Night Float Schedule vs Traditional OB Call = Improved Obstetric Outcomes?

As a result of mandatory work hour restrictions, residency programs have moved from the traditional call schedule, where they worked up to 36 hours at a time, to a night float system with distinct day and nightime shifts similar to the ones nurses have worked for years.

While no work restrictions exist for attending physicians, some obstetric attending practices are moving towards a night float system similar to that of the young doctors they supervise, with some not-so-surprising changes in labor management and patient outcomes.

When a 6 person academic OB generalist practice at Northwestern University’s Feinberg College of Medicine changed from a traditional call schedule to a night float system, there were  –

  • Less inductions;
  • More labor augmentation with pitocin;
  • Less manual extractions of placentas;
  • Less episiotomies;
  • Less 3rd and 4th degress lacerations;and
  • Improved neontal unbilical artery pH (A sign of fetal well-being)

Of course, this is just one small study in a single practice, and the results may not be generalizable to other practices in other settings. But it makes sense. If you’re not worried about getting some shut eye, you’re less likely to feel the need to use induction to move deliveries to daytime, more likely to move along a night time stalled labor with a little pitocin, and more likely to wait for the perineum to stretch fully and the placenta to take it’s sweet time to deliver.

__________________________________________________

Type of Attending Obstetrician Call Schedule and Changes in Labor Management and Outcome. Barber, Emma L. MD; Eisenberg, David L. MD; Grobman, William A. MD, MBA. Obstetrics & Gynecology: December 2011 – Volume 118 – Issue 6 – p 1371–1376

Image – Van Gogh’s Starry Night from Wikimedia Commons

Basa Filets with Pine Nut, Parmesan and Basil Pesto Crust

It hasn’t been easy.

I’ve been married for almost a quarter century to a man who eats whatever he wants and is still the same weight he was in high school. That means having to sit next to him at Sunday morning breakfast watching him sop up the yolks of his two sunny-side up eggs with a buttered bagel, while I nibble at an egg white omelet.  On the other hand, it also means feeling like a pig when he refuses to even taste the delicious appetizer I’m eating, because he doesn’t want to “ruin” his dinner.   After said dinner, however, I’ll open the freezer to find that once again, he’s brought home, not one but two half gallons of ice cream (he likes to mix the flavors).  I swear I want to just take those damned ice cream cartons and toss them in the trash. But who am I to tell a guy who rides his bike to work every day and plays tennis at least once a week that he can’t have ice cream?

Not that he purposefully sabotages me or anything.

Because he doesn’t. After all, the poor guy never knows which wife he’s getting when he calls me from work to plan the evening’s meal – the wife who loves Shephard’s Pie as much as he does or the one who’s starting South Beach – again. If I counter with a suggestion for fish for dinner, he may just argue back that he really is in the mood for meat. How could he know that this is not a “what are you in the mood for?” discussion but yet another of many, many make-or-break moments for my diet?  (Unless of course,  I’ve  already broken my diet at lunch and given up for the day, in which case it is a “what are you in the mood for?” discussion…)

Now I’m sure at some point early on, when love was young (and I was much thinner), he must have been a little more clued in to my dietary routine. But now, after so many years of countless diets,  it seems he’s learned to just keep to his own food desires and leave me to handle the weight issues on my own.  It pisses me off sometimes, but mostly I understand.

Why am I telling you this?

I’m telling you all this now so that you can appreciate what it is I am going to tell you next, which is this – His doctor just told him he has 3 months to lower his cholesterol or he has to take a statin.

I won’t say that I’ve been waiting for this moment for 25 years...

But you know, it kind of feels that way. For the first time in our marriage, my husband and I are actually on a shared road diet-wise.

It’s really quite amazing when I think about it. We actually had the same breakfast last weekend – steel cut oatmeal. He called tonight from work to suggest we have tofu for dinner! (Which we did.)   And last night, when I suggested this wonderful fish entree from Kalyn’s Kitchen for dinner, he jumped at the chance to have one of the three fish meals he’s decided to eat a week.  I’ve already lost 5 pounds since his doc gave him the ultimatum – all without feeling at all like I’m dieting.

I finally have a live-in diet buddy. Not a lose weight and starve yourself diet buddy, but a let’s eat healthy and keep eating great food buddy.  Add in the fact that he’s always been my ” Do you wanna’ join me on a bike ride?” buddy, and I have a feeling we’re off on a wonderful journey together.

Oh, and the ice cream in the freezer?

It’s GONE.

Basa Filets with Pine Nut, Parmesan and Basil Pesto Crust

Makes 3-4 servings. Adapted from Kalyn, who adapted it from Cooking New American. I encourage you to check out her recipe, which also has great prep pics. Kalyn chops her pine nuts, giving a more even crust. I think I will do that next time; I was just feeling lazy tonight. I wanted to be sure I had enough topping for three filets, so I increased the pesto and decreased the mayo a tad from the original recipe. I also added more garlic.

3 basa or other white fish fillets, about 6 oz. each (You could use flounder, tilapia or cod to name a few)
3 tbsp pine nuts
2 tbsp grated Parmesan Cheese
1/2 tsp finely minced garlic
3 tbsp basil pesto (Made without cheese – see recipe below)
1 tbsp mayonnaise

Preheat oven to 400 F.  Brush casserole dish with olive oil (We used a Le Creuset lasagna pan).  Remove the fish fillets from the refrigerator and let them come to room temperature while the oven heats.

Mix together the pine nuts, Parmesan cheese, garlic, pesto and mayo. Use a rubber scraper to spread the crust mixture evenly over the surface of each fish fillet. Pile it on so all the crust mixture is used.

Bake fish 10-15 minutes, until fish is firm to the touch and crust mixture is starting to lightly brown. If necessary, pop the filets under the broiler for a few minutes to get the crust brown (as we did).

Serve hot. (We served with string beans sauteed in oil and roasted cauliflower, sweet potato and figs.)

Basil Pesto
I decided to make this batch of pesto  without cheese or pine nuts, since I was adding these to the topping later. Turns out it tastes great – my daughter had it on pasta, which she heavily tops with grated parmesan anyway.
  • 2 cups packed fresh basil leaves
  • 2 large garlic cloves, peeled
  • pinch of salt
  • 1/2 cup olive oil
  • (1/4 cup grated Parmesan cheese -optional)

Combine the basil, garlic, and salt in the bowl of food processor and grind till the mixture forms a paste.  While running the food processor, slowly drizzle in the olive oil.  Stores well in the fridge or freezer. Before serving beat in 1/4 cup grated Parmesan or pass the Parmesan at the table.

Grand Rounds Vol 8:No 15 – The Twitter Edition

ONCE UPON  TIME…

Before Facebook and Twitter and Google+, and long before the word “social media” became religion, something called the Medical Blogging made its appearance on the world-wide web.

In those days, there was a small, close-knit community of medical bloggers, who read and commented on one another’s blogs, held long discussions in the comments sections and embedded links to one another’s posts in order to send a message – “I’m reading you and this is what I think about what you wrote”.  In this group, there was no one with a product or a book to sell, no one with ads on their pages, and no one aggregating other blogger’s content (although Kevin was very busy linking away – he was always way ahead of the rest of us at this game).

GRAND ROUNDS IS BORN

At the forefront of this little group of bloggers was Nick Genes, who one day said “Let’s do a medical blog carnival!” For those of you too internet-young to know what a blog carnival is, it is a compilation of posts on a given topic submitted by bloggers and curated by a rotating series of volunteers who post that week’s compilation on their own site. Nick cleverly called his carnival “Grand Rounds” and the rest, as they say, is history.

When Grand Rounds started in September 2004, it was the highlight of the week for all of us. We hung out on our computers on Tuesday mornings with a cup of coffee, checking out the best of what the medical blogsphere had produced that week, linking to it on our own blogs and leaving lots of comments for the host. Hosting and having your blog post cited in Grand Rounds evolved to be a great honor and was the best way to introduce yourself to your fellow medical bloggers and to jumpstart your presence in the online medical community. It was our little home on the internet, and we loved it.

BUT THAT WAS SEVEN YEARS AGO…

Which in internet time is like an entire generation. Since then, the number of doctors engaged in social media has skyrocketed as has the volume and quality of the conversation about healthcare on the internet. Mainstream media healthcare journalists, some of whom are doctors, are creating fabulous content that truthfully is outshining what many of us docs with a busy day job (including myself) can produce on a regular basis. Aggregator sites like Kevin MD, Better Health and even Huff Post are republishing the best of what many bloggers are writing.  More importantly, the concept of the individual blog has been augmented and in some cases, overshadowed by Twitter and to a lesser extent, Facebook, whose continual unending stream demands our constant attention, lest we miss something important that someone said (or re-said, as is mostly the case).

In truth, Grand Rounds has dropped a bit off all of our radars. Many, if not most of us have abandoned the old RSS feed to hang out on Twitter, where our online community has grown from a few dozen bloggers to feeds and followers in the hundreds and even thousands. Which begs the question –

WHAT IS THE FUTURE OF GRAND ROUNDS ?

It’s a topic that has garnered much discussion in the past few weeks, as Nick and current Grand Rounds curator Val Jones surveyed the medical blogging community about what they thought Grand Rounds should be.  

I expect Dr Vartebedian, our rapid-rising social media guru, will have something interesting to say and do on the topic next week when he hosts Grand Rounds. And so, I will leave my edition of Grand Rounds more as prelude to his than the definitive word on what the New Grand Rounds format will be.

THIS WEEK’S GRAND ROUNDS EXPERIMENT

Think of this edition more as a little experiment to see if Grand Rounds can make it in the era of the short communiqué (which already this post has far, far exceeded, making me an official blogging dinosaur).

I’ve culled 12 posts well worth your read from submitted links and my wanderings around the internet. Every post is summarized and commented on in 140 characters or less. I’m posting at 7 am and tweeting both the entire set and each post individually throughout the morning, and ask that you re-tweet if you feel about a post the same way I do. If you submitted a post and it wasn’t listed, please don’t be offended – and do submit again next week! 

I actually found the curating a shorter list of posts made hosting a much less laborious and more enjoyable process than previously, and while composing tweets is ever challenging, it’s always fun. 

Perhaps the echo chamber will not only revive but rejuvenate this old dinosaur, so that it will reverberate throughout and beyond our not so little anymore blogging community. Whether or not that happens, dear reader, is up to you.

So Tweet! Tweet! Tweet!

GRAND ROUNDS – THE TWITTER EDITION

Dan Muro at Forbes.com

  • Healthcare Stats for 2012.  Some will astound, some frighten, some anger you (esp no. 11). http://onforb.es/vRqRDs @GrandRounds

Shara Yurkowitz at Plosblogs –

  • “This may hurt a bit” Why some docs fail to live up to their title in a patient’s eyes (and ears). http://bit.ly/vM168E @GrandRounds

Dr Michael Korlwchak at Wired Medical Practice

  • Deep Thoughts from the Meaningful Use Mountaintop. The harsh realities of EMR in practice. http://bit.ly/sKUt5n @GrandRounds

Dr.Bertalan Meskó at Science Roll

  • 12 predictions for HIT, Tech & Innovation in 2012. (He got most of 2011 right.) http://bit.ly/rLB0uh @GrandRounds

Beth L Gainer at Calling the Shots.

  • “Five years ago today, I had to get something off my chest. It was my breasts.” Brutally honest. http://bit.ly/up8V2s @GrandRounds

RL Bates, MD at Suture for a Living

  • @RLBates – Top Eleven of 2011. The years’s best from one of medicine’s best bloggers. http://bit.ly/udij9t @GrandRounds

Jamie Rauscherat Health Jam

Michele R Berman, MD at Celebrity Diagnosis

  • Celebrity Health – 2011. Shamelessly taking advantage of Rich & Famous to teach rest of us about health. @CelebrityDx. http://bit.ly/sLRM93

Dr Elaine Schattnerat Medical Lessons

  • @MedicalLessons – IOM report on environment & breast cancer – great summary of an important report. http://bit.ly/uFjQDP @GrandRounds

Dr Mike Sevilla at Family Medicine Rocks

  • @drmikesevilla – Open Letter to Congress – I Will Stop Taking Medicare. (Cuts delayed – Go Mike!) http://bit.ly/sgo6bm @GrandRounds

Richard Winters, MD at Beyond the Clinical

  • @drwinters. How I lost credibility in 5 mins – Investigating MD Incident Reports.Docs & admins must-read  http://bit.ly/uBwcY3 @GrandRounds

William Dale, MD at WilliamDaleMd

  • A Personal Journey Down the Rabbit Hole – Doc tries to get son’s med record. Powerful. @WilliamDale_md  http://bit.ly/vWVcQIl @GrandRounds

TBTAM 2011 – The Year in Health Blogging (Plus Two Songs)

Asking a blogger to pick her top posts of the year is like asking a mom which of her children she loves best. Because I love them all. Finding out which posts you love most is not possible – my stat counter only reports details on the last few days. So I picked the posts I think reflect what this blog is about (other than the recipes, of course…) and of which I am particularly proud.

Looking back on 2011, I’m frustrated to realize that so much of my energy was spent countering Big Pharma marketing, inaccuracies in health reporting and those who would limit reproductive rights for women. I like to think I’m having an impact, limited though it may be, among my small but treasured cadre of readers. A sincere thanks to each and every one of you for your visits, comments, tweets, likes and most importantly, your friendship and encouragement.

I don’t know what the future holds for the individual medical blogger, as the short-form communique grows in dominance and the online medical community becomes larger and more diffuse. As more and more docs enter social media, I hope we continue to be individual voices and not just an echo chamber for the mainstream media and medical marketing machines.

  • How To’s – A Twofer.
  • Mammograms – The controversy led to 4 posts this year (and an exciting research project that I’ll be telling you about soon)
  • Emergency Contraception – Important enough for two posts as the battle for OTC availability for teens wages on.
  • Big Pharma – My favorite whipping boy.
  • Birth Control and Blood Clots – The Patch & Yaz dominated the contraceptive conversation this year.
    • FDA Patch Ruling – The FDA allowed the Patch to stay, but with modified labeling. I put in my two sense and describe the population of women for whom the Patch remains an important contraceptive option.
    • Birth Control & Blood Clots : Visualizing the Risks – Driven by me need to put the risks into perspective for my patients, I pull out my time-honored dot charts and some common sense.
  • Another Death from Cancer – My post about my sister’s death from cancer, while intensely personal, is one that untold millions of us who have had a loved one die of this devastating disease could have written.

And for your musical pleasure –

  • The Healthcare Social Media Anthem – with apologies to the Grateful Dead. Sing along now –  “Set out marketing myself online, A friend on Facebook is a friend of mine…”
  • The Meaningful Use Song – With apologies to Gilbert & Sullivan, the only songwriters with music appropriate to handle the ridiculous complexity of the EMR. 880 views on You Tube!

Art vs. Medicine

 

 

 

 

 

 

 

 

 

 

 

 

I came across this compelling little dyad in a pop-up gallery on 57th St on New Year’s Eve.  Artist Kristian Glynn compares his own financial status –  “Empty”  to that of his surgeon girlfriend – “Loaded”.

I’d love to have bought them both, but I can’t afford it…

Best of luck to Glynn and especially to young gallery owner EA Glitner, whose travels have led him on a world journey to collect art. It’s a lifestyle I envy and which takes a very different kind of courage than it takes to accept the responsibility for another’s life under anesthesia. Both are courageous, though clearly the latter provides a more secure income.

I’ll be Tweeting Grand Rounds on January 3 – Call for Submissions

A New Year calls for a new Grand Rounds.  Let’s see if we can move this blogger-era dinosaur into the new era of social media by integrating it more fully into Twitter.

Submit your post to tbtam@rcn.com by 11:59 pm on Jan 1. Include your twitter @profile name and a shortened url for your post (via bitly.com, tinyurl.com, goo.gl, or whatever url shortener you like).

I’m going to play more of a curating role than previously and will be publishing just 12 submissions – one for each year of this still new-feeling century. I’ll post them here, then tweet the lot as a whole and each one individually. I’ll encourage all of those whose submissions are accepted and those reading to retweet the lot and individual posts as well.

Let’s make a whole lotta’ New Year’s noise in the Tweetspace and see if we can crank up the social media volume on Grand Rounds! (You can start now by tweeting this post – just click on the twitter link down there on the left.)

Teen Mom Kailyn Gets Mirena – Contraceptive Choice or Product Placement?

In this week’s episode of Teen Mom 2, Kailyn heads to her gynecologist for birth control and leaves with a Mirena IUD in her uterus.

The entire encounter, obviously edited, ran more like a commercial for Mirena than a contraceptive counseling session. Other contraceptives were mentioned generically only  -“a patch”, “a ring”, “the pill” – but when it came to the IUD, all we hear is the word Mirena – six times, to be exact, during the entire 2 and a half minute encounter with the doc.

DOC: If you don’t like the birth control pill, you do have other options. You know that there’s a birth control patch.
KAILYN: (suspiciously) Yeah
DOC: There’s a once a month vaginal ring. The ring itself is not uncomfortable. (Hands her the ring) They’re one size fits all – Right Isaac? (Baby plays with Nuvaring) They’re cool, right?
KAILYN: I just feel like me putting something in myself is all that much more room for error.
DOC: There’s also the Mirena.
KAILYN: Whaaaat is Mirena?
DOC: The Mirena goes right inside your uterus. They’re THE most effective method of birth control available because it really doesn’t rely on you to do anything or remember to do anything. (Part of a pamphlet shot) That’s what it looks like. It lasts for 5 years. If before 5 years you decide you want to have another child, it’s very easy to remove a Mirena right in the office.
KAILYN: I think I want Mirena.
DOC: If you want to, we can put it in today – and it only takes about a minute to put it in.
KAILYN: Does it hurt?
DOC: It’ll hurt a little tiny bit for a few seconds when it goes in
KAILYN: OK.All right – let’s do it.
DOC: You’re sure?
KAILYN: I’m sure
DOC: I’ll get you set up for it then.
(Staff member, who appears to have been waiting outside the door on cue walks in and offers to take the baby. Kailyn next gets onto table and we cut to Doc doing insertion.)
DOC: All right, if at any point it’s too much, we’ll stop…All right, this is the part that causes the little cramp (Kailyn winces slightly) You’re Mirena is in! You have birth control for FIVE YEARS. You can push yourself up off the edge.
KAILYN: So I’m being protected right now?
DOC: Immediately
KAILYN: I feel better already
DOC: (Smiles) Good. And I will recheck it for you in 6 weeks. Call me in the meantime if you need something before then.
KAILYN: All right, thank you.
(“Protected” stamped across screen. Fade out)

What Kailyn (and MTV’s millions of teen viewers) didn’t hear about Mirena

No one appears to have told Kailyn about anything other than Mirena’s convenience and efficacy and that it pinched a bit going in.

There is no mention that if Kailyn chooses Mirena, she should be prepared for changes in her menstrual cycle, most likely irregular spotting and over time, absence of menses.

Or that Mirena may worsen what appears to be her already pretty bad case of acne, so let’s have a plan for handling that up front.  (Or maybe reconsider Nuvaring – it’s actually pretty darned easy to use and could actually help her skin.)

No one mentioned  that there is another IUD called Paragard that acts a little differently. Or that IUD’s in general carry a small risk of pelvic infection at the time of insertion, should not be used by women who have already had PID, and don’t protect against STD’s, so is her boyfriend still going to use a condom?

All MTV viewers saw was a young woman dismissing every other form of birth control and happily leaving her doctor’s office with Mirena. Best 180 seconds of product marketing Bayer ever got.

Kailyn chose Mirena, but will she continue it?

If Kailyn’s counseling session really went down the way it was edited, I’d have concerns that she was not adequately prepared for the actual experience of having a Mirena, and might end up discontinuing her IUD much sooner than either she or her doctor expect.  She wouldn’t be alone in that regard – Early data suggest that close to 50% of teens will discontinue their IUD in the first 1-2 years of use.

Let’s not set teens up for failure by hyping Mirena on reality TV. Tell them what they need to know in order to make responsible, informed decisions.

It’s called contraceptive choice. Not Contraceptive marketing.

Coffee-Marinated Braised Short Ribs for Christmas Eve

The wonderful thing about braised meat is that it literally cooks itself. The not-so-wonderful thing is that you need to plan ahead for the pr0longed cook time, especially if there is also a pre-braising marinade.

Which means that if you decide at 10 am to make marinated braised short ribs for dinner, then spend the entire marinade time doing last minute Christmas shopping with the kids, you won’t be eating Christmas Eve Dinner till after 10.

Which was fine since we weren’t entertaining anyone but our ourselves.  We had plenty of relaxed family time decorating the tree, wrapping presents, enjoying mulled wine and watching It’s a Wonderful Life on TV before sitting down to what was a delicious and very special meal. So special we may just do it again next year!

COFFEE-BRAISED SHORT RIBS

This recipe is modified from a bison-rib recipe on Epicurious.  I’ve since found another coffee braise that does not call for marinade, and will try that one next time. Serves 4-6.

Marinade
4 cups water
3 cups strong brewed coffee
1/2 cup coarse kosher salt
3 tbsp + 2 tsp packed  brown sugar
1/4 cup pure maple syrup
2 tablespoons chopped fresh rosemary
2 tablespoons + 1 tsp Worcestershire sauce
2 cups ice cubes
4 lbs short ribs

Short Ribs:
1 cup boiling water
1 tbsp instant espresso
4 strips bacon, chopped
2 cups chopped onions
6 garlic cloves, chopped
1/2 tsp red pepper flakes
1 cup low salt chicken broth
1/4 cup Mr TBTAM’s barbecue sauce (you can use tomato paste or chili sauce)
1/4 cup brown sugar
2 tablespoons Dijon mustard
2 tablespoons apple cider vinegar
1 tablespoon soy sauce

Marinade
Stir  water, coffee,  salt and sugar in large bowl until salt and sugar dissolve. Add syrup and remaining marinade ingredients. Stir until ice melts. Add ribs. Place plate atop ribs to keep submerged. Cover and chill 4 to 6 hours. Drain ribs; discard marinade.

Short ribs
Preheat oven to 325°F. In a pyrex measuring cup, stir instant espresso into boiling water and set aside to cool.(Alternatively, use another cup of strong brewed coffee.)

Sauté bacon in heavy heavy ovenproof pot over medium heat until fat starts to render and it begins to brown (be careful – don’t burn it!) Remove  bacon to a plate. Increase heat to medium-high. Sprinkle ribs with salt and pepper.

Working in batches, cook ribs until browned on all sides and transfer to a plate. Add onions, garlic, carrots and red pepper flakes to the pot and cook over medium heat till veggies are soft, about 10 minutes. Add coffee and broth; stir, scraping up browned bits. Add remaining ingredients; bring to boil. Add bacon and ribs, cover, and transfer to oven. Braise until meat is tender, about 2 hours.

Transfer ribs to plate; tent with foil to keep warm. Spoon fat from surface of sauce. Boil sauce until thickened and reduced to your satisfaction (about 2 cups). Pour sauce over ribs.

Serve over homemade mashed potatoes.

The Latke Master’s Latkes

This latke recipe was good enough in 2007  to garner my blog a mention in the New York Times.

Secrets of the latke masters. Happy Hannukah. [The Blog That Ate Manhattan]

I figure that makes it good enough to re-post today.  Happy Hanukkah!

Potato Latkes

3 pounds yukon Gold potatoes
2 eggs, lightly beaten
1 1/2 large onions
A little less than 1/4 cup Motzah Meal
Salt
Pepper
Canola oil for frying

Peel potatoes. Shred using the food processor and remove to a large bowl. Shred the onion the same way and add to the bowl. Open out a large clean dishtowel onto the counter and dump the potato onion mixture on it. Top with a second clean towel and lightly roll to mop up the excess liquid (Don’t overdo it, you need a little of the potato starch and liquid for things to stick together.If you use Russet potatoes, don;t drain them at all, as they have very little water content) Dump back into the bowl and add the eggs and the motzah meal. Season with salt and pepper.

Heat about a 1/2 inch of canola oil in electric frying pan at highest heat (mine goes to 400 degrees Fahrenheit). Scoop some of potato mixture into a large spoon, then put into the oil, flattening with the back of the spoon. Cook until the edges start to crisp and the underside is light brown, then gently flip and cook the other side.

Remove from pan to a cookie sheet lined with paper towels or newspaper. Keep warm in a low oven while cooking the rest of the potato pancakes.

Serve with sour cream and warm homemade applesauce.

BTW,  if you noticed there are two different spellings of Chanukkah on this post, well, that’s just the way it is.

Pharmacies Commonly Deny Older Teens Access to Emergency Contraception

It’s bad enough that the federal government is preventing younger teens from getting easier access to the morning after pill.

Now we find out that older teens, who by current law should be able to buy ECP’s without a prescription, are being told by pharmacies that they can’t. 

In a phone survey conducted by researchers in five cities nationwide, pharmacies gave a disturbingly high rate of incorrect information out to callers posing as 17 year olds seeking access to the morning after pill, telling them that they could not obtain it based on their age.

The availability of emergency contraception did not differ based on neighborhood income… However, in 19% (n = 138) of calls, the adolescent was told she could not obtain emergency contraception under any circumstance. This misinformation occurred more often (23.7% vs 14.6%) among pharmacies in low-income neighborhoods (adjusted odds ratio [AOR], 1.93; 95% CI, 1.53-2.43). When callers queried the age threshold for over-the-counter access, they were given the correct age less often by pharmacies in low-income neighborhoods (50.0% vs 62.8%; AOR, 0.59 [95% CI, 0.45-0.79]). In all but 11 calls, the incorrect age was stated as erroneously too high, potentially restricting access. Adjusting analyses for pharmacy chain as a fixed effect yielded virtually identical results.

The back and forth on teen access to ECP has been confusing, to say the least.  But since 2009, teens age 17 and older have had over the counter access to Plan B.

Pharmacists need to get the rules straight.

 

Chicken Marbella – A Truly Sweet Repast

New York has been my home now for 18 years, but it feels even more like home now that my old buds from Philly have moved here too. Add in a sister and her daughter visiting for the weekend and dinner becomes a truly sweet repast. Make it it all the more sweet by serving chicken that’s been cooked with brown sugar and white wine after being marinated for hours in vinegar and oil with bay leaves, capers, prunes and green olives. Serve with plain orzo and sides of roasted carrots (recipe coming tomorrow) and Mr TBTAM’s amazing sauteed kale with garlic (I’m gonna’ get him to do a video lesson on this next time he makes it).

Chicken Marbella

This is a modern American classic from the original Silver Palate Cookbook, modified for a crowd and published at Epicurious, made made with legs and thighs instead of cut up whole chicken. This recipe serves up to 12, which was way too much for our small group, but we wanted lots of leftovers for the upcoming pre-holiday week. 

Don’t let the overnight marinade dissuade you from making this marvelous dish. Ours marinated for 6 hours and it tasted great. Other have said 2-3 hours is even enough.  

I’d like to try this again using fresh oregano instead of dried (I have a large pot of it on the terrace). Just have to figure out the quantities to use. The chicken did not get as brown as I’d like (though no one cared but me), not sure why. Thinking about browning it next time before baking. Anyone with tips on this let me know. 

10 lbs chicken legs and thighs
1 head of garlic, peeled and finely pureed
1/4 cup dried oregano
Coarse salt and freshly ground black pepper to taste
1/2 cup red wine vinegar
1/2 cup olive oil
1 cup pitted prunes
1/2 cup pitted Spanish green olives
1/2 cup capers with a bit of juice
6 bay leaves
1 cup brown sugar
1 cup white wine
1/4 cup Italian parsley or fresh coriander (cilantro), finely chopped (we forgot to add it!)

In a large bowl, combine the chicken pieces, garlic, oregano, salt, olive oil, vinegar, prunes, olives, capers and juice, and bay leaves. Season with salt and pepper. Cover and let marinate, refrigerated, overnight.

Preheat the oven to 350°F. Arrange the chicken in a single layer in one or two large, shallow baking pans and spoon the marinade over it evenly. Sprinkle the chicken pieces with brown sugar and pour white wine around them.

Bake for 50 minutes to 1 hour, basting frequently with pan juices. Chicken is done when thigh pieces, pricked with a fork at their thickest, yield clear yellow (rather than pink) juice. With a slotted spoon, transfer the chicken, prunes, olives, and capers to a serving platter. Moisten with a few spoonfuls of pan juices and sprinkle generously with parsley. Serve with the remaining juices.

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More on Chicken Marbella