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    Friday, January 29, 2010

    Caution Not to Take Sertaline, Citalopram in Pregnancy Because of Link to Heart Defects in Offspring

    Women who use the antidepressants sertraline (Zoloft) or citalopram (Celexa) early in pregnancy face increased risk for septal heart defects in their offspring, BMJ reports online.

    Researchers examined data on more than 490,000 infants born in Denmark between 1996 and 2003. They found that women who filled prescriptions for sertraline and citalopram (but not other SSRIs) during their first trimester were significantly more likely to have children with septal heart defects (but not other malformations) than those who didn't use SSRIs (odds ratios: 3.2 and 2.5, respectively).

    The authors and an editorialist (both with ties to SSRI manufacturers) note that the absolute risks for septal heart defects were low: 0.9% in children exposed to at least one SSRI and 2.1% in those exposed to more than one.

    The editorialist concludes: "Clinicians and patients need to balance the small risks associated with SSRIs against those associated with under-treatment or no treatment."


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for ONE DRUG CAUSES LIFE EXTENSION BY 14%.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, January 25, 2010

    MAKE MEDICAL ERROR REPORTING COMPULSORY?

    Few states have instituted compulsory medical error admissions. William M. Sage et al., The Relational Regulatory Gap: A Pragmatic Information Policy For Patient Safety and Medical Malpractice, 59 Vand. L. Rev. 1263 (2006) noted that four states recently passed legislation requiring patients to be informed when they were the victim of medical errors. One state that has is New Jersey, which, in 2004, enacted the Patient Safety Act, N.J.S.A. 26:2H-12.23 (PSA). This landmark legislation changed the way medical errors are dealt with in New Jersey by creating a legal duty to immediately disclose medical errors to patients who are harmed by them. N.J.S.A. 26:2H-12.25.

    Should The Law in New Jersey be the Same in Other States?
    Under the PSA, when the patient is a victim of a serious preventable adverse event, he or she must be informed no later than the end of the episode of care; or, if discovery occurs after the end of the episode of care, in a timely fashion. N.J.S.A. 26:2H-12.25(d). A "serious preventable adverse event" is any adverse event that is preventable and results in death, loss of a body part, or disability or loss of bodily function either lasting more than seven days, or that is still present at the time of discharge. N.J.S.A. 26:2H-12.25(a). In addition to requiring adverse events to be reported to the victims of medical malpractice, the PSA also requires health care providers to report medical errors to the New Jersey Department of Health and Human Services (the Department). N.J.S.A. 26:2H-12.25(c).

    On Jan. 24, 2008, the Department enacted regulations that gave teeth to the notification and reporting requirements of the Act. As of March 3, 2008 (for hospitals), Aug. 30, 2008 (for ambulatory care facilities, home health care agencies and hospice providers), and March 3, 2009, (for nursing homes and assisted living facilities), health care providers have five business days after discovery of a serious preventable adverse event to notify the Department that a preventable adverse event has occurred. N.J.A.C. 8:43E-10.1, N.J.A.C. 8:43E-10.6(b). The notification requires the inclusion of specific categories of information, including: 1) the date and time the event occurred; 2) a brief description of the event; 3) a statement about the impact of the event on the health of the patient; 4) the date and time the facility became aware of the event; 5) how the event was discovered; 6) the immediate corrective actions the facility took to eliminate or reduce the adverse impact of the event on the patient; and 7) what steps were taken to prevent the occurrence of future similar events. N.J.A.C. 8:43E-10.6(c).

    Failure to comply with these reporting requirements results in a fine of $1,000 a day. N.J.A.C. 8:43E-3.4(14).


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for Caution Not to Take Sertaline, Citalopram in Pregnancy Because of Link to Heart Defects in Offspring.


    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Friday, January 22, 2010

    Hospitals And Medical Staffs Have Failed To Be Effective In Reducing Medical Errors

    A recent Medicare policy change has brought into critical focus the fact that hospitals and medical staffs have failed to be effective in reducing medical errors. The Centers for Medicare and Medicaid Services (CMS) announced that it would no longer pay hospitals for the extra costs of treating injuries, infections, or other complications caused by preventable errors (never events). At the same time that hospitals are encountering this looming payment restriction from Medicare, they also are confronting the possibility of payment restrictions from commercial payors. Cigna, Aetna, Health Net, and Health Partners are among the payors that have indicated they are considering making nonpayment for “never events” a standard part of their provider contracts.

    There are significant potential liability concerns that may arise from the new CMS payment plan and from similar state and commercial plans.

    Not all of the qualifying "preventable" complications selected by CMS are comparable in terms of their preventability, nor are they entirely within the control of the hospital or its medical staff. It is without question that instruments or sponges left behind after surgery should be never events. However, current best efforts may not entirely prevent vascular infections from catheter use, for example. Similarly, the amount of effort and expense required to prevent the formation of pressure ulcers is far greater than that required to avoid retained instruments. This alone could lead hospitals to alter admission policies and practices. The aspect of the Medicare never event payment policy change requiring hospitals to report Present on Admission Indicators may make it inevitable.

    This Heller article suspects that plaintiff’s attorneys may well argue that never events should be viewed as res ipsa occurrences or, at the least, that they should always be viewed as representing below standard care. This would appear to be an excellent example of the law of unintended consequences as "the mere designation of never events will likely result in both more numerous and more valuable plaintiffs’ verdicts nationwide."

    Some sets of these never events, for example those recently approved by the Washington State Hospital Association and the Washington State Medical Association, employ the modifier "serious," penalizing hospitals only for "serious disability associated with a fall" or "serious disability from medication error," without, not surprisingly, offering criteria for defining the term "serious."

    This may then be left for the legal system to define. It is not clear how far out in time from the never event the ban on hospital charges extends. On the one hand, says Heller, if a patient sustains a hip fracture from an in-hospital fall, it is clear that the hospital may not bill for the fracture repair. If, on the other hand, three months post-discharge, the patient develops what appears to be a nonhospital acquired infection at the hip repair wound site and the patient is readmitted, who pays the bill? What if a patient develops a deep pressure ulcer in the hospital (clearly, not reimbursable) and is discharged when the ulcer appears to be healed, but is readmitted after two weeks at home with an ulcer at precisely the same site. Who pays? It is possible to develop many confusing and confounding scenarios that may evolve from the new CMS rule and its progeny, and the end effects are not in sight.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for Reducing Medical Errors.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, January 18, 2010

    A Balance Disorder Known As Vestibular Dysfunction

    A Balance Disorder Known As Vestibular Dysfunction

    Which Affects Up To 69 Million Americans Should Be Part Of The Routine Medical Checkup

    Millions of people may suffer from inner-ear disorders that affect their balance but not be aware that they have a problem, a new study has found. Writing in The Archives of Internal Medicine, researchers noted the connection between balance problems and falls, especially among the elderly. The findings of the study, they said, suggest that doctors should make balance tests a routine part of checkups. This is especially true in nursing and assisted-living homes, they said.
    “The big deal here really is falls,” the lead author, of Johns Hopkins, adding that a serious fall can be the beginning of the end for an older patient. The researchers drew on data from a federal study in which more than 5,000 people age 40 and over were surveyed about their history of falls and balance problems. They were then given examinations to determine how well they could maintain their balance in a variety of situations, including with their eyes closed.
    More than a third of the subjects, the researchers found, had the balance disorder known as vestibular dysfunction — a figure that would translate to 69 million Americans. They also found that 32 percent of the volunteers who did not report problems with dizziness showed evidence of balance problems. Though they did not experience symptoms, they were still at higher risk for falls, the study said.
    For doctors, detecting balance problems in a patient is not very complicated. And treatment is available, including exercises that help people compensate for inner-ear problems that lead to poor balance. The cost of the treatment, would most likely be less than medical costs associated with falls.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for Reducing Medical Errors.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Friday, January 15, 2010

    COLONOSCOPY IS RISKIER IN OLDER AGE

    Despite low overall adverse event risk with colonoscopy, every age group 70 and older is at elevated risk of adverse gastrointestinal and cardiovascular events from the procedure, reports Joan L. Warren, Ph.D., of the National Cancer Institute in Bethesda, Md.. The risk of intestinal bleeding or perforation is 75% higher at age 80 to 84 than at age 66 to 69.These findings, from the Medicare claims database, support the controversial upper age limit for screening colonoscopy set by the U.S. Preventive Services Task Force.
    Because competing causes of mortality often outweigh the potential benefit from detecting colon cancer at progressively older ages, guidelines do not recommend screening past age 75 and recommend against it after 85 The reason for the increased complication risk in older persons and those with these conditions may be related to the preparation, sedation, or the procedure itself, the researchers noted.
    Certain preparations, such as sodium phosphate, can increase the likelihood of electrolyte imbalances, especially in elderly persons. In addition, persons taking ACE inhibitors, angiotensin-receptor blockers, diuretics, and nonsteroidal anti-inflammatory drugs -- all of which are commonly used in elderly persons -- may have more adverse events related to the bowel preparation for colonoscopy speculates Dr.Warren.
    Indeed Warren cautions, that the use of administrative claims data to determine complication risks -- rather than medical record review -- might underestimate the true risk of adverse events.
    Source reference:
    Warren JL, et al "Adverse events after outpatient colonoscopy in the Medicare population" ANN INTERN MED 2009; 150: 849-57.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for A Balance Disorder Known As Vestibular Dysfunction.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, January 11, 2010

    Only 24% of Doctors Report Medical Errors Committed On Their Patients

    Under the American Medical Association Code of Ethics, physicians have an ethical obligation to advise a patient when they commit consequential acts of medical malpractice where "a patient suffers significant medical complications that may have resulted from the physician’s mistake or judgment." Am. Med. Ass’n Code of Medical Ethics A-02 Edition, E-8.12 Patient Information, 77. Similarly, the American College of Physicians Ethics Manual mandates disclosure of errors if disclosure of this information is "material to the patient’s well-being." Lois Snyder & Cathy Leffler, Ethics Manual, Fifth Edition, 142 Ann Intern Med 560, 563. Finally, the Joint Commission requires that patients be informed of unanticipated results that differ from the expected outcome in a significant way when a medical error occurs at a hospital. Joint Comm’n on Accreditation of Health Care Orgs., Revisions to Joint Commission Standards in Support of Patient Safety and Medical/Health Care Error Reduction 12 (2001).
    Disclosure of medical errors is not only ethically mandated, it is consistent with the fiduciary nature of the physician-patient relationship, since in most instances, disclosure of errors will be help the patient to understand why unexpected problems have developed. Some commentators have suggested that since patients need information about errors to make decisions about their medical care, disclosure of malpractice is part of a physician’s duty to provide a patient with informed consent. Thomas H. Gallagher, Wendy Levinson, Disclosing Medical Errors to Patients: a Status Report in 2007,177(3) Can Med Assn J 265 (2007).
    In theory, physicians agree that they have an ethical obligation to disclose medical errors. One study suggests that between 70% and 90% of the physician population believes that doctors should disclose errors to patients. Kathleen M. Mazor et al., Communicating with Patients about Medical Errors, 164 Arch Intern Med 1690, 1692 (2004). In another study, 97% of the faculty and resident population surveyed indicated that they would disclose medical errors that caused minor harm, and 93% indicated that they would disclose an error causing major harm. Lauris Kaldjian, et al., Disclosing Medical Errors to Patients: Attitudes and Practices of Physicians and Trainees, 22(7) J Gen Intern Med 988-96 (2007). This being the case, one would expect physicians, nearly universally, to report medical errors to their patients. However, research does not bear this theory out. For example, one study revealed that only 24% of residents surveyed reported the medical errors they committed to their patients. Albert Wu, et al., Do House Officers Learn from Their Mistakes? 12 Quality & Safety Health Care 221, 224 (2003). Another study estimated that, nationwide, physicians are only disclosing errors to patients about 1/3 of the time. Robert J. Blendon et al., Views of Practicing Physicians and the Public on Medical Errors, 347 New. Eng. J. Med. 1933, 1935 (2002).


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.


    *Tune in later for COLONOSCOPY IS RISKIER IN OLDER AGE.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Friday, January 8, 2010

    CDI is one Infection you Don’t Want to Get IN the Hospital-Clostridium Difficile Infections (CDI) Are Difficult To Treat

    Episodes of recurrent Clostridium difficile infection (CDI) are difficult to treat for several reasons. Foremost, data are lacking to support any particular treatment strategy. In addition, treatment of recurrent episodes is not always successful, and repeated, prolonged treatment is often necessary. Identification of subgroups at risk for recurrent CDI may aid in diagnosing and treating these patients. Two likely mechanistic factors increasing the risk of recurrent CDI are an inadequate immune response to C. difficile toxins and persistent disruption of the normal colonic flora. Important epidemiologic risk factors include advanced age, continuation of other antibiotics, and prolonged hospital stays. Current guidelines recommend that the first recurrent episode be treated with the same agent (i.e., metronidazole or vancomycin) used for the index episode. However, if the first recurrence is characterized as severe, vancomycin should be used. A reasonable strategy for managing a subsequent episode involves tapering followed by pulsed doses of vancomycin. Other potentially effective strategies for recurrent CDI include vancomycin with adjunctive treatments, such as Saccharomyces boulardii, rifaximin “chaser” therapy after vancomycin, nitazoxanide, fecal transplantation, and intravenous immunoglobulin. New treatment agents that are active against C. difficile, but spare critical components of the normal flora, may decrease the incidence of recurrent CDI.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for INFORMING THE PATIENT OF MEDICAL ERRORS.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com

    Monday, January 4, 2010

    What is the Best Treatment for Patients with BOTH Heart Disease and Diabetes?

    For patients with both coronary artery disease and type 2 diabetes, outcomes are similar regardless of whether revascularization or medical therapy is used — and whether insulin sensitization or insulin provision is used — reports an industry-supported study published online in the New England Journal of Medicine.

    Researchers randomized some 2400 patients to either prompt revascularization or medical treatment, and to either insulin-sensitization or insulin-provision therapy. At 5 years, all-cause mortality did not differ between the revascularization and medical-therapy groups or between the insulin-sensitization and insulin-provision groups. Similarly, major cardiovascular events did not differ between groups.

    Patients were stratified before randomization according to type of revascularization, and patients in the CABG (but not PCI) group had fewer major cardiovascular events with revascularization but a similar mortality rate.

    Asked to comment, Journal Watch Cardiology Editor-in-Chief Dr. Harlan Krumholz said that the failure of the study to show clear superiority of revascularization and insulin sensitization "reinforces the need to incorporate the patient's preferences, values, and goals — and costs — into decisions about which strategy to pursue."


    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for CDI is one Infection you Don’t Want to Get IN the Hospital-Clostridium Difficile Infections (CDI) Are Difficult To Treat.

    Deepen your understanding of "medical malpractice"... www.MedMalBook.com

    For more health info and links visit the author's web site www.hookman.com