Patient Safety
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Patient Safety
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3 Common Drugs Trigger Most ER Visits by Seniors "In 2004 and 2005, the blood thinner warfarin, the diabetes drug insulin and the heart drug digoxin caused about 58,000 emergency room visits a year in those 65 and older, the researchers found. The major problem is that it's hard to determine the correct dose for each drug, said study lead author Dr. Daniel Budnitz, a medical officer with the U.S. Centers for Disease Control and Prevention (CDC). "
15 Questions to Ask Your Doctor About Hospital Risks
94 deaths in Panama from tainted medicine "A top Panamanian prosecutor said tests show at least 94 people have died from taking medicine contaminated with diethylene glycol since July 2006 and that 293 more deaths are under investigation. Prosecutor Dimas Guevara told The Associated Press on Wednesday that people have continued to die this year even though the tainted medicine was pulled from shelves in October, with some struggling for months before dying. … A chemical commonly found in antifreeze and brake fluid, diethylene glycol was used in cough syrup, antihistamine tablets, calamine lotion and rash ointment made in a Panama government laboratory. Investigations revealed the chemical was made by a Chinese company that fraudulently passed it off as 99.5 percent pure glycerin, a sweetener commonly used in drugs, to a Spanish company. That company sold it to Panama’s Medicom SA, which sold it to a government laboratory."
After Sanctions, Doctors Get Drug Company Pay "Medical ethicists have long argued that doctors who give experimental medicines should be chosen with care. Indeed, the drug industry’s own guidelines for clinical trials state, “Investigators are selected based on qualifications, training, research or clinical expertise in relevant fields.” … The Times’s examination of Minnesota’s trove of records on drug company payments to doctors found that from 1997 to 2005, at least 103 doctors who had been disciplined or criticized by the state medical board received a total of $1.7 million from drug makers. The median payment over that period was $1,250; the largest was $479,000. The sanctions by the board ranged from reprimands to demands for retraining to suspension of licenses."
America's Top Hospitals Are Real Lifesavers "Patients in the top-ranked hospitals in the United States are 71 percent less likely to die than those in the lowest-rated hospitals, according to a new study from the health-care ratings company HealthGrades."
Bar Code Technology Could Help Curb Drug Errors at Hospitals "Wu added that errors are so common because the U.S. is a "medication society" in which four out of five residents take at least one drug weekly. One possible solution is using a system in which the drugs are labeled with a bar code that is swiped and run through a computer system that checks the dosage and medication, the Times reports."
Before Surgery: Your Top 6 Hospital Risks
Better Grasp of Health Info May Boost Life Span "Being better able to read and understand health-related information might help you live longer, a new study finds. "Inadequate health literacy is associated with less knowledge of chronic disease and worse self-management skills for patients with hypertension, diabetes mellitus, asthma and heart failure," concluded a team from Northwestern University Feinberg School of Medicine, Chicago. "
Cancer Patients, Lost in a Maze of Uneven Care "Cancer, more than almost any other disease, can be overwhelmingly complicated to treat. Patients are often stunned to learn that they will need not just one doctor, but at least three: a surgeon and specialists in radiation and chemotherapy. Diagnosis and treatment require a seemingly endless stream of appointments. Doctors do not always agree, and patients may find that at the worst time in their lives, when they are ill, frightened and most vulnerable, they also have to seek second opinions on biopsies and therapy, fight with insurers and sort out complex treatment options. The decisions can be agonizing, in part because the quality of cancer care varies among doctors and hospitals, and it is difficult for even the most educated patients to be sure they are receiving the best treatment. "
CDC Revised Guidelines for Infection Prevention in Hospitals and Healthcare Settings
CDC: New Respiratory Bug Has Killed 10 "A mutated version of a common cold virus has caused 10 deaths in the last 18 months, U.S. health officials said Thursday. Adenoviruses usually cause respiratory infections that aren't considered lethal. But a new variant has caused at least 140 illnesses in New York, Oregon, Washington and Texas, according to a report issued Thursday by the U.S. Centers for Disease Control and Prevention."
Chemicals Flow Unchecked From China to Drug Market "Pharmaceutical ingredients exported from China are often made by chemical companies that are neither certified nor inspected by Chinese drug regulators, The New York Times has found. Because the chemical companies are not required to meet even minimal drug-manufacturing standards, there is little to stop them from exporting unapproved, adulterated or counterfeit ingredients. The substandard formulations made from those ingredients often end up in pharmacies in developing countries and for sale on the Internet, where more Americans are turning for cheap medicine. … China has an estimated 80,000 chemical companies, and the United States Food and Drug Administration does not know how many sell ingredients used in drugs consumed by Americans. "
China Recalls Tainted Leukemia Drugs
Cholinesterase inhibitors: tremor and exacerbation of Parkinson's disease. (Prescrire Int. 2007) "Tremor and dystonia are known adverse effects of cholinesterase inhibitors. (2) In patients with Parkinson's disease who have cognitive disorders, or in patients with Lewy body dementia, exacerbations of parkinsonism and tremor have been observed during treatment with cholinesterase inhibitors at normal doses."
CT Heart Scans Raise Cancer Risk "CT scan coronary angiography (CTCA), a test to determine the presence of heart trouble, can up the risk for cancer, especially for women and younger people. The finding comes from a new study in which doctors sought to estimate lifetime cancer risk from CTCA for particular patients. It suggests that doctors should carefully evaluate which patients are the best candidates for this test. "
Common MRI poisoning some kidney patients "For most people, dyes based on gadolinium — the magnetic ion blamed for the condition — are safe, said David Seidenwurm, a neuroradiologist with Radiological Associates of Sacramento. But for people with severe kidney problems, the ion can poison the patient by causing collagen to build up in tissues."
Direct-to-Consumer Drug Ads Booming Despite Criticisms
Docs often write off patient side effect concerns "In a survey of 650 patients, taking cholesterol-lowering drugs called statins, who reported having adverse drug reactions, many said their physicians denied that the drug could be connected to their symptoms, Dr. Beatrice A. Golomb of the University of California at San Diego and her colleagues found. "Physicians seem to commonly dismiss the possibility of a connection," Golomb told Reuters Health. "This seems to occur even for the best-supported adverse effects of the most widely prescribed class of drugs...Clearly there is a need for better physician education about adverse effects, and there is a strong need for patient involvement in adverse event reporting." The best-known side effects of statins, which include widely prescribed drugs such as Lipitor and Zocor, are liver damage and muscle problems, although statins have also been tied to changes in memory, concentration and mood, among other problems. Physician reaction to a potential side effect is crucial because the muscle problems can progress to a rare but potentially fatal condition called rhabdomyolysis if the drug isn't discontinued."
Doctor Says Drug Maker Tried to Quash His Criticism of Avandia "Dr. Buse, who is about to become the president of the American Diabetes Association, was an early and frequent critic of Avandia after it reached the market in 1999. In a March 2000 letter to the F.D.A., he said Avandia might raise patients’ risk of heart attacks, and he criticized the company’s marketing, saying it employed “blatant selective manipulation of data” to overstate the drug’s benefits and understate its risks."
Doctors Don't Care for Incentives "According to a new study, pay-for-performance programs at hospitals were not associated with significant improvement in processes of care or outcomes for heart attack patients. Patients are not always receiving the care they deserve. "There have been a couple prominent studies in the past couple of years showing that unfortunately there are often gaps in the care that is delivered and the care that's supposed to be delivered according to evidence-based guidelines," Seth W. Glickman, M.D., M.B.A., and lead author of the study told Ivanhoe."
Doctors suffer too after making medical errors "Patients are not the only ones harmed by medical errors, according to a survey that found many doctors who make mistakes — and even those who come close — suffer stress, sleep problems and loss of confidence. Job stress related to medical errors potentially could make some doctors prone to depression, quitting or even making additional mistakes, underscoring the need for helping them cope, said Washington University psychologist Amy Waterman, the lead author of the study which was released Wednesday. "
Drug company ties common in med schools "Nearly two-thirds of academic leaders surveyed at U.S. medical schools and teaching hospitals have financial ties to industry, illustrating how pervasive these relationships have become, researchers say. Serving as paid consultants or accepting industry money for free meals and drinks were among the most common practices reported by the heads of academic departments. Drug companies and makers of medical devices often use these connections to influence doctors to use products that aren't necessarily in the patient's best interest, said Eric Campbell, the study's lead author. He is a researcher at Massachusetts General Hospital and Harvard Medical School. … But they are dangerous when doctors are so beholden to the company that they withhold safety concerns or push the newest or most expensive products when they aren't necessarily best for the patient, Kassirer said. "
Drug reactions 'kill thousands' “While many of the cases involve drugs commonly prescribed by GPs and in hospitals, such as the blood-thinning drug warfarin and diuretics, a list of common culprits includes some which can be bought without prescription in any high street chemist. These include aspirin, and the anti-inflammatory drug ibuprofen, both of which can cause gastric bleeding if taken in high doses over longer periods. “
Fatal errors more likely on 24-hour call "Their research reveals that first-year medical school graduates who worked five shifts of 24 hours or more during a month were three times more likely to make an error that contributed to a patient's death."
FDA Requests Boxed Warning for Contrast Agents Used to Improve MRI Images
FDA Scrutiny Scant In India, China as Drugs Pour Into U.S. "After the pet food scandal that triggered fears over the safety of human and animal foods imported from China, experts say medicines from that country and from India pose a similar risk of being contaminated, counterfeit or simply understrength and ineffective. … Analysts estimate that as much as 20 percent of finished generic and over-the-counter drugs, and more than 40 percent of the active ingredients for pills made here, come from India and China. Within 15 years, they predict, as much as 80 percent of the key ingredients will come from those countries -- which are quickly becoming attractive to brand-name drugmakers, too. William Hubbard, a former FDA associate commissioner, called the situation dire and deteriorating."
FDA Warns Consumers about Counterfeit Drugs from Multiple Internet Sellers "The Food and Drug Administration (FDA) is cautioning U.S. consumers about dangers associated with buying prescription drugs over the Internet. This alert is being issued based on information the agency received showing that 24 apparently related Web sites may be involved in the distribution of counterfeit prescription drugs."
FDA warns Viagra tied to hearing loss " … in poring over FDA’s database of possible drug reactions, what struck him was these 29 reports said the hearing loss occurred within hours to two days of taking one of the drugs."
F.D.A. Tracked Tainted Drugs, but Trail Went Cold in China "After a drug ingredient from China killed dozens of Haitian children a decade ago, a senior American health official sent a cable to her investigators: find out who made the poisonous ingredient and why a state-owned company in China exported it as safe, pharmaceutical-grade glycerin. The Chinese were of little help. Requests to find the manufacturer were ignored. Business records were withheld or destroyed."
Fire Your Doctor! "Be sure to check your doctor's credentials. Find out if they are respected by their peers. If you can't communicate with or understand your doctor, or if you feel apprehensive going to the appointment, get a new doctor."
Frequently used CT scans may raise cancer risk "Millions of Americans, especially children, are needlessly getting dangerous radiation from “super X-rays” that raise the risk of cancer and are increasingly used to diagnose medical problems, a new report warns. In a few decades, as many as 2 percent of all cancers in the United States might be due to radiation from CT scans given now, according to the authors of the report. Some experts say that estimate is overly alarming. But they agree with the need to curb these tests particularly in children, who are more susceptible to radiation and more likely to develop cancer from it. "
From China to Panama, a Trail of Poisoned Medicine "The syrupy poison, diethylene glycol, is an indispensable part of the modern world, an industrial solvent and prime ingredient in some antifreeze. … Over the years, the poison has been loaded into all varieties of medicine — cough syrup, fever medication, injectable drugs — a result of counterfeiters who profit by substituting the sweet-tasting solvent for a safe, more expensive syrup, usually glycerin, commonly used in drugs, food, toothpaste and other products. … The counterfeit glycerin passed through three trading companies on three continents, yet not one of them tested the syrup to confirm what was on the label. Along the way, a certificate falsely attesting to the purity of the shipment was repeatedly altered, eliminating the name of the manufacturer and previous owner. As a result, traders bought the syrup without knowing where it came from, or who made it. With this information, the traders might have discovered — as The Times did — that the manufacturer was not certified to make pharmaceutical ingredients. An examination of the two poisoning cases last year — in Panama and earlier in China — shows how China’s safety regulations have lagged behind its growing role as low-cost supplier to the world. It also demonstrates how a poorly policed chain of traders in country after country allows counterfeit medicine to contaminate the global market. "
Getting to see your GP (UK - NHS) "The average appointment slot in general practice is ten minutes - not long when you consider it can take an older person several minutes to get undressed and dressed again. Some people need less than this (a repeat prescription for the contraceptive pill, for example) but many take longer. … People who bring long lists of problems can really slow things down for everybody. If you're someone who hoards medical problems, or if you have lots of symptoms you think are relevant, scribble them all down on a piece of paper. Then - and this is key - hand the list to your GP at the start of the consultation. You can both decide what your priorities are and how much, realistically, can be achieved in ten minutes."
Gut Feelings May Trump Evidence-Based Medicine When Choosing PCI to Treat Stable CAD "Gut instincts may sometimes trump evidence-based medicine when it comes to performing percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD), a new study suggests.[1] Cardiologists asked hypothetically about their motives for choosing PCI even in patients who might do just as well or better with medical therapy acknowledged that PCI instinctively seemed a better choice, or that past experiences or anticipated regret sometimes guided their decision. "The apparent gulf between evidence and practice appears to be motivated primarily by emotional and psychological factors," Dr Grace A Lin (University of California-San Francisco [USCF]) and colleagues write in the August 13/27, 2007 issue of Archives of Internal Medicine."
Have you been misdiagnosed? "It's a lesson worth learning because misdiagnoses are more common than you might think: A 2005 study in the Journal of the American Medical Association says autopsy studies show doctors are wrong 10 percent to 15 percent of the time."
Hazards of Buying Prescription Drugs Online "Many people are choosing to buy prescription drugs online, but unless they are very careful, this can be a risky undertaking. Drugs bought over the internet can be fake, substandard in potency, unapproved by the FDA, counterfeit, or just plain dangerous."
Health insurance didn’t keep cancer-stricken California woman solvent (USA health insurance issues) " 'When the illness began ... they were floored,' she said. 'They assumed incorrectly that if you have health insurance that you’re fine and that you’ll get the treatment that you’ll need and not have to mortgage the farm to pay for it.' … 'We see it all the time in our practice,' said William Shernoff, who said insurance companies often leave patients on their own to deal with medical providers who bill too much. 'None of these carriers go out of their way to help these people. They’re just looking after their own interests, and they don’t seem to have any consumer-friendly people out there trying to assist their customers. They take the first opportunity they can to get rid of any problems, especially if it’s going to cost them money.' "
Health care errors affect one in 10 patients - WHO "The nine key points listed by the World Health Organisation (WHO) include double-checking similar-sounding medication names, ensuring patients are correctly identified, and improving hand hygiene to avoid preventable infections."
Health Literacy and Mortality Among Elderly Persons (Arch Intern Med. 2007) "Background Individuals with low levels of health literacy have less health knowledge, worse self-management of chronic disease, lower use of preventive services, and worse health in cross-sectional studies. We sought to determine whether low health literacy levels independently predict overall and cause-specific mortality. … Conclusions Inadequate health literacy, as measured by reading fluency, independently predicts all-cause mortality and cardiovascular death among community-dwelling elderly persons. Reading fluency is a more powerful variable than education for examining the association between socioeconomic status and health."
Hospital Quality Info on Web Can Be Misleading "In looking over six hospital-comparison Web sites, researchers found they produced inconsistent results and used inappropriate or incomplete standards to measure a center's quality, according to the report in the September issue of the Archives of Surgery. "Patients are using the Internet to find health-related quality information, and the information is out there," noted lead researcher Dr. Michael J. Leonardi, from the department of surgery at David Geffen School of Medicine, University of California, Los Angeles. "But the information is inconsistent and varies from Web site to Web site," he said. A lot of Web sites try to rank hospitals, Leonardi said. But because there is no standard way of calculating quality differences, Internet sites come up with different results for the same hospitals, he noted. "
Hospital Superbugs Now In Nursing Homes And Community "Hospital superbugs that can break down antibiotics are so widespread throughout Europe that doctors increasingly have to use the few remaining drugs that they reserve for emergencies. Now these hospital superbug strains have spread to nursing homes and into the community in Ireland …"
Hospital volume and stroke outcome (NEUROLOGY 2007) "Conclusions: High annual hospital volume was consistently associated with lower stroke mortality. Our study encourages further research to determine whether this is due to differences in case mix, more organized care in high-volume facilities, or differences in the performance or in the processes of care among facilities."
Hospital-acquired hyponatremia--why are hypotonic parenteral fluids still being used? (Nat Clin Pract Nephrol. 2007) "Virtually all neurological morbidity resulting from hospital-acquired hyponatremia has been associated with administration of hypotonic fluids. Multiple prospective studies have shown that 0.9% NaCl is effective prophylaxis against hyponatremia. There is not a single report in the literature of neurological complications resulting from the use of 0.9% NaCl in non-neurosurgical patients. Patients at greatest risk of developing hyponatremic encephalopathy following hypotonic fluid administration are children, premenopausal females, postoperative patients, and those with brain injury or infection, pulmonary disease or hypoxemia. When hyponatremic encephalopathy develops, immediate administration of 3% NaCl is essential."
In Health Care, Cost Isn’t Proof of High Quality "In a Pennsylvania government survey of the state’s 60 hospitals that perform heart bypass surgery, the best-paid hospital received nearly $100,000, on average, for the operation while the least-paid got less than $20,000. At both, patients had comparable lengths of stay and death rates. And among the 20 hospitals serving metropolitan Philadelphia, two of the highest paid actually had higher-than-expected death rates, the survey found. … the Pennsylvania findings support a growing national consensus that as consumers, insurers and employers pay more for care, they are not necessarily getting better care. Expensive medicine may, in fact, be poor medicine. “For most consumers, the fact that there is no connection between quality and cost is one of the dirty secrets of medicine,” said Peter V. Lee, the chief executive of the Pacific Business Group on Health, a California group of employers that provide health care coverage for workers."
Infections, Bacteria 'Critical For Healthy Life' "Mothers around the world are armed with anti-bacterial gels, sprays and baby blankets, diligently protecting their children from nasty forms of bacteria. But recent research shows that society's anti-bacterial and anti-infection crusade makes children and adults more likely to develop asthma and allergies - and perhaps even mental illnesses."
Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States (JAMA. 2007) "Conclusions Invasive MRSA infection affects certain populations disproportionately. It is a major public health problem primarily related to health care but no longer confined to intensive care units, acute care hospitals, or any health care institution."
Is consumer health information by drug companies trustworthy?
Lens Solution Is Pulled Over Link to Infection "Customers were advised to immediately stop using the solution, AMO Complete Moisture Plus Multi-Purpose Solution. The solution, used to clean and store soft contact lenses, is made by Advanced Medical Optics of Santa Ana, Calif. … They should also throw out their current contact lenses and the lens storage case because they may harbor an infection-causing amoeba, officials of the federal Centers for Disease Control and Prevention in Atlanta said. The agency also advised people who have used the product to call an eye doctor if they have experienced eye pain or redness, blurred vision, sensitivity to light, the feeling of something in the eye or excessive tearing. "
Many Americans Dissatisfied With Their Medical Care "Although the United States spends more than twice as much on health care as other western countries, many Americans say they are forced to forgo care because of costs, experience more medical errors, and say the health-care system needs to be overhauled, a new survey finds. U.S. patients also have the highest out-of-pocket costs and the most difficulty paying medical bills, according to the survey of seven countries conducted by The Commonwealth Fund."
Many U.S. Adults Do Not Follow Physician Recommendations, Survey Finds "According to the survey, about one-fifth of respondents said they or immediate family members have sought second opinions, 13% have avoided diagnostic tests, 7% have decided not to undergo surgical procedures and 7% have switched physicians because they considered the recommendations of their physicians overly aggressive. Among respondents who said they or immediate family members did not follow the recommendations of their physicians, 89% said they experienced no negative effects, the survey found. The survey also found that 43% of respondents said they are concerned about overtreatment by physicians."
Medical Errors Common in Stroke Care "Of preventable adverse events, 37% were transcription/documentation errors, 23% were due to failure to perform a clinical task, 10% were due to communication/handoff errors between providers, and 10% were due to failed independent checks/wrong calculations."
Medical standards in 21 states based on local rule, not national standards "Although most patients don’t know it, 21 U.S. states follow some form of an 1880 ruling that says the standard of care physicians must meet by law depends on where the doctor practices, even if, in some cases, it is a small town with only two doctors. … “This can help physicians because it requires patients who file malpractice suits to find expert witnesses who also are familiar with that local standard of care,” she says. “But I have seen a lot of cases of malpractice thrown out because it is often difficult to find physicians in the same community who will serve as expert witnesses against a fellow doctor. “But this has become a double-edged sword for many physicians, because it can inhibit the adaptation of scientific advancement, and means that some doctors who want to practice the best evidence-based medicine are at risk if they do so,” Lewis says. "
Minimizing Adverse Drug Events in Older Patients (Am Fam Physician 2007)
More Hospital Nurses Mean Fewer Infections "Fewer nurses at a hospital may mean more infections and life-threatening pneumonia for patients, research shows."
More U.S. Deaths From MRSA Than AIDS "It appears that more people in the U.S. now die from the mostly hospital-acquired staph infection MRSA than from AIDS, according to a new report from the CDC. Methicillin-resistant Staphylococcus aureus (MRSA) was responsible for an estimated 94,000 life-threatening infections and 18,650 deaths in 2005, CDC researchers report in the Oct. 17 issue of The Journal of the American Medical Association. That same year, roughly 16,000 people in the U.S. died from AIDS, according to CDC figures."
Mortality among hospitalized Medicare beneficiaries in the first 2 years following ACGME resident duty hour reform. (JAMA. 2007) "CONCLUSION: The ACGME duty hour reform was not associated with either significant worsening or improvement in mortality for Medicare patients in the first 2 years after implementation."
MRSA Kills 1 in 20 Hospital Patients Who Have the Infection "One of every 20 (or 5%) of the roughly 368,600 patients treated in US hospitals in 2005 for methicillin-resistant Staphylococcus aureus (MRSA) died, according to the latest News and Numbers from AHRQ. Most of the patients who died of this highly dangerous antibiotic-resistant infection were elderly or low-income."
One In Ten Patients Comes To Harm While In Hospital, British Study Finds "Surgical patients were more likely to come to harm, but these incidents were less preventable. Diagnostic errors, on the other hand, were less common, but more preventable, the findings showed."
Patient safety may suffer at busy hospitals "At hospitals already running at full or over capacity, busy admission days and inadequate staff may raise the risk of adverse events that injure patients, according to report published this month."
Patients Should Ask Surgeons About Using Honey To Heal Wounds " 'Honey has a number of properties that make it effective against bacterial growth, including its high sugar content, low moisture content, gluconic acid -- which creates an acidic environment -- and hydrogen peroxide. It has also been shown to reduce inflammation and swelling.' … Studies have suggested that honey should be applied at regular intervals, from hourly to twice daily and that wounds can become sterile in three to 10 days."
Patients want 'better NHS data' "Many patients do not know about the performance of their local NHS services, a poll suggests. Nearly a third said they were unaware how their local hospitals and GPs compared to others. "
Patient, protect thyself "Hospitalized patients can expect to experience at least one medication error a day, says the Institute of Medicine, which advises Congress on health policy. Though some mistakes are harmless or quickly corrected, others can be deadly. Forty-four thousand to 98,000 Americans a year die from medical errors. … EIGHT WAYS TO HELP YOU, THE PATIENT: • Bring an advocate. … • Educate yourself. … "
Preoperative Hematocrit Levels and Postoperative Outcomes in Older Patients Undergoing Noncardiac Surgery (JAMA. 2007) "Conclusions Even mild degrees of preoperative anemia or polycythemia were associated with an increased risk of 30-day postoperative mortality and cardiac events in older, mostly male veterans undergoing major noncardiac surgery."
Questions on deaths (Australia)
Report Assails F.D.A. Oversight of Clinical Trials "The Food and Drug Administration does very little to ensure the safety of the millions of people who participate in clinical trials, a federal investigator has found. In a report due to be released Friday, the inspector general of the Department of Health and Human Services, Daniel R. Levinson, said federal health officials did not know how many clinical trials were being conducted, audited fewer than 1 percent of the testing sites and, on the rare occasions when inspectors did appear, generally showed up long after the tests had been completed. … Privately financed noncommercial trials have no federal oversight. …While some of the report’s findings surprised ethicists, its conclusion that the agency’s oversight of clinical trials is disorganized and underfinanced has long been known and is, in many ways, identical to criticisms leveled at other agency functions, including its oversight of imported food, foreign drug manufacturers, animal food and the safety of older medicines."
Resistant Staph Struck Rapidly: Teacher Died Within Days of First Pains
Satisfied with your medical care? Don't be "Most people have heard the statistics that we pay ridiculously more for our health than other industrialized countries (twice as much per person as Germany, for example) and that our outcomes are far worse (the U.S. is 45th in the world in life expectancy, according to the Central Intelligence Agency's World Factbook). We hear the numbers about the massive death rates from medical errors in this country. And we all hate rising premiums and co-pays, and fear losing our insurance. ... It is not just a question of extra expense. Cancer patients who suffer the horrible side effects of unneeded chemotherapy often believe their doctor saved their life. How could they know the treatment was unnecessary?"
Serious Adverse Drug Events Reported to the Food and Drug Administration, 1998-2005 (Arch Intern Med. 2007) "Conclusions These data show a marked increase in reported deaths and serious injuries associated with drug therapy over the study period. The results highlight the importance of this public health problem and illustrate the need for improved systems to manage the risks of prescription drugs."
South lags in report card on health care "The rate of premature death in Minnesota, Utah, Vermont, Wyoming and Alaska is half of that of the lowest-performing states, South Carolina, Tennessee, Arkansas, Louisiana and Mississippi. Premature death is defined as dying before age 75 from conditions that could be delayed or prevented by appropriate medical care."
Spending up, enforcement down for drug ads "Only the United States and New Zealand permit such advertising, but existing bans in Canada and the European Union are being challenged."
States' "Locality Rule" Hurts Patients "What is considered malpractice in some states may be considered acceptable practice in others. Twenty-one states base physicians' standard of care on a "locality rule," which is based on where they practice as opposed to a nationwide standard of care. "Medicine has increasingly become standardized; we use national standards for board certifications, licensing and medical education in medical schools. The majority of states has adopted a nationwide standard of care. However, many states still follow some version of the locality rule," Michelle Huckaby Lewis, M.D., J.D., lead author of this study told Ivanhoe. … The states that adhere to some form of the locality rule are: Arizona, Virginia, Washington, Idaho, New York, Arkansas, Illinois, Kansas, Maryland, Michigan, Minnesota, Nebraska, North Carolina, North Dakota, Oregon, Tennessee, Colorado, Louisiana, Montana, Pennsylvania and South Dakota."
Study paints picture of rampant "superbug" "People colonized with MRSA typically carry it in their nose without being symptomatic. They're at risk of passing the superbug on to others unknowingly, by wiping their nose and then touching a table that a doctor or nurse later touches, for instance. MRSA can live on surfaces for days or even weeks. … It found that 34 of every 1,000 patients in the survey had active MRSA infections and that 12 were colonized with the superbug, for a total prevalence rate of 46 per 1,000 patients. … There is considerable uncertainty about the true mortality rate associated with MRSA, however, and it may be as high as 10 percent, said Dr. Lance Peterson, director of infectious-disease research at Evanston Northwestern Healthcare in Evanston, Ill. Using the new estimates, that suggests as many as 119,000 hospital patients each year may be felled by the superbug."
'Superbug' deaths could surpass AIDS "Researchers found that only about one-quarter involved hospitalized patients. However, more than half were in the health care system — people who had recently had surgery or were on kidney dialysis, for example. Open wounds and exposure to medical equipment are major ways the bug spreads. In recent years, the resistant germ has become more common in hospitals and it has been spreading through prisons, gyms and locker rooms, and in poor urban neighborhoods. … A survey earlier this year suggested that MRSA infections, including noninvasive mild forms, affect 46 out of every 1,000 U.S. hospital and nursing home patients — or as many as 5 percent. These patients are vulnerable because of open wounds and invasive medical equipment that can help the germ spread."
Survey Picks 41 Top Hospitals in U.S. "Hospitals in Oakland, Calif., Pittsburgh, Boston, and Seattle were among those singled out by the Leapfrog Group, a group started by corporations and other large employers worried about health care costs. Children's hospitals in Atlanta, Los Angeles, and Detroit were also among top scorers."
Swabs in Hand, Hospital Cuts Deadly Infections "The problem of infections in hospitals is growing. MRSA has been a particularly troublesome pathogen since its emergence in the United States in 1968. Resistant to a number of antibiotics, it can cause infections of surgical sites, the urinary tract, the bloodstream and the lungs, leading to extended hospital stays. MRSA can be brought into hospitals by patients who show no symptoms, and it then thrives in settings where immune systems are weakened and where incisions provide inviting ports of entry. It now accounts for 63 percent of hospital staphylococcus infections, up from 22 percent in 1995. "
Tests of dubious value drive up health costs: study "For all the talk about aging baby boomers bankrupting the U.S. health care system, the real cost culprits may be tests and treatments of dubious value, according to a government study released on Tuesday."
The diseases we cause: Iatrogenic illness in a department of internal medicine. (Eur J Intern Med. 2007) "Eighteen percent of all iatrogenic disease was severe, 61.9% predictable, 54.5% avoidable, and 59% drug-related."
The importance of health literacy "Researchers have found that poor health literacy, which is especially prevalent among the elderly, results in poor adherence to prescription instructions, infrequent use of preventive medical services, increased hospitalizations and visits to the emergency room and worse control of chronic diseases. The consequences are poorer health and greater medical costs."
Top U.S. Hospitals Have 28% Lower Mortality Rate: Study " The top 5 percent of hospitals in the United States have a 28 percent lower death rate than other hospitals in the nation, a new study finds. The analysis, released Jan. 29 by HealthGrades, an independent health care ratings company, also found that patients who have surgery at the top-rated hospitals are about five percent less likely to suffer complications than patients at other hospitals."
Two-month waiting time for cancer treatment nowhere near being met (Scotland NHS) "THE NHS in Scotland is still failing to hit a long-overdue cancer waiting-time target, with large variations across the country. The target for all cancer patients to start treatment within two months of being urgently referred by their GP should have been met by the end of 2005. But new figures yesterday showed that, at the start of this year, the NHS was still well adrift of this target - and moving further away."
UI Research: Patient-Centered Approach Can Backfire
Uninsured More Likely to Die From Cancer Following Diagnosis: Report finds they're less likely to get screening tests, so have advanced disease “People diagnosed with cancer who don't have health insurance are more likely to die because they are less likely to get screening tests and so are typically diagnosed with advanced disease, a new study from the American Cancer Society finds. The finding proffers strong evidence that differences in cancer survival are directly related to lack of access to health care. “
Unsafe at Any Speed "Now the true picture is emerging, and it isn't pretty. Far from the disciplined and tightly controlled economy China was thought to have, the ongoing scandals have revealed an often chaotic system with lax standards, where the government's economic authority has been weakened by rapid reforms. This sorry state is not unprecedented—other economies, such as South Korea's and Japan's, experienced similar growing pains decades ago. The difference, and the danger, is one of scale, since Chinese goods now dominate the world in so many sectors. … Virtually every product category is affected, from candy that has choked children to killer fireworks to toxic face cream. At least 300 million Chinese citizens—roughly the same number as the entire U.S. population—suffer from food-borne diseases annually, according to a recent report by the Asian Development Bank and World Health Organization."
U.S. Health Experts Rate Hospitals' Cardiac Care "U.S. health officials have rated the nation's hospitals on their treatment of heart attack and heart failure and found that most meet the national average for quality of care. Scoring 4,700 centers across the country, experts at the Department of Health and Human Services took into account heart-related death rates as well as the mix of patients at each hospital to come up with their findings. "
U.S. Hospital Errors Continue to Rise "Patient safety incidents in U.S. hospitals increased by three percent overall from 2003 to 2005, and the error gap between the nation's best- and worst-performing hospitals remained wide, a report released Monday found. America's top rated centers had 40 percent lower rates of medical errors than the poorest-performing hospitals, the study showed."
VA Hospitals Do Well in Preventing Catheter Infections "The recommendations from the U.S. Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality include: • Maximal sterile barrier precautions for inserting a central venous catheter. This includes sterile gloves and gown, mask, cap, and a large sterile drape. • Chlorhexidine gluconate (2 percent) on the skin as an antiseptic before insertion, rather than povidone iodine or alcohol. • Replacing catheters as needed, rather than every 4 to 7 days. • Using antimicrobial catheters, but only if other precautions don't reduce infection rates. "
Virus Starts Like a Cold But Can Turn Into a Killer "There are 51 known strains of adenovirus, ubiquitous germs that cause many illnesses, including colds, pinkeye, bronchitis, stomach flu and a respiratory infection called boot camp flu that has long plagued soldiers. But adenovirus infections rarely have been life-threatening, especially for healthy young adults. The new adenovirus is a variant of a strain known as adenovirus 14. First identified in Holland in 1955, it has caused sporadic outbreaks in Europe and Asia. No outbreaks, however, had ever been documented in the Western Hemisphere. But then Gilbert started seeing patients like Joseph Spencer, 18, a high school varsity swimmer who was suddenly racked by fever, chills and vomiting. "
Want to stop superbugs? Clean up hospitals "Clean hands can only go so far in protecting patients from infection if doorknobs, bed rails and even sheets are covered with bacteria and viruses, Dr. Stephanie Dancer of South General Hospital in Glasgow writes in the journal Lancet Infectious Diseases."
What’s Making Us Sick Is an Epidemic of Diagnoses
Why pay for mistakes? "THE ANNOUNCEMENT that Medicare will no longer pay hospitals for "conditions that could reasonably have been prevented" is a loud and, many would say, long-overdue wake-up call for American hospitals. Officials are reflecting the rising indignation of the public at the high rate of harm they experience when hospitalized. People have long been baffled by -- and unforgiving of -- the so-called "never" events: sponges left in patients, surgery on the wrong site, mismatched transfusions, etc. But they also don't think they should fall or get infections or pressure ulcers when they go into a hospital, and they think hospitals have been far too blasé about their responsibilities to prevent harm."
ARTICLES:
5 Diagnoses That Call for a Second Opinion
5 operations you don't want to get -- and what to do instead
10 Patient Safety Tips for Hospitals
Brandjacking Index (article discusses buying online pharmaceuticals - beware)
Computed Tomography (CT) Scan of the Body
Do Hospitals Heal or Harm?: 6 Top Hospital Risks
Guilty, Afraid, and Alone — Struggling with Medical Error
Misleading Ads and How They Hurt Us "The pharmaceutical industry spent much of its $4.2 billion direct-to-consumer advertising budget in 2005 on ads targeting healthy upper-income, middle-aged people. A common underlying message was this: you appear to be healthy, but a deadly heart attack, hip fracture, or other medical catastrophe could occur at any time. Therefore, you should take a prescription drug to prevent such problems. … With such direct-to-consumer ad campaigns, which highlight risk factors and promote screening tests, drug companies move beyond promoting certain pills for treatment of diagnosed conditions to expanding their use in healthy people"
MRSA infection (Mayo)
OIG Clinical Trial Report (Safety of Clinical Trial Participation Examined)
Pharma money: we can do better "What the evidence tells us is that the information doctors receive from pharmaceutical companies omits important safety information, promotes increased prescribing, increases costs of prescribing and results in less rational prescribing."
Radiation Risk From CT Scans: A Call for Patient-Focused Imaging
JOURNAL ARTICLES:
Adverse effects of spinal manipulation: a systematic review. (J R Soc Med. 2007) "The most common serious adverse effects were due to vertebral artery dissections. The two prospective reports suggested that relatively mild adverse effects occur in 30% to 61% of all patients."
An outbreak of Pseudomonas aeruginosa infection caused by contaminated mouth swabs. (Clin Infect Dis. 2007) "CONCLUSIONS: Contamination of mouth swabs during production caused the largest-ever outbreak of P. aeruginosa infection in Norway. Susceptible patient groups should use only documented quality-controlled, high-level-disinfected products and items in the oropharynx."
Approaches to serious methicillin-resistant Staphylococcus aureus infections with decreased susceptibility to vancomycin: clinical significance and options for management. (Curr Opin Infect Dis. 2007)
[Corticosteroids and osteoporosis.] (Actas Dermosifiliogr. 2007) "Corticosteroids are the principal cause of secondary osteoporosis due to drug treatment. Doses of more than 5 mg daily and periods of treatment lasting more than 3 months increase the risk of osteoporosis and fragility fractures."
Do contaminated dental unit waterlines pose a risk of infection? (J Dent. 2007)
Do people want to be autonomous patients? Preferred roles in treatment decision-making in several patient populations. (Health Expect. 2007) "Conclusions Despite consumerist rhetoric among some bioethicists, very few respondents wish an autonomous role. Most wish to share DM with their providers."
Nosocomial Infections after Peripheral Arterial Bypass Surgery. (World J Surg. 2007) "RESULTS: A total of 67 infections were diagnosed in association with 607 procedures, yielding an infection ratio of 10.0%. Surgical site infection was the most common (55.2%), followed by urinary tract infection (16.4%), pneumonia (14.9%) and bacteremia (10.4%). Staphylococcus aureus was the most commonly found isolate in surgical site infections (48.6%) and in bacteremia (42.9%). Age, the use of corticosteroids (p = 0.02), and critical ischemia with tissue loss (p = 0.009) could be identified as risk factors for the development of a nosocomial infection. Blood transfusion was a postoperative risk factor for nosocomial infection (p < .0001)."
Patients at high risk of adverse events from intravenous contrast media after computed tomography examination. (Eur J Radiol. 2007) " Prior to examinations using CM, patients should be adequately assessed by obtaining thorough medical histories and using simple screening tests. Studies have demonstrated that patients with a history of asthma, allergy, hyperthyroidism, and previous reaction to CM are at risk for severe reactions to iodinated CM. Renal adverse reactions reportedly occur more frequently in patients with pre-existing chronic kidney disease, especially those with diabetic nephropathy. Patients with congestive heart failure, dehydration, older age, and those who use nephrotoxic medications are also at risk for developing contrast-associated nephropathy. The occurrence of adverse events may be further increased in patients with multiple risk factors."
Risk Factors Affecting In-hospital Mortality in Patients with Nosocomial Infections. (J Formos Med Assoc. 2007) "Conclusion: Measures that prevent the occurrence of NI, such as improving the immunity status of the host, removal of catheters as soon as possible, and implementing an infection control program, could reduce the risk of in-hospital deaths attributable to NI."
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