Patient Safety
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Patient Safety
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5 MRSA 'Hot Spots': MRSA Loves Gyms, Barracks, Prisons, Schools -- and Your Nose “By far the largest epidemic is going on inside hospitals and other health care facilities. The staph bug causing these infections resists treatment with a broad range of antibiotics. Because it attacks so many people with weakened immune systems, hospital-acquired MRSA accounts for the vast majority of fatal MRSA infections. But another, unrelated strain of MRSA is circulating in communities across the U.S. This strain is resistant to first-line antibiotics. News that MRSA is now killing at least 19,000 Americans each year has focused public attention on community-acquired MRSA.“
Adverse Reactions To Antibiotics Send Thousands Of Patients To The ER “Half of the visits were for reactions to penicillins and the other half were from reactions to other antibiotics used to treat a wide variety of bacterial infections. After accounting for how often antibiotics were prescribed, children less than one year old were found to have the highest rate of adverse drug events. Almost 80 percent of all antibiotic adverse events in the study were allergic reactions, ranging from rash to anaphylaxis, and the remaining 20 percent were caused by errors and overdoses. Unlike errors and overdoses from other drugs, allergic reactions to antibiotics typically can only be prevented by avoiding exposure to the drug in the first place.”
Alcohol hand rubs not enough to curb hospital infections
Americans Cutting Back On Medical Care, Poll Finds
America’s 50 Best Hospitals – Healthgrades
'Are clinicians trained to read the evidence? Sadly not' “In a clinical trial, a drug is said to "work" when differences between the group taking it and the control group are statistically significant. In sufficiently large trials even a small difference may be statistically significant. As a result of this, drugs that are sedating or tranquillising can be deemed to "work for depression". Provided the drug can be shown to beat a placebo in two trials, the regulators are prepared to license it - even if it fails in the other 98 trials out of 100. The regulators acknowledge that what they do is take these hints that the drugs "might" work as grounds to let companies market them as effective treatments. And once regulators have approved such drugs, companies market them by selectively publishing from the trials undertaken, in articles that are little more than marketing copy appearing under the apparent authorship of the biggest names in the field and in the most distinguished journals. But once marketed, surely clinicians are trained to read the evidence rather than just reach for their prescription pad? Sadly not.”
Average ER waiting time nears 1 hour, CDC says (USA)
Avoiding Unnecessary CT Scans “At least one reason for the overuse of CT is certainly financial. Major insurers still pay fairly well for the scans. While it's true that advanced technology has made CT machines better, faster and more affordable over the years, the only thing that's really different now versus five years ago is that more hospitals are going bankrupt — they need to be a lot keener at making money to survive. So, for starters, they're hiring doctors: The hospital pays them a salary while billing for the services they order or perform. (Doctors in private practice, unlike hospital-employed doctors, work in but not for the hospital.) Hospital-employed docs must earn their keep. And ordering CT scans is a good way of doing that: Since the exact reasons (what we call the "indications") for ordering a CT scan in a given medical situation are often vague and fudgeable, it's hard to claim they're over-ordered. The cancer caused by a CT scan doesn't generally show up for decades — and there are all sorts of other intervening reasons why a patient would develop cancer — so no one is too scared of getting sued for ordering a CT scan. Getting sued for not ordering one is more likely. So, the people who should be the most worried about CT scans are the patients.”
Beware Of Doctors And Nurses Wearing Wristwatches: They Could Be Potential Sources Of Hospital-acquired Infection “According to a study conducted by A.R. Jeans, R.C. Read and colleagues (Sheffield University, UK), presented at the 18th European Congress of Clinical Microbiology and Infectious Diseases in Barcelona, healthcare workers who wear wristwatches are more likely to be contaminated by Staphylococcus aureus.”
Blood Thinner Might Be Tied to More Deaths “Amid indications that more people may have died or been harmed after being given a brand of the blood thinner heparin, federal drug regulators said Thursday that they had found “potential deficiencies” at a Chinese plant that supplied much of the active ingredient for the drug. Baxter International, which makes the brand of heparin associated with the problems, and buys supplies from the Chinese plant, announced that it was expanding a recall to include virtually all its heparin products. Though Baxter produces much of the heparin used in the United States, regulators said the other major supplier would be able to meet the demand.”
Chinese Ginseng Blamed for Three Deaths “China has banned the sale and use of a popular brand of Siberian ginseng after the deaths of three people who had received injections of the herbal drug. At least three others are reported seriously ill. The latest crisis comes as China tries to deal with the tainted milk scandal that has caused worldwide concern. The banned ginseng was made by Wandashan Pharmaceutical, a company based in northeastern China. Chinese authorities said they had found two harmful batches of the medicine and were continuing to investigate. It's not known whether Wandashan markets its products outside of China. Symptoms found in victims of the tainted herb included feeling cold, vomiting, dropping blood pressure and coma. Besides its injectable form, the herb is also sold in capsules and in herbal teas.”
Cigarette Company Paid for Lung Cancer Study “In October 2006, Dr. Claudia Henschke of Weill Cornell Medical College jolted the cancer world with a study saying that 80 percent of lung cancer deaths could be prevented through widespread use of CT scans. Small print at the end of the study, published in The New England Journal of Medicine, noted that it had been financed in part by a little-known charity called the Foundation for Lung Cancer: Early Detection, Prevention & Treatment. A review of tax records by The New York Times shows that the foundation was underwritten almost entirely by $3.6 million in grants from the parent company of the Liggett Group, maker of Liggett Select, Eve, Grand Prix, Quest and Pyramid cigarette brands. The foundation got four grants from the Vector Group, Liggett’s parent, from 2000 to 2003. “
Clinic accused of reusing syringes sued
Common Medications May Harm Memory in Older People “Common medications known as anticholinergic drugs — used to treat ulcers, stomach cramps, motion sickness, Parkinson's disease and urinary incontinence — may cause older people to lose their thinking skills more quickly than seniors who don't take the medicines, new research suggests.”
Copper Fights Hospital Infections “Once you enter a hospital for care, your risk of developing a hospital-acquired infection is one in twenty. It's a common problem plaguing our nation's hospitals and the patients inside them and the consequences can be deadly. Now, why a common metal could save thousands of lives and billions of dollars. … These three individuals are part of the two million people in the United States that get hospital infections every year. One-hundred-thousand of them will die. … No one's sure why copper kills, but studies show it destroys nearly all of infection-causing microbes. "They are not coming back to life," Dr. Schmidt said. "They are dead and as they say, 'Dead microbes tell no tales.'" In Dr. Schmidt's study, copper replaces plastic components in hospital rooms like bed rails, nurse call buttons, tray tables, keyboards and mice. Cassandra Salgado, M.D., an infectious disease specialist at the Medical University of South Carolina, says copper will add another much-needed layer of protection.“
CPR: Just Chest Compressions, Mouth-to-Mouth Not Necessary
Creutzfeldt-Jakob Disease: Humans Could Be Infected Through Blood Transfusions “While cases of vCJD are tailing off there are concerns that up to 4,000 people could be carrying the disease in the UK, which could then be transmitted through infected blood causing further infections.”
Cumulative Radiation Exposure Shows Increased Cancer Risk For Emergency Department Patients “Patients had an average cumulative estimated effective radiation dose of 45.0 milliseiverts, with CT scans and nuclear medicine studies contributing the most radiation. Twelve percent of the sample population was estimated to have received 100 or more millisieverts of radiation, a value that exceeds the accepted threshold of safety for exposure to low level ionizing radiation. If study patients are representative of the general emergency department population, then a substantial number of people may be placed at increased risk of developing cancer over their lifetime from diagnostic imaging studies as a result of these exposures.“
Deadly Dose: Pharmacy Error Kills Infant: Reporter: Hospital's Pharmacy Run Like a 'Temp Agency'
Deadly Infections in Hospitals “Deadly infections are on the upswing in hospitals around the world. Overcrowding and understaffing may be at least partially to blame.”
Death rate 70 percent lower at top hospitals “Researchers have long documented how hospitals can kill you. Blame is placed on everything from exhausted doctors and staff to antibiotic-resistant microbes. … The region with the lowest overall risk-adjusted mortality rates (that's good) was the East North Central region (Illinois, Indiana, Michigan, Ohio and Wisconsin), while the East South Central region (Alabama, Kentucky, Mississippi and Tennessee) had the highest mortality rates (that's bad).”
Doctors Under-reporting Medical Errors To Hospitals, Study Suggests “As an example, 41 percent of physicians in the earlier study said they actually had disclosed a minor error to a patient but only 18 percent of physicians in the current study said they had reported a minor error to their hospital. "Taken together, the findings indicate that physicians have more experience talking to patients about medical errors than reporting them to hospitals," said Kaldjian, who also is director of the college's Program in Biomedical Ethics and Medical Humanities. "It may be that physicians find it more important or meaningful to talk to patients about mistakes and may not see as much value in communicating the same mistakes to a reporting system," he added. “
Drug Tied to China Had Contaminant, F.D.A. Says “Federal drug regulators said Wednesday that a critical blood thinner that had been linked to at least 19 deaths and whose raw components were produced in China contained a possibly counterfeit ingredient that mimicked the real drug.”
Drugs that don't work: a tough pill to swallow “The situation has renewed debate about the ways drugs are tested and approved in the U.S. and whether they’re being released to market too soon. It also has raised doubts about the FDA’s practice of accepting “surrogate endpoints” for drug approval. Instead of relying on ultimate outcomes — a reduction in heart attacks or strokes, for instance, or a decrease in deaths — many studies measure a drug’s effectiveness by using interim markers, such as decreasing blood pressure levels or lowering LDL cholesterol. The FDA long has allowed use of such markers because waiting for the results of large-scale outcome trials would cost too much and take too long, possibly delaying life-saving advances for millions of people, said Dr. Robert Temple, director of the agency’s office of medical policy. But the practice has been called into question by the surprises of recent research, said Dr. Nortin M. Hadler, a professor of medicine at the University of North Carolina. “In our zeal to do modern medicine ... we’ve managed to lose our way,” he said. “We’ve forgotten to ask: ‘Does this matter to the patient?’” “
Early Mobility Better than Bed Rest for ICU Patients “Intensive care unit patients who were able to get up and moving often do better when they leave the hospital than those who remained in their beds. In fact, a critical care specialist at Johns Hopkins who has reviewed recent studies of intensive care unit (ICU) patients and data from The Johns Hopkins Hospital concludes that the routine use of deep sedation and bed rest in ICU patients may be causing unnecessary and long-term physical impairment and poor quality of life after hospital discharge. "The benefits of getting hospitalized patients out of bed and moving were understood during World War II with battlefield injuries," said Dale Needham, M.D., Ph.D., assistant professor in the Division of Pulmonary and Critical Care Medicine and Department of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine. "My review shows it may be time to go back to the future. It's becoming clear that the safety and benefits of early mobilization are real and that it's better to get moving sooner rather than later." “
Easy health care access for all becoming a thing of the past “One 2007 study says nearly one in five Americans - 56 million people - don't have ready access to primary health care because of local shortages of primary care doctors. The report - entitled "Access Denied: A Look at American's Medically Disenfranchised" - found that lack of access isn't just a consequence of being poor and uninsured. Instead, most Americans who don't have access to a primary care doctor actually do have health insurance. Even doctors themselves are not immune to the problem of finding a doctor: Prescott's Dr. Roger Jenkins said that after he switched health insurers himself, he had to find a new doctor because his old one wouldn't accept the new insurance.”
Elderly at risk of memory trouble after surgery “People 60 years of age or older who undergo elective surgery may be at higher risk of lasting memory problems, U.S. researchers said on Wednesday. They said people 60 and older who have major surgeries such as joint replacements or hysterectomies are more likely to have cognitive problems after surgery. And those who do are more likely to die in the first year after their surgery. … It is not clear why some patients suffer these problems, but it may be that surgery and anesthesia cause swelling in the brain that can affect the patient's ability to learn, retain or remember information, Monk said in a statement. She said the study suggests the elderly may be predisposed to cognitive problems after major surgery. And knowing this might help doctors devise better strategies to prevent the effects of surgery and anesthesia on the aging brain.“
Even the Insured Feel the Strain of Health Costs (USA) “Since the recession of 2001, the employee’s average cost of an annual health care premium for family coverage has nearly doubled — to $3,300, up from $1,800 — while incomes have come nowhere close to keeping up. Factor in other out-of-pocket medical costs, and the portion of the average American household’s income that goes toward health care has risen about 12 percent, according to the consulting and accounting firm Deloitte, and is now approaching one-fifth of the average household’s spending. In a recent survey by Deloitte’s health research center, only 7 percent of people said they felt financially prepared for their future health care needs.”
Experts: Staph germs becoming harder to treat “Drug-resistant staph bacteria picked up in ordinary community settings are increasingly acquiring “superbug” powers and causing far more serious illnesses than they have in the past, doctors reported Monday. These widespread germs used to be easier to treat than the dangerous forms of staph found in hospitals and nursing homes. … The germ is methicillin-resistant Staphylococcus aureus, or MRSA. People can carry it on their skin or in their noses with no symptoms and still infect others — the reason many hospitals isolate and test new patients to see if they harbor the bug.”
Explain a Medical Error? Sure. Apologize Too? “Most doctors are afraid to take responsibility for medical errors. We are acutely aware of the potential hazards — legal and professional — of taking ownership of a mistake. But studies have shown that physicians’ apologies do not necessarily increase malpractice lawsuits. In fact, they may protect against litigation. Seventeen states have enacted legislation encouraging such apologies, some even making physicians’ expressions of remorse inadmissible in court. It was not always this way. Hospital legal departments routinely used to advise doctors never to admit responsibility for an error.”
FDA Alert - Fluoroquinolone Antimicrobial Drugs “Fluoroquinolones are associated with an increased risk of tendinitis and tendon rupture. This risk is further increased in those over age 60, in kidney, heart, and lung transplant recipients, and with use of concomitant steroid therapy. Physicians should advise patients, at the first sign of tendon pain, swelling, or inflammation, to stop taking the fluoroquinolone, to avoid exercise and use of the affected area, and to promptly contact their doctor about changing to a non-fluoroquinolone antimicrobial drug.“
FDA Deadlines may Hurt Patient Safety “Congressionally mandated deadlines may be causing the U.S. Food and Drug Administration (FDA) to rush drugs to market before they are really ready. That’s the key finding from Harvard researchers who reviewed the data on FDA drug approvals. Results showed drugs that were approved right before the deadline were two to three times more likely to be pulled from the shelves over time than drugs approved at a more leisurely pace, and two to seven times more likely to end up needing special “black box warnings” alerting patients to safety issues.”
FDA Warns Consumers Not to Use Super Shangai, Strong Testis, Shangai Ultra, Shangai Ultra X, Lady Shangai, and Shangai Regular (also known as Shangai Chaojimengnan) “These products, which originate in China, are being marketed for the treatment of erectile dysfunction (ED) and for sexual enhancement. Although labeled as dietary supplements, these products do not qualify as dietary supplements because they contain undeclared active ingredients of FDA-approved prescription drugs for erectile dysfunction. The products are thus drugs that are illegal because they lack FDA approval. The undeclared ingredients in these products may interact with nitrates found in some prescription drugs (such as nitroglycerin) and can lower blood pressure to dangerous levels. Consumers with diabetes, high blood pressure, high cholesterol, or heart disease often take nitrates. … FDA performed chemical testing of the products that revealed that Super Shangai, Strong Testis, Shangai Ultra, Shangai Ultra X, and Lady Shangai contain sildenafil, the active ingredient in Viagra, an FDA-approved drug for erectile dysfunction. Shangai Regular, also marketed as Shangai Chaojimengnan, contains an unapproved substance with a structure similar to sildenafil that may cause similar side effects and drug interactions. Neither sildenafil nor the analog of sildenafil is listed as an ingredient on the label of any of these products.”
France best, U.S. worst in preventable death ranking “France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations, researchers said on Tuesday. If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs. Researchers Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine tracked deaths that they deemed could have been prevented by access to timely and effective health care, and ranked nations on how they did. They called such deaths an important way to gauge the performance of a country's health care system.“
Frequency of Stress Testing to Document Ischemia Prior to Elective Percutaneous Coronary Intervention (JAMA. 2008) “Conclusion The majority of Medicare patients with stable coronary artery disease do not have documentation of ischemia by noninvasive testing prior to elective PCI.”
Germicidal Wipes Can Spread Bacteria “Researchers Jean-Yves Maillard, PhD, Gareth Williams, PhD, and colleagues observed hospital staffers as they used the wipes to disinfect hospital rooms. "We saw that there was a tendency to use one wipe on consecutive surfaces, such as bed rails, computer monitors, and keyboards," Williams tells WebMD. The researchers used the wipes in this way in laboratory tests designed to measure their ability to remove and kill the bacteria that cause staph infections, including MRSA. While most of the wipes tested did remove large numbers of bacteria from contaminated surfaces, they also commonly transferred live bacteria to uncontaminated surfaces when used in more than one place. Even some wipes that claimed to kill bacteria were found to transfer live bacteria from one surface to another, the researchers report. "Many of the wipes were effective, but the message is that they have to be used properly," Williams says. That means using one swipe per wipe on a single surface, Maillard tells WebMD.“
Health 'Shocks' Diminish Wealth More Later In Life ““If you have a chronic health condition, it diminishes your wealth throughout your life. And if you get a health shock, it diminishes your wealth even more,” Lee said. “Though over time the costs associated with that shock may decrease, that illness will still deflate your wealth continuously thereafter.” To Lee, this research demonstrates how costly healthcare is to Americans, even if they have Medicare coverage. Medicare typically pays a little over half of someone’s medical bills, and seniors -- most of whom are living on a fixed income -- are forced to make up the difference by dipping into their savings. Add to that the fact that Americans are living longer, and the cost of healthcare keeps increasing. Even if seniors can recover physically from a health shock, they can’t recover financially.“
Hospitalized Patients With CKD Are At Increased Risk Of Being Harmed By Medical Errors, Study Finds
[Hospital-acquired infections after caesarean delivery in selected hospitals in the southern Poland] (Ginekol Pol. 2008)
How Independent Are Vaccine Defenders? “The vaccine industry gives millions to the Academy of Pediatrics for conferences, grants, medical education classes and even helped build their headquarters. The totals are kept secret, but public documents reveal bits and pieces.”
In Hospitals, Simple Reminders Reduce Deadly Infections
In Spain, 6 Of Every 100 Patients Die In Hospital Due To Adverse Drug Reaction, Study Suggests “The work carried out at the UGR has revealed that the drugs which provoked an ADR usually were AINE (medicines with a strong anti-inflammatory, analgesic and antipyretic effect) as well as platelet anti-aggregants, such as acetylsalicylic acid, two types of drugs frequently used in the daily medical practice. Pardo Cabello has also shown the importance of avoiding the mixing of gastro-damaging drugs such as NSAIDs, anti-aggregants and corticoids, as 53% of the deaths caused by ADR analyzed in this study had received a mixing of such medicines.“
Infection Control Guidelines Issued “The recommended practices, like vigorous hand-washing before the insertion of catheters and warnings against using razors to remove hair before surgery, do not vary in significant ways from the encyclopedic guidelines issued and revised over the last two decades by a government advisory panel. But their authors said they had been written more clearly and concisely, with advice not only on what hospitals should do, but also on what they should not, and on secondary approaches to try if first-line measures do not lower infection rates. “
Magazine Reveals 'Best Hospitals' List (USA)
Medical litter: Device debris poses serious risk
Medicine Mix - Ups Harm Hospitalized Kids “Medicine mix-ups, accidental overdoses and bad drug reactions harm roughly one out of 15 hospitalized children, according to the first scientific test of a new detection method. That number is far higher than earlier estimates and bolsters concerns already heightened by well publicized cases like the accidental drug overdose of actor Dennis Quaid's newborn twins last November. ''These data and the Dennis Quaid episode are telling us that ... these kinds of errors and experiencing harm as a result of your health care is much more common than people believe. It's very concerning,'' said Dr. Charles Homer of the National Initiative for Children's Healthcare Quality. His group helped develop the detection tool used in the study. Researchers found a rate of 11 drug-related harmful events for every 100 hospitalized children. That compares with an earlier estimate of two per 100 hospitalized children, based on traditional detection methods. The rate reflects the fact that some children experienced more than one drug treatment mistake.“
Merck, Schering-Plough Sued Over Cholesterol Drugs Marketing “The makers of popular cholesterol drugs Vytorin and Zetia are being sued in at least four states over allegations that Merck & Co. and Schering-Plough Corp. misled consumers into thinking the drugs were more effective than generic ones.”
Misdiagnoses Caused in Part by Overconfidence
MRSA Epidemic Hits Denmark “"The new threat is MRSA transmission in the community, without infected people visiting a hospital or care home themselves, where they might be expected to risk contact with drug resistant bacteria", says Professor Robert Skov from the Statens Serum Institut in Copenhagen, Denmark. "The spread of community acquired MRSA among the general population creates a huge problem for us", says Professor Skov. "Some infected people will inevitably be hospitalised themselves, or visit friends and relatives who are patients in hospitals. Or they could be health care workers and so will increase the risk of outbreaks of these new types of MRSA. These community strains have evolved independently of the hospital strains and so present a whole new series of problems for control and treatment". “
New push sticks hospitals with cost of errors “It's a new way to push for patient safety: Don't pay hospitals when they commit certain errors. Medicare will start hitting hospitals where it hurts in October, and other insurers are hot on the trail. … lessening of a big indignity: Today, one in four hospitalized patients is outfitted with a urinary catheter. The tubes trigger more than half a million urinary tract infections a year, the most common hospital-caused infection. Yet many patients don't even need catheters — they're an automatic precaution after certain surgeries — and many who do have them for days longer than necessary. Why? The University of Michigan reported the first national study of catheter practices last month, finding nearly half of hospitals don't even keep track of who gets one. Fewer than one in 10 hospitals does a daily check to see if the catheter is still needed, a simple but proven infection-reducing system. … With those infections topping Medicare's do-not-pay list, Gordon says hospitals already are beginning to get choosier about who needs catheters, and to yank them faster. Even when a hospital makes a preventable error, it still can be reimbursed for the extra treatment that patient will now require. Some errors can add $10,000 to $100,000 to the cost of a patient's stay. Beginning Oct. 1, Medicare no longer will pay those extra-care costs for eight preventable hospital errors, including catheter-caused urinary tract infections, injuries from falls, and leaving objects in the body after surgery. Nor can hospitals bill the injured patient for those extra costs. Next year, Medicare will add three more errors to the no-pay list; ventilator-caused pneumonia and drug-resistant staph infections are top candidates.“
News Media Coverage of Medication Research “Conclusion News articles reporting on medication studies often fail to report pharmaceutical company funding and frequently refer to medications by their brand names despite newspaper editors' contention that this is not the case. “
[Nosocomial infections caused by Pseudomonas aeruginosa: Exogenous or endogenous origin of this bacterium?] (Pathol Biol (Paris). 2008)
Older Patients Less Likely to Be Taken to Trauma Centers “Older trauma patients are less likely to be transported to an official trauma center for immediate care than younger patients, a new study found. The finding was based on a review of a decade's worth of Maryland's statewide emergency medical services (EMS) records. And it suggests that the difference in care first comes into play as patients reach age 50 and worsens again at age 70. “
Patients rarely use online ratings to pick physicians “A Harris Interactive poll commissioned by the California HealthCare Foundation found that although more than 80% of the state's adults turn to the Internet for health-related information, less than one-quarter have looked at physician ratings sites. Only 2% of those surveyed made a change in physicians based on information posted on a rating site.”
Patients still stuck with bill for medical errors “When Kevin Baccam of Urbandale, Iowa, went in for hernia surgery in August 2005, he expected to come home with a scar on the right side of his groin. But the 33-year-old school district controller actually wound up with two scars in the delicate region — one on each side — after the surgeon mistakenly operated on the left and had to start over. Nearly as painful, Baccam said, was when he opened his mail a few weeks later and saw his health insurance had been billed for both operations. “
People With Cardiac Arrest Less Likely To Survive If Admitted On Weekend, Study Shows “Dubinsky says hospitals need to make more resources available on weekends to improve the likelihood people with cardiac arrest who are admitted on the weekend will survive.”
Poor Health Literacy in the Elderly Predicts All-Cause and Cardiovascular Mortality
Recall issued for heparin marketed in Canada “Canada has been drawn into the ever-widening scandal surrounding a commonly used blood thinner contaminated with a drug that can provoke life-threatening allergic reactions. Health Canada said yesterday that testing had revealed that heparin products marketed in Canada by B. Braun Medical Inc. of Mississauga, Ont., were tainted. The company immediately recalled its products in Canada, Australia and the United States.“
Resistant staph kills healthy people too “The more well-known MRSA superbugs found in hospitals generally infect the young and old. But this research refers to so-called non-multiresistant forms of MRSA. These can infect young adults, adolescents and other age groups in the community and are generally more susceptible to antibiotics than their hospital-acquired counterparts. What commonly starts as boils in otherwise healthy people, can if untreated, progress to life-threatening pneumonia or bone destruction, says director of microbiology with Pathology Queensland, Associate Professor Graeme Nimmo. … Patients normally present to their doctor with a boil, and if untreated, symptoms can include fever, feeling extremely unwell and a rapid heartbeat. "People with boils, especially recurring boils, need them drained by a doctor, antibiotics and an antiseptic skin wash, and relatives might also need treatment," Nimmo says. Prisoners, gay men, some indigenous groups, gymnasts and rugby players are at higher risk, he says. Improving household hygiene, increasing washing of linen and towels and reducing overcrowding reduces the bacteria burden.”
Risk factors and outcome in ICU-acquired infections. (Acta Anaesthesiol Scand. 2008)
Safety checklist for ops launched “Its primary aim is to target the three biggest cause of mortality in surgery - preventable infections, preventable complication from bleeding, and safety in anesthesia. It includes six basic steps in care, including verifying that it is the correct patient, ensuring equipment is not left inside the patient, and administering an antibiotic before making an incision - which cuts the risk of infection by half. Preliminary results from patients at eight pilot sites - including London, Seattle and Toronto - indicate that the checklist has nearly doubled the likelihood that patients will receive proven standards of surgical care, leading to a significant cut in complications and deaths. The study, published in the Lancet, found that before the checklist was used there was a 64% chance that at least one of the procedures was forgotten - with no difference between rich and developing countries. “
Sponges, surgical instruments miscounted in 13% of surgeries
Study Finds Many Patients Dissatisfied With Hospitals
Study Finds Surgical Errors Cost Nearly $1.5 Billion Annually
Study: Deadly Stomach Bug More Common Than Thought “The germ, Clostridium difficile, is resistant to some antibiotics and has become a regular menace in hospitals and nursing homes. Doctors say it plays a role in hundreds of thousands of hospitalizations each year, and that number has been growing. The latest study estimates that more than 7,100 hospital patients are infected with it on any given day. That number is between 6.5 and 20 times greater than previous estimates, according to the Association for Professionals in Infection Control and Epidemiology. … The most dangerous form is spread by spores in feces, and the spores are difficult to kill with most conventional household cleaners or antibacterial soap.”
'Superbugs' On The Rise In Canadian Hospitals, New Study Shows “Since the first survey was conducted, the rates of MRSA (Methicillin-resistant Staphylococcus aureus) have more than doubled across Canada, from 2.0 to 5.2 per 1,000 hospital admissions. Another deadly bacterium, VRE (Vancomycin-resistant enterococcus), was found in 77 per cent more hospitals in the 2005 survey than in 1999.”
Tainted Pills From Puerto Rico Reach U.S.
The epidemic of overmedication “Here's what I learned: The use of multiple, often unnecessary medications — especially among older people — is an entrenched, escalating, frightening, and mostly unexamined problem in modern health care. Although medications can ease many conditions, multiple-drug use often exacerbates existing ailments and causes troubling side effects that are treated with yet more drugs. Many doctors, researchers, and pharmacists I talked to agree. "Overmedication is a true epidemic," says Armon B. Neel Jr., PharmD, a clinical pharmacist in Georgia who evaluates medication plans for private and nursing home clients. "It's completely out of hand."”
The Germs Are Potent. But So Is a Kiss. “Like the better-known MRSA, VRE is a so-called multidrug-resistant organism, able to survive an assault from powerful antibiotics. Half a century ago these bugs did not exist; a decade ago they were rare; today, nearly 30 percent of the Enterococcus bacteria collected from cultures in hospitals are VRE, and 60 percent of the Staphylococcus aureus are MRSA. Their emergence is an unintended consequence of our use (and overuse) of antibiotics. Hardy organisms like MRSA evolve to withstand the drugs; then, through vectors like the unwashed hands of health care workers, they hitch a ride from patient to patient, hiding like terrorists among the natural bacteria that all humans harbor. “
The Obsession With Medical Advances and the High Cost of False Promises
Unsponsored websites give best surgery info “If you're searching the Internet for surgery information, you may want to stick with sites run by professional medical groups and other sources free of commercial sponsors, a new study suggests. In a study that examined the quality of various surgery-related websites, researchers found that unsponsored sites generally gave more reliable information than sponsored sites did. When it came to the specific sources, sites run by professional medical groups got the highest marks, followed by government-run sites. The findings, published in the Journal of the American College of Surgery, underscore the need for consumers to consider the source when looking for online medical information. "Empowering patients with a trusted source of information will lead to better informed patients and, in turn, improved expectations of surgery outcomes," senior researcher Dr. Clifford Ko, a professor of surgery at the University of California, Los Angeles, said in a statement.“
Vein tubes 'fitted needlessly' “Cannulas - hollow plastic tubes with a needle at the tip which cost around £1.70 each - are used to give medication and fluids to people who cannot swallow because they are unconscious or being given nil by mouth, and it has been estimated that around 80% of hospital patients have them fitted. Drugs may also be more easily absorbed if given this way. But potential complications include problems with veins (phlebitis), drugs leaking into tissues around the site of the tube, serious infection and blood clots. “
Vioxx studies used drugmaker ghostwriters “Two new reports involving the painkiller Vioxx raise fresh concerns about how drug companies influence the interpretation and publication of medical research. The reports claim Merck & Co. frequently paid academic scientists to take credit for research articles prepared by company-hired medical writers, a practice called ghostwriting. They also contend Merck tried to minimize deaths in two studies that showed that the now withdrawn Vioxx didn’t work at treating or preventing Alzheimer’s disease. Merck called the reports in Wednesday’s Journal of the American Medical Association false and misleading. Five writers of the articles were paid consultants for people who sued Merck over Vioxx’s heart and stroke risks; the sixth testified about Merck and Vioxx’s heart risks before a Senate panel. Merck says those connections makes the reports themselves biased.”
Watch what you touch: A bad germ gets worse “C. diff has long been a common, usually benign bug associated with simple, easily treated diarrhea in older patients in hospitals and nursing homes. About 3 percent of healthy adults harbor the bacteria with no problem. But overuse of antibiotics has allowed the germ to develop resistance in recent years, doctors said, creating the toxic new type that stumps traditional treatment. … About 90 percent of CDAD cases occur in patients who've used antibiotics recently, especially fluroquinolines such as the popular drug Cipro. The resistance allows the C. diff bacteria to take over and flourish. Consequences can range from severe diarrhea to colitis and toxic megacolon, a condition that can lead to shock and death. … “The biggest problem in our hospitals is that they are filthy dirty,” said Dr. Alfonso Torress-Cook, an epidemiologist who says he adopted practices that cut C. diff infections by 90 percent at his acute rehabilitation center in Orange County, Calif. "If we start cleaning the environment, the infection will take care of itself," he added. Interventions can range from ultra-violet light targeted to kill C. diff germs to silver-infused flooring and antimicrobial curtains aimed at resisting the bugs.“
Weighing the Costs of a CT Scan’s Look Inside the Heart “CT scans, which are typically billed at $500 to $1,500, have never been proved in large medical studies to be better than older or cheaper tests. And they expose patients to large doses of radiation, equivalent to at least several hundred X-rays, creating a small but real cancer risk. Dr. Rosenblatt worried that he and other doctors in his clinic would feel pressure to give scans to people who might not need them in order to pay for the equipment, which uses a series of X-rays to produce a composite picture of a beating heart. “If you have ownership of the machine,” he later recalled, “you’re going to want to utilize the machine.” He said no to the offer. … Some medical experts say the American devotion to the newest, most expensive technology is an important reason that the United States spends much more on health care than other industrialized nations — more than $2.2 trillion in 2007, an estimated $7,500 a person, about twice the average in other countries — without providing better care. No one knows exactly how much money is spent on unnecessary care. But a Rand Corporation study estimated that one-third or more of the care that patients in this country receive could be of little value. If that is so, hundreds of billions of dollars each year are being wasted on superfluous treatments. … But others — like artificial spinal disks, which can cost tens of thousands of dollars to implant but have not been shown to reduce back pain in many patients, and Vytorin, a new cholesterol drug that costs 20 times as much as older medicines but has not been proved superior — have been criticized for not justifying their costs. And sometimes, the new technologies prove harmful. Physicians were stunned, for example, when clinical trials showed last year that expensive anemia medicines might actually hasten death in kidney and cancer patients. Such drugs are used more widely in the United States than elsewhere. … Once the F.D.A. approves a test or device, Medicare rarely demands evidence that it benefits patients before agreeing to pay for it. But last year, Medicare officials raised questions about the benefits of CT heart scans and said it would demand more studies before paying for them. But after heavy lobbying by cardiologists, Medicare backed down. Private insurers, while initially reluctant to pay for the tests, are also covering them. … Cardiologists who oppose wide use of the scans agree that they can sometimes find dangerous blockages that require immediate surgery in asymptomatic patients. But they said such cases are extremely rare — not common enough to justify using the scans routinely, given their cost and radiation risks. … Even cardiologists who think the CT scans are overused say they may one day prove valuable. If manufacturers can produce scanners that can determine which plaques are stable and which are likely to rupture, the machines could revolutionize the treatment of heart disease. Patients found to be at low risk might be able to avoid taking medicine entirely, while others would be given intensive treatment. … Based on a reporter’s notes about the duration of the scan and the power output reported by the scanner, Dr. Brenner of the Center for Radiological Research estimated that Mr. Franks had received 21 millisieverts of radiation — even more than a typical test, equal to about 1,050 conventional chest X-rays. … “The biggest problem we have with radiation is that the doses are cumulative and additive,” Dr. Brindis said. “So the concept of doing serial CT testing on asymptomatic patients, I think, is abhorrent. I cannot justify that.” … And so CT angiograms seem destined to continue, in ever greater numbers. “Once the train leaves the station, once the technology gets on the marketplace, we don’t get the evidence,” said Dr. Redberg, the University of California, San Francisco, cardiologist. “We’re spending a lot of money on technology of unclear benefit and risk.””
Well, Well, Well: A few more words about statins risks “John Carey, in the Jan 17 Business Week cover story, reports that a large, government-funded clinical trial on cholesterol-lowering medications showed no statistically significant reduction in mortality risk at all. There’s more. Experts like Dr Rodney A Hayward, professor of internal medicine at the University of Michigan, are now saying that current evidence supports ignoring LDL cholesterol completely when assessing heart disease risk. Even Pfizer’s own numbers (with the help of a little math by John Carey) tell us that for 99 out of 100 people taking Lipitor there is no measurable benefit—and that’s based on an industry-sponsored trial, one which used carefully selected patients with multiple risk factors, which likely explains the findings of the government study showing no significant benefit at all. … Where statins do help, they help not so much because they successfully lower cholesterol levels, but very likely because they also reduce inflammation, which is a somewhat different problem, and one that so-called unproven alternative approaches specialize in. The sad victory of those bent on convincing us that alternative ways of achieving heart health are ineffective is that too many of our mothers and fathers now have, thanks to the supposedly life-saving statins, experienced Alzheimer-like memory losses, muscle losses significant enough to make walking past the mailbox a chore, and feeling young and amorous a very dim memory. Yet, almost unbelievably, some are still calling for wider use of statins. “
While the U.S. Spends Heavily on Health Care, a Study Faults the Quality “The report, the second national scorecard from this influential health policy research group, shows that the United States spends more than twice as much on each person for health care as most other industrialized countries. But it has fallen to last place among those countries in preventing deaths through use of timely and effective medical care, according to the report by the Commonwealth Fund, a nonprofit research group in New York.”
Why Can Grapefruit Interfere With Some Medications?
Why don't doctors wash their hands? A correlational study of thinking styles and hand hygiene. (Am J Infect Control. 2008)
ARTICLES:
At Risk: The True and False Promises of Medical Screening “It turns out that many of the commonly recommended screening tests fall far short on this promise. They fall so far short that no one should have them without first discussing them with their doctor. If you are not convinced you will be advantaged by having the test, why bother? Let me illustrate this with three of the commonly recommended tests. I will explain why I have never let anyone check my cholesterol or my PSA, and why I have submitted to colonoscopy once, and never again. “
Hospital Infections: Tips for Reducing Your Risk
Medication errors: the human factor.
Nine Secrets Health Insurers Don’t Want You to Know
Prednisone and other corticosteroids: Balance the risks and benefits
Tough Times Prompt Patients to Skip Care
JOURNAL ARTICLES:
A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals (Infect Control Hosp Epidemiol 2008)
Air-borne microbial contamination of surfaces in a UK dental clinic. (J Gen Appl Microbiol. 2008)
[Current issues related to nosocomial infections in general surgery.] (Klin Mikrobiol Infekc Lek. 2008)
Does the Leapfrog program help identify high-quality hospitals? (Jt Comm J Qual Patient Saf. 2008) “DISCUSSION: Consumers who choose hospitals identified by Leapfrog as having begun to implement patient safety practices will likely find hospitals with better process quality and lower mortality rates.”
Survival From In-Hospital Cardiac Arrest During Nights and Weekends (JAMA. 2008) “Conclusion Survival rates from in-hospital cardiac arrest are lower during nights and weekends, even when adjusted for potentially confounding patient, event, and hospital characteristics.”
Systematic evaluation of errors occurring during the preparation of intravenous medication (CMAJ 2008) “Interpretation: Our data suggest that the reduction of provider fatigue and production of pediatric-strength solutions or industry-prepared infusions may reduce medication errors. “
Use of corticosteroids in treating infectious diseases. (Arch Intern Med. 2008)
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