Kristen Parker, the surgical tech accused of diverting fentanyl and infecting at least 20 patients with hepatitis C, has entered a plea of not guilty in federal court. She is charged with 21 counts of tampering with a consumer product and 21 counts of obtaining a controlled substance by deceit or attempt.

Ms. Parker told police she diverted fentanyl 15 to 20 times between January and April 2009 while employed at Rose Medical Center in Denver, Colo. She claims to have filled syringes with 5cc of sterile saline solution, hid them in her scrub pocket and switched them for fentanyl syringes whenever she was alone in one of the hospital's ORs. Sometimes the saline-filled syringes were ones she had already used, which put thousands of patients at risk of HCV infections.

As of Aug. 7, the Colorado Department of Public Health and Environment has linked Ms. Parker to 19 patient infections originating at Rose. The agency also connected Ms. Parker to an infection at Audubon Surgery Center in Colorado Springs, where she worked for 7 weeks following her time at Rose.

Daniel Cook

A pair of new studies suggests that vertebroplasty procedures, which involve the injection of polymethylmethacrylate cement into a vertebral compression fracture, are no more effective than simulated sham procedures. The results of these first randomized and blinded control trials of the procedure contradict several published case studies and unblinded trials.

Each study showed pain scores for patients in both groups improving over time. After 1 month, patients in the vertebroplasty group and the control group reported similar levels back pain intensity, according to researchers. The studies were published separately in the Aug. 6 edition of the New England Journal of Medicine.

The authors of one study, which examined 131 patients, speculated that natural healing, the placebo effect or the effect of local anesthesia might have accounted for patients' improvement, regardless of the treatment they received. In the other study, which included 71 patients, researchers found little difference when pain scores were extended to 6 months after treatment.

"The results may change vertebroplasty from a procedure that is virtually always considered to be successful to one that is considered no better than placebo," wrote James N. Weinstein, DO, MS, of Dartmouth Medical School in Hanover, N.H., in an accompanying editorial. "When faced with several choices for which the evidence is less than clear, patients and doctors must thoroughly review the options together."

Kent Steinriede

The milky sedative has been a fixture in anesthesia carts since 1986, but propofol's alleged role in the death of pop star Michael Jackson has gained it mass media attention and scrutiny from the Drug Enforcement Administration, which is considering adding it to its list of federally controlled substances.

An article in the August 6 edition of the New York Times examines researchers' and addiction specialists' reports that illicit abuse of the drug is on the rise, especially among healthcare professionals.

"I thought, How the heck can you abuse propofol?" says a 38-year-old anesthesiologist whose story of drug theft, abuse and recovery is told in the article. "Then, in the back of my mind, I thought, I wonder what that feels like?" The article cites a 2007 survey of anesthesia residency programs that found that 71% did not secure or track their stock of propofol, and that 18% reported cases of misuse.

An article in the April 2009 issue of the journal Anesthesia & Analgesia recounts the first propofol murder on record. A University of Florida anesthesiology professor, a state prosecutor and a Gainesville, Fla., police sergeant describe the case of a 24-year-old woman with no history of drug abuse found dead in her home in 2005 as a result of propofol toxicity.

Investigators traced the fatal dose to an acquaintance that had stolen it during his shift as a registered nurse in the surgical intensive care unit at Shands Hospital at the University of Florida. He fled the country, but upon his return was tried and convicted of first-degree homicide. In May 2008, he was sentenced to life in prison without parole.

David Bernard

What's your biggest challenge in keeping implant cases profitable? Go to our Web site to register your choice and see real-time results.

Last week's InstaPoll asked which low-temperature sterilization method you use in your facility. Your 101 responses were distributed pretty evenly.