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2011 Archives

2011 Archives:
Patient Safety

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Do robots drive up prostate surgeries?

Confessions of a Pharma Rep (opinion-video)

Ex Drug Rep -- Manipulating Doctors (opinion-video)


FDA Finds U.S. Drug Research Firm Faked Documents

Frequently Asked Questions About Drug Shortages

Half of hospitals buy back-door drugs, new survey shows

High Central-Line Infection Rates at Many Teaching Hospitals “Preventing these infections, experts say, boils down to following a simple checklist of precautions. Caregivers need to scrupulously wash their hands, disinfect the patient's skin before inserting a catheter and during dressing changes, don full-barrier protection, avoid placing the catheter in the groin, and remove unnecessary catheters. "This is straightforward stuff," John Santa, MD, MPH, director of the Consumer Reports Health Ratings Center, told Medscape Medical News. "There's not a $2 million machine you need to buy, or a cadre of highly paid physicians you need to hire. This is a culture issue, not a knowledge issue." “

Hospital garb harbors nasty bacteria, new study says “They might look quite clean, but the white coats, pastel uniforms and colorful surgical scrubs worn by doctors and nurses actually may harbor a host of nasty, potentially dangerous bacteria, a new study finds. More than 60 percent of health workers’ uniforms sampled by researchers tested positive for pathogens, including the germs that can cause pneumonia, bloodstream infections and drug-resistant infections such as MRSA. … To be sure, the study doesn’t verify a link between the germy garb and actual patient infections, the authors say. But it does raise enough questions to reignite conversations about the ick factor of hospital uniforms and scrubs — especially when health workers wear them in public: out to grocery stores, say, or to sandwich shops. “I do cringe,” said Ramona Conner, a registered nurse and manager of standards and recommended practices for the Association of periOperative Registered Nurses. “We do know that antibiotic-resistant organisms have been found to survive for extended lengths of time on hospital materials including clothing and linens. …At the University of Rochester Medical Center in Rochester, N.Y., hospital policy calls for staff to don only scrubs laundered at a hospital-owned facility and to refrain from wearing them outside the premises, said Ann Marie Pettis, director of infection prevention. "The compliance with the policy, however, is less than perfect, unfortunately," Pettis admitted in an e-mail. ””

Hospital Visitors' Cellphones May Carry 'Worrisome' Germs

Hospitals Performed Needless Double CT Scans, Records Show

Hospitals with a teamwork culture have better patient safety climates

Paxil study under fire "The published manuscript was biased in its conclusions, made unsubstantiated efficacy claims and downplayed the adverse-event profile of Paxil," Amsterdam's lawyer wrote in an 8 July letter to the Office of Research Integrity (ORI), the body responsible for investigating research misconduct in US Public Health Service agencies and its grant recipients. The letter accuses the study's academic authors of engaging in scientific misconduct by allowing their names to be attached to the manuscript (C. Nemeroff et al. Am. J. Psychiatr. 158, 906–912; 2001), which has been cited more than 250 times. Documents accompanying Amsterdam's complaint are offered as evidence that "most if not all" of the authors were handpicked by GSK, working in conjunction with the medical-communications company Scientific Therapeutics Information (STI) in Springfield, New Jersey, to lend credibility to a result that Amsterdam says places Paxil in an overly favourable light. In one such document, Karl Rickels, a psychiatrist not involved with the study who looked at the issue for the department in 2001 said that "apparently … [academic] participants never had a chance to review or even just see the manuscript before it went to press".“

Risky pelvic mesh highlights worries about FDA process “Unlike prescription drugs, which must be proven safe and effective before they’re marketed, most medical devices have no such requirement. Only about 10 percent of devices, those deemed the riskiest, such as breast implants and implantable pacemakers, fall into that category. Surgical mesh, used to support organs that have slipped over time, does not.”

Study Finds Equal Number of Errors in Hospitals, Doctors' Offices “Adverse outcomes in doctors' offices were most often the result of incorrect diagnoses, whereas unsuccessful surgery was the most common cause of negative outcomes in hospitals, according to the study, published in the June 15 issue of the Journal of the American Medical Association.”

Surgical tools used in NHS operations 'substandard'“Poor quality surgical implements have been identified as a likely cause of MRSA infections because shards of steel have caused microscopic holes in surgical gloves. Badly made instruments that have unwanted grooves or trenches can trap body tissue and fluids - another possible source of infection.”

The Waits That Matter “Such tragic deaths happen every day in U.S. hospitals. The factors that contribute to ED crowding and its consequences have been amply documented in reports by the Institute of Medicine, the Government Accountability Office (GAO), the Robert Wood Johnson Foundation, the Center for Studying Health System Change, and others.1,2 “Boarding” admitted patients in ED exam rooms and corridors for extended periods has become so commonplace that it is accepted as the norm, particularly in large urban hospitals. But a crowded ED is more than a nuisance; it is a threat both to individual patients and to overall public health. Still, the financial imperatives of hospital operations trump patient safety. The GAO has noted that many hospital administrators tolerate ED crowding and even divert inbound ambulances rather than postpone or cancel elective admissions.3 Crowded EDs are only one part of the problem. Inefficient hospital operations are another. Death, disease, and injury occur around the clock, but many hospitals still operate the majority of their services only 5 days a week. A growing number of specialists are either refusing to take after-hours call or demanding payments for doing so.4 After-hours and weekend gaps in coverage have real consequences; mortality rates associated with acute myocardial infarction and other time-critical conditions are significantly higher on weekends than on weekdays.5“

Wrong-Site Surgery Occurs 40 Times a Week

Hospitals Shouldn’t Make You Sicker “The agency used a “bundle” of measures, including screening all patients with nasal swabs and isolating those found infected with MRSA, or methicillin-resistant Staphylococcus aureus. All health care workers were urged to take special precautions to prevent spreading germs from those patients and to wash their hands carefully. And the V.A. sought to change its “institutional culture” so that all personnel felt responsible for controlling the bacterium.”

Lessening the Dangers of Radiation: Ultrasound as Effective as CT Scans for Most Diagnoses, Research Finds “For diagnosing head and neck ailments, tests that use radiation are always less desirable than those that don't. Otolaryngologists have a wide range of techniques available to them, including CT or "CAT" scans, MRI and ultrasound. CT uses significant radiation and MRI a lower amount, but ultrasound is a non-invasive, non-radiating technique. It does not require injection of radioactive contrast material and has no side effects. … "I would recommend the use of ultrasound scans, and not radiating CT scans, for most procedures," Dr. Vaiman says. "I would especially recommend ultrasound when children are investigated. There are some tumors that do require CT or MRI investigation, but these cases are rare. When in doubt, and high-resolution imaging is necessary, I would suggest a low-radiating MRI." His findings follow warnings from international health organizations about the dangers of overexposure to CT-related radiation. Some medical experts caution that patients are exposed to too many CT scans, and the results could be harmful to their health. Excessive radiation can itself lead to cancerous growths, for example.”

Out of joint: The story of the ASR “The story of the ASR shows the power that companies have in deciding the fate of their devices, their hold over surgeons, and the lack of regulatory power in Europe.”

Public Health update of Carbapenem-Resistant Enterobacteriaceae (CRE) producing metallo-beta-lactamases (NDM, VIM, IMP) in the U.S. reported to CDC “KPC producers have been reported in about 35 states and are associated with high mortality, up to 40 percent in one report. They may be present in the other 15 states as well, but have not been reported to CDC. The presence of CRE, regardless of the enzyme that produced that resistance, reinforces the need for better antibiotic stewardship, transmission prevention, and overall HAI prevention in any healthcare setting.”

Results Vary for MRSA-Reduction Efforts

Robotic Surgery Oversold on Hospital Websites, Study Contends “Many hospitals tout the benefits of robotic surgery on their websites without solid scientific evidence to back up those claims, Johns Hopkins researchers report. In fact, four out of 10 hospitals in the study only used manufacturers' claims that robotic surgery is better than conventional surgery, an assertion that the researchers said is unproven and misleading. The findings are especially troubling since consumers depend on hospital websites for reliable, trustworthy information, the study authors said. "Hospital websites are a trusted source of medical information for the public," said lead researcher Dr. Marty Makary, an associate professor of surgery at Hopkins. "This is the first time we've seen industry create content, with disclosures, and put it on the official hospital website to educate patients about treatment options," he said. "To me, that's a very scary trend." Robotic surgery has grown more than 400 percent over the past four years, Makary pointed out. "It's one of the great modern crazes," he said. "And the public is driven by the idea that more technology means better care." Proponents say robot-assisted surgeries require smaller incisions, are more precise and result in less pain and shorter hospital stays. The study authors said those claims are unsubstantiated. The growth of robotic surgery has been driven by hospital marketing, Makary said. "Marketing a robot has become a very successful strategy for hospitals. It implies the hospital has state-of-the-art care," he said. "Patients may perceive the hospital is on the cutting edge because they do robotic surgery."“

Study: Doctors Order Tests Out of Fear of Lawsuits “CT scans, MRIs and other pricey imaging tests are often more for the doctor's benefit than the patient's, new research confirms. Roughly one-fifth of tests that bone and joint specialists order are because a doctor fears being sued, not because the patient needs them, a first-of-its-kind study in Pennsylvania suggests. … Patients expect the highest level of care and think this means the most advanced technology, Flynn said. Many patients feel better when a doctor orders lots of tests -- until they get the bill. Besides hurting your wallet and adding to health care costs, unnecessary tests can expose people to radiation that accumulates over a lifetime and can raise the risk of cancer. Ordinary X-rays are rarely a concern, but an MRI, or magnetic resonance imaging scan, can cost $1,000 or more. And super-sharp X-rays called CT scans involve relatively large radiation doses. Yet doctors often order tests they don't really think a patient needs because they fear being sued if the diagnosis was wrong or they miss detecting a problem.”

Study: Harmful Medical Devices Get OK Too Easily

Study: Newer Antipsychotic Drugs Are Overused

Study: Reluctance to Speak Up Encourages Medical Errors “Nurses often don't speak up about incompetent colleagues or when they see fellow health-care workers making mistakes that could harm patients, new research finds.”

Supreme Court Allows Suit Against Drug Company That Withheld Adverse Data “The U.S. Supreme Court ruled on Tuesday that a class-action lawsuit by investors against Matrixx Initiatives Inc can go forward after the company failed to disclose initial reports of adverse side effects from consumers who used its cold treatment Zicam.”

The regulation of medical devices

Top Hospitals Across United States Ranked Based on Patient Mortality

Top Metro Hospitals Ranked by US News & World Report

When Docs Own MRIs, Back Pain Scans Increase: Study

Which hospitals have more problems after surgery?

Why Defensive Medicine Won't Go Away...and Might Become Worse

X-Rays Linked to Increased Childhood Leukemia Risk

Younger Docs More Likely to Prescribe Drugs for Heart Disease: Study "Although younger doctors prescribed more drugs, this did not result in significantly better control of their patients' major CV [cardiovascular] risk factors, suggesting that other factors have an important role to play in the clinical management of CV risk, including lifestyle changes," Professor Massimo Volpe from the Faculty of Medicine at Sapienza University in Rome said in a journal news release.”

Angioplasty associated with triple costs and unclear safety and efficacy “Angioplasty and stenting of the blood vessels within the skull (intra-cranial vessels) that supply blood to the brain was predominantly performed at urban teaching hospitals and was associated with nearly triple the cost compared to usual care. However, data on the efficacy and safety of these procedures remains uncertain according to late-breaking science reported at the American Stroke Association’s International Stroke Conference 2011.”

Association Found Between Industry Funding and Promotional Pieces on Menopausal Hormone Therapy

Dueling 'Best Hospital' Ratings

Elderly Patients Are Often Prescribed Inappropriate Medicines in the ICU “The most common potentially inappropriate medications were anticholinergic drugs, Dr. Morandi noted.“

Experts Urge Even Greater Caution in Use of X-Rays During Pregnancy and Infancy “Clinicians should be careful about using x-rays on pregnant women and infants because of the potential for a slight increase in the risk of children developing cancer, concludes a new study published on the British Medical Journal website.”

Hospital Errors May Be More Common Than Thought “Medication errors, infections, and other hospital-related errors may be 10 times more common than previously estimated, according to a study involving a new tracking tool. Medical errors may actually occur in as many of one-third of hospital admissions, according to a new study in the April issue of Health Affairs. “It’s a little scary,” admits study author David C. Classen, MD, an associate professor of medicine at the University of Utah in Salt Lake City. Whether the problem is getting worse or error tracking methods are improving is not known. “We have gotten better tools to detect medical errors which give us a better yardstick to determine if we are improving,” he says. … Common hospital errors included medication-related issues, procedure-related mistakes, and hospital-acquired infections. The most severe mistakes were related to a surgery or procedure, the new study showed. Classen says that asking questions and demanding answers can help reduce the risk of medical errors when you are hospitalized. If someone tries to give you medication, “stop and say ‘I want to hear all about it before I take it,’” he suggests. Before surgery, “insist that your surgeon comes and sees you before starting the procedure to review the steps,” Classen says. A patient advocate is important, he says. “If you don’t have family, you need another advocate to watch over things.” “If your surgery involves the use of any type of device such as a urinary catheter, ask daily when it is coming out,” he says. These devices can increase your risk of developing an infection and should be removed as soon as they are no longer medically necessary.”

Hospital Infection Raises Death Risk for Bowel Patients

Hospital Safety Varies Widely Nationwide: Report “Certain types of medical errors are 46 percent less likely to occur at top-rated U.S. hospitals than bottom-ranked hospitals, according to a new study. … Patients in top-ranked hospitals were 30 percent less likely to contract a hospital-acquired bloodstream infection and 39 percent less likely to suffer from post-surgical sepsis than those at low-rated hospitals. Those infections can be deadly: Nearly one in six patients who acquired a bloodstream infection while hospitalized died.”

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.”

Hands of Anesthesia Providers May Be a Source of Operating Room Contamination

Kids' radiation exposure common and dangerous “The first large study to examine the use of X-rays, CT scans and other medical radiation in children estimates the average child will get more than seven radiation scans by age 18, a potentially worrisome trend. Most of the scans involve X-rays, which use relatively little radiation. But there is growing concern about CT scans, which entail far more radiation and can raise the risk for cancer, particularly in children. The study found that X-rays of the chest, hand and foot are the most common. Forty-two percent of children had at least one radiation procedure and 25 percent had two or more during the three-year study period. Dental X-rays were not included in the study.”

[Nosocomial diarrhea.] (Internist (Berl). 2011) “Hospital acquired or nosocomial diarrhea affects up to one third of hospitalized patients. It increases mortality rates as well as lenght and costs of the hospital stay. Drug side effects are the predominant cause of nosocomial diarrhea whilst clostridium difficile is the most common infectious agent, whose development is closely linked to antibiotic usage. The causal therapy of mild clostridium difficile infections is controversially discussed. Nevertheless, the use of Metronidazol for mild cases and of vancomycin for severe forms of the disease is recommended. Diarrhea outbreaks might be caused by viruses and less often by Salmonella and Listeria.”

Physicians Say Good Riddance to 'Worst Drug in History' “An estimated 10 million patients have used the pain reliever propoxyphene and were sent scrambling to doctors' offices when it was recently pulled from the market. Many physicians are still dealing with the aftermath of the product, first approved by the US Food and Drug Administration (FDA) in 1957. "Propoxyphene is the worst drug in history," Ulf Jonasson, doctor of public health, from the Nordic School in Gothenburg, Sweden, told Medscape Medical News. The researcher played a role in the decision to stop the pain reliever in the United Kingdom, Sweden, and later in the entire European Union. "No single drug has ever caused so many deaths," Dr. Jonasson said.”

Private ICU rooms may lower infection risks

Risk of Cancer Increases With Exposure to Low-Dose Radiation from Cardiac Imaging, Study Finds

Serotonin syndrome associated with polypharmacy in the elderly (General Hospital Psychiatry 2011) “As this case illustrates, serotonin syndrome can be caused by combinations of direct serotonin agonists (e.g., serotonergic antidepressants) and indirect serotonin agonists (e.g., atypical antipsychotics).”

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