Patient Safety
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Patient Safety
General Information
NEWS:
4 MRI Agents to Carry Warnings, 3 Agents Contraindicated for Patients With Kidney Disease
9 in 10 docs blame lawsuit fears for overtesting
99,000 Die Yearly From Preventable Hospital Infections
After Stroke Scans, Patients Face Serious Health Risks “The cases come at a time when Americans are receiving more medical radiation than ever before, a result of rapid technological advancements that improve diagnosis but can also do harm when safeguards and oversight fail to keep pace. Even when done properly, CT brain perfusion scans deliver a large dose of radiation — the equivalent of about 200 X-rays of the skull. But there are no hard standards for how much radiation is too much. The overdoses highlight how little some in the medical profession understand about the operation of these scanning devices and the nature of radiation injuries, as well as the loose requirements for reporting accidents when they are detected. For a year or more, doctors and hospitals failed to detect the overdoses even though patients continued to report distinctive patterns of hair loss that matched where they had been radiated. After the Food and Drug Administration issued a nationwide alert asking hospitals to check their radiation output on these tests, a few hospitals continued to overdose patients for weeks and in some cases months afterward, according to records and interviews. “
Americans overtested, overtreated, experts say “"People have come to equate tests with good care and prevention," Redberg, a cardiologist with the University of California at San Francisco, said in an interview Thursday. "Prevention is all the things your mother told you — eat right, exercise, get enough sleep, don't smoke — and we've made it into getting a new test." This week alone, a New England Journal of Medicine study suggested that too many patients are getting angiograms — invasive imaging tests for heart disease — who don't really need them; and specialists convened by the National Institutes of Health said doctors are too often demanding repeat cesarean deliveries for pregnant women after a first C-section. Last week, the American Cancer Society cast more doubt on routine PSA tests for prostate cancer. And a few months ago, other groups recommended against routine mammograms for women in their 40s, and for fewer Pap tests looking for cervical cancer. Does screening save lives? Experts dispute how much routine cancer screening saves lives. It also sometimes detects cancers that are too slow-growing to cause harm, or has false-positive results leading to invasive but needless procedures — and some risks. Treatment for prostate cancer that may be too slow-growing to be life-threatening can mean incontinence and impotence. Angiograms carry a slight risk for stroke or heart attack. “
Are hospitals deadlier in July?
Biggest radiation threat is due to medical scans “Doctors don't keep track of radiation given their patients — they order a test, not a dose. Except for mammograms, there are no federal rules on radiation dose. Children and young women, who are most vulnerable to radiation harm, sometimes get too much at busy imaging centers that don't adjust doses for each patient's size. … He led an eye-opening study that found that U.S. heart attack patients get the radiation equivalent of 850 chest X-rays over the first few days they are in the hospital — much of it for repeat tests that may not have been needed.”
C Difficile Surpasses MRSA as the Leading Cause of Nosocomial Infections in Community Hospitals
Cancer risks after radiation exposure in middle age. (J Natl Cancer Inst. 2010) “For radiation exposure in middle age, most radiation-induced cancer risks do not, as often assumed, decrease with increasing age at exposure. This observation suggests that promotional processes in radiation carcinogenesis become increasingly important as the age at exposure increases. Radiation-induced cancer risks after exposure in middle age may be up to twice as high as previously estimated, which could have implications for occupational exposure and radiological imaging.”
Children and obese hard hit by swine flu: experts “Preliminary data showed the morbidly obese had four times the rate of hospitalizations and deaths, while the death rate for children was five times higher than usual, experts at the U.S. Centers for Disease Control and Prevention said.”
Children in Intensive Care Should Be Screened for MRSA “Community-acquired, drug-resistant bacterial infections are becoming more common among children in hospital intensive care units, so patients should be screened when they're admitted and weekly thereafter, a new study suggests. Researchers found that 6 percent of the 1,674 children admitted to the pediatric ICU unit at the Johns Hopkins Children's Center between 2007 and 2008 were colonized with methicillin-resistant Staphylococcus aureus (MRSA). This means the children carried MRSA even though they didn't have an active infection -- and they could have unknowingly infected other patients.”
CT scan use 'risk to children' “A RADIOLOGY expert is urging doctors to obtain formal written consent from parents before ordering CT scans on children, warning that the risk of a single scan triggering a fatal cancer is 70 times greater than the chance of dying from a general anaesthetic. Soaring rates of CT scan ordering by doctors in general triggered a national alert by the Medicare watchdog, which warned that patients were being exposed to unnecessary cancer risks by being given scans for complaints as trivial as back pain. CT, or computed tomography, involves hundreds of times more radiation than a simple X-ray. Statistical analysis suggests 430 cancer deaths a year may be due to ionising radiation from both procedures. Radiology expert John de Campo has warned that the risks of CT scans for young people up to the age of 20 are much higher than for adults, because their cells are dividing more rapidly and more easily damaged, and because they have more remaining years of life for a fatal cancer to develop.”
Death of Rep. John Murtha Highlights Limitations of Laparoscopic Cholecystectomy
Deficits Found in Quality of Care Provided to Dying Patients
Doctor says heart groups too cozy with industry “The flap caused a stir at the conference and riled doctors and industry members alike. Dr. Robert Harrington, head of heart research at Duke University, who also spoke at the session, said scientists and professional societies need to do more to have "firewalls" to protect their work from corporate influence. However, most research in the United States is paid for by industry, and fair and ethical partnerships are needed to develop treatments, he said. "While it's easy to say all of this should be funded by the NIH, that's not the reality," Harrington said.”
Decolonizing Nasal Carriers May Reduce Surgical-Site Staphylococcus aureus Infections
Drug Companies Influence Prescribing, Study Finds “Doctors tend to prescribe drugs that pharmaceutical companies promote to them and patients end up paying more but not always getting the most suitable medicines, researchers reported on Wednesday. An analysis of 58 studies in several countries found that information from drug companies influenced the decisions doctors made, and not necessarily in a positive way. "You couldn't say that information from pharmaceutical companies benefited doctor's prescribing, which is what pharmaceutical companies claim," said Dr. Geoffrey Spurling of the University of Queensland in Brisbane, Australia, who led the study.”
Eaten Alive: 5-Year Battle With Flesh-Eating Germ
Emergency Department Wait Times Continue to Rise
ER Patients Put Faith in CT Scans “The study also found that 75 percent of patients underestimated the amount of radiation delivered by a CT scan, and only 3 percent understood that CT scans increase a person's lifetime risk of cancer. It's estimated that 1.5 percent to 2 percent of all cancers in the United States may be attributable to CT scan radiation.”
FAQ: Radiation Risk From Medical Imaging
Germ Cops Help Hospitals Prevent Infection, Death
Glaxo Whistle-Blower Lawsuit: Bad Medicine “Of all the things that you trust every day, you want to believe your prescription medicine is safe and effective. The pharmaceutical industry says that it follows the highest standards for quality. But in November, we found out just how much could go wrong at one of the world's largest drug makers. A subsidiary of GlaxoSmithKline pleaded guilty to distributing adulterated drugs. There was reason to believe that some of the medications were contaminated with bacteria, others were mislabeled, and some were too strong or not strong enough. It's likely Glaxo would have gotten away with it had it not been for a company insider: a tip from Cheryl Eckard set off a major federal investigation.”
Heart tests add to U.S. radiation dose concerns “"For many patients in the United States, there is a substantial cumulative radiation exposure from cardiac procedures," said Dr. Jersey Chen of Yale University School of Medicine, whose study appears in the Journal of the American College of Radiology. An advanced type of heart stress test called myocardial perfusion imaging, in which doctors inject a radioactive tracer in patients to test blood flow, accounted for 74 percent of radiation exposure from heart scans. Heart catheterization and stenting -- procedures in which thin tubes are fished through blood vessels to open blocked arteries -- were the second biggest contributor to radiation exposure, Chen said.”
High Hospital Occupancy Confers Increased Inpatient Mortality Risk “Inpatient mortality was 5.9% overall, with some variation across hospitals. In multivariate analysis, each of the 4 factors analyzed — hospital occupancy, nurse staffing levels, weekend admission, and seasonal influenza activity — had statistically significant associations with in-hospital mortality. Hospital admission during widespread or regional seasonal influenza activity conferred the greatest increase in absolute risk for inpatient mortality (0.5 percentage points; 95% confidence interval [CI], 0.23 - 0.76), followed by weekend admission (0.32 percentage points; 95% CI, 0.11 - 0.54) and high hospital occupancy on admission (0.24 percentage points; 95% CI, 0.06 - 0.43). Increased nurse staffing levels decreased the absolute risk for in-hospital mortality by 0.25 percentage points (95% CI, 0.04 - 0.48) for each additional full-time equivalent nurse per patient-day. … In terms of nurse staffing levels, Dr. Conway cautioned that in his experience, "There is a plateau on how much staffing is effective as it relates to mortality and complications. Assigning a single nurse to every single patient in a hospital is not going to make your mortality rate that much better," he explained. "It levels off around 5-to-1 nursing. If you go down to 10-to-1 nursing, I assure you [the] mortality rate is going to go up." “
High Hospital Occupancy Rate Linked To High Death Rate “The higher the occupancy rate at your hospital, the less likely you are to leave alive. That's the conclusion of a new University of Michigan Health System study that shows you have a 5.6 percent higher risk of dying in a hospital operating at near capacity.”
Hospital infection deaths caused by ignorance and neglect, survey finds “Yet evidence suggests hospital workers could all but eliminate CRBSIs by following a five-step checklist that is stunningly basic: (1) Wash hands with soap; (2) clean patient's skin with an effective antiseptic; (3) put sterile drapes over the entire patient; (4) wear a sterile mask, hat, gown and gloves; (5) put a sterile dressing over the catheter site.”
Hospital infections killed 48,000, report shows “Patients who developed sepsis after surgery had to stay in the hospital on average nearly 11 days extra, at a cost of $32,900 per patient, they found. And just under 20 percent of them died. Pneumonia patients stayed an extra 14 days after surgery, at a cost of $46,400 and more than 11 percent of them died, the researchers found. "That's the tragedy of such cases," said Anup Malani of the University of Chicago, who worked on the study. "In some cases, relatively healthy people check into the hospital for routine surgery. They develop sepsis because of a lapse in infection control and they can die." … Measures to prevent infection are simple and include careful handwashing, hygiene and screening patients when they check in. However, these measures are difficult to enforce, many studies have found.”
Hospitals hurt 18 percent of patients, study says
Hospital-acquired sepsis, pneumonia kill 48,000 each year “Researchers examined 69 million hospital discharges in 40 states from 1998 to 2006, looking at two conditions, sepsis and pneumonia, often caused by drug-resistant infections. Nosocomial sepsis and pneumonia kill 48,000 patients annually and cost $8.1 billion to treat, said the study, published in the Feb. 22 Archives of Internal Medicine.”
Lifesaving cancer drugs may put workers' lives at risk “The same powerful chemotherapy drugs that have saved hundreds of thousands of patients’ lives for decades have at the same time potentially taken a deadly toll on the hospital and clinic workers who handled them.”
Many Americans overtreated to death
Many Doctors Don't Report Incompetent Colleagues
Medical tourism: first report of multiresistant bacteria after elective surgery in India
MRSA Found in 4% of Healthcare Workers; Most Are Healthcare-Related Strains
Nearly 1 in 7 Hospitalized Medicare Patients Experience Adverse Events
Popular Best-Hospital List Tracks Subjective Reputation, But Not Quality Measures
Primary Care Doctors Ordering Unnecessary Scans “Inappropriate exams included brain CT for chronic headache, lumbar spine MRI for acute back pain, and knee or shoulder MRI in patients with osteoarthritis.”
PSA Discoverer Says PSA Screening is "Public Health Disaster" “In his opinion piece, Dr. Ablin writes: "As I've been trying to make clear for years now, PSA testing can't detect prostate cancer." He points out that infections, over-the-counter drugs like ibuprofen, and benign swelling of the prostate can all elevate PSA levels. More important, the test cannot differentiate between prostate cancer that is rapidly growing and potentially fatal from one that is growing slowly and will not kill, he adds. However, Dr. Ablin states categorically that PSA testing "should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit." "Drug companies continue peddling the tests and advocacy groups push 'prostate cancer awareness' by encouraging men to get screened," he asserts. "I never dreamt that my discovery 4 decades ago would lead to such a profit-driven public health disaster," Dr. Ablin says. "The medical community must confront reality and stop the inappropriate use of PSA screening," he states. "Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatment." “
Radiation beam strays, harming instead of helping “The treatment Ms. Faber received, stereotactic radiosurgery, or SRS, is one of the fastest-growing radiation therapies, a technological innovation designed to target tiny tumors and other anomalies affecting the brain or spinal cord, while minimizing damage to surrounding tissue. Because the radiation is so concentrated and intense, accuracy is especially important. Yet, according to records and interviews, the SRS unit at Evanston lacked certain safety features, including those that might have prevented radiation from leaking outside the cone. “
Review Suggests Bias in Drug Study Reporting “Drug studies paid for by the pharmaceutical industry are more likely to publish favorable results than those funded by sources with no financial interest in the findings, a new review has found.”
Scientists Say F.D.A. Ignored Radiation Warnings “Urgent warnings by government experts about the risks of routinely using powerful CT scans to screen patients for colon cancer were brushed aside by the Food and Drug Administration, according to agency documents and interviews with agency scientists.”
Sharing a Hospital Room Increases Risk of 'Super Bugs' “A new study led by infectious diseases expert Dr. Dick Zoutman says the chance of acquiring serious infections like C. difficile (Clostridium difficile) rises with the addition of every hospital roommate. "If you're in a two, three or four-bedded room, each time you get a new roommate your risk of acquiring these serious infections increases by 10 per cent," says Dr. Zoutman, professor of Community Health and Epidemiology at Queen's. "That's a substantial risk, particularly for longer hospital stays when you can expect to have many different roommates." “
Study suggests too many invasive heart tests given
Study: No Improvement in Hospital Safety “Some hospitals are no safer today than they were 10 years ago, according to a study published in the New England Journal of Medicine. In 1999, an Institute of Medicine (IOM) report revealed that medical errors cause as many as 98,000 deaths and more than 1 million injuries per year. Researchers have found that despite efforts to ensure patient safety in the years since the report was published, those rates have remained largely unchanged.”
Superbug detected in health tourists from South Asia
Top 50 US Hospitals for Inpatient Cardiovascular Care
Two Methods Help Prevent Infections After Surgery
Tylenol, Motrin, Benadryl, St. Joseph Aspirin, Rolaids Recall “Because of a sickening smell in some containers, 54 million packages of 27 different over-the-counter remedies now are being recalled. Products include various types of child and/or adult Tylenol, Motrin, Benadryl, St. Joseph Aspirin, Rolaids, and Simply Sleep. This adds to the 6 million packages of Tylenol recalled late last year, bringing the total number of recalled products to 60 million. A musty, moldy odor coming from the products has sickened at least 70 people with nausea, stomach pain, vomiting, and diarrhea. The symptoms go away by themselves and no one has been seriously injured. The FDA says Johnson & Johnson's McNeil Consumer Health Care knew of the problem for more than a year. When the company did act in November and December 2008, it did too little too late, said Deborah M. Autor, director of the FDA's Office of Compliance. "When something smells bad, literally or figuratively, companies must aggressively investigate and take all actions necessary to solve the problem," Autor said at a news conference. "McNeil should have acted faster." “
Unneeded, riskier spinal fusion surgery on rise “A study of Medicare patients shows that costlier, more complex spinal fusion surgeries are on the rise — and sometimes done unnecessarily — for a common lower back condition caused by aging and arthritis. What's more alarming is that the findings suggest these more challenging operations are riskier, leading to more complications and even deaths.”
Use of anticholinergics and the risk of cognitive impairment in an African American population (NEUROLOGY 2010)
Web Site for Hospital Comparisons Is Faulty: Study
Wet Breathing System Filters Transmit Harmful Bacteria and Yeast, Hospitals Warned
When Drugs Cause Problems They Are Supposed to Prevent “Something new is happening, said Daniel Carpenter, a government professor at Harvard who is an expert on the drug agency. The population is aging, many have chronic diseases. And companies are going after giant markets, huge parts of the population, heavily advertising drugs that are to be taken for a lifetime. And the way drugs are evaluated, with the emphasis on shorter-term studies before marketing, is not helping, Dr. Carpenter said. “Here is a wide-scale institutional failure,” he said. “We have placed far more resources and requirements upon premarket assessment of drugs than on postmarket.” “
Why Do Physicians Order Costly CTs? Ultrasound Yields Better Diagnosis, Safer, Less Costly, Expert Argues “Dr Benacerraf concludes: "It may be time for ultrasound to regain its rightful place in the evaluation of acute female pelvic and lower abdominal conditions and save the population from the dangerous radiation exposure and excessive cost of starting a workup with CT as a first-line imaging test."”
Wide Variation in Response to FDA Rosiglitazone Warning “Doctors do not respond adequately to FDA boxed warnings on drug labels, resulting in significant exposure of patients to potentially unsafe medications, according to researchers who use the rosiglitazone saga as an example.”
ARTICLES:
National Healthcare Quality Report, 2009
Public information as a marketing tool: Promotion of diseases and medicines
Q: Are all over-the-counter pain medications safe?
Ranking 37th — Measuring the Performance of the U.S. Health Care System
JOURNAL ARTICLES:
Curbing Methicillin-Resistant Staphylococcus aureus in 38 French Hospitals Through a 15-Year Institutional Control Program (Arch Intern Med. 2010)
Insomnia medication: Do published studies reflect the complete picture of efficacy and safety? (Eur Neuropsychopharmacol. 2010) “In conclusion, selective publication and reporting lead to an overestimation of efficacy and underestimation of safety of insomnia products. Authors of treatment guidelines should be aware of this bias. EPARs/FDA reviews provide a more unbiased view of the benefit-risk balance of insomnia and other medications and hence these documents should be consulted by e.g. authors of meta-analyses and of treatment guidelines.”
Radiation dose-volume effects in the brain. (Int J Radiat Oncol Biol Phys. 2010) “We have reviewed the published data regarding radiotherapy (RT)-induced brain injury. Radiation necrosis appears a median of 1-2 years after RT; however, cognitive decline develops over many years. The incidence and severity is dose and volume dependent and can also be increased by chemotherapy, age, diabetes, and spatial factors.”
Severe isoniazid-associated liver injuries among persons being treated for latent tuberculosis infection --- United States, 2004--2008. (MMWR Morb Mortal Wkly Rep. 2010)
The adherence of GPs to guidelines for the diagnosis and treatment of lower urinary tract infections in women is poor. (Fam Pract. 2010)
Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults (JAMA. 2010) “Conclusions Among Medicare recipients, between 2002 and 2007, the frequency of complex fusion procedures for spinal stenosis increased while the frequency of decompression surgery and simple fusions decreased. In 2007, compared with decompression, simple fusion and complex fusion were associated with increased risk of major complications, 30-day mortality, and resource use.”
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