In a move intended to ease the shortage of propofol on the U.S. market, the Food and Drug Administration has authorized drugmaker APP Pharmaceuticals to import and distribute a version of the sedative it markets overseas, effective immediately.

The product, Fresnius Propoven 1% (propofol 1%), is manufactured in FDA-inspected plants to agency standards by APP's German parent company and is sold in 39 countries. It "contains the same active ingredient, propofol, in the same concentration as Diprivan (propofol 1%) and is a clinically acceptable substitute to other currently marketed generic propofol products in the United States," says APP.

The company, which has increased production of and is continuing to allocate its domestically marketed propofol products, Diprivan and APP Propofol 1% (generic Diprivan), will supply Fresnius Propoven 1% in 20mL, 50mL and 100mL single-dose vials.

While Fresnius is positioned as equivalent to other propofol products, differences in its formulation present contraindications for patients who are allergic to peanuts or soy, the company notes in its letter to providers. Also, while the labeling is in English, its international bar coding may not be readable to domestic scanning devices.

Late last year, in response to propofol recalls and manufacturing issues, APP distributed Fresnius in the U.S. under the FDA's approval until its available inventory ran out in February.

David Bernard

For the fourth year in a row, starting salaries for CRNAs were higher than those of family physicians', according to Merritt Hawkins & Associates, an Irving, Texas-based healthcare recruiting firm.

CRNAs were offered $189,000 in 2009 as compared to $173,000 for family physicians. But those averages are expected to drop to $186,000 for the CRNAs and rise to $178,000 for the physicians this year, says the firm.

"From our perspective, we are fairly compensated for the level of responsibility we shoulder," says Lisa Thiemann, CRNA, MNA, the senior director for professional practice at the American Association of Nurse Anesthetists.

But for primary care physicians, who are just as hotly demanded industrywide, the lower average may be tough to swallow after an education that is usually 4 or 5 years longer than that of a CRNA, says Kurt Mosley, senior vice president of business development at Merritt Hawkins. The idea that nurses are making $16,000 more than they are "won't make them feel better."

Kent Steinriede

Orthopedic surgeons should close wounds with sutures rather than staples in order to minimize wound infection risks, according to research published in the British Medical Journal.

Researchers reviewed 6 previously published studies that presented wound infection data for 332 patients who had undergone suture closure and 351 who'd had staple closure following orthopedic surgeries. While they observed no significant difference between the 2 groups with respect to wound inflammation, discharge, dehiscence, necrosis and allergic reaction, wound infection rates were seen to increase threefold following staple closure as compared to suturing.

The study notes that while staples are quicker and easier to use than suture, they've also been seen as a more expensive, and less cosmetically appealing option.

In an accompanying editorial, orthopedic surgeon Bijayendra Singh, MD, says the literature on skin closure techniques' effects on infection rates is sparse, but adds that this study's results coincide with similar reviews of closure infection risks following other procedure types.

While many surgeons believe closing wounds with staples is more efficient, he writes, the time it saves is rarely more than 2 to 3 minutes and that this speed "may be reduced by the increased costs of removing the staples (compared with absorbable subcuticular stitches) and reduced even further by the costs of treating the increased number of infections."

Since only 1 of the 5 papers reviewed was appropriately designed and reported, he says, "well designed, randomized, controlled trials are needed to examine further the increased risk of infection risk" that researchers found.

Daniel Cook

Are most of your nurses closing in on retirement, or are they fresh out of nursing school? Tell us in this week's poll question. We'll report the results in this space next week.

Last week, 70% of 171 respondents told us that their facilities are smoke-free, inside and out. Another 29% said staffers can catch a smoke at a designated area outside of the building. Only 1% said they have designated smoking areas indoors and out.

Dan O'Connor