Seniors taking psychotropic medications may be at increased risk for falls

According to a study published in the Archives of Internal Medicine, seniors who take certain "psychotropic medications may be at increased risk for falls." After analyzing "22 published studies" including "79,081 participants older than 60," University of British Columbia researchers "concluded that there was a significant association between the use of sedatives, hypnotics, antidepressants, and benzodiazepines and the risk of falls in older adults."

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

USE CELL PHONES TO PROTECT FROM ALZHEIMERS?

If you’re a mouse using a cell phone you’ve got it made. In mice prone to an animal form of Alzheimer's disease, long-term exposure to electromagnetic radiation typical of cell phones slowed and reversed the course of the illness. Cell phone exposure, begun in early adulthood, protects the memory of mice otherwise destined to develop Alzheimer's symptoms. And the electromagnetic waves generated by cell phones actually reversed memory impairment in old Alzheimer's mice. A similar exposure in normal mice -- for two hours a day over seven to nine months -- improved their cognitive abilities compared with controls reports the Journal of Alzheimer's Disease, which is the research journal of the Alzheimer's Association.

Rreactions to the study ranged from "interesting" to "nonsense” because it's too early to say whether the findings have any relevance to humans. Even science published in reputable journals can turn out to be wrong, adding "extreme caution is necessary until this outcome has been confirmed independently in other laboratories. And even if the science is correct, "humans are not just big mice, and we must always be cautious in extrapolating results from mice to man."

The report comes almost exactly two years after researchers at the University of Sunderland, in England, said they had shown that infrared light could improve cognition in mice.That report led to the development of the so-called "Alzheimer's helmet," aimed at slowing or reversing the disease in humans. Whether that works has not been shown yet.


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

Hormone Replacement Drug Lawsuits

Most of the hormone lawsuits in the U.S."focus on the drug Prempro [conjugated estrogens and medroxyprogesterone]," which was "prescribed to treat" menopausal symptoms.

On Jan. 6, 2010 the 8th US Circuit Court of Appeals "reinstated more than 100 lawsuits against drug companies filed by women or their surviving relatives who claimed that hormone replacement therapy caused breast cancer." The move overturned "a 2008 district court ruling that had blocked almost all of the suits from being sent back to state court in Minnesota and dismissed most of the lawsuits that were being heard in Little Rock." The appeals court also "reversed the dismissal of dozens of cases that the lower court ruled should not have been part of the litigation because they duplicated claims pending in California."

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

Section III of III The Debate between Doctors and Insurance carriers about “pay for performance” [P4P] reimbursement plans

Section III of III The Debate between Doctors and Insurance carriers about “pay for performance” [P4P] reimbursement plans

MY OPINION:
The idea of paying physicians more for providing guideline-based care has taken the American health system by storm in the last decade. Today, more than 150 pay-for-performance programs are centered on the notion that rewarding evidence-based care is key to improving health care quality.

Does evidence based research show that P4P is efficacious and improves quality care? No. At least not yet.

Some P4P efforts have shown beneficial results, according to the Centers for Medicare & Medicaid Services. An evaluation of its Physician Group Practice Demonstration found that all 10 participating practices hit or exceeded targets on at least seven of 10 quality metrics of diabetes care. A Feb. 1, 2007, New England Journal of Medicine study found that Medicare's pay-for-performance demonstration project was associated with a modest improvement on quality metrics, compared with hospitals not in the project.

Steven D. Pearson, MD, president of Harvard Medical School's Institute for Clinical and Economic Review says that "Unless you look at a control group of some kind, you may be misled about what's really happening."

There appears to be a fundamental problem with current P4P programs. They have had little to no impact on quality. That is the conclusion of many studies, including an analysis of quality incentives, published in the July/August, 2008 of Health Affairs. It compared 81 Massachusetts physician groups eligible for quality incentives with 73 that were not. The study did find, however, that overall performance from 2001 to 2003 improved on 73% of preventive care measures such as diabetes hemoglobin A1c testing, breast cancer screening and well-child visits. But the performance of the 5,350 physicians analyzed was statistically indistinguishable. Everyone's quality improved, regardless of whether the physician group stood to earn a bonus, which ranged from $200 to $2,500 per quality measure for an individual physician, depending on the health plan.

Another study that examined the CMS hospital P4P data also wasn't positive about P4P. A June 6, 2007, Journal of the American Medical Association study of heart attack care found no significant improvement for 54 hospitals in the CMS P4P demonstration, compared with 446 nonparticipating hospitals.

And a systematic review of 17 studies, published in the Aug. 15, 2006, Annals of Internal Medicine, found positive or partially positive effects of P4P programs, but the impact was usually small.

We actually have remarkably few evaluations that have a comparison group of any kind, so the evidence on pay-for-performance is rather spotty.
Overall the P4P programs evaluated over the last five years have been largely unimpressive in their results.

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 Acid reflux foods.

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

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

PART II OF III -FDA ALERT ON DANGERS OF TAINTED WEIGHT LOSS PRODUCTS

FDA laboratory tests have revealed the presence of sibutramine, fenproporex, fluoxetine, bumetanide, furosemide, phenytoin, rimonabant, cetilistat, and phenolphthalein in weight loss products being sold over-the-counter. The tainted products are listed below in alphabetical order along with the undeclared drug and/or chemical ingredient

1. 2 Day Diet - sibutramine
2. 2 Day Diet Slim Advance - sibutramine
3. 2x Powerful Slimming - sibutramine
4. 3 Day Diet - sibutramine
5. 3 Days Fit - sibutramine
6. 3x Slimming Power – sibutramine, phenytoin
7. 5x Imelda Perfect Slimming - sibutramine
8. 7 Day Herbal Slim - sibutramine
9. 7 Days Diet - sibutramine
10. 7 Diet - sibutramine
11. 7 Diet Day/Night Formula - sibutramine
12. 8 Factor Diet – sibutramine, phenolphthalein
13. Eight Factor Diet - sibutramine
14. 21 Double Slim - sibutramine
15. 24 Hours Diet – sibutramine, phenolphthalein
16. 999 Fitness Essence - sibutramine
17. BioEmagrecim, sample 1 – fenproporex
BioEmagrecim, sample 2 – fluoxetine, furosemide
18. Body Creator – sibutramine
19. Body Shaping - sibutramine
20. Body Slimming - sibutramine
21. Cosmo Slim - sibutramine
22. Extrim Plus – sibutramine, phenytoin
23. Extrim Plus 24 Hour Reburn - sibutramine
24. Fasting Diet - sibutramine
25. Fatloss Slimming – sibutramine, phenolphthalein
26. GMP – sibutramine
27. Herbal Xenicol - cetilistat
28. Imelda Fat Reducer - sibutramine
29. Imelda Perfect Slim – sibutramine, phenolphthalein
30. JM Fat Reducer - sibutramine
31. Lida DaiDaihua - sibutramine
32. Meili - sibutramine
33. Meizitang - sibutramine
34. Miaozi MeiMiaoQianZiJiaoNang - sibutramine
35. Miaozi Slim Capsules - sibutramine
36. Natural Model - sibutramine
37. Perfect Slim - sibutramine
38. Perfect Slim 5x – sibutramine, phenolphthalein
39. Perfect Slim Up – sibutramine
40. Phyto Shape - rimonabant
41. Powerful Slim - sibutramine
42. ProSlim Plus - sibutramine
43. Reduce Weihgt - sibutramine
44. Royal Slimming Formula – sibutramine, phenolphthalein
45. Sana Plus - sibutramine
46. Slim 3 in 1 - sibutramine
47. Slim 3 in 1 Extra Slim Formula - sibutramine
48. Slim 3 in 1 Extra Slim Waist Bumetanide is the active pharmaceutical ingredient in Bumex, a prescription diuretic.



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 III OF III -FDA ALERT ON DANGERS OF WEIGHT LOSS PRODUCTS.

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

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

PART I OF III -FDA ALERT ON DANGERS OF TAINTED WEIGHT LOSS PRODUCTS

Nearly 30 weight loss products sold over the internet and in retail stores are tainted with undeclared, active pharmaceuticals or chemicals, the FDA warned. All consumers should be familiar with the following signs of health fraud:
• Promises of an "easy" fix for problems like excess weight, hair loss, or impotency.
• Claims such as "scientific breakthrough," "miraculous cure," "secret ingredient," and "ancient remedy."
• Impressive-sounding terms, such as "hunger stimulation point" and "thermogenesis" for a weight loss product.
• Claims that the product is safe because it is "natural."
• Undocumented case histories or personal testimonials by consumers or doctors claiming amazing results.
• Promises of no-risk, money-back guarantees.
An FDA analysis found the following undeclared ingredients:
• phenytoin;
• sibutramine, an antiobesity drug that can cause hypertension, seizures, tachycardia, palpitations, heart attack, or stroke;
• rimonabant, an antiobesity drug not approved for use in the U.S.;
• phenolphthalein, a possible cancer-causing agent used in chemical experiments.

HOW IS THIS FRAUD BEING PEPERTRATED?
Regulatory requirements for dietary supplements differ from those covering "conventional" foods and drug products (prescription and Over-the-Counter). Under the Dietary Supplement Health and Education Act of 1994 (DSHEA), the dietary supplement manufacturer is responsible for ensuring that its products are safe before they are marketed. Generally, manufacturers do not need to register their products with FDA nor get FDA approval before producing or selling dietary supplements. Manufacturers must make sure that product label information is truthful and not misleading.

The FDA has expanded its list of tainted weight loss products containing undeclared pharmaceutical ingredients. Herbal Xenicol (found to contain cetilistat, an obesity drug not approved in the U.S.) along with Slimbionic and Xsvelten (both containing sibutramine, a prescription-only weight loss drug) have been added to the list of tainted dietary supplements. There are now 72 products on the list.The FDA also identified the following undeclared pharmaceutical ingredients as appearing in some other products on the list:
• fenproporex, an amphetamine derivative that can cause arrhythmia;
• fluoxetine, an antidepressant;
• furosemide, a prescription-only diuretic.

The agency advises consumers to discontinue use of these supplements and then to consult their healthcare provider.
In part II we will discuss the FDA laboratory tests which have revealed the presence of sibutramine, fenproporex, fluoxetine, bumetanide, furosemide, phenytoin, rimonabant, cetilistat, and phenolphthalein in weight loss products being sold over-the-counter. We will list the tainted products in alphabetical order along with the undeclared drug and/or chemical ingredient Nd how they can make you sicker.


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 II OF III -FDA ALERT ON DANGERS OF TAINTED WEIGHT LOSS PRODUCTS.

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

CONTAMINATION FORCES RECALL OF HAND SANITIZERS

WASHINGTON, June 10 -- A line of skin care products -- including some hand sanitizers -- was voluntarily recalled after FDA inspectors discovered high levels of disease-causing bacteria in them, according to the agency.

Clarcon Biological Chemistry Laboratory, based in Roy, Utah, said the recall covers all Clarcon products.
The FDA said its analyses of several samples of over-the-counter topical antimicrobial skin sanitizer and skin protectant products revealed high levels of various bacteria, including some associated with unsanitary conditions.

According to the FDA warning, some of the bacteria identified in the products can "cause opportunistic infections of the skin and underlying tissues. Such infections may need medical or surgical attention, and may result in permanent damage."

The inspection findings, the FDA said, were "particularly concerning because the products are promoted as antimicrobial agents that claim to treat open wounds, damaged skin, and protect against various infectious diseases."

The agency said the inspection also uncovered serious deviations from current Good Manufacturing Practice requirements.
The FDA released this list of products covered by the recall:
• Citrushield Lotion
• Dermassentials DermaBarrier
• Dermassentials by Clarcon Antimicrobial Hand Sanitizer
• Iron Fist Barrier Hand Treatment
• Skin Shield Restaurant
• Skin Shield Industrial
• Skin Shield Beauty Salon Lotion
• Total Skin Care Beauty
• Total Skin Care Work
From MedPage Today


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 CDC DATA IMPLICATE POULTRY AS MOST COMMON SOURCE OF FOOD POISONING.

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Esophageal Adenocarcinoma-the White Man’s Disease

Development of Barrett's esophagus and esophageal adenocarcinoma appears to be strongly affected by ethnic factors, with populations resident at the west end of the Eurasian continent, such as Anglo-Celtics, being more prone to both conditions. On the other hand, ethnic groups from the eastern and southern ends of Eurasia, such as Chinese, Koreans and Japanese, and Africans might be more prone to developing esophageal squamous cell carcinoma.

Esophageal adenocarcinoma (EAC) is the most rapidly increasing cancer in the Western world and Barrett’s esophagus (BE) is the only known precursor lesion for this lethal cancer. Long-term survival may be improved if EAC is diagnosed early, providing an opportunity for early intervention. Surveillance of all patients with known BE is probably not cost effective and factors predictive of BE progression to dysplasia/EAC are poorly understood. Screening and surveillance examinations are also faced with challenges in the endoscopic detection of intestinal metaplasia and dysplasia. Future application of molecular biomarkers may help identify the patients with BE most likely to progress, and the use of novel imaging methods may improve outcomes of BE screening and surveillance

Esophageal squamous cell carcinoma (ESCC) used to be the dominant type of esophageal malignancy both in Western and Asian countries. The rapid increase of EAC in Western countries has occurred in parallel with an increased prevalence of gastroesophageal reflux disease (GERD) and its major determinant, obesity.
Such an increase in EAC has not yet been observed in Asia, despite a recent increase in prevalence of GERD.

Hongo, Michio et al.Journal of Gastroenterology and Hepatology, Volume 24, Number 5, May 2009 , pp. 729-735(7)
Jeff Michalak et al. Current Gastroenterology ReportsVolume 11, Number 3 / June, 2009

COMMENT: The incidence of esophageal cancer is greatest in those people with chronic heartburn. Yet the screening of these patients for cancer is not deemed “cost effective.”

Read about the controversy and how it affects medical malpractice cases in-

Book I - “Medical Malpractice Expert Witnessing: Introductory Guide for Physicians and Medical Professionals” (Hardcover) by Perry Hookman, MD (Author) : 592 pages.27 chapters. Publisher: CRC; Potomac Press; Language: English ISBN-10: 1420058959 ISBN-13: 978-1420058956; Dimensions: 10.1 x 7.1 x 1.4 inches; Shipping Weight: 2.6 pounds; price $239.95.
For author information visit www.Hookman.com; for book purchase visit www.MedMalBook.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.

* Tune in tomorrow for CONTAMINATION FORCES RECALL OF HAND SANITIZERS.

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Avoidable Post Hospital Discharge Errors Are Common

Adverse events after discharge from the hospital are common. Many of these adverse events are avoidable or ameliorable.

400 consecutive patients discharged home from the general medical service of a tertiary care academic hospital were followed in one study. After discharge, 76 patients (19%) had adverse events, defined as injuries occurring as a result of poor medical management. Of these, 23 patients had preventable adverse events, defined as adverse events judged to have been caused by an error, and 24 patients had ameliorable adverse events, defined as adverse events in which the severity could have been decreased.

Adverse drug events accounted for 66% of adverse events, and procedure-related injuries for 17%. Of the 25 adverse events that caused a transient or permanent disability, 12 events were preventable and six events were ameliorable.
Adverse drug events [ADEs] are almost as common among outpatients and they have important litigation consequences.

A summary analysis of more than 1500 published case reports of ADEs yielded information on possible risk factors for drug-related deaths, disabilities, and life threats and on which events may have been preventable.

The study showed that the drug categories most commonly involved in ADEs were central-nervous-system agents, antimicrobials, antineoplastics, and cardiovascular agents.

CAUSES OF ADES

Faulty prescribing was the most common reason for medication error, and
Wrong dosage was the most common type of error.
Overall, 52% of the cases were judged to have been preventable;
Of these, 50% could have been prevented by a pharmacist.

Litigation was reported for 13% of the cases; Settlements and judgments averaged $3.1 million.


Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. Am J Health Syst Pharm. 2001;58:1399-1405.

Ann Intern Med. 2003;138:161-167
Comment: “In theory, there is no difference between theory and practice. In practice there is.”- Yogi Berra

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 Pressure Stockings 'Should Not Be Used' to Prevent DVT

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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 ling 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 Avoidable Post Hospital Discharge Errors Are Common

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Women Still Drinking During Pregnancy

Despite the Surgeon General's warning that alcohol can affect unborn children, pregnant women haven't changed their drinking habits much over the past two decades, the CDC saidAbout 40% of women realize they're pregnant at four weeks' gestation, a critical period for fetal organ development,

The U.S. Surgeon General has consistently advised women against drinking alcohol during pregnancy. National prevalence of fetal alcohol syndrome is about 0.5 to 2.0 cases per 1,000 births, but the other fetal alcohol spectrum disorders occur about three times as often, the researchers said.

Women with the highest rates of drinking during pregnancy were older, college graduates, employed, and unmarried.

Between 2001 and 2005, 17.7% of pregnant women ages 35 to 44 reported having at least one drink in the past 30 days, compared with 8.6% of women ages 18 to 24.

While it's not well understood why drinking habits differ across certain aspects of social status, the researchers had a few possible explanations. It could be that older women may be more alcohol dependent and have more difficulty abstaining from alcohol while pregnant, they speculated. Also, they said, more-educated women and employed women might have more discretionary money to spend on alcohol. And unmarried women might attend more social occasions where alcohol is served, the researchers said. They emphasized that healthcare providers should routinely ask women of childbearing age about their alcohol use and inform them of the risks of drinking during pregnancy.

Alcohol use levels before pregnancy are a strong predictor of alcohol use during pregnancy, the researchers said. Many women who use alcohol continue to do so during the early weeks of gestation because they don't realize they're pregnant, as about half of all births are unplanned.

Denny CH, et al "Alcohol use among pregnant and nonpregnant women of childbearing age -- U.S., 1991 -- 2005 MMWR 2009; 58(19): 529-32

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 ARE THE PPI’S SAFE IN PREGNANCY?

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IMPORTANCE OF CHLAMYDIA SCREENING

"One of the biggest frustrations in public-health circles today involves a tiny bacterium called Chlamydia trachomatis." some CDC experts "estimate that twice that many cases go undetected." Thus far, "efforts to screen for chlamydia have run into a number of obstacles," with one issue being "simple awareness." And, "many primary-care doctors may be too time-pressed to bring up chlamydia screening during office visits," or do not think it is an issue affecting their patient demographics. Therefore, the "CDC, along with the National Chlamydia Coalition, an umbrella group of nearly 40 medical associations, are working to spread the word about the importance of screening for chlamydia."

Chlamydia infection is the most common sexually transmitted disease, responsible for a record 1.1 million cases reported to the Centers for Disease Control and Prevention in 2007, and experts there estimate that twice that many cases go undetected. Left untreated, chlamydia can cause infertility or potentially fatal ectopic pregnancies. But many women aren’t even aware that they were exposed to it—possibly years ago—until they try to have a baby and can’t.

Chlamydia can be detected with a simple urine test. It can be treated with a single dose of antibiotics, and the CDC has been urging all sexually active women under 26 years old to be tested for it annually, as well as older women who have had a change of sexual partner. Yet fewer than 40 % of women in those categories are being screened. “You’d think this would be a no-brainer,” says John Douglas, director of the CDC’s division of STD prevention. “That’s why we’re trying to get the message out.”
The CDC, along with the National Chlamydia Coalition, an umbrella group of nearly 40 medical associations, are working to spread the word about the importance of screening for chlamydia.

Chlamydia is especially prevalent among women ages 15 to 19 and African-Americans, but sample studies have found the infection in nearly 10% of all female Army recruits, 10% of female college freshmen and 14% of women in managed-care plans. Experts say it’s about three times as prevalent in women than men, but it may be that men eliminate it from their bodies more readily, while it goes on to cause far more damage in women.

Many girls in the prime chlamydia age group are under the care of pediatricians, who may be uncomfortable bringing up sex with patients they’ve treated since infancy. Even when pediatricians discuss the human papilloma virus (HPV) vaccine with adolescents and parents, it’s often in the context of preventing cancer in the future, not current sexual activity.“But to pretend that teenagers aren’t having sex is very dangerous.”

Even when women are treated for chlamydia, about 25% become reinfected within six months—probably due to a partner who wasn’t treated. So the CDC recommends that doctors give women a second course of antibiotics for their partners, even without being seen by a doctor themselves. It can be treated either with a weekly dose of doxycycline or a single dose of azithromycin, which goes by the brand name Zithromax, made by Pfizer Inc., in many countries.

Chlamydia can be spread by oral or anal sex, as well as vaginal sex; condoms greatly reduce the transmission rate. No one knows for sure how long an infected person remains contagious. But experts advise caution. More insidiously, even when a woman no longer tests positive for an active infection, the chlamydia bacteria may have moved into her upper genital tract and set off pelvic inflammatory disease. PID can cause pelvic pain—or it can be asymptomatic—but it often leaves inflammation and scar tissue that blocks a woman’s fallopian tubes, preventing fertilization. PID is also the most common cause of ectopic pregnancy, which can be fatal. “It’s not the infection itself but the body’s response to get rid of the bacteria that causes the scarring,” There is also evidence of old chlamydia infections in women with endometriosis—a condition in which bits of uterine lining tissue grow outside the uterus, which can also cause pain and infertility. Chlamydia infecting the uterine wall can cause miscarriages, and that it can invade ovaries and lead to early ovarian decline and early menopause. Such scarring can sometimes be seen with a hysterosalpingogram. Severe scar tissue may need to be removed surgically before a woman can get pregnant or to resolve pelvic pain.

The CDC recommends that all pregnant women be tested for chlamydia at the first prenatal visit, although if you are planning to become pregnant, it’s a good idea to be tested for all STDs well in advance. Older women who are experiencing pelvic pain, intermittent bleeding, unusual vaginal discharge or signs of early menopause should ask their doctor if chlamydia could be involved

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 WHICH ORAL ANTIBIOTICS ARE SAFE DURING PREGNANCY AND BREASTFEEDING?

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Stronger warnings on drugs containing acetaminophen

In May, 2009 an FDA report recommended stronger warnings and dose limits on drugs containing the painkiller acetaminophen," which is "the active ingredient in Tylenol and a host of other pain relievers." The report "cites an increased risk of liver damage." The FDA working group that issued the report, "made up of 12 top officials in the FDA's Center for Drug Evaluation and Research, recommended lowering immediate-release tablet strength to no more than 325 milligrams from the current 500 milligrams and reducing the single adult dose to 650 milligrams, from 1,000 milligrams.

The FDA also warned that acetaminophen "overdose was linked to 458 deaths and 26,000 hospitalizations annually from 1990 to 2001," and the drug "is a leading cause of acute liver failure in the US."

These recommendations cover "both prescription doses and over-the-counter medication" and "include enhanced public information efforts, stronger labels warning of liver side effects, and dose limitations."

On June 30 the FDA panel recommended that prescription Vicodin [hydrocodone bitartrate and acetaminophen] and Percocet [oxycodone and acetaminophen] be banned, and that over-the-counter Tylenol, Excedrin, Nyquil, and Theraflu contain stronger warning labels...The problem, according to FDA advisors, is that they all contain acetaminophen, which can cause liver damage."

The FDA Drug Safety Advisory Committee also "recommended lowering the maximum daily nonprescription dose of acetaminophen," Current doses are "at four grams a day or eight extra strength Tylenol a day. The committee...said the maximum single adult dose, should be 650 milligrams. And while extra strength Tylenol recommends two, 500-milligram pills at once, the panel recommends that dose would require a prescription."

The FDA "panel noted that patients who take Percocet and Vicodin for long periods often need higher and higher doses to achieve the same effect." "The two drugs combine a narcotic with acetaminophen," and the panel's vote to "recommend a ban on the combination drugs was one of 11 it took" at the meeting. The experts also recommended "that the FDA reduce the highest allowed dose of acetaminophen in over-the-counter pills...to 325 milligrams, from 500," and "to reduce the maximum daily dosage to less than 4,000 milligrams."

The panel "of 37 doctors, pharmacists, and researchers voted on the recommendations after spending two days discussing steps the FDA should take to reduce the number of acetaminophen overdoses."


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 the IMPORTANCE OF CHLAMYDIA SCREENING.

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ILLEGAL USE OF OPIOIDS

Data from the National Survey on Drug Use and Health in 2007 suggested that 33 million people over the age of 12 used an opioid for a nonmedical purpose at some point.

Most obtained the drug for free from a friend or relative or in the case of Michael Jackson as an alias..

The FDA's Center for Drug Evaluation and Research is drafting a Risk Evaluation and Mitigation Strategy (REMS) aimed at reducing adverse events caused by opioids.

Physicians who prescribe opioids must register with the Drug Enforcement Agency (DEA), but the drugs might be less likely to be misused if more regulations were imposed on physicians who prescribe opioids. According to the DEA, a clinician who prescribes controlled substances has an obligation to take "reasonable measures" to prevent the drug from being diverted to those who use it for a nonmedical purpose.

Schedule II agents include morphine, oxycodone, pure hydrocodone, and methadone. A handful of hydrocodone and morphine combination products are listed in Schedule III, but the analgesic options in this class are relatively scarce.

State medical licensing boards, health insurance plans, and law enforcement officials must play a big role in enforcing the REMS.

FDA officials acknowledged the interplay of the FDA and the DEA on the issue of opioids. While the FDA normally focuses on the safety of drugs for medical purposes, it can't ignore the fact that millions of people use the drugs to get high.

One suggestion is that the FDA require opioid manufacturers to put serial numbers or microchips in opioid tablets, linked to the prescription that released them to a patient. That way, if law enforcement officials seize pills, the prescriber and patient can be easily traced. Other ways are creating opioid medications that are "less abusable" such as crush-proof pills.

The FDA is already considering serial numbers on some classes of medication for a different reason -- to confirm the integrity of the supply chain.

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 Stronger warnings on drugs containing acetaminophen.

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

Part I of II: IS IT SAFE TO TAKE ENTERIC COATED ASPIRIN?

Even low-dose aspirin (acetylsalicylic acid [ASA]) produces intestinal damage.

The small bowel was shown to be damaged by low-dose ASA even on a short-term basis in twenty healthy volunteers (age range, 19-64 years) who underwent video capsule endoscopy (VCE), fecal calprotectin, and permeability tests (sucrose and lactulose/mannitol [lac/man] ratio) before and after ingestion of 100 mg of enteric-coated ASA daily for 14 days.

Video capsule images were assessed by 2 independent expert endoscopists, fully blinded to the treatment group, by using an endoscopic scale.

Post-ASA VCE detected 10 cases (50%) with mucosal damage not apparent in baseline studies (6 cases had petechiae, 3 had erosions, and 1 had bleeding stigmata in 2 ulcers). The median baseline lac/man ratio (0.021; range, 0.011-0.045) increased after ASA use (0.036; range, 0.007-0.258; P = .08), and the post-ASA lac/man ratio was above the upper end of normal (>0.025) in 10 of 20 volunteers (vs baseline, P < .02). The median baseline fecal calprotectin concentration (6.05 microg/g; range, 1.9-79.2) also increased significantly after ASA use (23.9 microg/g; range, 3.1-75.3; P < .0005), with 3 patients having values above the cutoff (>50 microg/g). Five of 10 subjects with abnormal findings at VCE also had lac/man ratios above the cutoff. Median baseline sucrose urinary excretion (70.0 mg; range, 11.8-151.3) increased significantly after ASA administration (107.0 mg; range, 22.9-411.3; P < .05).

CONCLUSIONS: The short-term administration of low-dose ASA is associated with mucosal abnormalities of the small bowel mucosa, which might have implications in clinical practice.

E. Smecuol Low-dose aspirin affects the small bowel mucosa: results of a pilot study with a multidimensional assessment. Clin Gastroenterol Hepatol 7(5):524-9 (2009)

COMMENT:

The efforts to generate safer NSAIDS and aspirins includes enteric coated and slow release formulations. But these “safer” formulations simply shift the damage of these agents to a more distal site in the intestinal tract.

This study documents that even in the short term and in healthy controls a short course of enteric coated ASA can damage the small intestinal mucosa.

Half of the healthy study population showed mucosal damage.
This study must be taken into consideration by patients and their providers.

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 II of II SHOULD EVERYONE TAKE ASA?

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IN DEFENSE OF DEFENSIVE MEDICINE?

I was surfing through some medical blogs the other day and found this Emergency Physicians Monthly - White Coats Call Room – A blog from inside the emergency department http://www.epmonthly.com:80

The doctor writes that “During a recent ED shift, just for the heck of it, I started taking notes as I went from room to room treating patients. I wanted to try to show myself whether or not “defensive medicine” was a figment of my imagination. It isn’t a figment of my imagination.”The ED doctor gives these examples which do not serve his purpose of showing up “defensive medicine as bad.” In fact if f I were judging by this doctor’s examples I would defend the indefensible. I would defend defensive medicine.
See if you agree.

His Example 1.
A patient in her 60s fell and hit her head 5 days ago. She was having a headache. I couldn’t find a mark on her and was inclined to send her home with pain medications. But she was on Coumadin which put her at risk of bleeding. So I did a CT scan of her head to “make sure” that she didn’t have a bleed. She didn’t.

But she could have! Couldn’t she? Remember the late Catherine Graham owner of the Washington Post who died post fall cerebral bleed. And how about the beautiful actress daughter of the famous Redgrave clan - Natasha Richardson--mother of 2 children who also died post a skiing accident of a subdural hematoma—even without Coumadin to precipitate and prolong the bleeding inside her head.. The only way to help these patients is early diagnosis by x-ray. When clinical findings occur it’s usually too late-- which this doctor, seems to disregard.

Example 2 given by this ED doctor as defensive medicine.
An out of town patient in her 40’s who had a long history of smoking and a history of COPD came in for coughing and shortness of breath. She was at a baby shower and had forgotten her albuterol inhaler. Her oxygen saturation was 92% on room air. Her heart rate was 105. She got a couple of treatments and steroids and was marginally improved. Her symptoms were most likely explained by her underlying COPD. I was inclined to discharge her with a prescription for steroids and another inhaler. Instead, I did a CT scan of her chest to “make sure” that she didn’t have a pulmonary embolism. She didn’t. She went home on steroids and an inhaler. We made sure to recommend that she stop smoking so that we wouldn’t get dinged by CMS for failing to meet a “quality indicator.”

This patient could very well have a pulmonary embolus kicking in a bout of SOB.

His third Example.
A patient dropped a TV on his foot. There was only a little red mark on the back of his foot, but the patient stated that he could not bear weight on his foot. I was inclined to wrap him up and send him home with pain medication and crutches, but I did an x-ray of his foot to “make sure” that there was no fracture. There wasn’t.
Only a little red mark of his foot-but he could not bear weight on his foot? Sounds like an x-ray certainly is indicated here.

Example 4.
A 94 year old demented lady was brought in because she was not “acting right.” Her daughter tried to wake her from sleep and had a more difficult time than usual waking the patient up. The daughter stated that the patient was “acting different,” even though nurses who had seen the patient before and the nursing home staff stated that the patient was not acting different. The patient got a bunch of labs and a head CT just to “make sure” that the allegedly incremental increase in her dementia wasn’t caused by a metabolic problem or a spontaneous bleed in her brain. It wasn’t. She was discharged back to the nursing home to finish her nap.

The most common causes of sudden dementia or worsening of dementia in the elderly are medication problems, metabolic causes and infections. This lady certainly deserved these “defensive medical tests.”

Example 5.
Then there was the suicidal patient. She was drinking, became upset with her boyfriend, and used a piece of broken glass to cut her wrists. Her alcohol level was in the mid-200s. She was drunk and she “was going to f***ing die.” But no psychiatric institution would accept her in transfer until she had a complete laboratory and toxicological workup, including an EKG and a urinalysis just to “make sure” that a whacked out chloride level or a raging UTI wasn’t really behind her suicidal tendencies.

That’s right. How many “psychiatric” patients die in the psychiatric unit not from psychiatric but because of drugs and metabolic causes? Too many.

This particular ED doctor obvious from his remarks, thought that he had to do all the “extra” studies because of “defensive medicine.”

“Why,” he asks, “was I ordering all of these things when my clinical judgment led me to believe that they would “probably” not lead to any changes in the patient’s management?

Hello! Clinical judgment is great where indicated. These examples however do not prove this doctor’s point. In fact the opposite.

The answer, he gives is that “because in our culture, “probably” doesn’t cut the mustard any more. Clinical medical judgment has been supplanted, he says, by the demand that physicians disprove the improbable. Society has made it so that physicians are more concerned with proving that unlikely diagnoses with the possibility of a “bad outcome” don’t exist and with maintaining good Press - Ganey scores. Many physicians are afraid to practice rational medicine based upon clinical judgment and physical examination skills. No one wants to face the liability. For those who would assert that I was practicing inappropriate medicine for ordering all of the “unnecessary tests” above, tell me which conditions that it would have been acceptable to “fail to diagnose” on the possibility that my clinical examination alone missed an unlikely disease process. That, my friends, is defensive medicine at work.”

Doctor, your case would be better made with better examples.

And doctor, I would further reply ---how about this case?

40 yr old indigent street guppy shows up to the ER with altered level of consciousness. Blood alcohol was .3 (almost 4 times the normal intoxication limit 0.08). ER Doc runs CBC, metabolic panel that shows only elevated liver enzymes, no surprise for chronic alcoholism. ER Doc decides to wait it out, and discharges patient after almost a full shift, alert and oriented. (No discharge blood alcohol done). Said patient returns 1 hr later, again altered LOC. Being a bounce back, this time he gets the full work-up. Blood alcohol 0.12, CT shows subdural hematoma.

What really is defensive medicine? Defensive medicine eludes easy definition

Definitions include:
“Medical practices designed to avert the future possibility of malpractice suits.”
“ In defensive medicine, responses are undertaken primarily to avoid liability rather than to benefit the patient.”
“Doctors order tests, procedures, or visits, or avoid high-risk patients or procedures primarily (but not necessarily solely) to reduce their exposure to malpractice liability.”

“Medical practices designed to avert the future possibility of malpractice suits.”
Some defensive medicine, however, presumably helps patients. Some paradoxically puts the patients in harm's way (the more you do, the more you are likely to "break something.")

As the blog complained, many believe that sound clinical judgment has been supplanted by disproving the improbable. Failure to diagnose, no matter how improbable, can, and often does, evolve into a multi-year odyssey narrated by "a plaintiff's attorney telling everyone how the patient's injury is an example of why [the physician] is a bad doctor and why clinical examination alone is simply not good enough." But the problem with the definitions are that defensive” medicine - ie medicine done to avoid the risk of liability, remains undefinable, because you don’t know if your liability is actually reduced by each “unnecessary” test you order.

COMMENT:
If I were judging by this doctor’s examples I would defend the indefensible. I would defend defensive medicine.


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 TOP 10 Laws and Rules Every Physician Should Know

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HHS says researcher fabricated, falsified data on sleep apnea in severely obese patients

In the Wall Street Journal (4/10/09) Health Blog, Sarah Rubenstein wrote that, according to the Office of Research Integrity at the Health and Human Services Department, "Robert Fogel, a former assistant professor at Harvard Medical School, fabricated and falsified data in a study of sleep apnea in severely obese patients." The office said that Fogel "changed or falsified nearly half of the sleep data "so that those data would better conform to his hypothesis." He is also accused of fabricating "about 20 percent of anatomic data that supposedly came from CT scans."

The study, titled "Anatomic and Physiologic Predictors of Apnea Severity in Morbidly Obese Subjects," has since been retracted from the journal Sleep. Commenting on the false data, Fogel said "What I did was obviously horrendously wrong," but that "this was the only paper on which he'd done this." Fogel’s fabrications don’t appear as widespread as those of a Massachusetts doctor who allegedly faked data in 21 published studies. Specifically, PHS found that for the data reported in the Sleep paper, the Respondent:

• Changed/falsified roughly half of the physiologic data
• Fabricated roughly 20% of the anatomic data that were supposedly obtained from Computed Tomography (CT) images
• Changed/falsified 50 to 80 percent of the other anatomic data
• Changed/falsified roughly 40 to 50 percent of the sleep data so that those data would better conform to his hypothesis.

A New Low in Drug Research: 21 Fabricated Studies

We’ve written about plenty of controversies around drug trials, from ghostwriting to keeping quiet about unflattering results.

But the latest news is particularly eye-popping: A prominent Massachusetts anesthesiologist allegedly fabricated 21 medical studies involving major drugs. Baystate Medical Center in Springfield, Mass., has asked several anesthesiology journals to retract the studies, which appeared between 1996 and 2008. The hospital says its former chief of acute pain, Scott S. Reuben, faked data used in the studies.

Some of the studies reported favorable results from use of Pfizer’s Bextra and Merck’s Vioxx, both painkillers that have since been pulled from the market. Others offered good news about Pfizer’s pain drugs Lyrica and Celebrex and Wyeth’s antidepressant Effexor XR. Doctors said Reuben’s work was particularly influential in pain treatment and that they were shocked by the news.

“We are left with a large hole in our understanding of this field,” said the editor-in-chief of Anesthesia and Analgesia, which first reported on the retractions. “There are substantial tendrils from this body of work that reach throughout the discipline of postoperative pain management.”Pfizer had funded some of Reuben’s research and had also paid him to speak on behalf of its medicines.

And another horror story:

A medical device company and four of its executives have been indicted on charges of conducting unapproved clinical trials in which three patients died, according to the U.S. Department of Justice.

The company, Norian Corporation, of Cupertino, Calif., faces 52 felony counts, including conspiracy to impede the lawful functions of the FDA, seven counts of making false statements, and 44 counts of shipping an adulterated product. Its parent company, Synthes, of Switzerland and West Chester, Pa., faces 44 misdemeanor counts of shipping an adulterated product

The indictment charges that, from May 2002 to fall 2004, Norian conspired with parent company Synthes and four top executives to use Norian XR and Norian SRS to surgically treat vertebral compression fractures of the spine Norian SRS, in vertebral compression fracture procedures as part of a test market, according to the Department of Justice. Ultimately, 52 surgeons were trained on use of the product in such procedures.

The surgeries were performed despite a warning on the FDA approved label for Norian XR against such use -- preliminary studies had found that the cement reacted chemically with human blood, resulting in clotting. Animal studies had shown that the blood clots became lodged in the lungs, according to the Department of Justice.

Norian conducted three of the training sessions, canceling others after three patients in whom Norian XR was used died on the operating table. The company did not recall the product from the market -- doing so would have required a disclosure about the deaths to the FDA.

Instead, the Department of Justice charges that the company carried out a cover-up in which they lied to the FDA during inspections in May and June 2004.

* Tune in tomorrow for In defense of Defensive medicine.

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Do Not Eat Nestle Toll House Prepackaged Cookie Dough

Nestle Toll House prepackaged refrigerated products were recalled on June 19, 2009, over concerns about E. coli contamination, with the FDA advising consumers to throw away any dough they may have already purchased. (Cooking the dough is not recommended, as the bacterium could contaminate one's hands or cooking surfaces.)

Since March, E. coli infections potentially linked to the dough have been reported in 66 people in 28 states, according to the FDA. There have been 25 hospitalizations —
some with hemolytic uremic syndrome — and no deaths.The U.S. Food and Drug Administration and the Centers for Disease Control and Prevention are warning consumers not to eat any varieties of prepackaged Nestle Toll House refrigerated cookie dough due to the risk of contamination with E. coli O157:H7 (a bacterium that causes food borne illness).

The FDA advises that if consumers have any prepackaged, refrigerated Nestle Toll House cookie dough products in their home that they throw them away. Cooking the dough is not recommended because consumers might get the bacteria on their hands and on other cooking surfaces. Retailers, restaurateurs, and personnel at other food-service operations should not sell or serve any Nestle Toll House prepackaged, refrigerated cookie dough products subject to the recall. Since March 2009 there have been 66 reports of illness across 28 states. Twenty-five persons were hospitalized; 7 with a severe complication called Hemolytic Uremic Syndrome (HUS). No one has died.

Because the appearance of E. coli 0157 in cookie dough is so unusual, investigators are looking at a broad range of possible factors, analyzing the ingredients, the plant's equipment and interior, the health of workers and whether the facility is located near cattle. Federal officials are also considering whether the dough might have been intentionally contaminated. E. coli O157:H7 causes abdominal cramping, vomiting and a diarrheal illness, often with bloody stools. Most healthy adults can recover completely within a week. Young children and the elderly are at highest risk for developing HUS, which can lead to serious kidney damage and even death. E. coli refers to many kinds of bacteria, most of which are harmless or even beneficial. But certain types, including E. coli 0157, produce a toxin that can cause severe illness and even death in humans. The E. coli 0157 bacterium lives in the intestines of cows and other animals -- goats, sheep, deer and elk -- and is found most often in ground beef. But over the past decade, a number of E. coli 0157 illness outbreaks have been associated with green, leafy produce, such as spinach

For more information on safe food handling practices, go to http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm109899.htm.

State health officials first noticed cases of E. coli 0157 emerging in March. Initially, they suspected ground beef or strawberries. But after interviewing victims, state officials and the CDC compared notes during a conference call Tuesday and settled on the refrigerated cookie dough as the prime suspect.

The risk usually associated with cookie dough is salmonella, a bacteria that can be found in raw eggs contained in the dough. Nestlé's cookie dough is packaged with labels warning consumers not to eat it raw. But people tend to disregard the warning -- 39 percent of consumers eat raw cookie dough, according to Consumer Reports. It has become such a popular snack that many ice cream makers have developed a cookie dough flavor.


* Tune in tomorrow for A Great Idea-- Specialized Health Care Courts

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America's other drug problem

The National Council on Patient Information and Education has termed medication nonadherence "America's other drug problem.”

Approaches to improve adherence can be complex and labor intensive. The problem of medication nonadherence poses an even greater risk among elderly patients in the United States, among whom poor medication adherence is common, morbid, costly, and difficult to treat. And it is among the elderly, that polypharmacy, which is the use of multiple medications resulting in complicated drug regimens, is an important barrier to medication adherence. Of 4053 patients aged 65 years or older prescribed medications for hypertension and hyperlipidemia, the adherence to both classes of medication decreased rapidly to 40.5% at the 3-month interval, and then to 32.7% at 6 months.

• The adherence rate for medical treatments [ or non-compliance rate] averages in some studies about 50%, with a range that extends from 0% to 100% .
• A Physicians' estimates of their own patients' adherence have no better than “chance accuracy”.
• Thus the problem of low adherence can be almost invisible to the individual practitioner dealing with a specific patient. This is true even for patients whom physicians feel they know well.
• Thus, part of the problem of detecting low adherence is that clinicians often think they know a poor or good complier when they see one, perhaps cueing on such characteristics as age, gender, education, and intelligence—none of which have been shown to have any consistent relationship to adherence.
• Adherence to chronic pharmacological therapies is poor.
• This often leads to worsening disease severity and increased costs associated with higher hospital admission rates.
• Barriers to medication adherence are numerous,and are particularly prevalent among the elderly population, placing them at increased risk for medication nonadherence.
  

J. K. Lee et al noted that poor medication adherence diminishes the health benefits of pharmacotherapies, especially in elderly patients with coronary risk factors who frequently require treatment with multiple medications, placing them at increased risk for nonadherence.

Of a total of 200 elderly patients, a pharmacy care program led to increases in medication adherence, medication persistence, and clinically meaningful reductions in BP, whereas discontinuation of the program was associated with decreased medication adherence and persistence.

“Effect of a Pharmacy Care Program on Medication Adherence and Persistence, Blood Pressure, and Low-Density Lipoprotein Cholesterol A Randomized Controlled Trial” published in JAMA. 2006;296: (doi:10.1001/jama.296.21.joc60162)
Chapman RH, Benner JS, Petrilla AA, et al. Predictors of adherence with antihypertensive and lipid-lowering therapy. Arch Intern Med. 2005;165:1147-1152.



* Tune in tomorrow for the latest Food Scare

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CAN WE BELIEVE HOSPITAL STATISTICS?

Reporting of Mistakes by Hospitals Is Faulted

A.Hatocollis reports that at least in one city--New York City-- hospitals are the least reliable in the state at reporting preventable mistakes and adverse incidents for patients like heart attacks, blood clots, hospital infections and medication errors, according to a new report by the office of City Comptroller.

The comptroller also expressed concern that the New York City data on medication errors appear to run counter to the national trend, citing estimates by the Institute of Medicine of the National Academies that at least 400,000 hospital patients are harmed and 7,000 killed by medication errors annually. In contrast, the report said, from 2004 through 2007, city hospitals rarely reported medication errors: 37 that resulted in death, near death or permanent harm to patients, with 22 hospitals, including four very large ones, reporting none.

The lack of accurate reporting makes it virtually impossible for consumers to judge accurately the quality of a hospital or for the hospital to compare itself with its peers and make improvements, the comptroller’s office argues, saying the consequences include longer hospital stays and higher health-care costs. “Without the fullest possible reporting, hospitals cannot identify areas where systematic improvement may be needed,” reads the report. “Weak enforcement and flagging commitment to a broad-based effort has compromised the whole program.”

NewYork-Presbyterian/Weill Cornell Medical Center one of New York City’s major academic medical centers, reported only about 20 adverse incidents per 10,000 patient discharges, while a comparable institution outside the city, which was not named, reported about 166 incidents per 10,000, a rate more than eight times higher.

Within New York City’s 60-plus hospitals, there was great range: 17 reported no heart attacks unrelated to a cardiac procedure while one had more than 40; six hospitals reported 2 blood clots or acute pulmonary embolisms per 10,000 patient discharges while two others had more than 60 per 10,000; one major academic medical center reported 3.6 post-operative infections per 10,000 discharges and a similar hospital had 32 per 10,000. None of these hospitals were named in the report.

The report, which looks at data from 2004 through 2006, with some additional data from 2007, echoes a state Health Department study in 2001 that similarly concluded that New York City underreported adverse incidents, with 6 of the 11 city-run public hospitals among the 25 lowest reporters. The new analysis faulted the state for not being more aggressive in enforcing penalties such as fines against hospitals with lax reporting, and cited “enormous and inexplicable disparities among individual hospitals.”

A hospital’s size and the type of procedures it performs do not seem to explain the differences in reporting rates.

The report does not name individual hospitals, but the comptroller’s office separately released a list of the 12 lowest reporters in the city based on 2006 data. The top three — St. Vincent’s Midtown and Cabrini Medical Center in Manhattan, and Mary Immaculate in Jamaica, Queens — have all since closed.

The others include some of New York’s biggest and most prestigious hospitals: Lenox Hill, on the Upper East Side (No. 7); Bellevue, the flagship hospital of the city’s Health and Hospitals Corporation (10); Weill-Cornell (11); and Mount Sinai (12).

COMMENT:
It’s not difficult to believe that NYC is not an isolated city. I believe that hospital statistics reported from other cities will have to also be investigated—with severe sanctions applied to violaters.