2006 Archives

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2006 Archives:
Patient Safety

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Risks and benefits of combining aspirin with anticoagulant therapy in patients with atrial fibrillation: an exploratory analysis of stroke prevention using an oral thrombin inhibitor in atrial fibrillation (SPORTIF) trials. (Am Heart J. 2006) "CONCLUSIONS: Aspirin combined with anticoagulant therapy was associated with no reduction in stroke, systemic embolism, or myocardial infarction in patients with AF. Aspirin combined with warfarin was associated with an incremental rate of major bleeding of 1.6% per year. No increased major bleeding occurred with aspirin and ximelagatran. These results suggest that the risks associated with addition of aspirin to anticoagulation in patients with AF outweigh the benefit."

Selling Soap

Soaring CT use may prompt need for long-term dose monitoring "We can't be absolutely sure that those scans will significantly boost this patient's chances of cancer later in life, but available evidence suggests we have a reason to be concerned. Most experts believe that dose is cumulative and exposure to ionizing radiation in medical settings can cause cancer. Further, the National Toxicology Program last year added x-ray and gamma radiation to its list of human carcinogens."

Ten Things Your Hospital Won't Tell You

Ten Rules for Safer Drug Use

U.S. gets bad grade on health care scorecard "The United States spends far more on health care than any other country but gets only mediocre care in return for its investment, according to a report released Wednesday. The U.S. national average score on 37 separate measures of health care falls far short when compared either to a few centers of excellence within the country, or to other countries, the report from the Commonwealth Fund found."

Misprescribing and Overprescribing of Drugs

Poor Handwashing Practices Among Health Care Workers

FDA Warns Consumers Not to Buy or Use Prescription Drugs from Various Canadian Websites That Apparently Sell Counterfeit Products

Fixing America's Hospitals "The most urgent hurdle of all: improving patient safety. In 1999, the Institute of Medicine declared that close to 100,000 Americans die annually from medical errors. This year, more dire news: medication errors harm at least 1.5 million people and cost some $3.5 billion per year. What goes wrong? Missed diagnoses, incorrect drug dosing, failure to treat promptly. Experts agree that doctors, nurses, pharmacists and technicians will always make mistakes—it's the safety net around them that needs to be fixed."

Many Americans Say They Get Poor Health Care "Problems cited included medical errors; duplicated tests; uncoordinated, inefficient or unsafe care involving unnecessary treatment; and a failure to communicate important information or test results, according to the report from the Commonwealth Fund Commission on a High Performance Health System."

Adverse Drug Reactions

COX-2 Inhibitors and Cancer: Questions and Answers

Drug-Induced Diseases

Performance of Top-Ranked Heart Care Hospitals on Evidence-Based Process Measures. (Circulation. 2006) "CONCLUSIONS: A number of the US News & World Report top hospitals fell short in regularly applying evidenced-based care for their heart patients. At the same time, many lesser known hospitals routinely provided cardiovascular care that was consistent with nationally established guidelines."

Antibiotic-Resistant Staph Now a Major Threat: It's the No. 1 source of skin infections seen in U.S. emergency rooms, study finds "People can prevent infections by not sharing towels, razors or other common items, and by washing hands with soap and water, experts say."

Antidepressant discontinuation syndrome. (Am Fam Physician. 2006) "Antidepressant discontinuation syndrome occurs in approximately 20 percent of patients after abrupt discontinuation of an antidepressant medication that was taken for at least six weeks. Typical symptoms of antidepressant discontinuation syndrome include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal."

Drug errors injure more than 1.5 million a year "Perhaps the most stunning finding of the report was that, on average, a hospitalized patient is subject to at least one medication error per day, despite intense efforts to improve hospital care in the six years since the institute began focusing attention on medical mistakes of all kinds."

Acetaminophen Use Could Trigger Liver Damage "In a new study, people who repeatedly took the maximum recommended daily dose of acetaminophen developed abnormalities in blood tests that can be a signal for liver damage."

Recovery after hip fracture. (Injury. 2006) "CONCLUSIONS: Patients with proximal femoral fracture derive no benefit from acute hospital admission of more than 8 days and the majority acquire nosocomial infection after this."

Study suggests possible risk from Tylenol "Healthy adults taking maximum doses of Tylenol for two weeks had abnormal liver test results in a small study, researchers found, raising concerns that even recommended amounts of the popular painkiller might lead to liver damage."

CONCERN OVER “AGGRESSIVE” CHOLESTEROL RECOMMENDATIONS "By aggressively, it means that LDL-cholesterol concentrations should be lowered to less than 1.81 millimoles per litre of blood (mmol/l) in high-risk individuals. Current guidelines generally recommend 2.56 mmol/l as a healthy reading. To achieve this new goal, most of the Western world’s adult population would be on statins, and doses would have to be more than eight times higher than currently used, say the authors. This would increase both the number and seriousness of side effects. But clinical trials suggest that higher doses of statins do not lower overall mortality and side effects are generally under-reported. The authors conclude that any reduction in non-fatal events may be outweighed by more numerous and more severe adverse effects. "

What a Pain! Now It's Tylenol Troubles

How To Read A Drug Label

Medications: Make No Mistake

There Have Been Inadequate Warnings That Erectile Dysfunction Drugs Can Cause Blindness

Prescribing errors resulting in adverse drug events: how can they be prevented? (Expert Opin Drug Saf. 2006) "As approximately 19% of medical errors occurring in hospitals are related to medication errors, reduction of these is one of the major goals to be achieved by healthcare providers. Medication errors may occur at different levels: i) prescribing; ii) transcription; iii) dispensing; and iv) administration."

Cautions Issued on Use Of Psychiatric Drugs "Newborns whose mothers took antidepressants such as Prozac, Paxil and Zoloft in the last trimester of pregnancy had six times the risk of suffering oxygen deprivation after birth compared with newborns whose mothers had not taken the drugs … adults taking medications such as Adderall and Ritalin to treat attention-deficit hyperactivity disorder might be at higher risk of sudden death and other serious side effects, especially if they have high blood pressure."

Chronic Aspirin Therapy for the Prevention of Cardiovascular Events: A Waste of Time, or Worse? (Nat Clin Pract Cardiovasc Med. 2006) "Few therapies in cardiovascular medicine have been studied so intently and adopted so widely into clinical practice as aspirin, especially with so little evidence of long-term benefit for people with or at risk of coronary artery disease. A series of studies has shown that long-term aspirin therapy is ineffective, or worse, for the primary, secondary or tertiary prevention of cardiovascular events; however, distorted reporting of these studies, in a way that would not be tolerated for other pharmacologic agents, has led many readers to misinterpret neutral studies as showing benefit with aspirin (see Supplementary Table 1 online for a list of these investigations). … Aspirin should be used to treat or prevent medical problems only when the effective dose and duration of therapy is known—that is, for short-term treatment of acute vascular events and relief of pain. Aspirin should not be given to patients to achieve misguided health-service targets. International guidelines now recommend aspirin withdrawal in some patients with coronary disease, and such recommendations should be extended to other patient groups after scientific review of the relevant evidence.[1]"

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