Since NSF’s identification as a disease entity, there has been a marked shift in radiological standards and practices, as well as rapid growth of literature regarding the disease.
For now, there is no data suggesting any harm to patients from working with industry because no studies have used clinical outcomes.
The acceptance of P4P is so antithetical to the basic medical ethical tradition that I cannot believe professional organizations of physicians are supporting it...
The health care legislation that Congress enacted earlier this year, contrary to much of today’s overheated rhetoric, does many things right. But it does almost nothing to reform medical malpractice laws. Lawmakers missed an important opportunity to shield from malpractice liability any doctors who followed evidence-based guidelines in treating their patients.
The traditional way to reform medical malpractice law has been to impose caps on liability — for example, by limiting punitive damages to something like $500,000. A far better strategy would be to provide safe harbor for doctors who follow evidence-based guidelines. Anyone who could demonstrate that he has followed the recommended course for treating a specific illness or condition could not be held liable.
...this approach to reform will require larger investments in research into what works and what doesn’t. Fortunately, both the health care reform act and the 2009 economic stimulus act provided additional financing for such comparative effectiveness medical research, and the health care act provides for a Patient-Centered Outcomes Research Institute to coordinate the work. It’s a good start.
The pace of malpractice claims against hospitals is picking up, according to a recent report from Aon Risk Solutions and the American Society for Healthcare Risk Management...
Erik Johnson, health care practice leader for Aon Risk Solutions’ Actuarial and Analytics Practice, tells the Health Blog it’s not clear why the frequency of claims against hospitals is edging up. ..
A full 23% of hospital professional liability costs are associated with health-care acquired infections, health-care acquired injuries, medication errors, objects left in surgery and pressure ulcers, the report says.
Design Analysis of a prospective physician insurance database performed from January 1, 2002, to June 1, 2008...
Results A total of 25 wrong-patient and 107 wrong-site procedures were identified during the study period. Significant harm was inflicted in 5 wrong-patient procedures (20.0%) and 38 wrong-site procedures (35.5%). One patient died secondary to a wrong-site procedure (0.9%). The main root causes leading to wrong-patient procedures were errors in diagnosis (56.0%) and errors in communication (100%), whereas wrong-site occurrences were related to errors in judgment (85.0%) and the lack of performing a "time-out" (72.0%). Nonsurgical specialties were involved in the cause of wrong-patient procedures and contributed equally with surgical disciplines to adverse outcome related to wrong-siteoccurrences.
In the worst case reported, a chest tube was inserted into the wrong lung — the healthy one — and it collapsed, killing the patient.
With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. We did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies.
Studies in support of this argument do not give a balanced view. Surveys of the effects of drug detailing on doctors' prescribing have focused selectively on areas of overuse, such as antibiotics in the ambulatory setting and new expensive drugs compared with equally effective generics. Although some promotions undermine evidence-based practice, others may enhance it. Because promotional literature is a mix of good and bad information, the net effect on patient care is not known. Many heavily promoted treatments are evidence-based and known to be underutilized by doctors. A good example is the inadequate use of low-molecular-weight heparin for thromboembolism prophylaxis.[11] The promotion of statin drugs[12-14] and angiotensin-converting enzyme inhibitors for appropriate patients[15-17] is another example. Such a promotion toward best practice has been ignored in published studies. Research in a broader range of clinical situations is needed before conclusions can be made about the overall effect on evidence-based practice.
Ta da! Way to go President Obama and Democratic Congress. Way to control health care costs.
But they knew this would happen. I mean, how could they not? But why? I believe the point of Obamacare is to destroy the private health insurance system, which would leave only the government there to pick up the pieces. Then, it will be ration, ration, ration, and centralized control, control, control over our lives–in the name of promoting “wellness” and “cutting costs.”
Repeal. Reform. Replace. Defund.
Aerospace giant Boeing is joining the list of companies that say the new health care law could have a potential downside for their workers.
In a letter mailed to employees late last week, the company cited the overhaul as part of the reason it is asking some 90,000 nonunion workers to pay significantly more for their health plan next year.Via Secondhand Smoke.
A review by sonographers of cardiologist-interpreted echocardiography findings at a Milwaukee medical center during a period of just over a year indicated major discrepancies in 29% of cases, leading to unnecessary further diagnostic testing or treatments for the wrong indication, according to a study presented here at the American Society of Echocardiography meeting.
A total of 25 reports of false-positive UDS results were identified. Categories of medications included antihistamines, antidepressants, antibiotics, analgesics, antipsychotics, and nonprescription agents. Reports of false-positive results were found for the following formulary and nonprescription medications: brompheniramine, bupropion, chlorpromazine, clomipramine, dextromethorphan, diphenhydramine, doxylamine, ibuprofen, naproxen, promethazine, quetiapine, quinolones (ofloxacin and gatifloxacin), ranitidine, sertraline, thioridazine, trazodone, venlafaxine, verapamil, and a nonprescription nasal inhaler. False-positive results for amphetamine and methamphetamine were the most commonly reported. False-positive results for methadone, opioids, phencyclidine, barbiturates, cannabinoids, and benzodiazepines were also reported in patients taking commonly used medications. The most commonly used tests to screen urine for drugs of abuse are immunoassays, even though false-positive results for drugs of abuse have been reported with a number of these rapid-screening products.
Results: Extended-duration enoxaparin reduced VTE incidence compared with placebo (2.5% vs. 4%; absolute risk difference favoring enoxaparin, −1.53% [95.8% CI, −2.54% to −0.52%]). Enoxaparin increased major bleeding events (0.8% vs. 0.3%; absolute risk difference favoring placebo, 0.51% [95% CI, 0.12% to 0.89%]). The benefits of extended-duration enoxaparin seemed to be restricted to women, patients older than 75 years, and those with level 1 immobility.
Conclusion: Use of extended-duration enoxaparin reduces VTE more than it increases major bleeding events in acutely ill medical patients with level 1 immobility, those older than 75 years, and women.
One of the site’s creators, Graham Walker, chief emergency resident at St. Luke’s-Roosevelt Hospital Center in New York City, tells the Health Blog he was surprised that data on the effectiveness of treatments “was out there, but not easily accessible.”
It has been argued that the difference between studies suggesting benefit and all other studies is the timing of the intervention. The Cochrane findings do not support this view, nor does one extensive post-hoc analysis.13 More importantly, the most recent study (ECASS-3) suggested benefits when thrombolytics were administered between 3 and 4.5 hours. This is outside the window that purportedly distinguished the NINDS trials, and effectively neutralizes time as the defining factor that separates trials concluding benefit from those that do not.
Findings
Treatment was started within 360 min of stroke onset in 3670 patients randomly allocated to alteplase (n=1850) or to placebo (n=1820). Odds of a favourable 3-month outcome increased as OTT decreased (p=0·0269) and no benefit of alteplase treatment was seen after around 270 min. Adjusted odds of a favourable 3-month outcome were 2·55 (95% CI 1·44–4·52) for 0–90 min, 1·64 (1·12–2·40) for 91–180 min, 1·34 (1·06–1·68) for 181–270 min, and 1·22 (0·92–1·61) for 271–360 min in favour of the alteplase group. Large parenchymal haemorrhage was seen in 96 (5·2%) of 1850 patients assigned to alteplase and 18 (1·0%) of 1820 controls, with no clear relation to OTT (p=0·4140). Adjusted odds of mortality increased with OTT (p=0·0444) and were 0·78 (0·41–1·48) for 0–90 min, 1·13 (0·70–1·82) for 91–180 min, 1·22 (0·87–1·71) for 181–270 min, and 1·49 (1·00–2·21) for 271–360 min.
Interpretation
Patients with ischaemic stroke selected by clinical symptoms and CT benefit from intravenous alteplase when treated up to 4·5 h. To increase benefit to a maximum, every effort should be taken to shorten delay in initiation of treatment. Beyond 4·5 h, risk might outweigh benefit.
Most physicians who were science majors have of course come out in passionate defense of tradition, with some showing embarrassingly arrogant contempt for their counterparts in the humanities. They have called the Mount Sinai program an example of the “dumbing down” of American education, which I find patently offensive as a former English major who chose one of the most science-oriented specialties in medicine (but also, to my mind, one of the most artful).
I find the habit of many physicians of looking down at the humanities and humanities students completely obnoxious, but of course, I am biased.
What a joke. Last week there were reports that McDonald’s was going to drop its employees from health insurance coverage because Obamacare would increase the company’s costs. This was roundly denied at the time, but now, guess what? The bureaucrats have exempted McDonald’s and other companies–not to mention a big teacher’s union–from the rules that were supposed to protect us all.
Doctors, like most people, don’t love to work weekends, and they probably don’t enjoy being evaluated against their peers. But their industry can no longer afford to protect them from the inevitable.
Such an outcome would trouble ACA opponents: their goal is repeal. It would trouble ACA supporters: they want the law to work. But it should terrify everyone. The strategy of consciously undermining a law that has been enacted by Congress and signed by the president might conceivably be politically fruitful in the short term, but as a style of government it is a recipe for a dysfunctional and failed republic.
