Sunday, April 30, 2006
Perhaps spreading the word via blogs might be better.... :)
Thursday, April 27, 2006
One suggestion I'd make: Make a Class I Safety Alert the least concerning, while Class III Safety Alert would be the most concerning.... this would be in line with other schema in medicine (Class A vs Class D cancer, Class I vs Class IV heart failure)... Just a thought.
On a (much) less serious note, since "recall" was thought by the committee to be to troublesome to the public, a few other terms that could be used instead of "Safety Alert" were passed around in our lab today. They included: "glitch," "hiccup," "boo-boo," and the best: "faux pas."
Wednesday, April 26, 2006
At the 17 surveyed centers, 2915 patients had recall devices, including 533
(18.3%) who had advisory ICDs replaced a mean (SD) of 26.5 (11.5) months after
their initial implant. Of these patients, 66% had a secondary prevention ICD,
and 45% had received a previous appropriate shock. During a mean (SD) of 2.7
(2.8) months' follow-up after ICD generator replacement, complications occurred
in 43 patients (8.1%). Major complications attributable to advisory device
replacement requiring reoperation occurred in 31 patients (5.8%), with death in
2 patients after extraction for pocket infection. Minor complications occurred
in 12 patients (2.3%). There were 3 (0.1%) advisory-related device malfunctions
reported, without clinical consequences.
Remember, every person's circumstance and device indication is different. These data help with the decisions you and your doctor can discuss.
Tuesday, April 25, 2006
Sunday, April 23, 2006
If the AHA or Advocate had experienced even a frisson of conscience, one would have at least expected the award to go to an Advocate system heart specialist. Is this for the lack of any heroic, tireless clinicians deserving such an award this year? On the contrary, the ballroom was filled with dismayed physicians and bedside clinicians, excellent professionals who devote countless hours to forward research, who run in at 11pm when a defibrillator is shocking someone every five minutes, who stands, legs swollen, at the operating table long past the point of reason trying to stitch up a dissected aorta. But here is what the physicians did NOT do: they did not head up a hospital group that made a major financial contribution. The age of unapologetic cynicism in health-care has arrived.
But why dissemble? If this wasn't bad enough, the clinicians attending were treated to a promo video about the Advocate Healthcare system - a system certainly under scrutiny recently.
Who cares if the AHA wants to pat the back of one of its' chief funders? It only matters to the little guy if AHA similarly tilts its' public policy toward the interests of its corporate supporters. Are we now to look without cynicism at the treatment recommendations the AHA makes to the public? The medical device recommendations? The dietary? Should we be asking for a financial disclosure statement? Are rewards granted to sponsors in direct violation of the AHA's of conflict of interest policy?
The AHA opens itself to this scrutiny in its' breathless endorsement of its' own funders last night - and it's abandonment of the front-line for the deep pockets. It would be interesting to know if the national organization endorses this new orientation.
Friday, April 21, 2006
Communities would be wise to consider placing defibrillators in the back of police squad cars, since there are typically many more police officers than paramedics or firemen on the publics' payrolls. Often, they respond before paramedics to similar incidences and on occassion (as in cases like this), have the ONLY defibrillator available. Illinois offered a grant in 2001 to MANY communities in our state (tho' we could still use more), but the need is still great throughout other communities in America. And remember, about 20% of sudden death survivors are under 18 years of age! (This is not just for "old" people!! For instance...'Commodio cordis' a rare but real cause of sudden death due to blunt trauma to the chest, seen most often in baseball players.)
Thursday, April 20, 2006
Wednesday, April 19, 2006
Tuesday, April 18, 2006
See if these can be used for your device.
Sunday, April 16, 2006
"When you go to the doctor for a routine blood test or mole removal, when you
have an appendectomy or any other type of –ectomy, the stuff you leave behind
does not get thrown out. Doctors, hospitals, and laboratories keep them. ….
Scientists use these products to develop everything from flu vaccines to tissue
penis enlargement products. … Without these tissues, we would have no tests for
diseases like hepatitis and H.I.V.; no vaccines for polio, smallpox, measles;
none of the new promising drugs for leukemia, breast cancer, colon cancer. And
without these tissues, the developers of these products would be out millions of
The article describes a case regarding John Moore, a man who had hairy cell leukemia and required splenectomy. His spleen supplied valuable proteins and carried a rare virus that might lead to treatments for H.I.V., and the doctor who removed that spleen filed a patent on Mr. Moore’s cell line, the "Mo" cell line, standing to make $3.5 million in potential royalties.
Here's an idea: why don't hospitals and industry just stop this practice because we're so upset that our polyp is over at University of Massachusetts! Or at least make sure every shaved basal cell comes with a travel itinerary!
First of all, the "payday" like this is unusual: the article describes cells of 178 million people's tissues or blood on file somewhere (duh, can you say DNA for the FDA's crime lab?). The dollars and intellectual property to develop such tests and treatments is as extraordinary. How many tests, hours of research, and teams of researchers had to be made (and paid) to find one such tissue sample?
Simple question: should doctors and researchers request your consent to use your discarded tissues to conduct research that could potentially be profitable?
Friday, April 14, 2006
Thursday, April 13, 2006
I feel a major problem in our misunderstanding of controlling costs of healthcare lies in a superficially simple (but realistically exceedingly complex) observation – people don’t have to pay for the services rendered when they get sick – insurance does. In ways, this encourages people not to ignore their health care if they become ill since the monetary disincentive does not exist. Doctors don’t have to worry about the cost of procedures or tests for their patients. They order tons of blood tests, EKG’s, x-rays, fancy scans, and the like because the patient needn’t worry about the bill. No test is too frivolous or too repetitive. Computers make daily (or even hourly) laboratory blood test ordering easy. But are such daily tests necessary? Liability concerns help counter the guilt regarding the expense. Protect theyself, o’ physician, lest ye be sued! (And believe me, this is no small issue.)
But what if costs were disclosed? What if costs were available online or during the ordering process on the Electronic Medical Record for physicians to make judgments about how many tests they REALLY need? Might it affect care negatively? I doubt it. Would it change outcomes? Probably not. Reduce cost? Absolutely. Is it difficult to implement? No.
And taking that concept one further, what if the patient could see the costs of expensive technologies? What if the costs of implantable defibrillators were available online? (For instance, it’s easier to find what a defibrillator weighs, than what it costs…. I checked Google, the big three ICD manufacturers websites [Guidant, Medtronic, St. Jude] and could find none.) Stents? Would patients always want the “expensive version” of technology or would they settle for a lesser model if it saved them or the system a few bucks? I don’t know. But to shield the ultimate consumers (the patient and their doctors) from these costs is counter-productive and serves to permit price increases to occur without public awareness and limits free-market competition. Transparency in healthcare costs is just as important as transparency on corporate financial statements. Maybe more. And this won’t just help the doctors and patients.
More and more doctors help hospital administrators bid on bulk purchases of expensive technologies. You see, these administrators really don’t know what’s “in” and “cutting edge” in a particular field, but they know to ask an experienced doctor for guidance (after all the doctors have to agree to use the purchased technology). Wouldn’t it be nice for the hospitals to know the retail price for equipment across provider lines and thereby make more informed decisions in concert with these physicians?
Anyone who has read The Tipping Point by Malcolm Gladwell knows that big epidemic changes can occur through the action of small, summative, incremental actions. Price transparency might be one of these actions. I say, show me the money.
Tuesday, April 11, 2006
Monday, April 10, 2006
"Collectively, for the most part, clinical trials have failed to demonstrate a
beneficial effect of antioxidant supplements on CVD morbidity and mortality.
With regard to the meta-analysis, the lack of efficacy was demonstrated
consistently for different doses of various antioxidants in diverse population
Friday, April 07, 2006
Whether man OR woman, think about getting an EKG with your next physical. It might be best thing you ever do.
Thursday, April 06, 2006
Wednesday, April 05, 2006
In an effort to be launched this week, the Centers for Disease Control and
Prevention is collaborating with the nonprofit Institute for Healthcare
Improvement and two leading infectious control professional societies in a
program to boost compliance using behavior modification techniques, "best
practice" guidelines, and rigorous programs to monitor adherence.
“We are in an era of smarter bacteria and we need to be more aggressive in ensuring patient safety,” says Rebecca Shadowen, the infectious-disease specialist who led the study” that showed hand-washing reduced their “smart” bacteria infection rates. But more concerning was the attitude that the program implemented at Greenview Regional Hospital and Medical Center (Bowling Green, KY) “emphasized that the hospital’s top officials were monitoring compliance and prepared to take disciplinary action…”
Now, I’m no infectious disease expert, and I certainly understand the importance of careful hygiene and careful infection control strategies, but draconian measures like this are sure to fail. Education should be the cornerstone for health care workers and physicians alike. Rewarding good behavior rather than flogging bad behavior makes MUCH more sense. And let’s be real here. Taken to the next extreme (which was done at our hospital for a recent Joint Commission inspection), I would dare say that keyboards, like the one I’m typing on now, should be disinfected, too! (yes, we were supposed to wash our little mitts after every keyboard use, too!) And so should all stethoscopes be similarly disinfected? What about my tie? Who will monitor that I dry-clean it after each wearing (remember, those dirty hands and stethoscopes touch all of our ties!!!)? Should be implemented as well! Will hall monitors demand dry-cleaning receipts? Ridiculous? Yes! Worth revoking my privileges? Not!
Yet the drumbeat continues:
"It is no longer tolerable to accept (hand-washing) non-compliance rates of 50%
when we are dealing with critically-ill patients," says Don Goldman, MD, a
senior vice president of IHI and a professor of pediatrics at Harvard Medical
School, who notes that computer chip makers have better hand-cleaning standards
than most hospitals. While the IHI program emphasizes education and
positive feedback, "repeat violations in healthcare, or any industry, need to
have consequences, " Dr. Goldman says.
So can you see it now: clean rooms, laminar air flow, white bunny suits, and hand-washing like computer chip makers! And best of all, consequences if we don't comply!
Later in the article, a voice of reason existed:
John Boyce, and infectious disease specialist who helped write the CDC (Center for Disease Control) guidelines and runs a free instructional Web site, handhygiene.org, says hospitals often view monitoring hand-hygiene compliance as time-consuming, tedious, and ineffective. “We need to come up with strategies that are believable,” Dr. Boyce says.
Please make it believable! (And along those lines, Dr. Boyce site quotes the statistic that 90,000 deaths (at the cost of 4.5 million per year) are caused by hospital-based infections, but how many of these were really caused by poor hand-washing technique? Are ventillator infections, GU infections and the like from handwashing infringements? - in my humble opinion and reading, patients themselves and the instruments we place in them are the most likely contaminants). If other sources of contamination are not just as important, then I’ll be first to develop contact dermatitis on weekends between the 25 or so patients I see each day. And hear me clearly: I do think there are data that hand-washing is helpful to decrease bacterial concentrations on my hands between patients. But I resent administrative personnel threatening to revoke privileges of a credentialed health care provider on the basis of failure to hand-wash. I would counter that the expense of administering this program unnecessarily drives the expense for health care delivery through the roof at way too little return on the investment and like all such rules, how exactly will it betracked, enforced, and most important accepted by doctors?
Another concern for our student physicians - what a way to further disempower them and ingender further dehumanization of the patient-physician encounter! If a monitor is near, and the credentials threat were clear, perhaps it will be perceived as "safer" just not to enter a patient's room - just keep typing at your contaminated keyboard since Big Brother is watching you.
None of us want patients to suffer such infections, and hand-washing is a relatively inexpensive way to, perhaps, reduce spread of resistant organsisms, but doctors should demand of administrators that they treat us as professionals as much as we desire to do the right thing for our patients. That way, everybody wins. My preference: remove bureaucracy in favor of good, prudent, touching care.