Saturday, December 30, 2006
Thursday, December 28, 2006
Per the Centers for Disease Control, "For Americans ages 15 to 24, suicide is the third leading cause of death." Click here for the CDC's Injury Fact Book.
Wednesday, December 27, 2006
Friday, December 22, 2006
Thursday, December 21, 2006
Wednesday, December 20, 2006
Tuesday, December 19, 2006
“'The study underscores that patients and clinicians can have different views of the things that constitute a medical error,'” says Dr. Burroughs. “'For patients, clear communication and responsiveness are particularly important. If these are lacking, patients may view this as a medical error. It is important that clinicians recognize these differences, and the importance of communication and responsiveness.'”Click here for the press release on this study.
Sunday, December 17, 2006
"The implants -- small, internal versions of the paddles that emergency rooms use to shock patients' malfunctioning hearts -- are saving many lives. But in some cases they also are making the act of dying harder, forcing terminally ill patients and families to make wrenching decisions about turning them off. The devices subject some dying patients to painful jolts and can prolong suffering, traumatizing loved ones as the devices fire fruitlessly."
Friday, December 15, 2006
"Promotional products of any kind, food supplied by vendors or literature distributed by vendors, will no longer permitted at any Henry Ford site."I think they mean "...will no longer be permitted..."; in any event, we get the point.
Thursday, December 14, 2006
"Precisely when and where grand rounds began is not known. There are many types of rounds where doctors learn from patients. For example, there are the daily working rounds as doctors walk through a hospital to visit and examine patients. In teaching rounds, more senior doctors supervise the work of residents, or house officers, at a patient’s bedside or in a clinic.Doctor Altman describes how grand rounds have evolved, and perhaps not for the better. In any event, I recommend y'all read the article...look for the Lollipop case.
Grand rounds were showcases featuring the best clinicians, and the practice thrived in an era when doctors knew little more than what they observed at the bedside. Professors often demonstrated characteristics of physical findings like an enlarged thyroid, a belly swollen with fluid or another grotesque disfigurement that the audience could see. Those with a flair for showmanship were often the best teachers, adapting the predictable structure to their needs and talents."
Wednesday, December 13, 2006
"Patients at hospitals that scored near the top on the quality-of-care measures did do better than those at hospitals near the bottom -- but not dramatically so.
For every 1,000 heart attack patients, there were about five fewer deaths at the better-performing hospitals than at the lower-performing ones, the study found. The figures were similar for patients with heart failure and pneumonia.
Rachel M. Werner, an assistant professor of medicine and the study's lead author, said the results point up the need for more meaningful quality measures."
Tuesday, December 12, 2006
"While many private sector hospitals already stipulate their own minimum number of CME hours doctors must attend, at present, there are no laws to ensure public sector medical practitioners - including doctors, dentists and nurses - do the same. And Dr Abdul Ghaffar Abdul Ghafoor, assistant undersecretary for curative medicine, at the Ministry of Health, said this move is vital to ensure Dubai’s doctors keep up-to-date with advances in treatment methods."
Monday, December 11, 2006
Also, see the Duke Med News article "Drug-Coated Stent Patients at Risk if Anti-Blood-Clotting Medication Discontinued" for an excellent description of the rather complex issues on the use of drug-eluting stents and why more research is needed.
Friday, December 08, 2006
"The problem for sleep apnea patients following surgery is they can’t wake themselves up under heavy sedation, according to Kevin Finkel, MD, an anesthesiologist at Barnes Jewish Hospital in St. Louis, MO, speaking to HCPro's Quality Improvement Report newsletter. About 90 percent of sleep apnea patients are undiagnosed, he said. For that reason hospital staff needs to look for signs of the condition and ask patients if they snore. Patients who are obese or have a neck circumference of more than 17 inches are also at more likely to have sleep apnea."The JCAHO is seeking input on the proposed 2008 Patient Safety Goals.
Wednesday, December 06, 2006
Tuesday, December 05, 2006
Monday, December 04, 2006
"...alcohol ads that feature cartoonish animal characters; fast-food ads on educational TV shown in schools; magazine ads with stick-thin models and toy and other product ''tie-ins'' between popular movie characters and fast-food restaurants."Let's hope that policymakers listen.
Friday, December 01, 2006
"The proposed Patient Safety Solutions address the issues of look-alike, sound-alike medications; correct patient identification; hand-over communications; wrong site, wrong patient surgery; use of concentrated electrolyte solutions; medication reconciliation; catheter and tubing misconnections; needle reuse and injection safety; and hand hygiene. The electronic Patient Safety Solution survey will be available online until February 16, 2007, at www.jcipatientsafety.org/survey."
Thursday, November 30, 2006
"The foundation’s panel will probably meet in January or early February and could release new treatment recommendations for public review a few weeks later, the foundation said.The FDA has, in fact, issued an alert on this topic. CME Providers who are in the process of planning CME activities on this topic need to read this alert!
The anemia panel consists of 15 nephrologists who meet under the auspices of the foundation, a private nonprofit group based in New York that provides financing for kidney researchers. The panel is one of several panels sponsored by the foundation that make recommendations about how to improve treatment for kidney patients.
But some scientists complain that Amgen has until now had too much influence on the creation of the foundation’s guidelines. The most recent version of the anemia guidelines, released earlier this year, encourages more aggressive treatment than the Food and Drug Administration recommends."
Wednesday, November 29, 2006
More than one-quarter of adults interviewed said they had experienced low back pain in the past three months.
Fifteen percent of adults experienced migraine or severe headache in the past three months. Adults ages 18-44 were almost three times as likely as adults 65 and older to report migraines or severe headaches.
Reports of severe joint pain increased with age, and women reported severely painful joints more often than men (10 percent versus 7 percent).
Between the periods 1988-94 and 1999-2002, the percentage of adults who took a narcotic drug to alleviate pain in the past month rose from 3.2 percent to 4.2 percent.
Monday, November 27, 2006
"Stories like Russell’s are becoming more common. Staph infections, in varying and sometimes deadly forms, are being reported in greater numbers across Ohio and nationwide as more virulent and resilient strains are infecting high school, college and professional athletes.
Football players, wrestlers and even fencers have contracted methicillin-resistant staphylococcus aureus, or MRSA, a serious superbug once isolated to hospitals and health-care settings that has found its way into locker rooms, weight rooms and athletic training facilities. Despite widely available information about the dangers of skin infections, staph has continued spreading."
Saturday, November 25, 2006
For CME providers interested in learning more about medical simulation, please click here to go to the Society for Simulation in Healthcare's website. This society was formed in January 2004 and is comprised of educators and researchers interested in using a "variety of simulation techniques for education, testing, and research in health care". It now has over 1,000 members!
Thursday, November 23, 2006
It turns what we have into enough, and more. It turns denial into acceptance, chaos into order, confusion into clarity.... It turns problems into gifts, failures into success, the unexpected into perfect timing, and mistakes into important events. Gratitude makes sense of our past, brings peace for today and creates a vision for tomorrow."
- Melody Beattie
I wish y'all a Very Happy Thanksgiving!
Tuesday, November 21, 2006
Monday, November 20, 2006
"Wall Street is getting worried. In a note to investors, analysts at Prudential Equity Group fret, 'Democrats are well positioned to force action on drug prices, and contrary to conventional wisdom, a [presidential] veto is not a sure thing.'"More changes to come in CME Land, methinks.
Sunday, November 19, 2006
Friday, November 17, 2006
The CDC has a Home Fall Prevention Checklist available online that older adults (and their loved ones) can utilize to make their homes safer.
Thursday, November 16, 2006
Galvin interviews Martin Roland, an advisor to the "world’s most ambitious P4P program," the United Kingdom’s Quality and Outcomes Framework (QOF). Roland discusses the unexpected results and findings of the QOF and offers some advice to the United States. Even though the UK and US health care delivery systems differ, it is still very worthwhile information. One important point that Roland makes is that exception reporting "was introduced on the basis that if you have some form of evidence-based guideline, nobody would ever suggest that it should be applied to all patients. So, for example, if you’ve got a diabetic who’s dying of cancer, you’re not going to try and get his cholesterol down."
I encourage all who are involved in CME to read this important article; check with your medical librarian to see if your institution already subscribes to Health Affairs (or this article can be purchased online for a nominal fee).
What a boost to primary care in the UK!
Wednesday, November 15, 2006
1. Aspirin chemoprophylaxis
2. Childhood immunization series
3. Tobacco-use screening and brief intervention
See the full results of this study at the AAFP website "Practice Guidelines:
Partnership for Prevention Ranks Preventive Services." Be certain to check out Table 2 which depicts current utilization rates (the current tobacco-use screening and brief intervention national utilization rate is only 35%) and the additional quality-adjusted life years saved if utilization rates were at 90%.
Tuesday, November 14, 2006
Mark and I have worked together in the past and he is so knowledgeable and such a nice person. I am so pleased that he was elected to the board as I know he will help lead the Alliance to a bright future. Here is his position statement (from the Alliance website):
"Position Statement: Over the years the Alliance has grown in membership. However, as often happens with a growing, nationally (internationally) based organization, only a small portion of the members take full advantage of what the organization has to offer. I believe it is the responsibility of the members of the Board to build on what previous Boards have done to make the Alliance more inclusive, welcoming, and, above all, of value to the entire membership. Issues the Alliance must address:
- Provide more educational opportunities, especially to those who can’t attend the annual conference.
- Help members address the challenges of developing more relevant content in varied formats.
- Help members recognize the similarities rather than differences of provider types; break the 'silo mentality'; foster concrete ways to partner and share strengths and even resources.
- Identify and secure other sources of revenue."
Friday, November 10, 2006
"He has chaired the United States Pharmacopoeia's Advisory Panel on Mediation Errors and he has served as an ex-officio Member on the National Coordinating Council for Medication Error Reporting and Prevention. He has consulted with healthcare organizations and regulatory authorities in the United States, South Africa, Brazil and the Middle East on medication safety.
He has experience in designing and implementing medication safety surveillance systems in large academic hospitals, small community hospitals and clinic environments. These surveillance systems have included:
- "triggers-based" concurrent monitoring system in a large academic hospital
- national drug information network to collect reports of adverse drug reactions
- voluntary reporting methods in hospitals and clinics
- observational methods and target-drug surveillance methods in hospitals
- computerized screening to identify adverse events in hospital diagnosis databases"
Please also keep John in mind if you are looking for an excellent speaker on medication safety!!
Wednesday, November 08, 2006
"While there is considerable pressure from the public and the legal system to blame and punish individuals who make fatal errors, filing criminal charges against a healthcare provider who is involved in a medication error is unquestionably egregious and may only serve to drive the reporting of errors underground. The belief that a medication error could lead to felony charges, steep fines, and a jail sentence can also have a chilling effect on the recruitment and retention of healthcare providers--particularly nurses, who are already in short supply."
"Dr. Karel Bakker, a foot specialist who is a chairman of the International Diabetes Federation, believes that more effective foot care and patient education strategies would render up to 85 percent of these procedures unnecessary. Lower-limb ulcers are the most reliable harbingers of future amputation: according to a study published earlier this year in the journal Diabetes Care, nearly 9 in 10 nontraumatic foot and leg amputations come after the development of these infected sores, which can spread and quickly destroy surrounding tissue."
What a great QI project for CME providers!
Tuesday, November 07, 2006
Monday, November 06, 2006
"Duke cardiologists were instrumental in the conception and implementation of one the three participating registries, known as CRUSADE. Started five years ago, this registry involves more than 500 hospitals in the United States and has collected clinical data on close to 200,000 patients.
The two other registries joining the collaboration are the National Registry of Myocardial Infarction, supported by Genentech, and the National Cardiovascular Data Registry, supported by American College of Cardiology Foundation.
Each of the three registries has collected detailed data on how patients with acute coronary syndrome were being treated in U.S. hospitals, with the goal helping hospitals stay current with the latest scientific findings."
KUDOS on the collaboration!
Friday, November 03, 2006
"'Although the U.S. pays more for health care than any other country, we are under-investing in our primary care system,' Karen Davis, president of the Commonwealth Fund, the foundation that sponsored the survey, said in a statement. 'Other countries have made high-quality primary care a priority by putting into place the financial and technical systems that support access to, and delivery of, such care.'"
Wednesday, November 01, 2006
"'We’re where the airline industry was 30 years ago' when a series of fatal mistakes increased scrutiny and provoked change, said Dr. Stephen B. Smith, chief medical officer at the Nebraska Medical Center in Omaha, the teaching hospital for the University of Nebraska.
It is well established that, like airplane crashes, the majority of adverse events in health care are the result of human error, particularly failures in communication, leadership and decision-making.
'The culture in the operating room has always been the surgeon as the captain at the controls with a crew of anesthesiologists, nurses and techs hinting at problems and hoping they will be addressed,' Dr. Smith said. 'We need to change the culture so communication is more organized, regimented and collaborative, like what you find now in the cockpit of an airplane.'"
Tuesday, October 31, 2006
"Everything has got a moral if you can only find it."
- Lewis Carroll
"While alcohol is linked to 34 percent of motor vehicle accidents, only 12.8 percent of television stories, 19.2 percent of newspaper articles, and 22.2 percent of magazine articles about such accidents mentioned the use of alcohol, the study revealed. For stories about fatal accidents not involving motor vehicles, alcohol was mentioned in 1.4 percent of television reports, 4.8 percent of newspaper stories and 13.6 percent of magazine articles. However, statistics suggest 31 percent of these accidents involve the use of alcohol. The link between violent crime and alcohol use was also rarely acknowledged."
Food for thought...(certainly not drink for thought).
Monday, October 30, 2006
Friday, October 27, 2006
"Rates of minor bleeding and thrombocytopenia were similar in the two patient groups, and no major bleeding was observed, note Sellier et al, suggesting that the educational intervention reduced the incidence of DVT without compromising patient safety."
Sellier E, et al. Effectiveness of a Guideline for Venous Thromboembolism Prophylaxis in Elderly Post–Acute Care Patients. Arch Intern Med. 2006;166:2065-2071.
Just curious, do articles like this get into the CME literature database even if there are no keywords like "continuing medical education"?
"Patz said the New England Journal of Medicine article raises awareness of the potential of CT scans for improving lung cancer diagnosis. But he said the study did not compare the use of CT scans against a control group of patients who received chest X-rays or no imaging at all. Such a comparative study is essential if the medical community is to prove whether CT scans decrease lung cancer deaths, the ultimate goal of a screening program, he said.
Because of these factors, Patz said, it is important to await the results of an ongoing randomized clinical trial comparing chest X-rays against CT before concluding that screening will save lives. The study, called NLST, is being conducted at over 25 sites nationally and is funded by the National Cancer Institute."
Thursday, October 26, 2006
- Ensure that prevention programs are funded and adequately staffed.
- Carefully track infection rates and related data to monitor the impact of prevention efforts.
- Ensure that staff use standard infection control practices and follow guidelines regarding the correct use of antibiotics.
- Promote best-practices with health education campaigns to increase adherence to established recommendations.
- Design robust prevention programs customized to specific settings and local needs.
Wednesday, October 25, 2006
"The new ARC protocol should standardize the definition of stent thrombosis and provide consistency in the reporting of future trials, explained Cutlip. The Food and Drug Administration (FDA) has requested that the drug-eluting-stent companies use this new definition when they present data at an FDA meeting on stent safety in early December. The proposed ARC definition includes patients with definite/confirmed stent thrombosis, probable stent thrombosis, and possible stent thrombosis."
"Americans also have changed their behavior — seeking out generic drugs, trying to take better care of themselves and talking to their doctors more carefully about treatment options, the study found."
Tuesday, October 24, 2006
"...among the 10 percent whose calls were not forwarded because they said the matter was not urgent was a man with chest pain radiating down his arm, another who had trouble breathing, and a pregnant woman leaking amniotic fluid -- situations that require prompt medical attention because they could be life-threatening."
The article reports on some good strategies to assure that a clinician decides what constitutes an emergency.
Monday, October 23, 2006
"In experiments reported in the November 2006 issue of the journal Nature Medicine, the researchers applied the genomic tests to cells derived from tumors of cancer patients. They found that the tests were 80 percent accurate in predicting which drugs would be most effective in killing the tumor.
The Duke team plans to begin a clinical trial of the genomic tests in breast cancer patients next year."
How cool is that!
Thursday, October 19, 2006
"'Dr. Peter Q. Eichacker , a senior investigator in NIH's critical care medicine department and primary author of the paper, said patients and physicians deserve guidelines that are free of industry bias and based on 'the best research and clinical experience available.'
Instead, Eichacker and his co authors wrote, pharmaceutical companies see medical guidelines as 'a potentially powerful vehicle for promoting their products.'
Lilly, in a prepared statement, said it was 'proper' to provide funding for the Surviving Sepsis Campaign. `'We do not believe that Lilly had any role in the development of guideline content, beyond funding the initiative,' the company said. 'The campaign worked independently and autonomously, and our funding for these grants was openly disclosed.'"
Apparently this drug has been hotly debated ever since the FDA approved it in 2001 "based largely on a single late-stage study showing it extended survival by 28 days."
"Accidental overdoses and allergic reactions to prescription drugs were the most frequent cause of serious illnesses, according to the study, the first to reveal the nationwide scope of the problem. People over 65 faced the greatest risks.
'This is an important study because it reinforces the really substantial risks that there are in everyday use of drugs," said patient safety specialist Bruce Lambert, a professor at the University of Illinois at Chicago's college of pharmacy."
Wednesday, October 18, 2006
• Payment rates (whether they are adequate or too heavily discounted);
• Timeliness of payments (whether clean claims are paid within an appropriate amount of time);
• Accessibility, knowledge and responsiveness to your practice's concerns (whether payer representatives are easy to reach, helpful, etc.);
• Formularies (whether the information is easy to access, how often it changes, etc.);
• Prior authorization (how often it is required, how reasonable the decisions are, etc.);
• Physician performance data (whether data is accurate, valid and used fairly);
• The contracting process (whether the payer is willing to negotiate, disclose its fee schedule, etc.).
It will be interesting to see the results of this survey and if it prompts other specialty societies to conduct similar surveys.
- Labeling requirements and advertising limits for new medications
- Clarified authority and additional enforcement tools for the agency
- Clarification of FDA's role in gathering and communicating additional information on marketed products' risks and benefits
- Mandatory registration of clinical trial results to facilitate public access to drug safety information
- An increased role for FDA's drug safety staff
- A large boost in funding and staffing for the agency
Tuesday, October 17, 2006
"For major health outcomes among adults, based on both the strength of the evidence and the potential magnitudes of effect, the benefits of fish intake exceed the potential risks. For women of childbearing age, benefits of modest fish intake, excepting a few selected species, also outweigh risks."
Since the authors found that "modest consumption" of fish results in a 17% drop in total mortality, I'd say that's a rational conclusion.
Monday, October 16, 2006
"This year, more dire news: medication errors harm at least 1.5 million people and cost some $3.5 billion per year. What goes wrong? Missed diagnoses, incorrect drug dosing, failure to treat promptly. Experts agree that doctors, nurses, pharmacists and technicians will always make mistakes—it's the safety net around them that needs to be fixed. ''No matter how good people are, they suffer from being human and they're going to screw up,' says Jim Conway, senior vice president at Boston's Institute for Healthcare Improvement. 'We have to put systems in place that stop that error from causing harm.'"
Sunday, October 15, 2006
Friday, October 13, 2006
"The FDA statement that 'coronary DES remain safe and effective when used for the FDA-approved indications' ignores the nearly 80% off-label use of these devices in the 'real world.' Although the FDA does not have the mandate to impact medical practice, it should nevertheless leverage its relationships with medical professional societies and device sponsors to collaborate on the development and implementation of new tools and programs that help mitigate unnecessary risk and promulgate best practice standards."
Thursday, October 12, 2006
Monday, October 09, 2006
"...the World Health Organization found that rates of partner violence ranged from a low of 15 percent in Yokohama, Japan, to a high of 71 percent in rural Ethiopia."
Sunday, October 08, 2006
The U.S. has committed to a health system promising greater wellness, longer lives, affordable prices, quick access, universal coverage, and uniform conformity.
Bipartisan politicians and neutral business coalitions now reign over a good society. They have reined in health spending and capped costs at 20 percent of Gross National Product, more than 16 percent in 2006, but less than 25 percent projected for 2030.1 In 2006 David Cutler, a Harvard economist, released a study showing health gains from 1960 to 2000 had been worth the spending.2 Still, in 2006, waste was rampant, duplication was constant, fraud was blatant.
Good health for all
In 2020, Americans brim with good health and delay disease until late in life. For good reasons:
All U.S. citizens have free genomic profiles at birth predicting future diseases and instructing how to prevent and circumvent these ailments."
For the entire article (registration required): http://www.healthleadersmedia.com
Wednesday, October 04, 2006
"Although there were variations, depending on the type of medicine prescribed, 74 percent of the doctors mentioned the trade or generic name of the medicine, and 87 percent stated its purpose. Sixty-six percent said nothing about how long to take the medicine, 45 percent did not say what dosage to take and 42 percent failed to mention the timing or frequency of doses. Physicians mentioned adverse side effects only 35 percent of the time."
CME providers...take note!
Wednesday, September 20, 2006
"The most effective families, it seems to me, are those who genuinely appreciate the efforts of frequently overwhelmed health care providers and who seek to work with them to help care for their relatives. At the same time, as a concerned family member, you may know the patient better than anyone else, and if you see something that doesn’t seem right, speak up. The doctors may not thank you, but perhaps they should."