non-governmental 457b, your personal funds are pooled with corporate resources. Your retirement contributions are at risk, should the company default and declare bankruptcy. This risk is apparently not born by GSRA 457b (Governmental agency 457b plans). A decade ago, this risk would seem insignificant. With the number of large companies and municipalities defaulting in this economic climate, prudence is warranted when considering this investment vehicle. DISCLAIMER - This pearl is not intended to provide financial advice. Please consult your HR department and / or financial advisor for additional information and advice.
Category: Medical Education
Keywords: education, quality improvement (PubMed Search)
Posted: 12/13/2010 by Dan Lemkin, MS, MD
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Dear Readers,
Thank you for your continued interest in the University of Maryland's EM Pearls program. We are conducting a survey to assess whether our pearls are meeting your needs. Data collected will be used to refine and improve our educational program. Please take 1 minute to complete our survey by clicking the link below.
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EM Pearls Development Team
University of Maryland School of Medicine
Department of Emergency Medicine
Category: Neurology
Keywords: chlorhexidine, arachnoiditis, lumbar puncture, neurotoxicity (PubMed Search)
Posted: 8/27/2010 by Dan Lemkin, MS, MD
(Emailed: 9/29/2010)
(Updated: 9/29/2010)
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Chlorhexidine (CHG) has rapidly become the antiseptic of choice for most skin preparation prior to any percutaneous procedures including:
The Chlorprep(R) label notes: "DO NOT USE FOR LUMBAR PUNCTURE OR IN CONTACT WITH THE MENINGES" (attached)
Authors of the British Royal College of Anaesthetists 3rd National Audit Project provided some guidance for the use of chlorhexidine for spinal procedures
Further: Correspondance from the Journal of Regional Anesthesia and Pain Medicine
"Dr. David Hepner published a correspondence in the April 2007 issue of Anesthesiology that stated the expert panel for Regional Anesthesia and Pain Medicine “felt strongly that although the US Food and Drug Administration has not approved chlorhexidine before lumbar puncture, it has a significant advantage over povidone iodine because of its onset, efficacy, and potency” and commented that “interestingly, povidone iodine is also not approved for lumbar puncture."
Chlorhexidine off-label use is supported in academic literature. Due to specific labeling prohibiting use, a formal institutional policy to support such use may be indicated.
Cook TM, Fischer B, Bogod D, et. al. Antiseptic solutions for central neuraxial blockade: which concentration of chlorhexidine in alcohol should we use? British Journal of Anaesthesia.2009. 103(3):456-457
http://bja.oxfordjournals.org/cgi/content/extract/103/3/456
http://www.apsf.org/newsletters/html/2008/fall/02_ltrchlorprep.htm
http://www.apsf.org/newsletters/html/2008/fall/10_fdaquest.htm
1008270020_chlorprep_instructions.pdf (293 Kb)
Category: Orthopedics
Keywords: winged scapula, trapezius, serratus anterior, long thoracic nerve (PubMed Search)
Posted: 10/18/2009 by Dan Lemkin, MS, MD
(Emailed: 10/24/2009)
(Updated: 8/14/2024)
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Winged scapula is caused by muscular injury or damage to corresponding muscular innervation. Mechanism can be due to blunt or penetating thoracic trauma.
Clinical findings include
Treatments
Category: Med-Legal
Keywords: legal, malpractice, discovery, privacy, online (PubMed Search)
Posted: 9/12/2009 by Dan Lemkin, MS, MD
(Emailed: 9/19/2009)
(Updated: 9/19/2009)
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Beware of your online contributions, they can come back to hurt you in legal settings. You must remember that there is a digital trail of everything you post online. Discovery rules vary state to state. It is best to practice save surfing. What you may perceive as paranoia is really just good practice.
The following guidelines apply to:
General guidelines
Assume that whenever you hit send, your message will be available to a plaintiff attorney who will twist it to suit his/her needs. The only potential exception is direct email communication to your personal legal counsel. Please verify that local laws protect this form of communication before making an assumption of privacy.
[This pearl is a review of published general recommendations on privacy practices and should not be interpreted as, or replace competent legal advice.]
Brenner, Ilene MD. Anything you tweet can, and will, be used against you. Emergency Physician's Monthly. September 2009. Vol 16-9.
Category: Orthopedics
Keywords: jones fracture,foot fracture,malunion (PubMed Search)
Posted: 6/21/2009 by Dan Lemkin, MS, MD
(Emailed: 7/18/2009)
(Updated: 7/18/2009)
Click here to contact Dan Lemkin, MS, MD
Jones fracture
Presented with persistant foot pain from
Jones fracture malunion.
http://www.wheelessonline.com/ortho/jones_fracture
http://www.wheelessonline.com/ortho/avulsion_frx_of_base_of_5th_metatarsal
Category: Toxicology
Keywords: overdose, precription drugs, pediatric, substance abuse (PubMed Search)
Posted: 4/1/2009 by Dan Lemkin, MS, MD
(Emailed: 4/2/2009)
(Updated: 5/24/2009)
Click here to contact Dan Lemkin, MS, MD
Classical illicit recreational drugs like cocaine, ecstacy, and marajuana are sometimes difficult for teens to acquire. As a result, many are turning to their parents medicine cabinets as a source for recreational drugs.
[From the website drugabuse.gov] In 2008, 15.4 percent of 12th-graders reported using a prescription drug nonmedically within the past year. This category includes:
When adolescent patient presents to the ED, consider the possibility of a poly-pharmacy overdose. Always query parents about the presence of OTC and Rx medications in their home, and what is within reach of their kids.
While sedatives and analgesics are concerning, be alert for overdoses of more mundane medications like beta blockers and calcium-channel blockers which often pose a much more lethal threat. Consider overdose in adolescent patients with:
Monitoring the Future Study: Trends in Prevalence of Various Drugs for 8th-Graders, 10th-Graders, and 12th-Graders
2005-2008 (in percent)*
8th-Graders | 10th-Graders | 12th-Graders | ||||||||||
2005 | 2006 | 2007 | 2008 | 2005 | 2006 | 2007 | 2008 | 2005 | 2006 | 2007 | 2008 | |
Any Illicit Drug Use | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Lifetime | 21.4 | 20.9 | [19.0] | 19.6 | 38.2 | 36.1 | 35.6 | 34.1 | 50.4 | 48.2 | 46.8 | 47.4 |
Full chart available by clicking link in references.
Category: Orthopedics
Keywords: maisonneuve, tibia, fibula, fracture, ankle, orthopedic (PubMed Search)
Posted: 11/2/2008 by Dan Lemkin, MS, MD
(Emailed: 11/8/2008)
(Updated: 8/14/2024)
Click here to contact Dan Lemkin, MS, MD
A maisonneuve fracture is a fracture dislocation resulting from external rotational forces to ankle -- through interosseous ligament to fibula.
If stability is questionable, orthopedic evaluation under anesthesia is required. Additionally always consider compartment syndrome. Do not rely on Kanduval's signs (pain, paraesthesia, pallor, poikilothermia, pulselessness) - "... with the exception of pain and paraesthesia, these traditional signs are not reliable." Emergent orthopedic consultation and compartment pressure assessment should be performed. (see attached photos)
Category: Med-Legal
Keywords: abdominal pain, exam, legal, pitfall, missed (PubMed Search)
Posted: 11/23/2007 by Dan Lemkin, MS, MD
(Emailed: 11/26/2007)
(Updated: 8/14/2024)
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Abdominal pain can be very confusing. Occasionally, serious etiologies may masquarade as benign complaints. Always consider the following pitfalls when addressing abdominal complaints.
Disclaimer: This information does not constitute legal advice, is general in nature, and because individual circumstances differ it should not be interpreted as legal advice. The speaker provides this information only for Continuing Medical Education purposes.
Content abstracted from: Nguyen Anh, Nguyen Dung. Learning from Medical Errors. Radcliffe Publishing, UK. 2005. P 11-13.
Category: Infectious Disease
Keywords: MRSA, resistant bacteria, sepsis, antiobiotics, baltimore (PubMed Search)
Posted: 10/17/2007 by Dan Lemkin, MS, MD
(Updated: 8/14/2024)
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A recent study came out which confirms what we already knew... that MRSA infections are no longer confined to ICUs but are spreading to the community. What the new study does show, is that it affects particular populations disproportionately and Baltimore City, more than any other study population. The full article is attached below, or can be obtained for free from the JAMA website.
"Unadjusted incidence rates of all types of invasive MRSA ranged between approximately 20 to 50 per 100 000 in most ABCs sites but were noticeably higher in 1 site (site 7, Baltimore City) (TABLE 2)." "... we calculated interval estimates excluding site 7 (Baltimore City) to allow the reader to interpret a range of estimates reflecting different metropolitan areas. Regarding the high observed incidence rates reported by site 7, we conducted an evaluation to determine whether these results were valid, including a review of casefinding methods, elimination of cases to include only those with zip codes represented in the denominator, contamination in any laboratory, and other potential causes for increased rates; however, none were in error." |
0710170948_jama_mrsa.pdf (129 Kb)
Category: Misc
Keywords: administrative, notice, admin, tech (PubMed Search)
Posted: 10/4/2007 by Dan Lemkin, MS, MD
(Updated: 8/14/2024)
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Notes to authors
|
Category: Misc
Keywords: Listserv, mailing list, test (PubMed Search)
Posted: 7/10/2007 by Dan Lemkin, MS, MD
(Emailed: 7/8/2007)
(Updated: 8/14/2024)
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Category: Toxicology
Keywords: hydrofluoric acid, burn, chemical burn, HFA, calcium gluconate (PubMed Search)
Posted: 9/5/2010 by Dan Lemkin, MS, MD
(Emailed: 8/14/2024)
(Updated: 10/2/2010)
Click here to contact Dan Lemkin, MS, MD
Hydrofluoric acid is a weak acid used primarily in industrial applications for glass etching and metal cleaning/plating. It is contained in home rust removers. Although technically a weak acid, it is very dangerous and burns can be subtle in appearance while having severe consequences.
Wilkes G. Hydrofluoric Acid Burns. Jan 28, 2010.
http://emedicine.medscape.com/article/773304-overview
*Extracted from emedicine article.
Wilkes G. Hydrofluoric Acid Burns. Jan 28, 2010.
http://emedicine.medscape.com/article/773304-overview