2010 Archives
2010 Archives:
Patient Safety
Recent archived links on top:
4 MRI Agents to Carry Warnings, 3 Agents Contraindicated for Patients With Kidney Disease
After Stroke Scans, Patients Face Serious Health Risks “The cases come at a time when Americans are receiving more medical radiation than ever before, a result of rapid technological advancements that improve diagnosis but can also do harm when safeguards and oversight fail to keep pace. Even when done properly, CT brain perfusion scans deliver a large dose of radiation — the equivalent of about 200 X-rays of the skull. But there are no hard standards for how much radiation is too much. The overdoses highlight how little some in the medical profession understand about the operation of these scanning devices and the nature of radiation injuries, as well as the loose requirements for reporting accidents when they are detected. For a year or more, doctors and hospitals failed to detect the overdoses even though patients continued to report distinctive patterns of hair loss that matched where they had been radiated. After the Food and Drug Administration issued a nationwide alert asking hospitals to check their radiation output on these tests, a few hospitals continued to overdose patients for weeks and in some cases months afterward, according to records and interviews. “
Cancer risks after radiation exposure in middle age. (J Natl Cancer Inst. 2010) “For radiation exposure in middle age, most radiation-induced cancer risks do not, as often assumed, decrease with increasing age at exposure. This observation suggests that promotional processes in radiation carcinogenesis become increasingly important as the age at exposure increases. Radiation-induced cancer risks after exposure in middle age may be up to twice as high as previously estimated, which could have implications for occupational exposure and radiological imaging.”
Despite FDA Warning, Avandia Use Varies Across U.S. “Using the controversial diabetes drug Avandia as an example, new research finds that doctors' prescribing patterns vary across the country in response to warnings about medications from the U.S. Food and Drug Administration. The result is that patients may be exposed to different levels of risk depending on where they live, the researchers said.”
Doctors discourage repeat calcium heart scans
Drug Companies Influence Prescribing, Study Finds “Doctors tend to prescribe drugs that pharmaceutical companies promote to them and patients end up paying more but not always getting the most suitable medicines, researchers reported on Wednesday. An analysis of 58 studies in several countries found that information from drug companies influenced the decisions doctors made, and not necessarily in a positive way. "You couldn't say that information from pharmaceutical companies benefited doctor's prescribing, which is what pharmaceutical companies claim," said Dr. Geoffrey Spurling of the University of Queensland in Brisbane, Australia, who led the study.”
Eaten Alive: 5-Year Battle With Flesh-Eating Germ
Emergency Department Wait Times Continue to Rise
Many Doctors Don't Report Incompetent Colleagues
Most Doctors Don't Follow Colon Cancer Screening Guidelines
Review Suggests Bias in Drug Study Reporting “Drug studies paid for by the pharmaceutical industry are more likely to publish favorable results than those funded by sources with no financial interest in the findings, a new review has found.”
Superbug detected in health tourists from South Asia
Web Site for Hospital Comparisons Is Faulty: Study
Wet Breathing System Filters Transmit Harmful Bacteria and Yeast, Hospitals Warned
When Drugs Cause Problems They Are Supposed to Prevent “Something new is happening, said Daniel Carpenter, a government professor at Harvard who is an expert on the drug agency. The population is aging, many have chronic diseases. And companies are going after giant markets, huge parts of the population, heavily advertising drugs that are to be taken for a lifetime. And the way drugs are evaluated, with the emphasis on shorter-term studies before marketing, is not helping, Dr. Carpenter said. “Here is a wide-scale institutional failure,” he said. “We have placed far more resources and requirements upon premarket assessment of drugs than on postmarket.” “
99,000 Die Yearly From Preventable Hospital Infections
Are hospitals deadlier in July?
Biggest radiation threat is due to medical scans “Doctors don't keep track of radiation given their patients — they order a test, not a dose. Except for mammograms, there are no federal rules on radiation dose. Children and young women, who are most vulnerable to radiation harm, sometimes get too much at busy imaging centers that don't adjust doses for each patient's size. … He led an eye-opening study that found that U.S. heart attack patients get the radiation equivalent of 850 chest X-rays over the first few days they are in the hospital — much of it for repeat tests that may not have been needed.”
Children in Intensive Care Should Be Screened for MRSA “Community-acquired, drug-resistant bacterial infections are becoming more common among children in hospital intensive care units, so patients should be screened when they're admitted and weekly thereafter, a new study suggests. Researchers found that 6 percent of the 1,674 children admitted to the pediatric ICU unit at the Johns Hopkins Children's Center between 2007 and 2008 were colonized with methicillin-resistant Staphylococcus aureus (MRSA). This means the children carried MRSA even though they didn't have an active infection -- and they could have unknowingly infected other patients.”
Deficits Found in Quality of Care Provided to Dying Patients
FAQ: Radiation Risk From Medical Imaging
Heart tests add to U.S. radiation dose concerns “"For many patients in the United States, there is a substantial cumulative radiation exposure from cardiac procedures," said Dr. Jersey Chen of Yale University School of Medicine, whose study appears in the Journal of the American College of Radiology. An advanced type of heart stress test called myocardial perfusion imaging, in which doctors inject a radioactive tracer in patients to test blood flow, accounted for 74 percent of radiation exposure from heart scans. Heart catheterization and stenting -- procedures in which thin tubes are fished through blood vessels to open blocked arteries -- were the second biggest contributor to radiation exposure, Chen said.”
High Hospital Occupancy Rate Linked To High Death Rate “The higher the occupancy rate at your hospital, the less likely you are to leave alive. That's the conclusion of a new University of Michigan Health System study that shows you have a 5.6 percent higher risk of dying in a hospital operating at near capacity.”
Hospital infection deaths caused by ignorance and neglect, survey finds “Yet evidence suggests hospital workers could all but eliminate CRBSIs by following a five-step checklist that is stunningly basic: (1) Wash hands with soap; (2) clean patient's skin with an effective antiseptic; (3) put sterile drapes over the entire patient; (4) wear a sterile mask, hat, gown and gloves; (5) put a sterile dressing over the catheter site.”
Hospital-acquired sepsis, pneumonia kill 48,000 each year “Researchers examined 69 million hospital discharges in 40 states from 1998 to 2006, looking at two conditions, sepsis and pneumonia, often caused by drug-resistant infections. Nosocomial sepsis and pneumonia kill 48,000 patients annually and cost $8.1 billion to treat, said the study, published in the Feb. 22 Archives of Internal Medicine.”
Is Medical Advice on the Internet Reliable?
Polypharmacy and Potentially Inappropriate Medication Use Among Community-dwelling Elders With Dementia (Alzheimer Disease & Associated Disorders 2010)
Use of anticholinergics and the risk of cognitive impairment in an African American population (NEUROLOGY 2010)
Loop Diuretic Therapy in Heart Failure: The Need for Solid Evidence on a Fluid Issue. (Clin Cardiol. 2010)
Medical tourism: first report of multiresistant bacteria after elective surgery in India
Metformin-Induced Vitamin B12 Deficiency Presenting as a Peripheral Neuropathy. (Med J. 2010) “Chronic metformin use results in vitamin B12 deficiency in 30% of patients.”
MRSA Found in 4% of Healthcare Workers; Most Are Healthcare-Related Strains
National Healthcare Quality Report, 2009
New Study: Avandia Riskier Than Actos “Older patients who take Avandia have a higher risk of death, heart failure, and stroke than patients taking Actos, a similar diabetes drug, a new study finds. It's far from the first study to address Avandia safety, but it's by far the largest to date, says FDA researcher and study leader David J. Graham, MD, MPH.”
-----Oxygen therapy for acute myocardial infarction. (Cochrane Database Syst Rev. 2010)
Use of Oxygen in MI Patients Questioned by New Cochrane Review “There is no conclusive evidence from randomized controlled trials to support the routine use of inhaled oxygen in patients with acute MI, a new analysis in the Cochrane Database of Systematic Reviews concludes [1]. In fact, the review of available clinical-trial data suggests that oxygen might actually be harmful.”
-----Popular Best-Hospital List Tracks Subjective Reputation, But Not Quality Measures
Primary Care Doctors Ordering Unnecessary Scans “Inappropriate exams included brain CT for chronic headache, lumbar spine MRI for acute back pain, and knee or shoulder MRI in patients with osteoarthritis.”
Proton Pump Inhibitors May Increase Fracture Risk, FDA Warns
PSA Discoverer Says PSA Screening is "Public Health Disaster" “In his opinion piece, Dr. Ablin writes: "As I've been trying to make clear for years now, PSA testing can't detect prostate cancer." He points out that infections, over-the-counter drugs like ibuprofen, and benign swelling of the prostate can all elevate PSA levels. More important, the test cannot differentiate between prostate cancer that is rapidly growing and potentially fatal from one that is growing slowly and will not kill, he adds. However, Dr. Ablin states categorically that PSA testing "should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit." "Drug companies continue peddling the tests and advocacy groups push 'prostate cancer awareness' by encouraging men to get screened," he asserts. "I never dreamt that my discovery 4 decades ago would lead to such a profit-driven public health disaster," Dr. Ablin says. "The medical community must confront reality and stop the inappropriate use of PSA screening," he states. "Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatment."“
Radiation dose-volume effects in the brain. (Int J Radiat Oncol Biol Phys. 2010) “We have reviewed the published data regarding radiotherapy (RT)-induced brain injury. Radiation necrosis appears a median of 1-2 years after RT; however, cognitive decline develops over many years. The incidence and severity is dose and volume dependent and can also be increased by chemotherapy, age, diabetes, and spatial factors.”
Scientists Say F.D.A. Ignored Radiation Warnings “Urgent warnings by government experts about the risks of routinely using powerful CT scans to screen patients for colon cancer were brushed aside by the Food and Drug Administration, according to agency documents and interviews with agency scientists.”
Severe isoniazid-associated liver injuries among persons being treated for latent tuberculosis infection --- United States, 2004--2008. (MMWR Morb Mortal Wkly Rep. 2010)
Study suggests too many invasive heart tests given
Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults (JAMA. 2010) “Conclusions Among Medicare recipients, between 2002 and 2007, the frequency of complex fusion procedures for spinal stenosis increased while the frequency of decompression surgery and simple fusions decreased. In 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resource use.”
Unneeded, riskier spinal fusion surgery on rise “A study of Medicare patients shows that costlier, more complex spinal fusion surgeries are on the rise — and sometimes done unnecessarily — for a common lower back condition caused by aging and arthritis. What's more alarming is that the findings suggest these more challenging operations are riskier, leading to more complications and even deaths.”
Valproic Acid in Pregnancy Linked to Several Congenital Malformations “A new study confirms that first-trimester exposure to valproic acid is associated with an increased risk for spina bifida compared with no use of antiepileptic drugs or with use of other antiepileptic drugs.”
When Patients Meet Online, Are There Side Effects?
Why Do Physicians Order Costly CTs? Ultrasound Yields Better Diagnosis, Safer, Less Costly, Expert Argues “Dr Benacerraf concludes: "It may be time for ultrasound to regain its rightful place in the evaluation of acute female pelvic and lower abdominal conditions and save the population from the dangerous radiation exposure and excessive cost of starting a workup with CT as a first-line imaging test."”
Americans overtested, overtreated, experts say “"People have come to equate tests with good care and prevention," Redberg, a cardiologist with the University of California at San Francisco, said in an interview Thursday. "Prevention is all the things your mother told you — eat right, exercise, get enough sleep, don't smoke — and we've made it into getting a new test." This week alone, a New England Journal of Medicine study suggested that too many patients are getting angiograms — invasive imaging tests for heart disease — who don't really need them; and specialists convened by the National Institutes of Health said doctors are too often demanding repeat cesarean deliveries for pregnant women after a first C-section. Last week, the American Cancer Society cast more doubt on routine PSA tests for prostate cancer. And a few months ago, other groups recommended against routine mammograms for women in their 40s, and for fewer Pap tests looking for cervical cancer. Does screening save lives? Experts dispute how much routine cancer screening saves lives. It also sometimes detects cancers that are too slow-growing to cause harm, or has false-positive results leading to invasive but needless procedures — and some risks. Treatment for prostate cancer that may be too slow-growing to be life-threatening can mean incontinence and impotence. Angiograms carry a slight risk for stroke or heart attack. “
Amiodarone - A 'Broad Spectrum' Antiarrhythmic Drug. (Cardiovasc Hematol Disord Drug Targets. 2009) “Amiodarone, an iodinated benzofuran derivative, introduced in 1960's as an anti-anginal agent, emerged as a potent anti-arrhythmic agent by 1970's and is currently one of the most commonly prescribed drugs in US for ventricular and atrial arrhythmias. Although amiodarone is considered a class III anti-arrhythmic agent, it also has class I, II, IV actions, making it a unique and effective anti-arrhythmic agent. Because of its minimal negative inotropic activity and very low rate of pro-arrhythmia, it is considered safe in treating arrhythmias in patients with Coronary Artery Disease and Left ventricular systolic dysfunction. Despite these advantages, long term oral therapy with amiodarone is limited by side effect profile involving various organs like thyroid, lung, heart, liver, skin etc. Though the side effects can be decreased significantly by keeping the maintenance dose at 200 to 300 mg/day, patients on amiodarone should be followed closely. Amiodarone interacts with medications such as Warfarin, Digoxin, Macrolides, Floroquinolones etc., which share Cytochrome P450 metabolic pathway. Hence reducing their doses prior to starting amiodarone is recommended. Amiodarone, a category D drug, is contraindicated in pregnant and breast feeding women.”
C Difficile Surpasses MRSA as the Leading Cause of Nosocomial Infections in Community Hospitals
CT scan use 'risk to children' “A RADIOLOGY expert is urging doctors to obtain formal written consent from parents before ordering CT scans on children, warning that the risk of a single scan triggering a fatal cancer is 70 times greater than the chance of dying from a general anaesthetic. Soaring rates of CT scan ordering by doctors in general triggered a national alert by the Medicare watchdog, which warned that patients were being exposed to unnecessary cancer risks by being given scans for complaints as trivial as back pain. CT, or computed tomography, involves hundreds of times more radiation than a simple X-ray. Statistical analysis suggests 430 cancer deaths a year may be due to ionising radiation from both procedures. Radiology expert John de Campo has warned that the risks of CT scans for young people up to the age of 20 are much higher than for adults, because their cells are dividing more rapidly and more easily damaged, and because they have more remaining years of life for a fatal cancer to develop.”
Curbing Methicillin-Resistant Staphylococcus aureus in 38 French Hospitals Through a 15-Year Institutional Control Program (Arch Intern Med. 2010)
Death of Rep. John Murtha Highlights Limitations of Laparoscopic Cholecystectomy
Decolonizing Nasal Carriers May Reduce Surgical-Site Staphylococcus aureus Infections
Doctor says heart groups too cozy with industry “The flap caused a stir at the conference and riled doctors and industry members alike. Dr. Robert Harrington, head of heart research at Duke University, who also spoke at the session, said scientists and professional societies need to do more to have "firewalls" to protect their work from corporate influence. However, most research in the United States is paid for by industry, and fair and ethical partnerships are needed to develop treatments, he said. "While it's easy to say all of this should be funded by the NIH, that's not the reality," Harrington said.”
Ranking 37th — Measuring the Performance of the U.S. Health Care System
Researchers With Financial Interests Show Strong Bias Toward Favorable Conclusions
Sharing a Hospital Room Increases Risk of 'Super Bugs' “A new study led by infectious diseases expert Dr. Dick Zoutman says the chance of acquiring serious infections like C. difficile (Clostridium difficile) rises with the addition of every hospital roommate. "If you're in a two, three or four-bedded room, each time you get a new roommate your risk of acquiring these serious infections increases by 10 per cent," says Dr. Zoutman, professor of Community Health and Epidemiology at Queen's. "That's a substantial risk, particularly for longer hospital stays when you can expect to have many different roommates."“
Staphylococcus aureus carriage in care homes: identification of risk factors, including the role of dementia. (Epidemiol Infect. 2010) “We concluded that cross-infection through staff caring for more dependent residents may spread MRSA within care homes and from the recently hospitalized. Control of MSSA and MRSA in care homes requires focused infection control interventions.”
Two Methods Help Prevent Infections After Surgery
Tylenol, Motrin, Benadryl, St. Joseph Aspirin, Rolaids Recall “Because of a sickening smell in some containers, 54 million packages of 27 different over-the-counter remedies now are being recalled. Products include various types of child and/or adult Tylenol, Motrin, Benadryl, St. Joseph Aspirin, Rolaids, and Simply Sleep. This adds to the 6 million packages of Tylenol recalled late last year, bringing the total number of recalled products to 60 million. A musty, moldy odor coming from the products has sickened at least 70 people with nausea, stomach pain, vomiting, and diarrhea. The symptoms go away by themselves and no one has been seriously injured. The FDA says Johnson & Johnson's McNeil Consumer Health Care knew of the problem for more than a year. When the company did act in November and December 2008, it did too little too late, said Deborah M. Autor, director of the FDA's Office of Compliance. "When something smells bad, literally or figuratively, companies must aggressively investigate and take all actions necessary to solve the problem," Autor said at a news conference. "McNeil should have acted faster."“
Go to the top