Study results in Hepatology indicate that safe biopsy is a rational and validated method for staging liver fibrosis in hepatitis C with a marked reduction in the need for liver biopsy. It is an attractive tool for large-scale screening of hepatitis C virus carriers.
The staging of liver fibrosis is pivotal for defining the prognosis and indications for therapy in hepatitis C. Although liver biopsy remains the gold standard, several noninvasive methods are under evaluation for clinical use. Researchers validated the recently described sequential algorithm for fibrosis evaluation biopsy. The safe biopsy detects significant fibrosis and cirrhosis by combining the AST-to-platelet ratio index and Fibrotest-Fibrosure, thereby limiting liver biopsy to cases not adequately classifiable by noninvasive markers.
The researchers enrolled hepatitis C virus patients in nine locations in Europe and the U.S. The diagnostic accuracy of safe biopsy versus histology, which is the gold standard, was investigated. The reduction in the need for liver biopsies achieved with safe biopsy was also assessed. Safe biopsy identified significant fibrosis with 90 percent accuracy, and reduced the number of liver biopsies needed by 47 percent. Safe biopsy had 93 percent accuracy for the detection of cirrhosis, obviating 82 percent of liver biopsies. A third algorithm identified significant fibrosis and cirrhosis simultaneously with high accuracy and a 36 percent reduction in the need for liver biopsy. The patient's age and body mass index influenced the performance of safe biopsy, which was improved with adjusted Fibrotest-Fibrosure cutoffs.
The team found that 10 percent of cases had discordant results for significant fibrosis with safe biopsy versus histology, whereas 8 percent of cases were discordant for cirrhosis detection. The research team also found that 71 of the former cases and 56 of the latter cases had a Fibroscan measurement within two months of histological evaluation. Fibroscan confirmed safe biopsy findings in 83 percent and 75 percent, respectively.
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.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Showing posts with label doctor. Show all posts
Showing posts with label doctor. Show all posts
Friday, August 27, 2010
Monday, April 26, 2010
PHYSICIAN URGES RETURN TO MORE PERSONAL CARE
In an op-ed for the New York Times Dr. Dena Rifkin, a physician at the University of California-San Diego, writes that since the Institute of Medicine's report on deaths caused by medical errors, "there has been tremendous focus on how many mistakes physicians and hospitals make, how much they cost and how to prevent them." She says that many hospitals reacted with a "brisk and multifaceted" response, but that "none of these interventions, however well meant, address a fundamental problem that is emerging in modern medicine: a change in focus from treating the patient toward satisfying the system."
A close family member was recently hospitalized after nearly collapsing at home. He was promptly checked in, and an electrocardiogram was done within 15 minutes. He was given a bar-coded armband, his pain level was assessed, blood was drawn, X-rays and stress tests were performed, and he was discharged 24 hours later with a revised medication list after being offered a pneumonia vaccine and an opportunity to fill out a living will.The only problem was an utter lack of human attention. An emergency room physician admitted him to a hospital service that rapidly evaluates patients for potential heart attacks. No one noted the blood tests that suggested severe dehydration or took enough history to figure out why he might be fatigued.
A doctor was present for a few minutes at the beginning of his stay, and fewer the next day. Even my presence, as a family member and physician, did not change the cursory attitude of the doctors and nurses we met.Yet his hospitalization met all the current standards for quality care.
It has been 10 years since the Institute of Medicine’s seminal report on deaths caused by medical errors (numbering at least 44,000 a year). Since then, there has been tremendous focus on how many mistakes physicians and hospitals make, how much they cost and how to prevent them.
The response at most hospitals has been brisk and multifaceted. Hospital accreditation committees now audit charts for outdated abbreviations and proper signing of notes. Electronic prescription systems are rapidly becoming the norm. Pay-for-performance interventions by insurers promise to reward those who make the grade and to refuse payment to those whose treatments cause complications like hospital-acquired infections.
But as we bustle from one well-documented chart to the next, no one is counting whether we are still paying attention to the human beings. No one is counting whether we admit that the best source of information, the best protection from medical error, the best opportunity to make a difference — that all of these things have been here all along. The answers are with the patients, and we must remember the unquantifiable value of asking the right questions.
She adds that medical professionals "are paying attention to the details of medical errors," yet "no one is counting whether we are still paying attention to the human beings."
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.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
A close family member was recently hospitalized after nearly collapsing at home. He was promptly checked in, and an electrocardiogram was done within 15 minutes. He was given a bar-coded armband, his pain level was assessed, blood was drawn, X-rays and stress tests were performed, and he was discharged 24 hours later with a revised medication list after being offered a pneumonia vaccine and an opportunity to fill out a living will.The only problem was an utter lack of human attention. An emergency room physician admitted him to a hospital service that rapidly evaluates patients for potential heart attacks. No one noted the blood tests that suggested severe dehydration or took enough history to figure out why he might be fatigued.
A doctor was present for a few minutes at the beginning of his stay, and fewer the next day. Even my presence, as a family member and physician, did not change the cursory attitude of the doctors and nurses we met.Yet his hospitalization met all the current standards for quality care.
It has been 10 years since the Institute of Medicine’s seminal report on deaths caused by medical errors (numbering at least 44,000 a year). Since then, there has been tremendous focus on how many mistakes physicians and hospitals make, how much they cost and how to prevent them.
The response at most hospitals has been brisk and multifaceted. Hospital accreditation committees now audit charts for outdated abbreviations and proper signing of notes. Electronic prescription systems are rapidly becoming the norm. Pay-for-performance interventions by insurers promise to reward those who make the grade and to refuse payment to those whose treatments cause complications like hospital-acquired infections.
But as we bustle from one well-documented chart to the next, no one is counting whether we are still paying attention to the human beings. No one is counting whether we admit that the best source of information, the best protection from medical error, the best opportunity to make a difference — that all of these things have been here all along. The answers are with the patients, and we must remember the unquantifiable value of asking the right questions.
She adds that medical professionals "are paying attention to the details of medical errors," yet "no one is counting whether we are still paying attention to the human beings."
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.
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, April 12, 2010
A BETTER ANSWER FOR DOCTORS WORRIED ABOUT HIGH MALPRACTICE INSURANCE PREMIUMS ?
Tom Baker, a professor at the University of Pennsylvania Law School, is the author of “The Medical Malpractice Myth. Says that our medical liability system needs reform. But anyone who thinks that limiting liability would reduce health care costs is fooling himself. Preventable medical injuries, not patient compensation, are what ring up extra costs for additional treatment. This means taxpayers, employers and everyone else who buys health insurance — all of us — have a big stake in patient safety.
Eighty percent of malpractice claims involve significant disability or death, a 2006 analysis of medical malpractice claims conducted by the Harvard School of Public Health shows, and the amount of compensation patients receive strongly depends on the merits of their claims. Most people injured by medical malpractice do not bring legal claims, earlier studies by the same researchers have found.
On the other hand, risk managers, for example, and spurring anesthesiologists to improve their safety standards and practices. Even medical societies’ efforts to attack the liability system have helped, by inspiring the research that has documented the surprising extent of preventable injuries in hospitals. That research helped start the patient safety movement. When it comes to rising medical costs, liability is a symptom, not the disease. Getting rid of liability might save money for hospitals and some high-risk specialists, but it would cost society more by taking away one of the few hard-wired patient safety incentives.
Besides, there’s a better answer for doctors worried about high malpractice insurance premiums.
Critics point to defensive medicine as the hidden burden that liability imposes on health care. Yet research shows that while the fear of liability changes doctors’ behavior, that isn’t necessarily a burden. Some defensive medicine is, like defensive driving, good practice. Too often, we can’t distinguish between treatments that are necessary and those that are wasteful. Better research on what works and what doesn’t — evidence-based medicine — will help. And it will address the more general challenge of avoiding costly but unnecessary care.
Just as we need evidence-based medicine, we also need evidence-based medical liability reform. The research shows, overwhelmingly, that the real problem is too much malpractice, not too many malpractice lawsuits. So medical providers should be required to disclose injuries, provide quicker compensation to deserving patients and — here’s the answer for doctors worried about their premiums — shift the responsibility for buying malpractice insurance to hospitals and other large medical institutions. Evidence-based liability reform would give these institutions the incentive they need to cut back on the most wasteful aspect of American health care: preventable medical injuries.
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.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Eighty percent of malpractice claims involve significant disability or death, a 2006 analysis of medical malpractice claims conducted by the Harvard School of Public Health shows, and the amount of compensation patients receive strongly depends on the merits of their claims. Most people injured by medical malpractice do not bring legal claims, earlier studies by the same researchers have found.
On the other hand, risk managers, for example, and spurring anesthesiologists to improve their safety standards and practices. Even medical societies’ efforts to attack the liability system have helped, by inspiring the research that has documented the surprising extent of preventable injuries in hospitals. That research helped start the patient safety movement. When it comes to rising medical costs, liability is a symptom, not the disease. Getting rid of liability might save money for hospitals and some high-risk specialists, but it would cost society more by taking away one of the few hard-wired patient safety incentives.
Besides, there’s a better answer for doctors worried about high malpractice insurance premiums.
Critics point to defensive medicine as the hidden burden that liability imposes on health care. Yet research shows that while the fear of liability changes doctors’ behavior, that isn’t necessarily a burden. Some defensive medicine is, like defensive driving, good practice. Too often, we can’t distinguish between treatments that are necessary and those that are wasteful. Better research on what works and what doesn’t — evidence-based medicine — will help. And it will address the more general challenge of avoiding costly but unnecessary care.
Just as we need evidence-based medicine, we also need evidence-based medical liability reform. The research shows, overwhelmingly, that the real problem is too much malpractice, not too many malpractice lawsuits. So medical providers should be required to disclose injuries, provide quicker compensation to deserving patients and — here’s the answer for doctors worried about their premiums — shift the responsibility for buying malpractice insurance to hospitals and other large medical institutions. Evidence-based liability reform would give these institutions the incentive they need to cut back on the most wasteful aspect of American health care: preventable medical injuries.
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.
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, April 2, 2010
Are Statin Medicines Good For Everyone?
Statins like Lipitor have gotten great publicity-with some advocating putting it in the drinking water. New research,however, shows that statin drugs may negatively impact some patients with cardiac disorders. A new study presented at the 75th annual international scientific assembly of the American College of Chest Physicians found that statins benefit patients with systolic heart failure (SHF), but not those with diastolic heart failure (DHF). These patients experienced increased dyspnea, fatigue, and decreased exercise tolerance. “It is possible that statins would help patients with systolic heart failure more than patients with diastolic heart failure due to the cholesterol-lowering and anti-inflammatory effects of statins. US Pharm. 2009;34(12):10.
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.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
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.
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, March 29, 2010
THE ABCs Of Colon Cancer [CRC] Screening
Involved organizations promote a message for adults: get screened if you are 50 or older.
It is predicted that if all individuals aged 50 or older had regular colorectal screening tests resulting in the removal of all precancerous polyps, up to 90% of deaths from colorectal cancer could be prevented. The premise for the utility of cancer screening, in general, is that early diagnosis may reduce cancer mortality, result in less radical therapy, and decrease costs. Colorectal cancer screening, in particular, is capable of detecting precancerous polyps in the colon or rectum for removal and can detect early-stage cancer so that treatment may be initiated when it is more effective, often leading to a cure.
Screening for colorectal cancer begins soon after an individual turns 50 years of age, then continues at regular intervals. People at higher risk for colorectal cancer should be tested at a younger age and/or more frequently, including individuals who 1) have a personal or close family history of colorectal polyps or colorectal cancer; 2) have inflammatory bowel disease; 3) have genetic syndromes such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer. Patients should speak to their health care provider to ascertain when they should begin screening and how often they should be tested.
A consensus guideline for colorectal cancer screening was released in March 2008 by the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology (ACS/USMSTF/ACR), while the USPSTF updated its screening recommendations in October 2008. Ongoing studies drive the constantly evolving recommended screening schedules. For the latest in cancer screening point your medical professional to these articles. Ask your medical professional where you fit in.
Levin B, Lieberman D, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130-160. U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149:627-637.
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.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
It is predicted that if all individuals aged 50 or older had regular colorectal screening tests resulting in the removal of all precancerous polyps, up to 90% of deaths from colorectal cancer could be prevented. The premise for the utility of cancer screening, in general, is that early diagnosis may reduce cancer mortality, result in less radical therapy, and decrease costs. Colorectal cancer screening, in particular, is capable of detecting precancerous polyps in the colon or rectum for removal and can detect early-stage cancer so that treatment may be initiated when it is more effective, often leading to a cure.
Screening for colorectal cancer begins soon after an individual turns 50 years of age, then continues at regular intervals. People at higher risk for colorectal cancer should be tested at a younger age and/or more frequently, including individuals who 1) have a personal or close family history of colorectal polyps or colorectal cancer; 2) have inflammatory bowel disease; 3) have genetic syndromes such as familial adenomatous polyposis (FAP) or hereditary nonpolyposis colorectal cancer. Patients should speak to their health care provider to ascertain when they should begin screening and how often they should be tested.
A consensus guideline for colorectal cancer screening was released in March 2008 by the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology (ACS/USMSTF/ACR), while the USPSTF updated its screening recommendations in October 2008. Ongoing studies drive the constantly evolving recommended screening schedules. For the latest in cancer screening point your medical professional to these articles. Ask your medical professional where you fit in.
Levin B, Lieberman D, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58:130-160. U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149:627-637.
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.
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, February 22, 2010
5 Tips on Nutrition and Aging
1. Nutrition plays a role in cardiovascular disease, some malignancies, adult-onset diabetes, osteoporosis, alcoholism, and recovery from major injury.
2. Malnutrition can weaken the immune system, impair healing following surgery or injury, lessen mobility, and reduce mental capabilities and function. It is common in older adults.
3. To maintain good health, total fat intake should be reduced to 30% or less of calories. Saturated fat intake should only account for 10% (one third of fat calories). Salt and alcohol intake also should be limited.
4. Dietary fat content composed primarily of monounsaturated fat (eg, olive oil) and polyunsaturated fat (eg, canola, corn and fish oils) may be associated with a lower incidence of cardiovascular disease.
5. Foods to be avoided include whole milk and dairy products (ice cream, cheese, butter); commercially baked goods (cookies and crackers); hot dogs, ham, and cold cuts; and oils, gravies, and salad dressing.
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.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
2. Malnutrition can weaken the immune system, impair healing following surgery or injury, lessen mobility, and reduce mental capabilities and function. It is common in older adults.
3. To maintain good health, total fat intake should be reduced to 30% or less of calories. Saturated fat intake should only account for 10% (one third of fat calories). Salt and alcohol intake also should be limited.
4. Dietary fat content composed primarily of monounsaturated fat (eg, olive oil) and polyunsaturated fat (eg, canola, corn and fish oils) may be associated with a lower incidence of cardiovascular disease.
5. Foods to be avoided include whole milk and dairy products (ice cream, cheese, butter); commercially baked goods (cookies and crackers); hot dogs, ham, and cold cuts; and oils, gravies, and salad dressing.
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.
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 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
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 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
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
Saturday, September 5, 2009
LONGER-TERM HORMONE THERAPY APPEARS TO BE THE STANDARD OF CARE IN ADVANCED PROSTATE CANCER
Research suggests prolonged chemical castration may be needed to suppress prostate tumor-fueling hormones.
There is, however, much debate regarding the appropriate treatment for tumors that have metastasized to both prostate lobes. While androgen-deprivation therapy has increased patients' survival odds, those subjected to the treatment for extended periods of time often experienced hot flashes, a sluggish libido, and other unwanted side effects. But this much appears certain at this time.
Prostate cancer patients need three years of treatment known as chemical castration to suppress the production of tumor-fueling hormones and improve their chance of survival," according to researchers in France who had hoped that "cutting back on the drugs would provide the same benefit as longer-term treatment." What they found instead was that "patients treated for six months were more likely to die than those on the drugs for several years."
So, the French team decided to see "if six months of androgen suppression could provide the same benefit as three years of treatment, but with fewer adverse effects. Study participants "had confirmed but nonmetastatic prostate cancer in either T1c to T2a-b clinical stage with pathological nodal stage N1 or N2 or stages T2c to T4 with clinical nodal stages N0 to N2." Following "external beam radiation, all of the men received six months of androgen blockade with a luteinizing hormone-releasing hormone analogue -- started on the first day of radiation -- and a daily antiandrogen agent started a week earlier." Six months later, "patients whose disease had not progressed were randomly assigned to no further treatment (and formed the short-term therapy group) or to another 2.5 years of androgen blockade with the luteinizing hormone-releasing hormone analogue but without the antiandrogen agent." Altogether, "970 men were randomized -- 483 to short-term suppression and 487 to long-term suppression."
By study end, investigators noted that "the five-year death rate of men in the longer-treatment group was 15.2 percent, compared with 19 percent for those in the shorter-term treatment group,"
COMMENT:
These results pretty much mirror those of a similar American trial according to Dr. Eric M. Horwitz, of the Fox Chase Cancer Center in Philadelphia, who led the group that did the US study of 1,554 men who were followed for 10 years. That work revealed that the disease-free survival rate for the short-term group was 13.2 percent, compared with 22.5 percent for those treated longer." "We have long believed that longer-term hormone therapy is the standard of care, and "these studies support that belief.
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 THE DANGERS OF ACID REDUCING MEDICATIONS LIKE NEXIUM AND OTHER PPIs-.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
There is, however, much debate regarding the appropriate treatment for tumors that have metastasized to both prostate lobes. While androgen-deprivation therapy has increased patients' survival odds, those subjected to the treatment for extended periods of time often experienced hot flashes, a sluggish libido, and other unwanted side effects. But this much appears certain at this time.
Prostate cancer patients need three years of treatment known as chemical castration to suppress the production of tumor-fueling hormones and improve their chance of survival," according to researchers in France who had hoped that "cutting back on the drugs would provide the same benefit as longer-term treatment." What they found instead was that "patients treated for six months were more likely to die than those on the drugs for several years."
So, the French team decided to see "if six months of androgen suppression could provide the same benefit as three years of treatment, but with fewer adverse effects. Study participants "had confirmed but nonmetastatic prostate cancer in either T1c to T2a-b clinical stage with pathological nodal stage N1 or N2 or stages T2c to T4 with clinical nodal stages N0 to N2." Following "external beam radiation, all of the men received six months of androgen blockade with a luteinizing hormone-releasing hormone analogue -- started on the first day of radiation -- and a daily antiandrogen agent started a week earlier." Six months later, "patients whose disease had not progressed were randomly assigned to no further treatment (and formed the short-term therapy group) or to another 2.5 years of androgen blockade with the luteinizing hormone-releasing hormone analogue but without the antiandrogen agent." Altogether, "970 men were randomized -- 483 to short-term suppression and 487 to long-term suppression."
By study end, investigators noted that "the five-year death rate of men in the longer-treatment group was 15.2 percent, compared with 19 percent for those in the shorter-term treatment group,"
COMMENT:
These results pretty much mirror those of a similar American trial according to Dr. Eric M. Horwitz, of the Fox Chase Cancer Center in Philadelphia, who led the group that did the US study of 1,554 men who were followed for 10 years. That work revealed that the disease-free survival rate for the short-term group was 13.2 percent, compared with 22.5 percent for those treated longer." "We have long believed that longer-term hormone therapy is the standard of care, and "these studies support that belief.
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 THE DANGERS OF ACID REDUCING MEDICATIONS LIKE NEXIUM AND OTHER PPIs-.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Sunday, August 23, 2009
WHY DOCS SHOULD HANG UP THEIR WHITE COATS
According to the CDC, nearly 100,000 U.S. patients died in 2002 from infections contracted in hospitals. There has been no conclusive evidence linking infected cuffs to any of these deaths — studies have been done showing that bacteria like MRSA and C. difficile exist on sleeves, but there’s no proof that those germs actually get passed around that way. But backers of the change in dress code argue that as long as there’s the slightest potential of transmission, everything possible should be done to avoid it. One of the policy questions that AMA delegates considered at their annual conference is whether doctors should forgo their iconic white coats for something a little more casual — and a little less dangerous for patients. The measure would urge hospitals to adopt dress codes of “bare below the elbows,” to avoid carrying bacteria between patients via coat sleeves.
The British National Health System has already adopted a policy, banning ties, long sleeves, jewelry and white coats. Scotland went so far as to establish a uniform dress code that includes a short-sleeve requirement.
While many U.S. docs already follow these rules, especially those in intensive-care units, some still prefer the professionalism the white coat implies. One irony, is that the spanking white coat was borrowed from lab scientists and introduced in hospitals in the 19th century in part to help prevent the spread of contamination.
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 tomorrow for WHAT ARE PROBIOTICS?
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
The British National Health System has already adopted a policy, banning ties, long sleeves, jewelry and white coats. Scotland went so far as to establish a uniform dress code that includes a short-sleeve requirement.
While many U.S. docs already follow these rules, especially those in intensive-care units, some still prefer the professionalism the white coat implies. One irony, is that the spanking white coat was borrowed from lab scientists and introduced in hospitals in the 19th century in part to help prevent the spread of contamination.
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 tomorrow for WHAT ARE PROBIOTICS?
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
For more health info and links visit the author's web site www.hookman.com
Saturday, August 1, 2009
FALLS IN THE ELDERLY
The Centers for Medicare and Medicaid Services (CMS) worked collaboratively with the Centers for Disease Control and Prevention (CDC) and on October 1, 2008, enacted new payment provisions: Medicare will no longer reimburse hospitals for a higher-paying DRG when one of eight selected hospital-acquired conditions develops during the hospital stay. The CMS heralded this move as an effort to align financial incentives with the quality of care, thereby promoting both quality and efficiency.
Hospital falls and trauma were included as one of the eight conditions that, the CMS argues, "should not occur after admission to the hospital." But, writing in the New England Journal of Medicine, Dr. Sharon K. Inouye of Harvard Medical School, and colleagues, "argue that because falls have proved to be such an intractable problem despite broad efforts to reduce them, they should not be included on a list of avoidable medical errors that result in hospitals not being paid." Each year, they point out about one third of persons who are 65 years of age or older living in community settings fall at least once. The percentage is 50% among those 80 years of age or older
There is little argument that hospital falls fulfill the first two criteria outlined by Congress — they are high-cost and high-volume, and they result in the assignment of a case to a higher-paying DRG. Some 3 to 20% of inpatients fall at least once during their hospital stay; these falls result in injuries, increased lengths of stay, malpractice lawsuits, and more than $4,000 in excess charges per hospitalization. Thus, hospital falls represent a major patient-safety problem and may complicate a patient's care and treatment. Yet we believe that the inclusion of falls and trauma in this initiative is misguided: it implies both that hospital falls occur as the result of lapses in the health care system and that they can reasonably be prevented through the application of evidence-based guidelines. Most important, their inclusion may have unintended consequences that may cause greater harm than the falls that the initiative is meant to prevent.
But, says the New England Journal of Medicine (NEJM), falls and injuries can occur even when hospitals provide the best possible care and unlike other hospital-acquired conditions that were selected by the CMS, falls are often the result not of medical errors but of diseases, impairments, and appropriate uses of medications and other treatments.
The CMS's statement that the selected conditions should not occur after admission to the hospital presumes that the conditions were not present before hospitalization — which is not true in the case of falls.
Of greatest concern the NEJM points out, is that the heightened focus on fall prevention will probably have unintended consequences. If hospitals are scrutinized for the occurrence of falls, the natural tendency will be to focus on such events even at the expense of competing (and perhaps more important) outcomes. Unintended consequences are likely to include a decrease in mobility and a resurgence in the use of physical restraints in a misguided effort to prevent fall-related injuries. Physical restraints have long been used because they are believed to prevent falls. Studies have shown, however, that not only do they not reduce the risk of falls or related injuries, but they are associated with increased rates of complications, including immobility, functional loss, delirium, agitation, pressure sores, asphyxiation, and death. Moreover, accumulating evidence suggests that restraints may actually increase the risk of falling or sustaining an injury from a fall.
The inclusion of hospital falls in the new Medicare initiative appears to be premature at best; at worst, it may be harmful to the very patients it is intended to protect and may ultimately increase the costs of Medicare because of its unintended consequences, concludes the NEJM.
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 tomorrow for NEW RECOMMENDATIONS FROM PRESCRIBERS NEWSLETTER FOCUS MORE ON AGE TO DETERMINE WHO SHOULD GET ASPIRIN FOR PRIMARY PREVENTION.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Hospital falls and trauma were included as one of the eight conditions that, the CMS argues, "should not occur after admission to the hospital." But, writing in the New England Journal of Medicine, Dr. Sharon K. Inouye of Harvard Medical School, and colleagues, "argue that because falls have proved to be such an intractable problem despite broad efforts to reduce them, they should not be included on a list of avoidable medical errors that result in hospitals not being paid." Each year, they point out about one third of persons who are 65 years of age or older living in community settings fall at least once. The percentage is 50% among those 80 years of age or older
There is little argument that hospital falls fulfill the first two criteria outlined by Congress — they are high-cost and high-volume, and they result in the assignment of a case to a higher-paying DRG. Some 3 to 20% of inpatients fall at least once during their hospital stay; these falls result in injuries, increased lengths of stay, malpractice lawsuits, and more than $4,000 in excess charges per hospitalization. Thus, hospital falls represent a major patient-safety problem and may complicate a patient's care and treatment. Yet we believe that the inclusion of falls and trauma in this initiative is misguided: it implies both that hospital falls occur as the result of lapses in the health care system and that they can reasonably be prevented through the application of evidence-based guidelines. Most important, their inclusion may have unintended consequences that may cause greater harm than the falls that the initiative is meant to prevent.
But, says the New England Journal of Medicine (NEJM), falls and injuries can occur even when hospitals provide the best possible care and unlike other hospital-acquired conditions that were selected by the CMS, falls are often the result not of medical errors but of diseases, impairments, and appropriate uses of medications and other treatments.
The CMS's statement that the selected conditions should not occur after admission to the hospital presumes that the conditions were not present before hospitalization — which is not true in the case of falls.
Of greatest concern the NEJM points out, is that the heightened focus on fall prevention will probably have unintended consequences. If hospitals are scrutinized for the occurrence of falls, the natural tendency will be to focus on such events even at the expense of competing (and perhaps more important) outcomes. Unintended consequences are likely to include a decrease in mobility and a resurgence in the use of physical restraints in a misguided effort to prevent fall-related injuries. Physical restraints have long been used because they are believed to prevent falls. Studies have shown, however, that not only do they not reduce the risk of falls or related injuries, but they are associated with increased rates of complications, including immobility, functional loss, delirium, agitation, pressure sores, asphyxiation, and death. Moreover, accumulating evidence suggests that restraints may actually increase the risk of falling or sustaining an injury from a fall.
The inclusion of hospital falls in the new Medicare initiative appears to be premature at best; at worst, it may be harmful to the very patients it is intended to protect and may ultimately increase the costs of Medicare because of its unintended consequences, concludes the NEJM.
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 tomorrow for NEW RECOMMENDATIONS FROM PRESCRIBERS NEWSLETTER FOCUS MORE ON AGE TO DETERMINE WHO SHOULD GET ASPIRIN FOR PRIMARY PREVENTION.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Thursday, July 30, 2009
WHO SAYS THE US DOES NOT RATION CARE?
Nearly half of kidney transplant waitlist patients over age 60 are at risk to die before they receive a deceased-donor organ, researchers found. The risk of death before acquiring a kidney for senior citizens is high and even higher for patients age 70 and older, for African Americans, and for diabetics.
These findings provide incentive for older patients to consider living donors as an alternative or to get on the list and navigate the deceased-donor process as quickly as possible.
Kidney transplant can nearly double the life expectancy of end-stage renal disease patients over age 60. But an increasing gap between supply and demand has produced longer waiting times and increased mortality on the waiting list, the researchers said. Expanding waiting times clearly affect all portions of the transplant candidate populations.However, older and frailer patients may be the most directly affected because of rapid mortality rates before receiving a deceased-donor transplant.
The number of newly listed kidney transplant candidates nearly tripled from 2,367 in 1995 to 6,982 in 2006, researchers found in an analysis of the Scientific Registry of Transplant Recipients database. The study included all 54,699 patients age 60 and older when placed on the U.S. waiting list for a single kidney transplant from 1995 to July 2007. Half of these older candidates were age 60 to 64 at the time of listing, and 79% were on dialysis at the time of listing.
Overall, 61% of the older population received a transplant within five years of going on the list, but the proportion projected to receive a transplant within five years declined during the study period. For those waitlisted in 2006-2007, it was projected that 46% would die before receiving a deceased-donor transplant, up from a projected 22% in 1995.
The waiting time for a deceased-donor transplant rose significantly from 1995 to 2007, but the gap between time to transplantation and average survival from waitlisting narrowed during the study period. However, the projections for the rate of death before receipt of a deceased-donor kidney varied widely within the older population:
• 61% for those with diabetes
• 52% for those older than 70
• 62% for black patients
• 60% for blood type O
• 71% for blood type B
• 68% for highly sensitized patients
• 53% for those on dialysis at listing
Where patients lived also made a big difference in projected rate of death before kidney transplantation. The mortality rate ranged from 81% for those in United Network for Organ Sharing region five (Arizona, California, Nevada, New Mexico, and Utah) to just 6% for those in region six (Alaska, Hawaii, Idaho, Montana, Oregon, and Washington).
These factors may help clinicians and patients in decision-making, the researchers said. "As these results demonstrate, a white candidate with type AB blood in region one [Connecticut, Maine, Massachusetts, New Hampshire, and Rhode Island] is in a very different circumstance than a black candidate listed with type B blood in region five," they noted. They cautioned, though, that the study was limited by its retrospective, population-based design: its database did not include many factors that ultimately influence patients' prognoses and likelihood of receiving a transplant.
"In this sense, these results provide a general framework that can be used to guide patients and illustrate the importance of various factors, but should not be used exclusively ignoring individual circumstances," they concluded. The practice of transplantation is rapidly changing, but not in favor of older patients, they noted. In particular, they cited a proposed policy for organ allocation that would give younger patients more rapid access to deceased-donor transplants than older candidates.
Clinical Journal of the American Society of Nephrology 2009
Schold J, et al "Half of kidney transplant candidates who are older than 60 years now placed on the waiting list will die before receiving a deceased-donor transplant"
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 tomorrow for STUDY INDICATES 47,000 OLDER AMERICANS ARE TREATED IN EDS EACH YEAR FOR FALLS ASSOCIATED WITH WALKING AIDS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
These findings provide incentive for older patients to consider living donors as an alternative or to get on the list and navigate the deceased-donor process as quickly as possible.
Kidney transplant can nearly double the life expectancy of end-stage renal disease patients over age 60. But an increasing gap between supply and demand has produced longer waiting times and increased mortality on the waiting list, the researchers said. Expanding waiting times clearly affect all portions of the transplant candidate populations.However, older and frailer patients may be the most directly affected because of rapid mortality rates before receiving a deceased-donor transplant.
The number of newly listed kidney transplant candidates nearly tripled from 2,367 in 1995 to 6,982 in 2006, researchers found in an analysis of the Scientific Registry of Transplant Recipients database. The study included all 54,699 patients age 60 and older when placed on the U.S. waiting list for a single kidney transplant from 1995 to July 2007. Half of these older candidates were age 60 to 64 at the time of listing, and 79% were on dialysis at the time of listing.
Overall, 61% of the older population received a transplant within five years of going on the list, but the proportion projected to receive a transplant within five years declined during the study period. For those waitlisted in 2006-2007, it was projected that 46% would die before receiving a deceased-donor transplant, up from a projected 22% in 1995.
The waiting time for a deceased-donor transplant rose significantly from 1995 to 2007, but the gap between time to transplantation and average survival from waitlisting narrowed during the study period. However, the projections for the rate of death before receipt of a deceased-donor kidney varied widely within the older population:
• 61% for those with diabetes
• 52% for those older than 70
• 62% for black patients
• 60% for blood type O
• 71% for blood type B
• 68% for highly sensitized patients
• 53% for those on dialysis at listing
Where patients lived also made a big difference in projected rate of death before kidney transplantation. The mortality rate ranged from 81% for those in United Network for Organ Sharing region five (Arizona, California, Nevada, New Mexico, and Utah) to just 6% for those in region six (Alaska, Hawaii, Idaho, Montana, Oregon, and Washington).
These factors may help clinicians and patients in decision-making, the researchers said. "As these results demonstrate, a white candidate with type AB blood in region one [Connecticut, Maine, Massachusetts, New Hampshire, and Rhode Island] is in a very different circumstance than a black candidate listed with type B blood in region five," they noted. They cautioned, though, that the study was limited by its retrospective, population-based design: its database did not include many factors that ultimately influence patients' prognoses and likelihood of receiving a transplant.
"In this sense, these results provide a general framework that can be used to guide patients and illustrate the importance of various factors, but should not be used exclusively ignoring individual circumstances," they concluded. The practice of transplantation is rapidly changing, but not in favor of older patients, they noted. In particular, they cited a proposed policy for organ allocation that would give younger patients more rapid access to deceased-donor transplants than older candidates.
Clinical Journal of the American Society of Nephrology 2009
Schold J, et al "Half of kidney transplant candidates who are older than 60 years now placed on the waiting list will die before receiving a deceased-donor transplant"
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 tomorrow for STUDY INDICATES 47,000 OLDER AMERICANS ARE TREATED IN EDS EACH YEAR FOR FALLS ASSOCIATED WITH WALKING AIDS.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Friday, July 24, 2009
How to Find a Good Hospital
The reality is, says S.Balauf of US News, that not all hospitals—or doctors or nurses, for that matter—deliver high-quality care. The United States has a "very inconsistent, uneven quality of healthcare," says Anne Weiss, who leads the quality/equality healthcare team at the Robert Wood Johnson Foundation, a healthcare philanthropy based in Princeton, N.J. Even the type of treatment that similar patients get can vary from hospital to hospital and region to region. In some parts of the country, for example, heart patients are more likely to receive angioplasty than coronary bypass surgery, while in many places the opposite is true. (U.S. NEWS wrote about this phenomenon and the fact that some heart patients may get the less appropriate procedure because they may not be fully informed about their options.)
The time to find a good hospital is long before you need one. By tapping a few readily available resources, however, patients can make informed decisions about a good local hospital for the treatment they need. According to the National Committee for Quality Assurance, a healthcare nonprofit based in Washington, D.C., patients who make informed choices and get engaged in their care early ultimately reap better health outcomes.
• Your primary-care physician. Consult this trusted source if a specialist ever tells you that surgery or treatment is necessary, and ask your primary-care doc where he recommends you have it done. Primary-care physicians have a good working knowledge of the hospitals in their area, including each institution's overall reputation and how it stacks up against its local peers for specific procedures and treatments. Ideally, their reasoning will be based on other patients' outcomes
• Your insurance company. Inquire about the quality data they've collected on each facility where they would cover your treatment. That info can typically be found on the plan's website or by phone. The data might be limited to the pool of patients your plan covers and the doctors and hospitals in the plan's network, but it's nevertheless a source of details that can inform your choice.
• That friend of a friend who is a nurse. Your extended social network may include more hospital employees than you realize. "Most people know someone in the local healthcare system. But realize they provide a narrow view, seeing perhaps only one slice of all the variables that make up a hospital's level of care.
• A trusted family member or friend. Bringing someone you trust to an important appointment, or simply going through the hospital-selection process with another person, can be quite powerful. "Never go alone" and "Never stay alone."If nothing else, your companion is likely to be more clear-headed than you are when you're faced with daunting new information about your health. He or she need not be a medical professional.
• I would not trust highway billboards touting a hospital's latest award. They're hard to miss—and plentiful in many regions of the country. But beware the source. The prize may or may not have any real bearing on the real quality of care a patient could expect at that hospital. As an example Hospital Compare, hosted by the federal Centers for Medicare and Medicaid Services, focuses on how often hospitals give heart attack patients aspirin within 30 minutes of their arrival at the ED, give surgery patients the correct antibiotic at the right time prior to the procedure, and otherwise do the right thing in 23 "process measures." Some-I believe most of these criteria-- are relative lightweights. Most hospitals show great success, for example, at giving smoking-cessation advice to heart patients who smoke. (Nurse: "I see you're a smoker, Mr. Smith. You know it doesn't help your heart condition, don't you?" Mr. Smith: "Yes, I do." Nurse marks box on discharge form.)
• Hospital Compare also indicates whether a hospital's death rates in heart attack, heart failure, and pneumonia patients is better, no different, or worse than the U.S. average. That might seem useful, but the average is so broadly defined that only about 2 percent of hospitals are "better" or "worse." Clicking on the graph or table view of the page will reveal the actual death rates, as well as average state and national rates. Last year, the site began offering patient satisfaction data gleaned from surveys, such as the percentages of patients who reported their nurses always communicated well and of those who said they would definitely recommend the hospital. Look, but take with a grain of salt. Studies show that individuals whose medical care was successful tend to be more satisfied with a hospital in other ways.
• Some websites [www.hookman.com] have links to other sites that also rank or rate good hospitals across the country, and such sites have potential value to people who are seeking a good hospital in their area.
Is there a correlation between hospitals’ “quality”scores?
Unfortunately no! A study reported in the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION found no correlation between how well hospitals scored on a 13-item set of Leapfrog quality and safety measures and death rates, adjusted for severity, of patients admitted to the hospitals. The study didn't look at rates of complications.The Leapfrog Group is a nonprofit business coalition that allows consumers to compare hospital safety and quality ratings based on results of a voluntary survey. Hospitals are rated on their ability to satisfy two sets of safety standards. One set, such as appropriate ICU staffing and a program to reduce bedsores, applies to the entire hospital. The other set reflects quality of care and cost for 10 specific procedures and conditions, including repairing an abdominal aortic aneurism and treating pneumonia. Hospitals can be compared directly. You may not be able to find yours, however. Roughly 1,300 hospitals out of more than 5,000 in the nation—two out of 16 in Baltimore, for example—responded to the most recent Leapfrog survey.
COMMENT:
In the end after you do all your research it then really comes down to luck and faith. Faith that you have a fine doctors who will make good decisions for you. Trust—but verify.
African medical facilities always have relatives in with patients. That’s a good thing.
Always have someone with you in the hospital—a friend or loved one who will stay with you and watch out for you.
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 tomorrow for WHAT DIET IS EFFECTIVE IN REDUCING PROSTATE CANCER RISK?.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
The time to find a good hospital is long before you need one. By tapping a few readily available resources, however, patients can make informed decisions about a good local hospital for the treatment they need. According to the National Committee for Quality Assurance, a healthcare nonprofit based in Washington, D.C., patients who make informed choices and get engaged in their care early ultimately reap better health outcomes.
• Your primary-care physician. Consult this trusted source if a specialist ever tells you that surgery or treatment is necessary, and ask your primary-care doc where he recommends you have it done. Primary-care physicians have a good working knowledge of the hospitals in their area, including each institution's overall reputation and how it stacks up against its local peers for specific procedures and treatments. Ideally, their reasoning will be based on other patients' outcomes
• Your insurance company. Inquire about the quality data they've collected on each facility where they would cover your treatment. That info can typically be found on the plan's website or by phone. The data might be limited to the pool of patients your plan covers and the doctors and hospitals in the plan's network, but it's nevertheless a source of details that can inform your choice.
• That friend of a friend who is a nurse. Your extended social network may include more hospital employees than you realize. "Most people know someone in the local healthcare system. But realize they provide a narrow view, seeing perhaps only one slice of all the variables that make up a hospital's level of care.
• A trusted family member or friend. Bringing someone you trust to an important appointment, or simply going through the hospital-selection process with another person, can be quite powerful. "Never go alone" and "Never stay alone."If nothing else, your companion is likely to be more clear-headed than you are when you're faced with daunting new information about your health. He or she need not be a medical professional.
• I would not trust highway billboards touting a hospital's latest award. They're hard to miss—and plentiful in many regions of the country. But beware the source. The prize may or may not have any real bearing on the real quality of care a patient could expect at that hospital. As an example Hospital Compare, hosted by the federal Centers for Medicare and Medicaid Services, focuses on how often hospitals give heart attack patients aspirin within 30 minutes of their arrival at the ED, give surgery patients the correct antibiotic at the right time prior to the procedure, and otherwise do the right thing in 23 "process measures." Some-I believe most of these criteria-- are relative lightweights. Most hospitals show great success, for example, at giving smoking-cessation advice to heart patients who smoke. (Nurse: "I see you're a smoker, Mr. Smith. You know it doesn't help your heart condition, don't you?" Mr. Smith: "Yes, I do." Nurse marks box on discharge form.)
• Hospital Compare also indicates whether a hospital's death rates in heart attack, heart failure, and pneumonia patients is better, no different, or worse than the U.S. average. That might seem useful, but the average is so broadly defined that only about 2 percent of hospitals are "better" or "worse." Clicking on the graph or table view of the page will reveal the actual death rates, as well as average state and national rates. Last year, the site began offering patient satisfaction data gleaned from surveys, such as the percentages of patients who reported their nurses always communicated well and of those who said they would definitely recommend the hospital. Look, but take with a grain of salt. Studies show that individuals whose medical care was successful tend to be more satisfied with a hospital in other ways.
• Some websites [www.hookman.com] have links to other sites that also rank or rate good hospitals across the country, and such sites have potential value to people who are seeking a good hospital in their area.
Is there a correlation between hospitals’ “quality”scores?
Unfortunately no! A study reported in the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION found no correlation between how well hospitals scored on a 13-item set of Leapfrog quality and safety measures and death rates, adjusted for severity, of patients admitted to the hospitals. The study didn't look at rates of complications.The Leapfrog Group is a nonprofit business coalition that allows consumers to compare hospital safety and quality ratings based on results of a voluntary survey. Hospitals are rated on their ability to satisfy two sets of safety standards. One set, such as appropriate ICU staffing and a program to reduce bedsores, applies to the entire hospital. The other set reflects quality of care and cost for 10 specific procedures and conditions, including repairing an abdominal aortic aneurism and treating pneumonia. Hospitals can be compared directly. You may not be able to find yours, however. Roughly 1,300 hospitals out of more than 5,000 in the nation—two out of 16 in Baltimore, for example—responded to the most recent Leapfrog survey.
COMMENT:
In the end after you do all your research it then really comes down to luck and faith. Faith that you have a fine doctors who will make good decisions for you. Trust—but verify.
African medical facilities always have relatives in with patients. That’s a good thing.
Always have someone with you in the hospital—a friend or loved one who will stay with you and watch out for you.
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 tomorrow for WHAT DIET IS EFFECTIVE IN REDUCING PROSTATE CANCER RISK?.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Tuesday, July 21, 2009
Pressure Stockings 'Should Not Be Used' to Prevent DVT
Deep vein thrombosis (DVT) and pulmonary embolism are common after stroke. In small trials of patients undergoing surgery, graduated compression stockings (GCS) appear to reduce the risk of DVT.
National stroke guidelines in several countries extrapolating from these trials recommend their use in patients with stroke. Researchers assessed the effectiveness of thigh-length GCS to reduce DVT after stroke.
In an international trial, researchers randomized some 2500 immobile patients hospitalized within 1 week of an acute stroke to either use of, or avoidance of, thigh-length stockings. Ultrasound studies done at roughly 30 days found no significant difference between the groups with regard to the occurrence of DVT in the popliteal or femoral vessels.
However, the risk for adverse effects (skin breaks, ulcers, blisters, and necrosis) was much higher in stocking users than nonusers (5% vs. 1%).
Graduated compression stockings don't reduce the risk for deep venous thrombosis after stroke, according to this large trial. Commentators say flatly that the stockings "should not be used after stroke and current guidelines will need to be amended."
The Lancet, Online Publication, 2009 doi:10.1016/S0140-6736(09)60941-7
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 tomorrow for Don't spend your life trying to impress others.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
National stroke guidelines in several countries extrapolating from these trials recommend their use in patients with stroke. Researchers assessed the effectiveness of thigh-length GCS to reduce DVT after stroke.
In an international trial, researchers randomized some 2500 immobile patients hospitalized within 1 week of an acute stroke to either use of, or avoidance of, thigh-length stockings. Ultrasound studies done at roughly 30 days found no significant difference between the groups with regard to the occurrence of DVT in the popliteal or femoral vessels.
However, the risk for adverse effects (skin breaks, ulcers, blisters, and necrosis) was much higher in stocking users than nonusers (5% vs. 1%).
Graduated compression stockings don't reduce the risk for deep venous thrombosis after stroke, according to this large trial. Commentators say flatly that the stockings "should not be used after stroke and current guidelines will need to be amended."
The Lancet, Online Publication, 2009 doi:10.1016/S0140-6736(09)60941-7
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 tomorrow for Don't spend your life trying to impress others.
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
Thursday, July 9, 2009
CAUTION YOUR FAMILIES ABOUT SWIMMING POOL DISEASES
Reports of gastrointestinal illness from use of public pools and water parks have risen sharply in recent years, according to the Centers for Disease Control and Prevention. The leading culprit is a microscopic organism that lives in human feces.
The CDC is increasingly documenting cases of "gastrointestinal illness from use of public pools and water parks," noting that a "microscopic organism that lives in human feces" appears to be at the center of the trend. "Called cryptosporidium, it is a parasite transmitted in an egg-like shell that can survive as long as 10 days even in chlorinated water." And "in 2007, the last year for which statistics are available, it was responsible for 31 recreational water outbreaks involving 3,726 people...up from seven outbreaks and 567 people in 2004." Although officials are not clear as to why this rise is taking place, CDC epidemiologists have pointed out that "detection and reporting had probably improved since a treatment for the diarrheal illness -- called cryptosporidiosis, or crypto for short -- became available in 2002." Furthermore, "the recent large outbreaks, she said, have raised awareness and led to better reporting."
Called cryptosporidium, it is a parasite transmitted in an egglike shell that can survive as long as 10 days even in chlorinated water. In 2007, the last year for which statistics are available, it was responsible for 31 recreational water outbreaks involving 3,726 people, according to the disease centers — up from 7 outbreaks and 567 people in 2004. One of the largest recent crypto outbreaks occurred in Utah in 2007. There were 2,000 confirmed cases, but that number vastly underestimates the illness’s total impact.
COMMENT:
People should not swim or allow their children to swim when they have diarrhea. The water you swim in is shared with everyone, so what one swimmer does has consequences for all the swimmers.
The symptoms of crypto resemble those of food poisoning. Though most cases clear up on their own, the illness can require hospitalization, particularly in small children and people with weakened immune systems.
In addition to not swimming while ill with diarrhea, health experts say people should shower before swimming and never use the pool as a toilet. Parents should wash young children before they enter the pool and take them on frequent bathroom breaks. Children in diapers require vigilant attention.
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 tomorrow for Drugs that increase photosensitivity
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
The CDC is increasingly documenting cases of "gastrointestinal illness from use of public pools and water parks," noting that a "microscopic organism that lives in human feces" appears to be at the center of the trend. "Called cryptosporidium, it is a parasite transmitted in an egg-like shell that can survive as long as 10 days even in chlorinated water." And "in 2007, the last year for which statistics are available, it was responsible for 31 recreational water outbreaks involving 3,726 people...up from seven outbreaks and 567 people in 2004." Although officials are not clear as to why this rise is taking place, CDC epidemiologists have pointed out that "detection and reporting had probably improved since a treatment for the diarrheal illness -- called cryptosporidiosis, or crypto for short -- became available in 2002." Furthermore, "the recent large outbreaks, she said, have raised awareness and led to better reporting."
Called cryptosporidium, it is a parasite transmitted in an egglike shell that can survive as long as 10 days even in chlorinated water. In 2007, the last year for which statistics are available, it was responsible for 31 recreational water outbreaks involving 3,726 people, according to the disease centers — up from 7 outbreaks and 567 people in 2004. One of the largest recent crypto outbreaks occurred in Utah in 2007. There were 2,000 confirmed cases, but that number vastly underestimates the illness’s total impact.
COMMENT:
People should not swim or allow their children to swim when they have diarrhea. The water you swim in is shared with everyone, so what one swimmer does has consequences for all the swimmers.
The symptoms of crypto resemble those of food poisoning. Though most cases clear up on their own, the illness can require hospitalization, particularly in small children and people with weakened immune systems.
In addition to not swimming while ill with diarrhea, health experts say people should shower before swimming and never use the pool as a toilet. Parents should wash young children before they enter the pool and take them on frequent bathroom breaks. Children in diapers require vigilant attention.
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 tomorrow for Drugs that increase photosensitivity
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
Tuesday, July 7, 2009
“SUN ALLERGY”---DRUG-INDUCED PHOTOSENSITIVITY IS PRIMARILY DUE TO UVA RAYS.
Advise patients taking photosensitizing drugs to use a broad-spectrum sunscreen.
A list of the usual culprits (isotretinoin, thiazides, etc)...include also ones that are often forgotten such as benzodiazepines and NSAIDs. This table summarizes drugs which have been associated with photosensitivity. It is important to note that many of the drugs listed were included based on case reports. However, patients taking these drugs should be counseled to minimize sun exposure and to use broad-spectrum (UVA and UVB) sunscreens when sun exposure cannot be avoided.
Drug-induced photosensitivity may present in a variety of ways. Most reactions are either phototoxic or photoallergic. Photoallergy is a rare, immunological response, which is not dose-related and occurs after continuous exposure. Photoallergy occurs when light causes a drug to act as a hapten, triggering a hypersensitivity response which often manifests as pruritic and eczematous rash.Phototoxic reactions are chemically-induced reactions which occur when the drug absorbs UVA light and causes cellular damage. This reaction can be seen with initial exposure to a drug, may be dose-related, and doesn't demonstrate cross-sensitivity. It usually has rapid onset and manifests as an exaggerated sunburn. This reaction will be seen only on skin areas exposed to the sun.
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 tomorrow for information on Heatstroke
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
A list of the usual culprits (isotretinoin, thiazides, etc)...include also ones that are often forgotten such as benzodiazepines and NSAIDs. This table summarizes drugs which have been associated with photosensitivity. It is important to note that many of the drugs listed were included based on case reports. However, patients taking these drugs should be counseled to minimize sun exposure and to use broad-spectrum (UVA and UVB) sunscreens when sun exposure cannot be avoided.
Drug-induced photosensitivity may present in a variety of ways. Most reactions are either phototoxic or photoallergic. Photoallergy is a rare, immunological response, which is not dose-related and occurs after continuous exposure. Photoallergy occurs when light causes a drug to act as a hapten, triggering a hypersensitivity response which often manifests as pruritic and eczematous rash.Phototoxic reactions are chemically-induced reactions which occur when the drug absorbs UVA light and causes cellular damage. This reaction can be seen with initial exposure to a drug, may be dose-related, and doesn't demonstrate cross-sensitivity. It usually has rapid onset and manifests as an exaggerated sunburn. This reaction will be seen only on skin areas exposed to the sun.
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 tomorrow for information on Heatstroke
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
Monday, July 6, 2009
WHAT KIND OF SPF SUNSCREENS TO USE
SPF is often misunderstood says the Prescriber’s Newsletter.
SPF applies only to UVB...not UVA. UVB causes the familiar sunburn. SPF is an estimate of how long a person can stay in the sun without obvious sunburn.
For example, if a person would burn in 10 minutes with NO protection, then an SPF 15 sunscreen will protect 15 times longer or 150 minutes...and an SPF 30 would protect 30 times longer or 300 minutes.There's no proof that an SPF over 50 gives any measurable added benefit.
UVB ratings get the most attention, but are only part of the story.
UVA ratings will appear on some sunscreens. You'll see 1, 2, 3, or 4 stars indicating low, medium, high, or highest protection.
UVA causes skin aging and skin cancer...not visual sunburn.
Recommend sunscreens labeled broad-spectrum. These contain UVA blockers such as avobenzone, zinc oxide, and/or titanium.
You'll now see Mexoryl SX (ecamsule) in some Anthelios sunscreens. Mexoryl SX covers some of the shorter UVA rays that are not covered by avobenzone...and it's more stable in sunlight.
But when avobenzone is combined with octocrylene, oxybenzone, or other ingredients it's more stable and has a broader spectrum.
Recommend zinc oxide or titanium dioxide for sensitive skin. They block UVA and UVB by sitting on top of the skin...not binding to it.
Water resistance ratings refer to how long the product is effective during swimming, heavy sweating, etc.
Explain to patients that a product labeled "water-resistant" lasts about 40 mins in water...and a "very water-resistant" product lasts about 80 mins.
Proper application is key. Instruct people to apply sunscreen 20 minutes before sun exposure...and reapply at least every 2 hours.
Emphasize applying enough...about 1/2 to one teaspoon per body part (leg, arm, back, face, etc)...or about 1 ounce for the full body. Applying only half the amount will give only half the protection.
Advise avoiding sunscreen/insect repellent combos. Suggest using separate products because the sunscreen needs to be applied more often than the repellent. Advise patients to apply the sunscreen first, then the repellent.
SUMMARY-COMMENT:
There are new ways to help you prevent the kind of damage to your skin that can cause not only wrinkles, but also skin cancer, which is the second most common form of cancer in the United States.
• Use skin care products with UVA/UVB and broad spectrum protection. Before going outside, apply sun-resistant skin care products such as body wash, makeup, and lip balm. Use sunscreen (SPF 30 or greater) that contains a broad spectrum protection ingredient such as oxybenzone, sulisobenzone, avobenzone, ecamsule, titanium dioxide or zinc oxide.
• Buy clothing with UVA/UVB protection. Everyone knows that the more you cover up, the less chance you have of damaging your skin. But did you know that you can get additional protection by choosing clothes made from fabrics that reflect ultraviolet light? These fashions, from bathing suits to sweatsuits, come with a label that states the UPF (ultraviolet protection factor) of the clothes. The higher the UPF, the more protection you receive.
• Add UPF to your own clothes. Special laundry additives are available that apply sun protection to your clothes for up to 20 washings. You can find more information about additives and purchase them online.
• Choose sun-resistant accessories. While you are outside, wear sunglasses that block at least 99 percent of UVB rays and at least 95 percent of UVA rays. Select a sun hat made with UPF fabric. Take an umbrella with you, even when it’s not raining.
* Tune in tomorrow for Sun Allergies!
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
SPF applies only to UVB...not UVA. UVB causes the familiar sunburn. SPF is an estimate of how long a person can stay in the sun without obvious sunburn.
For example, if a person would burn in 10 minutes with NO protection, then an SPF 15 sunscreen will protect 15 times longer or 150 minutes...and an SPF 30 would protect 30 times longer or 300 minutes.There's no proof that an SPF over 50 gives any measurable added benefit.
UVB ratings get the most attention, but are only part of the story.
UVA ratings will appear on some sunscreens. You'll see 1, 2, 3, or 4 stars indicating low, medium, high, or highest protection.
UVA causes skin aging and skin cancer...not visual sunburn.
Recommend sunscreens labeled broad-spectrum. These contain UVA blockers such as avobenzone, zinc oxide, and/or titanium.
You'll now see Mexoryl SX (ecamsule) in some Anthelios sunscreens. Mexoryl SX covers some of the shorter UVA rays that are not covered by avobenzone...and it's more stable in sunlight.
But when avobenzone is combined with octocrylene, oxybenzone, or other ingredients it's more stable and has a broader spectrum.
Recommend zinc oxide or titanium dioxide for sensitive skin. They block UVA and UVB by sitting on top of the skin...not binding to it.
Water resistance ratings refer to how long the product is effective during swimming, heavy sweating, etc.
Explain to patients that a product labeled "water-resistant" lasts about 40 mins in water...and a "very water-resistant" product lasts about 80 mins.
Proper application is key. Instruct people to apply sunscreen 20 minutes before sun exposure...and reapply at least every 2 hours.
Emphasize applying enough...about 1/2 to one teaspoon per body part (leg, arm, back, face, etc)...or about 1 ounce for the full body. Applying only half the amount will give only half the protection.
Advise avoiding sunscreen/insect repellent combos. Suggest using separate products because the sunscreen needs to be applied more often than the repellent. Advise patients to apply the sunscreen first, then the repellent.
SUMMARY-COMMENT:
There are new ways to help you prevent the kind of damage to your skin that can cause not only wrinkles, but also skin cancer, which is the second most common form of cancer in the United States.
• Use skin care products with UVA/UVB and broad spectrum protection. Before going outside, apply sun-resistant skin care products such as body wash, makeup, and lip balm. Use sunscreen (SPF 30 or greater) that contains a broad spectrum protection ingredient such as oxybenzone, sulisobenzone, avobenzone, ecamsule, titanium dioxide or zinc oxide.
• Buy clothing with UVA/UVB protection. Everyone knows that the more you cover up, the less chance you have of damaging your skin. But did you know that you can get additional protection by choosing clothes made from fabrics that reflect ultraviolet light? These fashions, from bathing suits to sweatsuits, come with a label that states the UPF (ultraviolet protection factor) of the clothes. The higher the UPF, the more protection you receive.
• Add UPF to your own clothes. Special laundry additives are available that apply sun protection to your clothes for up to 20 washings. You can find more information about additives and purchase them online.
• Choose sun-resistant accessories. While you are outside, wear sunglasses that block at least 99 percent of UVB rays and at least 95 percent of UVA rays. Select a sun hat made with UPF fabric. Take an umbrella with you, even when it’s not raining.
* Tune in tomorrow for Sun Allergies!
Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
Saturday, July 4, 2009
MEDICAL ETHICS CHECKLISTS
Hospitals using a checklist designed for the World Health Organization (WHO) cut deaths after surgery by 46% and surgical complications by 36%.
Using this as an example medical residents working in the intensive care unit at the Washington Hospital Center in Washington, D.C., got a different kind of reminder when caring for patients -- an ethics checklist.
The idea is the brainchild of Daniel K. Sokol, PhD, a medical ethicist at the University of London St. George's Hospital Medical School who served as a visiting bioethics scholar at the Washington Hospital Center in January and February. Sokol wrote about the ethics checklist in the March 4 British Medical Journal and said bioethicists at hospitals in Canada and the United Kingdom also are considering the idea.
"Having an ethics checklist changes the focus away from the purely clinical to include the ethical dimension," Sokol said. "In the back of my mind I had this idea of the surgical checklist, where uniformly the results have been quite astounding. I see no reason why there shouldn't be a similar thing for ethics."
The eight-item checklist at Washington Hospital Center -- actually an ID-sized badge that residents wear on lanyards -- covers ethical issues that commonly arise in the hospital setting. Is the patient able to make medical decisions? Is there a do-not-resuscitate order? Is there a disagreement among family members about how care should proceed?
Residents are asked to review the list for each patient, note any potential issues and call the hospital's bioethics staff if they need help resolving problems. The hospital's three ethics consultants already handle about 300 queries a year, said the director of bioethics and spiritual care. She said getting doctors to use the checklist could help avoid ugly squabbles with families and prevent lawsuits.
"We want to recognize the potential for an ethical problem earlier downstream and intervene early enough so that patient care doesn't get compromised and the family doesn't get negatively impacted by the emotional rollercoaster the ICU presents," he said. "It's preventive ethics at its best."
The ethics checklist will be considered at the Loyola University Chicago Stritch School of Medicine, said Kayhan Parsi, PhD, a clinical ethicist."What the checklist does, in my mind, is it more formally integrates ethics into the care of patients so it really just becomes part of the culture," Parsi said. "It actually standardizes care so everyone gets treated in a similar fashion."
Clinical Ethics Patient Assessment
• Patient's wishes unclear/refusal of treatment
• Questionable capacity to consent to, or refuse, treatment
• Disagreement involving relatives/surrogates/caregivers
• End-of-life (advance directive/power of attorney, do not resuscitate/allow natural death, withdraw/withhold Rx)
• Confidentiality/disclosure issue
• Resource or fairness issue
• Other (please note)
• No notable ethical issues
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 tomorrow for What types of sunscreens to use!
Deepen your understanding of Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
Using this as an example medical residents working in the intensive care unit at the Washington Hospital Center in Washington, D.C., got a different kind of reminder when caring for patients -- an ethics checklist.
The idea is the brainchild of Daniel K. Sokol, PhD, a medical ethicist at the University of London St. George's Hospital Medical School who served as a visiting bioethics scholar at the Washington Hospital Center in January and February. Sokol wrote about the ethics checklist in the March 4 British Medical Journal and said bioethicists at hospitals in Canada and the United Kingdom also are considering the idea.
"Having an ethics checklist changes the focus away from the purely clinical to include the ethical dimension," Sokol said. "In the back of my mind I had this idea of the surgical checklist, where uniformly the results have been quite astounding. I see no reason why there shouldn't be a similar thing for ethics."
The eight-item checklist at Washington Hospital Center -- actually an ID-sized badge that residents wear on lanyards -- covers ethical issues that commonly arise in the hospital setting. Is the patient able to make medical decisions? Is there a do-not-resuscitate order? Is there a disagreement among family members about how care should proceed?
Residents are asked to review the list for each patient, note any potential issues and call the hospital's bioethics staff if they need help resolving problems. The hospital's three ethics consultants already handle about 300 queries a year, said the director of bioethics and spiritual care. She said getting doctors to use the checklist could help avoid ugly squabbles with families and prevent lawsuits.
"We want to recognize the potential for an ethical problem earlier downstream and intervene early enough so that patient care doesn't get compromised and the family doesn't get negatively impacted by the emotional rollercoaster the ICU presents," he said. "It's preventive ethics at its best."
The ethics checklist will be considered at the Loyola University Chicago Stritch School of Medicine, said Kayhan Parsi, PhD, a clinical ethicist."What the checklist does, in my mind, is it more formally integrates ethics into the care of patients so it really just becomes part of the culture," Parsi said. "It actually standardizes care so everyone gets treated in a similar fashion."
Clinical Ethics Patient Assessment
• Patient's wishes unclear/refusal of treatment
• Questionable capacity to consent to, or refuse, treatment
• Disagreement involving relatives/surrogates/caregivers
• End-of-life (advance directive/power of attorney, do not resuscitate/allow natural death, withdraw/withhold Rx)
• Confidentiality/disclosure issue
• Resource or fairness issue
• Other (please note)
• No notable ethical issues
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 tomorrow for What types of sunscreens to use!
Deepen your understanding of Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
Friday, July 3, 2009
PART III OF IV BELIEVING IN MEDICAL TREATMENTS THAT DON’T WORK
HOMEOPATHIC REMEDIES
Homeopathic remedies are said to be safe—at least not harmful because the “active ingredients are so diluted.” The FDA, however, is alerting consumers that ZICAM COLD REMEDY NASAL GEL, ZICAM COLD REMEDY NASAL SWABS, and ZICAM COLD REMEDY SWABS, KIDS SIZE, a discontinued product that consumers may still have in their homes, have all been associated with long lasting or permanent loss of smell (referred to as anosmia). These products, marketed by Matrixx Initiatives, are zinc-containing, nasal cold remedies used to reduce the duration and severity of cold symptoms. However, these products have not been shown to be effective in the reduction of the duration and severity of cold symptoms. This advisory does not yet cover oral zinc tablets and lozenges taken by mouth.FDA recommends that consumers stop using these products and throw them away. See the FDA website for How to Dispose of Unused Medicines.
800 Zicam complaints from FDA.
The company didn't turn over to US regulators 800 consumer complaints about side effects linked to its withdrawn Zicam nasal spray and swabs." The company halted sales of "the cold remedies on June 16 after the Food and Drug Administration warned consumers the treatments may cause a loss of smell." The agency "found 800 reports of consumer concerns in May during a routine inspection.
Since the introduction of Zicam Cold Remedy Nasal Gel to the market in 1999, FDA has received reports of anosmia associated with the use of Zicam zinc-containing intranasal products. The reports vary. Many people state that the loss of sense of smell occurred with the first dose of the Zicam product, although some people report it happened after later doses. The loss of sense of smell may be long-lasting or even permanent in some people.
Loss of the sense of smell may cause serious problems, such as failing to smell smoke, a gas leak, or spoiled food. Also, loss of the sense of smell is often linked with a loss of the sense of taste. People who cannot taste could unintentionally eat spoiled food and not appreciate flavors, and lose much of the pleasure of eating. Further, there is evidence in the published scientific literature that various salts of zinc can damage olfactory function in animals and humans.
Zicam and hundreds of other homeopathic remedies — highly diluted drugs made from natural ingredients — are legally sold as treatments with explicit claims of medical benefit. Yet they don't require federal checks for safety, effectiveness or even the right ingredients. They're somewhat similar to dietary supplements, which use many of the same natural ingredients and also aren't federally tested for safety or benefit.
Many scientists view homeopathic remedies as — ineffective but mostly harmless because the drugs in them are present in such tiny amounts.But an Associated Press analysis of the Food and Drug Administration's side effect reports found that more than 800 homeopathic ingredients were potentially implicated in health problems last year. Complaints ranged from vomiting to attempted suicide.
In its review of homeopathy, the AP also found that:
_ Active homeopathic ingredients are typically diluted down to 1 part per million or less, but some are present in much higher concentrations. The active ingredient in Zicam is 2 parts per 100.
_ The FDA has set strict limits for alcohol in medicine, especially for small children, but they don't apply to homeopathic remedies. The American Academy of Pediatrics has said no medicine should carry more than 5 percent alcohol. The FDA has acknowledged that some homeopathic syrups far surpass 10 percent alcohol.
_ The National Institutes of Health's alternative medicine center spent $3.8 million on homeopathic research from 2002 to 2007 but is now abandoning studies on
homeopathic drugs. "The evidence is not there at this point," says the center's director, Dr. Josephine Briggs.
_ At least 20 ingredients used in conventional prescription drugs, like digitalis for heart trouble and morphine for pain, are also used in homeopathic remedies. Other homeopathic medicines are derived from cancerous or other diseased tissues. Many are formulated from powerful poisons like strychnine, arsenic or snake venom
Homeopathy sprang from the inventive — some would say fanciful — mind of German physician and chemist Samuel Hahnemann in the late 1700s. Experimenting on himself, he became convinced that if an ingredient causes a symptom in a healthy person, it will treat the disease that causes the same symptom. He also theorized that diluting ingredients to minuscule, even untraceable, concentrations paradoxically makes them more powerful. To this day, homeopaths put forth mystical-sounding explanations involving "vital force" and "healing energy, with arcane ingredients and names like "nux vomica" and "arsenicum album.”.
Since 2002, the U.S. homeopathic remedy market exploded by 89 percent to an estimated $830 million last year, according to market research company Mintel. By 2007, homeopathic remedies were taken by almost 4 million Americans, or 2 percent of adults, federal data show.
Though many homeopathic remedies consist mostly of sugar or alcohol, thousands of patients swear by their effectiveness anyway.
The FDA's own side effect reports potentially implicate at least 843 homeopathic ingredients just in the year ending September 2008, the AP found. It is impossible to verify how many were taken at low homeopathic concentrations. But dozens apparently were, and they were linked to side effects, including muscle and joint pain in reports submitted by consumers, doctors and others.
According to the FDA letter to the Zicam company “a homeopathic drug product marketed without an approved NDA is not subject to the enforcement discretion. But when there is evidence of a safety risk associated with the product, as is the case for the Zicam Cold Remedy intranasal products, the Agency enforces the Act’s new drug approval requirement, a provision that is essential to protect the public health by holding firms responsible for demonstrating, based on adequate and well-controlled clinical investigations, that a product is safe and effective for each of its intended uses before marketing it. Therefore, an approved NDA is required for the Zicam Cold Remedy intranasal products, regardless of their homeopathic status. Your introduction of the Zicam Cold Remedy intranasal products into interstate commerce, without an approved application, violates sections 301(d) and 505(a) of the Act, 21 U.S.C. §§ 331(d) and 355(a).
Additionally, Zicam Cold Remedy intranasal products are misbranded under section 502(f)(2) of the Act, 21 U.S.C. § 352(f)(2), because their labeling does not bear adequate warnings regarding the risk of anosmia associated with the product. In light of this failure to bear adequate warnings, these products are also misbranded under section 502(a) of the Act, 21 U.S.C. § 352(a), taking into account the considerations set forth in section 201(n) of the Act, 21 U.S.C. § 321(n).
See http://www.fda.gov/cder/regulatory/applications/default.htm.
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 tomorrow for an Ethics checklist to help hospitals avoid lawsuits
Deepen your understanding of Deepen your understanding of "medical malpractice"... www.MedMalBook.com
SUMMER SALE - SPECIAL OFFER - ONLY TILL LABOR DAY 2009 ALL PRICES SLASHED 50% + FREE SHIPPING & HANDLING
Homeopathic remedies are said to be safe—at least not harmful because the “active ingredients are so diluted.” The FDA, however, is alerting consumers that ZICAM COLD REMEDY NASAL GEL, ZICAM COLD REMEDY NASAL SWABS, and ZICAM COLD REMEDY SWABS, KIDS SIZE, a discontinued product that consumers may still have in their homes, have all been associated with long lasting or permanent loss of smell (referred to as anosmia). These products, marketed by Matrixx Initiatives, are zinc-containing, nasal cold remedies used to reduce the duration and severity of cold symptoms. However, these products have not been shown to be effective in the reduction of the duration and severity of cold symptoms. This advisory does not yet cover oral zinc tablets and lozenges taken by mouth.FDA recommends that consumers stop using these products and throw them away. See the FDA website for How to Dispose of Unused Medicines.
800 Zicam complaints from FDA.
The company didn't turn over to US regulators 800 consumer complaints about side effects linked to its withdrawn Zicam nasal spray and swabs." The company halted sales of "the cold remedies on June 16 after the Food and Drug Administration warned consumers the treatments may cause a loss of smell." The agency "found 800 reports of consumer concerns in May during a routine inspection.
Since the introduction of Zicam Cold Remedy Nasal Gel to the market in 1999, FDA has received reports of anosmia associated with the use of Zicam zinc-containing intranasal products. The reports vary. Many people state that the loss of sense of smell occurred with the first dose of the Zicam product, although some people report it happened after later doses. The loss of sense of smell may be long-lasting or even permanent in some people.
Loss of the sense of smell may cause serious problems, such as failing to smell smoke, a gas leak, or spoiled food. Also, loss of the sense of smell is often linked with a loss of the sense of taste. People who cannot taste could unintentionally eat spoiled food and not appreciate flavors, and lose much of the pleasure of eating. Further, there is evidence in the published scientific literature that various salts of zinc can damage olfactory function in animals and humans.
Zicam and hundreds of other homeopathic remedies — highly diluted drugs made from natural ingredients — are legally sold as treatments with explicit claims of medical benefit. Yet they don't require federal checks for safety, effectiveness or even the right ingredients. They're somewhat similar to dietary supplements, which use many of the same natural ingredients and also aren't federally tested for safety or benefit.
Many scientists view homeopathic remedies as — ineffective but mostly harmless because the drugs in them are present in such tiny amounts.But an Associated Press analysis of the Food and Drug Administration's side effect reports found that more than 800 homeopathic ingredients were potentially implicated in health problems last year. Complaints ranged from vomiting to attempted suicide.
In its review of homeopathy, the AP also found that:
_ Active homeopathic ingredients are typically diluted down to 1 part per million or less, but some are present in much higher concentrations. The active ingredient in Zicam is 2 parts per 100.
_ The FDA has set strict limits for alcohol in medicine, especially for small children, but they don't apply to homeopathic remedies. The American Academy of Pediatrics has said no medicine should carry more than 5 percent alcohol. The FDA has acknowledged that some homeopathic syrups far surpass 10 percent alcohol.
_ The National Institutes of Health's alternative medicine center spent $3.8 million on homeopathic research from 2002 to 2007 but is now abandoning studies on
homeopathic drugs. "The evidence is not there at this point," says the center's director, Dr. Josephine Briggs.
_ At least 20 ingredients used in conventional prescription drugs, like digitalis for heart trouble and morphine for pain, are also used in homeopathic remedies. Other homeopathic medicines are derived from cancerous or other diseased tissues. Many are formulated from powerful poisons like strychnine, arsenic or snake venom
Homeopathy sprang from the inventive — some would say fanciful — mind of German physician and chemist Samuel Hahnemann in the late 1700s. Experimenting on himself, he became convinced that if an ingredient causes a symptom in a healthy person, it will treat the disease that causes the same symptom. He also theorized that diluting ingredients to minuscule, even untraceable, concentrations paradoxically makes them more powerful. To this day, homeopaths put forth mystical-sounding explanations involving "vital force" and "healing energy, with arcane ingredients and names like "nux vomica" and "arsenicum album.”.
Since 2002, the U.S. homeopathic remedy market exploded by 89 percent to an estimated $830 million last year, according to market research company Mintel. By 2007, homeopathic remedies were taken by almost 4 million Americans, or 2 percent of adults, federal data show.
Though many homeopathic remedies consist mostly of sugar or alcohol, thousands of patients swear by their effectiveness anyway.
The FDA's own side effect reports potentially implicate at least 843 homeopathic ingredients just in the year ending September 2008, the AP found. It is impossible to verify how many were taken at low homeopathic concentrations. But dozens apparently were, and they were linked to side effects, including muscle and joint pain in reports submitted by consumers, doctors and others.
According to the FDA letter to the Zicam company “a homeopathic drug product marketed without an approved NDA is not subject to the enforcement discretion. But when there is evidence of a safety risk associated with the product, as is the case for the Zicam Cold Remedy intranasal products, the Agency enforces the Act’s new drug approval requirement, a provision that is essential to protect the public health by holding firms responsible for demonstrating, based on adequate and well-controlled clinical investigations, that a product is safe and effective for each of its intended uses before marketing it. Therefore, an approved NDA is required for the Zicam Cold Remedy intranasal products, regardless of their homeopathic status. Your introduction of the Zicam Cold Remedy intranasal products into interstate commerce, without an approved application, violates sections 301(d) and 505(a) of the Act, 21 U.S.C. §§ 331(d) and 355(a).
Additionally, Zicam Cold Remedy intranasal products are misbranded under section 502(f)(2) of the Act, 21 U.S.C. § 352(f)(2), because their labeling does not bear adequate warnings regarding the risk of anosmia associated with the product. In light of this failure to bear adequate warnings, these products are also misbranded under section 502(a) of the Act, 21 U.S.C. § 352(a), taking into account the considerations set forth in section 201(n) of the Act, 21 U.S.C. § 321(n).
See http://www.fda.gov/cder/regulatory/applications/default.htm.
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 tomorrow for an Ethics checklist to help hospitals avoid lawsuits
Deepen your understanding of Deepen your understanding of "medical malpractice"... www.MedMalBook.com
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Tuesday, June 30, 2009
Circumcision Prevents Sexual Transmitted Diseases (STDs)
Is there a reason why Catholic nuns and Jewish women have a decreased incidence of cervical cancer and the opposite applies to groups such as blacks and Hispanics, where rates of HIV, herpes, and cervical cancer are disproportionately high?
Johns Hopkins scientists, along with researchers in Uganda, are saying that "circumcision significantly reduces the risk of contracting herpes (HSV-2) and human papillomavirus (HPV)," contributing more hard data to a pool of "growing scientific evidence that the procedure helps stem the spread of some sexually transmitted diseases." A little "over half of male newborns in the US get circumcised, according to research published earlier this year in the American Journal of Public Health." It’s ironic that apparently, that "percentage has declined over the past decade, in part because the American Academy of Pediatrics said in 1999 that the evidence is 'not sufficient to recommend routine neonatal circumcision.'" But, pathologist and Hopkins' team member Aaron Tobian, MD, PhD, said, "The scientific evidence for the public-health benefits of male circumcision is overwhelming now."
For example, "landmark studies from three African countries, including Uganda, previously found circumcision lowered men's chance of catching the AIDS virus by up to 60 percent. The new work "stems from the Uganda research and looked at protection against three other STDs" -- herpes, HPV, and syphilis.
The research teams set up two parallel, but independent, trials comprised of "a total of 5,534 uncircumcised men between the ages of 15 and 49 who were negative for the AIDS virus. Then, "1,684 of the 3,393 men who tested negative for herpes were circumcised immediately, and the others received a medical circumcision after 24 months." In addition, "352 men in the circumcised group and 345 in the delayed circumcision group were evaluated for HPV at the start of the trial and at 24 months."
Two years later, investigators noted that "circumcised volunteers were one-fourth less likely to have genital herpes and one-third less apt to carry a type of HPV that causes cervical cancer, compared with the still-uncircumcised males." Even "when all HPV types were assessed, including those causing genital warts, the circumcised volunteers were still nearly one-third less likely to carry one of the types.”
COMMENT:
There are "several reasons that removing the foreskin of the penis might help reduce transmission of certain infections. The foreskin, has two different sides," with the outside being very much like "regular skin cells," but "the inside is mucosal, similar to a woman's vagina." And, "during intercourse, the skin side is pulled back and the mucosal side is open and exposed." One researcher opines that "it's likely that there are viral receptors on that mucosal side that make it easier for a virus to get into the cells." Moreover, "if a woman has passed along viral cells, they're now trapped inside the foreskin, in a moist environment that's conducive for the virus to replicate."
The study authors say their findings "should guide public health policies for neonatal, adolescent, and adult male circumcision programs," according to MedPage Today (3/25/09, Smith), particularly since "circumcision rates in the US are falling, especially among groups such as blacks and Hispanics, where rates of HIV, herpes, and cervical cancer are 'disproportionately high.'"
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 tomorrow for Part I of IV, Believing in Treatments that don't work
Deepen your understanding of How to Be an Effective Medical Expert www.MedMalBook.com
Johns Hopkins scientists, along with researchers in Uganda, are saying that "circumcision significantly reduces the risk of contracting herpes (HSV-2) and human papillomavirus (HPV)," contributing more hard data to a pool of "growing scientific evidence that the procedure helps stem the spread of some sexually transmitted diseases." A little "over half of male newborns in the US get circumcised, according to research published earlier this year in the American Journal of Public Health." It’s ironic that apparently, that "percentage has declined over the past decade, in part because the American Academy of Pediatrics said in 1999 that the evidence is 'not sufficient to recommend routine neonatal circumcision.'" But, pathologist and Hopkins' team member Aaron Tobian, MD, PhD, said, "The scientific evidence for the public-health benefits of male circumcision is overwhelming now."
For example, "landmark studies from three African countries, including Uganda, previously found circumcision lowered men's chance of catching the AIDS virus by up to 60 percent. The new work "stems from the Uganda research and looked at protection against three other STDs" -- herpes, HPV, and syphilis.
The research teams set up two parallel, but independent, trials comprised of "a total of 5,534 uncircumcised men between the ages of 15 and 49 who were negative for the AIDS virus. Then, "1,684 of the 3,393 men who tested negative for herpes were circumcised immediately, and the others received a medical circumcision after 24 months." In addition, "352 men in the circumcised group and 345 in the delayed circumcision group were evaluated for HPV at the start of the trial and at 24 months."
Two years later, investigators noted that "circumcised volunteers were one-fourth less likely to have genital herpes and one-third less apt to carry a type of HPV that causes cervical cancer, compared with the still-uncircumcised males." Even "when all HPV types were assessed, including those causing genital warts, the circumcised volunteers were still nearly one-third less likely to carry one of the types.”
COMMENT:
There are "several reasons that removing the foreskin of the penis might help reduce transmission of certain infections. The foreskin, has two different sides," with the outside being very much like "regular skin cells," but "the inside is mucosal, similar to a woman's vagina." And, "during intercourse, the skin side is pulled back and the mucosal side is open and exposed." One researcher opines that "it's likely that there are viral receptors on that mucosal side that make it easier for a virus to get into the cells." Moreover, "if a woman has passed along viral cells, they're now trapped inside the foreskin, in a moist environment that's conducive for the virus to replicate."
The study authors say their findings "should guide public health policies for neonatal, adolescent, and adult male circumcision programs," according to MedPage Today (3/25/09, Smith), particularly since "circumcision rates in the US are falling, especially among groups such as blacks and Hispanics, where rates of HIV, herpes, and cervical cancer are 'disproportionately high.'"
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 tomorrow for Part I of IV, Believing in Treatments that don't work
Deepen your understanding of How to Be an Effective Medical Expert www.MedMalBook.com
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