Tuesday, October 31, 2006

"Through the looking glass..."

It's Halloween, so here's something a bit off the med ed/public health track...a new study indicates that elephants exhibit mirror-recognition behavior and that they check themselves out in the mirror. Click here -- "Who's That Pretty Pachyderm?" -- for the full-length story.

"Everything has got a moral if you can only find it."
- Lewis Carroll

The role of alcohol in crime and accidents is underreported

A study to be published in the November 2006 issue of the Journal of Studies on Alcohol estimates that alcohol plays a role in about one-third of homicides and one-third of fatal non-traffic accidents. Interestingly, the study found that the media underreports this association:

"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

"Full court press"

If you missed 60 Minutes last night then you missed an excellent report on combat medicine. The good news is that you can read about it here "A Fighting Chance."

Friday, October 27, 2006

"CME" intervention on DVT prophylaxis in France

An Archives of Internal Medicine article by French doctors reports that provider education on evidence-based guidelines for the prevention of DVT was successful. What made the difference? As reported in the heartwire article, the lead author, Doctor Elodie Sellier (University Hospital, Grenoble, France) states that the decrease in DVTs (from 12.8% preintervention to 7.8% postintervention) was due primarily to an increase in the use of graduated compression stockings. Furthermore:

"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"?

More research needed on use of CT scans to screen for lung cancer

In a recent Duke News release, Duke Professor, Edward F. Patz Jr., M.D., (James and Alice Chen Professor of Radiology, Professor of Pharmacology and Cancer Biology, Professor of Pathology, Director, Molecular Diagnostics Laboratory) indicates that additional research needs to be completed before CT scans are routinely used to screen for lung cancer:

"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

CDC releases guidance on drug-resistant infections

In an effort to stem the continuing rise of drug-resistant infections, the Centers for Disease Control has issued the "Management of Multidrug-Resistant Organisms in Healthcare Settings" guidelines. These guidelines were developed by experts in collaboration with the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC). The guidelines recommend the followings steps for hospitals and healthcare facilities:
  • 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.
CME Providers, what a great opportunity for you -- contact your Infection Control folks!

Wednesday, October 25, 2006

More on the drug-eluting stent issue!

Visit www.theheart.org (registration is required) for additional information on a proposed standard definition of stent thrombosis. Using this standard definition, "the cumulative incidence of stent thrombosis might be no greater in patients treated with a drug-eluting stent than in those treated with a bare-metal stent." From the article:

"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."

Employee Benefit Research Institute survey shows

that "fewer than two in 10 Americans are satisfied with the cost of health insurance and with costs not covered by insurance. More than half are 'not too satisfied' or 'not at all satisfied.'" There was no change in satisfaction ratings with the quality of care. While increases in health care insurance premiums have slowed over the past few years, it is still approximately double the rate of increase in Americans' earnings and twice that of the rate of inflation. The EBRI phone survey indicated that Americans are not able able to save as much for retirement due to rising health care costs. While this survey only interviewed 1,000 Americans, its findings are interesting. The good news:

"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

Interesting news release on "Pharmaceutical CME..."

Cutting Edge Information has a new research report available, "Pharmaceutical CME: Measuring Program Effectiveness in the Compliance Environment." Here's the link to the news release. I'd love to hear your thoughts on this news release (and the full report if you happen to purchase it).

Another source of preventable medical errors?

An article in the Washington Post today reports on a study published in the Journal of the American Board of Family Medicine which indicates that, on an annual basis, between 2 million and 5 million patients call their doctors' offices after hours or on the weekend. Answering services routinely ask these patients "'Is this an emergency?'" The study found that 90% of the calls were put through as emergencies and investigated the 10% that were not:

"...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

Duke develops genomic test panel to improve selection of chemotherapy

A genomic test panel was developed at Duke University's Institute for Genome Sciences & Policy. The panel of tests can be utilized to analyze the "unique molecular traits of a cancerous tumor" and determine "which chemotherapy will most aggressively attack that patient's cancer":

"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

NIH senior scientists allege that Eli Lilly

provided financial support for the development of sepsis guidelines in order to market their product, Xigris. From the Boston Globe article:

"'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."

Study finds that severe outpatient drug events are common

We've all heard the statistics on adverse drug events in the hospital setting; however, a new U.S. government study indicates that outpatient drug reactions send over 700,000 Americans to Emergency Rooms every year:

"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

"What's new in medical education"

Check out Anne Taylor-Vaisey' blog for the latest in medical education. She just updated it today!
Anne, thanks!

"Turnabout is fair play"

Perhaps in response to the increasing practice of health plans in grading providers on practice performance measures, the American Academy of Family Practice (AAFP) is conducting a survey of its members asking them to assess health plans. Participating AAFP members will grade health plans in eleven categories, some of which are:

• 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.

Institute of Medicine (IOM) news release

The IOM released information last month that is worth another look! The IOM was asked by the FDA and the Department of Health and Human Services to convene a committee to examine the FDA process and make recommendations for improving said process. The recommendations of this committee were released on 9/22/06; copies of the full report, The Future of Drug Safety: Promoting and Protecting the Health of the Public can be purchased at the IOM website. Some of the recommendations from the committee include:

  • 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
Additionally, the committee report recommends "that a substantial majority -- at least 60 percent -- of advisory committee members be free of significant financial involvement with companies whose interests may be affected by their deliberations. FDA should issue waivers for the other committee members very sparingly." Yes, Virginia, a zero tolerance policy on financial relationships with industry just isn't practical, is it?

Tuesday, October 17, 2006

Fish oil: risks and benefits

A recent meta-analysis article in JAMA "Fish Intake, Contaminants, and Human Health Evaluating the Risks and the Benefits" concludes that:

"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

"Fixing America's Hospitals" - Newsweek article

In the October 16, 2006 issue of Newsweek, Claudia Kalb reports on the innovations of ten hospitals. The innovative approaches to improving patient care and patient safety delineated in the article are as varied as the institutions themselves. I encourage you to read this important article and see if you, as a CME professional, can work with others at your institution who might be working on similar improvement projects. An excerpt:

"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

"Therein lies the rub..."

Interesting posting at Sue Pelletier's CAPSULES blog about a new website, www.sermo.com, for physicians. Apparently, physicians subscribe to this website and then post their comments about their experiences with devices and drugs. The "rub" is that investment firms have access to their comments. To read Sue's wonderful blog, www.medicalmeetings.net

Friday, October 13, 2006

"Our romance with technology..."

Great phrase (and now blog headline) from a very recent editorial by Sanjay Kaul, M.D. and George A. Diamond, M.D., F.A.C.C. which is posted at www.cardiosource.com. The authors discuss the findings of major studies on the use of drug-eluding stents (DES), and they question the efficacy, risk and economics of DES use over that of bare metal stents. This is a great read and, hopefully, will generate much discussion on the more general issue of "our romance with technology..." and the closely aligned off-label use issue. An excerpt from the editorial:

"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

Irish CME system dubbed ineffective...

In the October 13, 2006 issue of "Irish Medical Times," Greg Baxter reports that consultant cardiologist Doctor John Clarke feels that CME credits (called "points" in Ireland) are "easy to come by...and doctors do not always learn something." It will be interesting to see if and when there is reform of the Irish CME point system.

Monday, October 09, 2006

For women, the most violent place is home

A new W.H.O. study has confirmed (as reported in the New York Times) that violence against women by their intimates is a common, worldwide phenomenon. W.H.O. conducted interviews in 10 countries at 15 different sites to ascertain the rates of violence against women. From the NY times article:

"...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."

How sad.

Sunday, October 08, 2006

Could it happen?

Richard L. Reece, M.D., a pathologist, is the author of an interesting article on health care in the United States in the year 2020. (He is also the author of a to-be-published book "Innovation-Driven Care: 36 Key Concepts for Transformation"). What "brave new world" does Doctor Reece envision in 2020?

"The commitment
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

Take two aspirin...

How well do physicians explain to their patients how to take the medications that they prescribe for them? A study published in the Archives of Internal Medicine and headlined in the New York Times today answers that question...apparently, not very well...excerpt from the Times article:

"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!