Harmony and balance...a Frenchman and his horses

As we close 2006 and look forward to 2007, I wish y'all harmony and balance in your lives. Click here to view a short video on what is possible.

Salah ad Din Province CME

Click here for an interesting article on continuing medical education in Iraq.

More on suicide risk screening

"Anonymous" posted a comment on the TeenScreen item and so I am posting a link here to the December 2004 issue of the American Family Physician article which delineates the U.S. Preventive Services Task Force recommendations on screening for suicide risk.

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.

Simple measures...

An article in the Baltimore Sun discusses the findings of a study just published in the New England Journal of Medicine on the impact that simple infection control measures had on reducing Michigan hospital infection rates. It's not always a knowledge deficit, folks, health care is delivered in an environment (with its own culture) and the systems need to be in place to optimize the quality of care provided. Involve everyone on the health care team -- yes, provide them with the knowledge, but set up the systems so that they have the skills, resources, and tools to apply that knowledge!

Mental health screening program for teens

Since half of all serious psychiatric disorders surface sometime between the ages of 14 and 25, it makes sense to screen teens for mental illness. A recent article in the New England Journal of Medicine reports on the success of TeenScreen, in which more than 55,000 teens in 42 states were screened. Click here to read the abstract. Fyi, a pdf of the entire article is available free -- THANKS to the NEJM!

Medical gains and new challenges

This New York Times essay by Lawrence K. Altman, M.D. is definitely worth reading -- "So Many Advances in Medicine, So Many Yet to Come" -- it's a great history lesson on the past 50 years of medicine but also highlights, methinks, the importance of continuing medical education.
:)

German company wins pharmaceutical packaging award

Came across a news article about a European competition for pharmaceutical packaging. The winning company, Faller, won this award because its design not only met customer needs in terms of functionality but also included a "means for recording" when tablets are taken. Click here for the article.

"ACCME Asked to Provide U.S. Senate Finance Committee with Information Regarding CME"

Click here to read the ACCME's news release on this matter.

Pharma company to pay $499 million in settlement?

"Bristol-Myers Squibb Co. on Thursday said it has tentatively agreed to pay $499 million to settle a long-standing probe by the Department of Justice into its marketing and pricing practices." The company has agreed to enter into an agreement with the DOJ and and the Massachusetts U.S. Attorney's Office to settle this investigation. "In return, there will be no criminal charges filed against the company. Bristol-Myers added that the deal had not yet been finalized." Click here to read the entire MarketWatch article.

A new model for surgical skills training

Very good article just published in the New England Journal of Medicine "Teaching Surgical Skills — Changes in the Wind". The authors discuss the Fitts–Posner Three-Stage Theory of Motor Skill Acquisition as well as several training and assessment models. All good stuff for CME Providers to be well versed in, especially in light of the new ACCME accreditation criteria.

Take the food portion quiz!

Hate to do this just before those big dinners and all the holiday goodies, but I'm sharing this CNN online quiz "Portions, Past and Present" just in case it helps y'all even a little bit in 2007. FYI, I failed this quiz miserably.

Definitions count

Which is more important -- the Institute of Medicine's definition of a medical error or a patient's definition of a medical error? A study published in the January 2007 issue of the Joint Commission Journal on Quality and Patient Safety indicates that patients may have their own definition of what constitutes a medical "error" or "mistake":

“'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.

An unintended consequence

The issue of a specific medical technology and its unintended consequence are discussed in this Washington Post article "Devices Can Interfere With Peaceful Death: Implants Repeatedly Shock Hearts Of Patients Who Cannot Be Saved". Frankly, I had never thought of this issue until I read this article!

"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."

Henry Ford cracks down on vendors

Henry Ford Health System is the latest large health care system to formalize and implement policies and procedures "aimed at eliminating potential conflict of interest between relationships with vendors and employees." A novel component of Henry Ford's new P&Ps is a certification program for vendors. The cost of the certification program is $100 (per person?). Bottom line:

"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.

Has the "grand" gone out of rounds?

Read an interesting article in the New York Times, "Socratic Dialogue Gives Way to PowerPoint," written by Lawrence K. Altman, M.D. Doctor Altman describes the history of grand rounds and how they have changed:

"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.

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."

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.

It's the patient outcomes that count

Do hospitals that perform better on quality measures have the best patient outcomes? A study published in JAMA tried to determine just that...from the Washington Post article reporting on this study:

"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."

New CME requirement for Dubai docs

Per a new ruling from the UAE Ministry of Health, physicians practicing in the public sector will now need 50 hours of CME every year in order to renew their medical licenses. The new ruling takes effect January 1, 2007:

"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."

More on drug-eluting stents

An expert panel convened by the FDA has issued caution in the use of drug-eluting or drug-coated stents, indicating that both physicians and patients be fully informed of the risks associated with their use. See the New York Times article "Panel Urges Caution on Coated Stents" for additional information.
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.

Proposed JCAHO Patient Safety Goals 2008

The Joint Commission on the Accreditation of Healthcare Organizations has released their proposed 2008 Patient Safety Goals. A new topic area goal is sleep apnea:

"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.

Conflict of interest charge for NIH scientist

Dr. P. Trey Sunderland III is the first NIH official since 1992 to be charged by federal prosecutors with conflict of interest. According to the LA Times article, Sunderland, in charge of the NIH's geriatric psychiatry division, received money from Pfizer, Inc. from 1998 to 2003 without NIH's permission or knowledge. Alledgedly, Sunderland provided Pfizer, Inc. with spinal-tap samples from patients and "failed to note his company fees and additional expense reimbursements on annual NIH financial reports."

December issue of Medical Meetings magazine published

"Aiming High" is the title of the lead article on the new ACCME accreditation criteria. The writer of the article is the virtuoso with a pen (or is that a keyboard?), Sue Pelletier. The article is a timely read, as they say...
:)

American Academy of Pediatrics issues policy statement

Apparently, several Western countries as well as Denmark, Belgium and Greece, Sweden, and Norway limit advertising to children, but the United States does not limit such targeted advertising. That's why the American Academy of Pediatrics has issued a policy statement on advertising to children; this statement will appear in the December issue of Pediatrics. The statement is critical of:

"...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.

Participate in an international survey on patient safety

The World Health Organization (WHO) is calling for health care professionals and patient advocates from around the world to participate in an online survey on nine solutions relative to patient safety:

"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."