Twitter Updates

    follow me on Twitter

    Tuesday, April 28, 2009

    Virtual Colonoscopy [VC]-What I tell my patients.

    Colon cancer is one of the most common and deadliest malignancies. Around 50,000 people die every year from colorectal cancer, mainly because they were not screened. Perhaps screening did not occur because they avoided a traditional optical colonoscopy- medicine's most unloved procedures. Colorectal cancer can be prevented -- or even cured and is highly treatable if detected early, but it remains the nation's second deadliest cancer. For years, the most reliable screening method has been optical colonoscopy, in which an endoscope is used to inspect the walls of the intestine and remove abnormal growths, or polyps.

    In a standard optical colonoscopy, a doctor inserts a long, flexible tube with a tiny camera at its tip into a patient’s rectum and colon. In a virtual colonoscopy, the doctor uses CT scans to produce images of the colon’s interior. If worrisome polyps are spotted, the patient then has to have them removed by a standard colonoscopy. Virtual colonoscopy uses three-dimensional images from a CT scan to detect polyps or cancers in the colon. When detected early the risks of colon cancer death decreases.

    But will Medicare and other insurance carriers pay for it?

    On Feb. 11, 2009, a federal agency -- The Centers for Medicare & Medicaid Services --drew a simple conclusion: "The beneficial evidence is inadequate." It recommended Medicare not cover virtual colonoscopy.

    This decision not to pay for VC has now become a political issue. Over 40 members of Congress urged on by proponents backing the new procedure -- the medical imaging industry, including other supporters, many of them radiologists who read CT scans have signed letters urging federal officials to reconsider. The dispute has even split doctors in the same specialty: the American Gastroenterological Association favors Medicare coverage, while the American College of Gastroenterology does not. VC has also received key endorsements as a first-line screening test from influential medical groups, notably the American Cancer Society, after several large studies found it to be effective at finding large polyps.

    The U.S. Preventive Services Task Force expressed reservations. An independent panel of health experts, concluded that there is insufficient evidence that virtual colonoscopy would benefit Medicare recipients. CMS cited concerns about radiation exposure and the number of patients who would require follow-up colonoscopies to remove polyps, as well as the inability of CT scans to reliably detect small or flat growths. The preventive services task force found that 7 to 16 percent of patients who undergo virtual procedures will have a finding "of potential clinical significance," but the panel said it is not known whether discovery "results in better outcomes for patients; it is possible that they result in extra follow-up testing without associated benefit."

    Disputes over the cost-effectiveness of virtual colonoscopy further complicated the analysis. The procedure, which typically costs less than $1,000, can be half as expensive as a traditional colonoscopy. However, some 20% of patients will have a polyp requiring a follow-up optical colonoscopy to have the growth removed. That has led to criticism that virtual colonoscopy is duplicative.
    Q&A adapted from the ACG

    1. What is VC aka CT colonography?
    CT colonography often referred to as "virtual colonoscopy." It is a CT scan x ray test designed to simulate colonoscopy to look for large colon polyps and cancers. Some patients are thought to prefer CT scans because they are less intrusive.
    Is that true?

    2. What happens during a CT colonography?
    First, a radiology technician inserts a tube into your rectum and gas is pumped into the colon until it is fully expanded. Then you are asked to hold your breath while lying on your back and a CT scan is performed. You then turn over onto your stomach and again hold your breath while a second CT scan of the abdomen and pelvis is performed.

    3. Does it require bowel-cleansing (laxatives)?
    Yes. The bowel-cleansing regimen is the same as that for colonoscopy. On the day before the procedure, you stay on clear liquids all day and on the evening before and the morning of the procedure; laxatives are taken to flush waste from the colon.

    4. Is CT colonography painful?
    Because no sedation is used, the expansion of the colon with gas can be painful. In some studies, patients reported more pain and discomfort with CT colonography than with a colonoscopy. Colonoscopy may be more comfortable because sedatives are given during the examination.

    5. What happens after the test?
    The radiologist will examine the colon and other structures within the pelvis and abdomen and generate a report for the physician who ordered the test. Sometimes information about polyps in the colon is known immediately. If so, some radiology centers and endoscopy units are equipped to perform colonoscopy and remove the polyp on the same day without having to repeat the bowel preparation. If not, colonoscopy will need to be performed on yet another day with the same amount of bowel cleansing discomfort prior to the colonoscopy.

    6. Summarize the advantages of CT colonography.
    • CT colonography is less invasive than colonoscopy.
    • It has a lower risk of perforation of the colon.
    • CT colonography is typically performed without sedation so no separate car driver is needed to drive you home.
    • One of the other benefits of virtual colonoscopy is its ability to detect other cancers and abnormalities -- tumors in the kidney, liver or lungs, and aortic aneurysms -- because of its additional images involving a wider area of the body.

    7. How accurate is CT colonography?
    • According to recent studies, CT colonography is 90% sensitive for the detection of patients with a polyp 1 cm or larger.
    • These large polyps constitute about 10% of all colorectal polyps and are the most likely to develop into cancer.
    • For polyps, less than 1 cm in size, however, the sensitivity of CT colonography falls off rapidly.
    • For polyps 6 to 9 mm in size, the sensitivity of CT colonography is well below 90%.
    • For polyps 5 mm and smaller, which constitute about 80% of all precancerous polyps in the colon, CT colonography is unreliable.
    • Radiologists are currently advised to NOT attempt interpretation of polyps 5 mm and smaller in size. Since some researchers believe there is a subset of small polyps smaller than 5 mm turn into cancer that are aggressive and malignant not being able to report on them is a disadvantage of VC.

    8. How often does the traditional colonoscopy remove polyps?
    The older the patient, the greater the chance that a polyp will be detected that requires a complete colonoscopy. In the hands of the best CT colonographers, about 12% of patients undergoing CT colonography will require colonoscopy and polypectomy, but in older populations, this number increases to 20 to 25%.

    9. Is CT colonography paid for by insurance?
    Currently, CT colonography is usually paid for if a colonoscopy is unable to be completed, or when cancer is detected by colonoscopy and the cancer blocks passage of the colonoscope.
    The Center for Medicare and Medicaid Services reviewed above recently decided to not cover CT colonography for screening for Medicare patients.
    Some private insurers, however, currently cover CT colonography for screening.

    10. How often should CT colonography be repeated?
    • CT colonography is currently recommended at 5-year intervals. If the study is normal,
    • Colonoscopy is recommended at 10-year intervals.
    • The difference in intervals between the two tests is accounted for CT colonography’ s lack of efficacy at detecting small colon polyps, and current uncertainty about how often these polyps will turn into cancer.

    11. What are the risks to CT colonography?
    • The immediate risks of CTC include a small rate of perforation related to gas distension, which is lower than the risk from colonoscopy.
    • Potential long-term risks include missing small polyps that could develop into cancer as mentioned above.
    • In addition, studies have found that multiple CT scans can increase the risk of cancer.
    • The risk from radiation exposure is uncertain.
    • The radiation dose from a CT colonography is equivalent to about 250 chest x-rays.
    • One expert estimated that a 50-year-old patient undergoing CT colonography would have a 1 in 714 chance of developing a solid tumor from radiation. This risk, however, must be balanced against a substantially higher than the risk of perforation from colonoscopy.
    • The US Preventative Services Task Force cited radiation risk as one of the factors underlying their decision to not endorse CT colonography as a colorectal cancer screening test.
    • Another risk pertains to findings seen on CT scan outside the colon, which when of no clinical significance often lead to the significant inconvenience, cost, and risk of additional follow-up x-ray tests to further characterize these incidental findings.
    • CT colonography also produces a considerable number of "false positives.” This means that if a radiologist finds a polyp on CT colonography, there is a less than 50% chance that a polyp is actually present at the colonoscopy.

    Monday, April 27, 2009

    How to Confirm Suspected Swine Flu

    Swine Flu information resources that are frequently updated:

    Google maps has a nice tool for tracking swine flu.

    There's also HealthMap which tracks all kinds of outbreaks:

    For those of you who follow events on social media sites, CDC has a Twitter feed that contains updates on the Swine Flu:

    If you are interested in the view from overseas - European Centre for Disease Prevention and Control

    Swine Flu Virus-What I Tell My Patients

    Many of my patients are calling for more information about about the new Swine Flu. This is what I tell them.

    Pigs, birds, and humans are each susceptible to lots of influenza viruses. Typically, these viruses infect only one species. However, sometimes the viruses swap genes, creating new viruses that have the capacity to infect more than one species. That’s why having taken the human flu vaccine last season may theoretically help you in with this flu-but only a bit because this new strain of influenza virus has been identified as containing a combination of two parts swine, one part avian, and one part human influenza virus genes.

    How is this New Virus Transmitted?
    The World Health Organization and the CDC have confirmed that the new swine flu virus is transmitted between humans. It is not clear yet how transmissible it is, nor how it is transmitted. Almost surely, like other flu viruses, it can be transmitted by aerosol and by skin-to-skin contact with an infected person. There is no vaccine yet for the new virus.

    The 20 confirmed cases in the U.S. young students are all recovering (with only 1 case requiring hospitalization) in contrast to many of the deaths in Mexico which seem to have occurred in healthy young adults, a pattern seen in past pandemics — not young children and the frail elderly, as is most often seen with the flu.

    The usual precautions for patients apply:
    • Sneeze and cough into tissues and throw the tissues in the trash.
    • Wash your hands or use alcohol-based hand cleaners frequently.
    • On greeting people, don’t shake hands or exchange kisses.

    Contagious period

    People should be considered contagious until at least 7 days after the start of symptoms; with children, it may be 10–14 days. If a global pandemic ensues, governments may well close schools and public places, require as many people as possible to work from home, warn any people who develop symptoms to isolate themselves at home.More updated information from the CDC is available at

    The initial symptoms with this swine flu virus are like those with the annual flu viruses: fever, sore muscles, running nose, and sore throat. Nausea, vomiting, and diarrhea may be more common with this flu than with regular flu. Also dizziness has been a prominent symptom. A symptom indicating a more severe disease is breathlessness. If this occurs seek medical attention immediately.

    The new virus is resistant to amantadine and rimantadine, but sensitive to oseltamivir (Tamiflu) and zanamivir (Relenza). Based on experience with other flu viruses, treatment would be most effective if given within two days of the onset of symptoms.

    • Swine Flu Update: What to Expect from Doctors & Public Health Professionals

    Swine Flu Update: What to Expect from Doctors & Public Health Professionals from the Centers for Disease Control and Prevention; 1600; Clifton Rd; Atlanta, GA 30333; 800-CDC-INFO; (800-232-4636); TTY: (888) 232-6348


    Clinicians should consider the possibility of swine influenza virus infections in patients presenting with febrile respiratory illness.If swine flu is suspected, clinicians should obtain a respiratory swab for swine influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact their state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.

    State Public Health Laboratories
    Laboratories should send all unsubtypable influenza A specimens as soon as possible to the Viral Surveillance and Diagnostic Branch of the CDC’s Influenza Division for further diagnostic testing.

    Public Health /Animal Health Officials
    Officials should conduct thorough case and contact investigations to determine the source of the swine influenza virus, extent of community illness and the need for timely control measures.

    Guidance Documents
    Interim Guidance for Swine influenza A (H1N1): Taking Care of a Sick Person in Your Home Apr 25, 2009

    Interim Guidance on Antiviral Recommendations for Patients with Confirmed or Suspected Swine Influenza A (H1N1) Virus Infection and Close Contacts Apr 25, 2009

    Interim CDC Guidance for Nonpharmaceutical Community Mitigation in Response to Human Infections with Swine Influenza (H1N1) Virus Apr 26, 2009, 11:45 PM ET

    Interim Recommendations for Facemask and Respirator Use in Certain Community Settings Where Swine Influenza A (H1N1) Virus Transmission Has Been Detected Apr 26, 2009

    Sunday, April 26, 2009

    Swine Flu Public Health Emergency –What To Look For; What To Do.

    A public health emergency was declared today in the U.S. as 20 cases of the disease were confirmed in this country. The Centers for Disease Control, in a news conference in Washington stated, “We expect to see more cases of swine flu. Homeland Security Secretary Janet Napolitano, speaking at the same news conference called the emergency declaration a “declaration of emergency preparedness.” However, experts at the WHO will wait until Tuesday before meeting to decide if it should increase its rating of the seriousness of the pandemic potential from the current level three to level four - which would indicate a "significant increase in risk of a pandemic.” Officials said they had confirmed eight cases in New York, seven in California, two in Kansas, two in Texas and one in Ohio, and that the cases looked to be similar to the deadly strain of swine flu that has killed more than 80 people in Mexico and infected 1,300 more. This was amid further reports of potential new cases from New Zealand to Hong Kong to Spain, raising concerns about the potential for a global pandemic. Canada also confirmed six cases of the flu. Swine flu was also likely in 10 New Zealand students.

    The symptoms of swine flu are nearly identical to the symptoms of other influenza, including high fever, aches, coughing, and congestion. It appears to spread through human-to-human contact and human contact with live pigs but not by eating pork products.

    WHAT TO DO if pandemic is declared by WHO
    -Interim Guidance for Swine influenza A (H1N1)
    • Wash hands frequently

    • stay home

    • don't board airplanes, if you feel sick

    • Keep sick children out of school.

    • Use Facemasks

    • Avoid close contact (less than about 6 feet away) with the sick person as much as possible.

    • If you must have close contact with the sick person (for example, hold a sick infant), spend the least amount of time possible in close contact and try to wear a facemask (for example, surgical mask)

    • An N95 respirator that fits snugly on your face can filter out small particles that can be inhaled around the edges of a facemask, but compared with a facemask it is harder to breathe through an N95 mask for long periods.

    • Wear an N95 respirator if you help a sick person with respiratory treatments using a nebulizer or inhaler, as directed by their doctor.

    • Respiratory treatments should be performed in a separate room away from common areas of the house when at all possible.

    • Used facemasks and N95 respirators should be taken off and placed immediately in the regular trash so they do not touch anything else.

    • Avoid re-using disposable facemasks and N95 respirators if possible.

    • If a reusable fabric facemask is used, it should be laundered with normal laundry detergent and tumble-dried in a hot dryer.

    • After you take off a facemask or N95 respirator, clean your hands with soap and water or an alcohol-based hand sanitizer.

    • Ask your doctor whether you are a candidate for Tamiflu or Relenza.

    • Do not take any drugs or medications prophylactic ally without your doctor’s permission.

    Saturday, April 25, 2009


    Is Mexico city ground zero for a global epidemic of a new kind of flu — a strange mix of human, pig and bird viruses?

    The illnesses breaking out in Mexico currently have epidemiologists at the U.S. Centers for Disease Control and Prevention deeply concerned. The World Health Organization [W.H.O.] says there have been 800 cases in Mexico in recent weeks, 60 of them fatal, of a flulike illness that appeared to be more serious than the regular seasonal flu. Doctors have warned for years about the potential for a pandemic from viruses that mix genetic material from humans and animals. The most notorious flu pandemic, thought to have killed at least 40 million people worldwide in 1918-19, also first struck otherwise healthy young adults. Scientists have long been concerned that a new killer flu could evolve when different viruses infect a pig, a person or a bird, mingling their genetic material. The resulting hybrid could spread quickly because people would have no natural defenses against it.

    Most of Mexico’s dead are young, healthy adults, and none were over 60 or under 3 years old, the World Health Organization said. That alarms health officials because seasonal flus cause most of their deaths among infants and bedridden elderly people, but pandemic flus — like the 1918 Spanish flu, and the 1957 and 1968 pandemics — often strike young, healthy people the hardest. The leading theory on why so many young, healthy people die in pandemics is the “cytokine storm,” in which vigorous immune systems pour out antibodies to attack the new virus. That can inflame lung cells until they leak fluid, which can overwhelm the lungs. But older people who have had the flu repeatedly in their lives may have some antibodies that provide cross-protection to the new strain, she said. And immune responses among the aged are not as vigorous.

    • Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza that regularly cause outbreaks of influenza among pigs.

    • Swine flu viruses do not normally infect humans, however, human infections with swine flu do occur, and cases of human-to-human spread of swine flu viruses has been documented.

    • From December 2005 through February 2009, a total of 12 human infections with swine influenza were reported from 10 states in the United States.

    • Since March 2009, a number of confirmed human cases of a new strain of swine influenza A (H1N1) virus infection in California, Texas, and Mexico have been identified. An investigation into these cases is ongoing.

    • The C.D.C. said that eight nonfatal cases had been confirmed in the United States, and that it had sent teams to California and Texas to investigate.

    • Still, only a small number have been confirmed as cases of the new H1N1 swine flu, according to , a W.H.O. spokesman.

    • Tests show 20 people in Mexico have died of the new swine flu strain, and that 48 other deaths were probably due to the same strain.

    • The caseload of those sickened has grown to 1,004 in Mexico.

    • The same virus also sickened at least eight people in Texas and California, though there have been no deaths yet in the U.S.

    • If the confirmed deaths are the first signs of a pandemic, then cases are probably incubating around the world by now, says a pandemic flu expert.

    • The new strain contains gene sequences from North American and Eurasian swine flus, North American bird flu and North American human flu, said the Centers for Disease Control and Prevention.

    • This similar virus has been found in the American Southwest, where officials have reported eight nonfatal cases.

    This swine flu and regular flu can have similar symptoms — mostly fever, cough and sore throat, though some of the U.S. victims who recovered also experienced vomiting and diarrhea.

    The World Health Organization has convened an emergency expert panel to consider whether to declare the outbreak an international public health emergency — a step that could lead to travel advisories, trade restrictions and border closures.

    • The CDC and Canadian health officials were studying samples sent from Mexico, and some governments around Latin America said they would monitor passengers arriving on flights from Mexico.

    • No vaccine specifically protects against swine flu, and it is unclear how much protection current human flu vaccines might offer.

    • Actually producing the vaccines could take months.

    • The relatively good news is--CDC says two flu drugs, Tamiflu and Relenza, seem effective against the new strain. Roche, the maker of Tamiflu, said the company is prepared to immediately deploy a stockpile of the drug if requested. Both drugs must be taken early, within a few days of the onset of symptoms, to be most effective.

    • anyone with a fever, a cough, a sore throat, shortness of breath or muscle and joint pain should seek medical attention.

    • When a new virus emerges, it can sweep through the population.

    • The Spanish flu is believed to have infected at least 25 percent of the United States population, but killed less than 3 percent of those infected.

    • Among the swine flu cases in the United States, none had had any contact with pigs; cases involving a father and daughter and two 16-year-old schoolmates convinced the authorities that the virus was being transmitted from person to person.

    General Information about Swine Flu

    Questions and answers and guidance for treatment and infection control
    Human Swine Flu Investigation Apr 24, 2009
    Information about the investigation of human swine flu in California

    Swine Influenza: General Information

    Swine Flu and You Apr 24, 2009
    What is swine flu? Are there human infections with swine flu in the U.S.?

    Swine Flu Video Podcast Apr 25, 2009
    Dr. Joe Bresee, with the CDC Influenza Division, describes swine flu - its signs and symptoms, how it's transmitted, medicines to treat it, steps people can take to protect themselves from it, and what people should do if they become ill.

    Key Facts about Swine Influenza (Swine Flu) Apr 24, 2009, 5:45 PM ET
    How does swine flu spread? Can people catch swine flu from eating pork?

    Thursday, April 23, 2009


    In-flight medical emergencies are increasing, and this is partly due to more people with medical conditions traveling by air. It is very important to note that unique environmental and physiological changes occur as a result of changes in pressure during routine commercial air travel. These changes can exacerbate preexisting medical conditions, such as cardiac and lung conditions.

    Passengers should always notify a flight attendant whenever they are having a health problem. Although the flight crew has only very basic training on responding to medical emergencies, they have the ability to communicate via satellite phones to physicians on the ground, and several tele-medical companies routinely assist flight crews during in-flight medical emergencies by providing instructions on what to do. Many times there are medically trained fellow passengers who also readily volunteer to assist whenever the flight crew broadcasts a call for help.

    All U.S–based commercial aircraft that carry more than 85 passengers, and most international air carriers, carry an automated external defibrillator, as well as both a basic and enhanced emergency medical kit. Only medical professionals or flight crew instructed by on-ground physicians are allowed access to the enhanced medical kit, which carries various emergency medications to deal with serious in–flight medical emergencies. The captain of the aircraft has the ultimate authority as to whether or not to divert the aircraft, but they tend to side with caution and what is in the best interest of the stricken passenger.

    Individuals with any cardiac, lung or blood diseases, diabetes or cancer, as well as those who have undergone any surgery within a 14-day period prior to travel, must check with their doctor to make sure they are fit for air travel. As a rule of thumb ,one should be able to walk a distance of 150 feet and climb one flight of stairs without developing any chest pain or severe shortness of breath.

    Saturday, April 18, 2009

    Medical Ethics

    The late Richard John Neuhaus, like the Catholic Convert he was, tied morality to natural law. In his “American Babylon” says Charles R. Morris [NYT 4/12/09] he also states his case for a natural-law approach to politics. Neuhaus insisted that politics and morals were inextricably linked. Neuhaus’s argument according to Morris proceeded as follows:

    • Political entities come with a narrative and, usually, a sense of purpose.

    • Neuhaus’s brand of natural law came from the Greeks, especially Aristotle, which was imported into Christian Europe in the 12th century and still the mainstay of Catholic moral teaching ala Pope Benedict.

    • The common thread of natural-law models is that the “oughts” come not from inside the individual but from “out there.”

    • Political dialogue is shot through with shared notions of right and wrong.
    Others, however, like the “ironists” hold as did Gertrude Stein in California that there is no there “out there.” Things are relative. The ironist believes that we know nothing except our own vocabularies; and that “nothing has an intrinsic nature, a real essence.” The ionist believes that:

    • Concepts like “just” and “rational” are simply “the language games of one’s time.”

    • An ironist may worry “that he has been . . . taught the wrong language game,” but “he cannot give a criterion of wrongness.”

    • The cultural assumptions we share with great philosophers are less likely to be “a tip-off to the way the world is in reality rather “than just a “mark of the discourse of people inhabiting a certain chunk of space-time.”

    • Schools of philosophy or science are thus just different vocabularies.

    • When an ironist works on developing a vocabulary, he is constructing himself.

    • He is not getting in closer touch with some underlying reality — for even if there is one, it isn’t knowable..

    But the danger is that politics without an anchor in an absolute morality from “out there” can quickly slip away in dark directions as was seen in Nazi Germany, Communist Russia and innumerable other polities.

    Now comes political analyist David Brooks who also challenges the new atheists, who see themselves involved in a war of reason against faith. He attacks them as having an unwarranted faith in the power of pure reason and in the purity of their own reasoning. He quotes [4/7/09 NYT] Michael Gazzaniga in his 2008 book, “Human,” “it has been hard to find any correlation between moral [rational] reasoning and proactive moral behavior, such as helping other people. In fact, in most studies, no correlation has been found.”

    But does that mean Brooks looks to God or an outside absolute as the source of morality? No.

    “Today, he says, “many psychologists, cognitive scientists, and even philosophers embrace a different view of morality.” Brooks agrees that today “moral thinking is more like aesthetics.” Brooks also quotes Jonathan Haid of the University of Virginia “The emotions are, in fact, in charge of the temple of morality, and ... moral reasoning is really just a servant masquerading as a high priest.” “The rise and now dominance of this emotional approach to morality,”
    Brooks also acknowledges “an epochal change which challenges all sorts of traditions. It challenges Talmudic law [based on a morality from “out there.” Is this what Nietzsche had in mind?

    Not so English philosopher Thomas Hobbs who had another understanding of moral law. Hobbes’s pointed out that if one gets to prefer one’s own internal judgments to the judgments of authorized external bodies the result will be the substitution of personal whim for general decorum.”

    The Supreme Court appears to agree with Hobbs. In a series of cases stretching from Reynolds v. United States (1878) to Employment Division v. Smith (1990), the Supreme Court has ruled that when the personal imperatives of one’s own… morality” lead to actions in violation of generally applicable laws the violations will not be allowed. For, says the court in Reynolds, “To permit this would be to make the professed doctrines of [personal] religious belief superior….and in effect to permit every citizen to become a law unto himself.”


    The voluntary Leapfrog Hospital Survey results are as of Dec. 31, 2008, and include 1,276 hospitals in 37 major U.S. metropolitan areas, representing 48 percent of the urban, general acute-care hospitals (53 percent of hospital beds in these areas),

    Individual hospital results can be viewed and compared with other hospitals at

    First The Good News:

    • Thirty-one percent of hospitals now meet the Leapfrog ICU staffing standard, up from 10 percent in 2002.
    • Hospitals with all of Leapfrog's recommended policies in place to prevent common HAIs jumped from 13 percent to 35 percent between 2007 and 2008.
    • Sixty percent of hospitals have agreed to implement Leapfrog's "Never Events" policy when a serious reportable event occurs in their facility.

    Now the Bad News: Most hospitals fall short on safety measures. Survey shows low rates of adherence to hospital safety, quality standards.

    Only 7 percent of hospitals meet Leapfrog medication error prevention (CPOE) standards and few hospitals are meeting mortality standards, according to the 2008 Leapfrog Hospital Survey, released 4/15/09.

    The healthcare watchdog organization surveyed 1,276 hospitals in 37 US metropolitan areas and found that "low percentages of reporting hospitals are meeting volume and risk-adjusted mortality standards or adhering to nationally endorsed process measures for eight high-risk procedures, where following nationally endorsed and evidence-based guidelines is known to save lives." Also, efficiency standards among surveyed hospitals "are met by only 24 percent of hospitals for heart bypass surgery, 21 percent for heart angioplasty, 14 percent for heart attack care and 14 percent for pneumonia care."

    Other alarming features of the 2008 hospital survey include:

    • Low percentages of reporting hospitals are meeting volume and risk-adjusted mortality standards or adhering to nationally endorsed process measures for eight high-risk procedures, where following nationally endorsed and evidence-based guidelines is known to save lives:
      • 43 percent for heart bypass surgery;
      • 35 percent for heart angioplasty;
      • 32 percent for high-risk deliveries;
      • 23 percent for pancreatic resections;
      • 16 percent for bariatric surgery;
      • 15 percent for esophagectomy;
      • 7 percent for aortic valve replacement; and
      • 5 percent for aortic abdominal aneurysm repair.
    • Sixty-five percent of participating hospitals do not have all recommended policies in place to prevent common hospital-acquired infections (HAIs).
    • Seventy-five percent do not meet the standards for 13 evidence-based safety practices, ranging from hand washing to nursing staff competency.
    • Only 26 percent and 34 percent of reporting hospitals are meeting standards for treating two common acute conditions, heart attacks (AMI) and pneumonia, respectively.

    Summary: Only 30 percent and 25 percent of hospitals are meeting standards to prevent hospital-acquired pressure ulcers or hospital-acquired injuries, respectively.

    Friday, April 17, 2009

    Sounding the Alarm About C. difficile

    Sounding the Alarm About C. difficile

    Like the more well-known methicillin-resistant Staphylococcus aureus, [MRSA] C. difficile is associated with the use of antibiotics, which provide room for “bad” bacterium in your gut, like the C. difficile bacteria, to take over. In other words, although the antibiotic you take for an illness may cure one infection, it may also trigger another infection in your gut -the development of C. difficile.

    C. difficile is particularly alarming because:

    • A hospitalized patient may catch the infection from up to two-thirds of hospitalized patients who may be infected with it.

    • The rate of C. difficile infection among hospital patients doubled between 2001 and 2005, according to a recent article on the subject in the “Science Times” section of The New York Times,

    • Individuals who have C. difficile but are asymptomatic, and who are admitted to healthcare facilities, can transmit the organism to other susceptible patients.

    • It has begun to appear in seemingly healthy adults who in some cases were never in a hospital or low term care facility.

    • It is becoming more deadly because of the emergence of a new hyper-virulent strain.
    To protect yourself and your loved ones from C. difficile, I recommend first and foremost that you limit your use of antibiotics.

    I also advise that if you are hospitalized you:

    • Confirm that the walls of your hospital room and especially its bathroom and toilet have been washed
    thoroughly with chlorine bleach before you move into your hospital room.

    • Ask your doctor to wipe the flat surface on his stethoscope to remove germs before he uses it to examine

    • Ask everyone who comes to visit you at the hospital to wash their hands when they enter your room and
    to not sit on your bed. Ideally, they should not use your bathroom either.

    Dr. Perry Hookman

    *follow me on twitter: