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Supreme Court OKs Prescription Data Mining

Supreme Court OKs Prescription Data Mining

In late June, the U.S. Supreme Court ruled that individual states cannot ban drug manufacturers and data-mining companies from using information on the prescriptions most written by individual physicians. In a 6-3 vote, the court struck down Vermont’s Pharmaceutical Confidentiality Law, which was meant to boost generic drug use in order to control healthcare costs. According to Justice Anthony Kennedy, the law violates the free speech rights of drug makers and data mining companies. Writing on behalf of the court, he said “the state cannot engage in content-based discrimination to advance its own side of a debate,” adding that “speech in aid of pharmaceutical marketing … is a form of expression protected by the Free Speech Clause of the First Amendment.” Vermont’s Pharmaceutical Confidentiality Law — which prevents the sale of prescribing information for a specific physician without his or her permission — reached the higher court after a federal appeals court struck down the law. A separate appeals court, however, upheld similar laws in Maine and New Hampshire. Vermont argued that the law protected physicians’ privacy and could help control healthcare costs. The data-mining companies involved in the case (IMS Health, SDI, and Source Healthcare Analytics) maintained that  prescribing information could be used to monitor safety issues for new drugs, reduce costs, and aid research efforts. Physician’s Weekly wants to know… Where do you stand on the issue of prescription data mining? Do you feel it is a violation of physician privacy? Do you think prescription data mining can help keep tabs on drug safety? Do you think the prevention of data mining can help control healthcare costs...

Updated Guidelines for BPH

Benign prostatic hyperplasia (BPH) with bladder outlet obstruction has been shown to contribute to overall lower urinary tract symptoms (LUTS). The prevalence and severity of LUTS in aging men can be progressive. “The diagnosis and treatment of LUTS/BPH is important for healthcare and our aging society,” says Kevin T. McVary, MD. “The primary goal of treatment for BPH has been to alleviate bothersome LUTS that result from prostatic enlargement. More recently, treatment has further focused on the alteration of disease progression and prevention of complications that can be associated with BPH and LUTS.” Studies have estimated the prevalence of moderate-to-severe LUTS to rise to nearly 50% by the time men reach their 80s. Although LUTS that are secondary to BPH are not often a life-threatening condition, the impact can be substantial on quality of life and should not be underestimated. Many patients are motivated to seek treatment from their physicians when bothersome symptoms become severe. Revisiting Previous Guidelines In 2011, the American Urological Association (AUA) released an updated clinical guideline on the treatment of BPH. Dr. McVary, who chaired the panel that developed the guidelines, says that it is the first update by the AUA since 2003. “It updates current guidance on diagnosing and treating LUTS/BPH, which can impact the quality of life,” he says. “The demographic of our society continues to age, meaning the number of elderly men who suffer from LUTS will increase. This will increase demands for treatment services and require the incorporation of evidence-based medicine in treatment plans.” The update to the AUA guidelines (which are available at www.AUAnet.org) includes a detailed diagnostic algorithm to...

Assessing Risk for OSAS & Postoperative Complications

Obstructive sleep apnea syndrome (OSAS) is a disorder in which patients periodically stop breathing during sleep. Research suggests that OSAS occurs in approximately 5% to 9% of the general population, with obese men affected most often. Research also suggests that OSAS is common among patients undergoing surgery. Studies have observed an increased risk of postoperative complications in patients with OSAS when compared with control subjects. Others have demonstrated that postoperative complication rates increase as the number of episodes of overnight desaturation increase. “The related cardiorespiratory consequences may be exacerbated after surgical procedures because anesthetic agents and pain relievers decrease muscle tone in the upper airways,” explains Tajender S. Vasu, MD. “This can diminish control of breathing. As a result, it’s important to identify surgical patients who are at high risk for OSAS.” Nocturnal polysomnography is the standard for diagnosing OSAS. Home sleep testing has also gained increasing acceptance and offers advantages to nocturnal polysomnography because of convenience and cost. “Unfortunately, neither of these diagnostics is used extensively in preoperative assessment settings,” says Dr. Vasu. “Therefore, most preoperative patients with OSAS have not had their conditions diagnosed. This raises the potential for a negative effect on postoperative outcome.” The STOP-BANG Questionnaire Recently, the STOP-BANG questionnaire was validated as a screening modality for OSAS in the preoperative setting. The questionnaire—which is a mnemonic that stands for snoring, tiredness during daytime, observed apnea, high blood pressure, BMI, age, neck circumference, and gender—is a concise, self-administered, and easy-to-use questionnaire that consists of eight “yes or no” questions (Figure). A study published in the October 2010Archives of Otolaryngology–Head & Neck Surgery evaluated the clinical usefulness...

Incretin Therapies in Diabetes Care

Diabetes is an epidemic in the United States. According to the most recent CDC estimates, the disease affects approximately 25.8 million Americans, representing 8.3% of the total population. Over the course of several years, safer and more effective therapies and treatment options have emerged to improve patient management. A greater understanding of the pathogenesis of diabetes has led to the development of additional therapies to individualize treatment approaches. Examining the Incretin System Type 2 diabetes is a progressive disease that results from a complex process that includes declining b-cell function and insulin resistance. Other factors that play a role include unsuppressed glucagon and impaired incretin function. The role of the incretin system in diabetes has been studied for several decades, and therapeutic agents that target these hormones have become available. These incretin hormones are synthesized predominantly in the small bowel. The major incretins in humans are GLP-1 (glucagon-like polypeptide) and GIP (glucose-dependent insulinotropic polypeptide). These hormones can increase insulin secretion, reduce glucagon secretion, slow gastric emptying, and enhance early satiety, all of which may ultimately improve glucose homeostasis. “The glucose-lowering effects of incretin-based therapies can provide the most beneficial improvements if they’re used early in the course of treatment.” Native GLP-1 has a short half-life of approximately 3 minutes and is degraded by the dipeptidyl peptidase-4 (DPP-4) enzyme. Synthetic GLP-1 agonists are not degraded by this enzyme and provide pharmacologic levels of GLP. By achieving these levels of GLP-1, delayed gastric emptying and early satiety occurs. DPP-4 inhibitors delay the breakdown of endogenous GLP-1, and therefore provide levels of GLP-1 slightly higher than normal. Both of these agents lower...
Live Meetings Sway MDs to Screen for HSDD

Live Meetings Sway MDs to Screen for HSDD

After a series of live continuing medical education (CME) activities on female hypoactive sexual desire disorder (HSDD), primary care clinicians who previously did not screen for the disorder indicated they would incorporate such screening into their practices, according to a new study from Pri-Med. Prior to the activities, 41% of primary care clinicians did not screen for sexual dysfunction in female patients, and almost 75% reported they “sometimes/rarely/never” assessed their sexual health. However, following the activity, 61% of clinicians indicated they planned to regularly assess sexual health in their female patients, and 63% of clinicians reported they would incorporate open-ended patient questioning about sexual health into their practice. Pri-Med, a leading provider of professional medical education solutions to a community of more than 248,000 U.S.-based primary care clinicians, announced the study findings at the American College of Obstetricians and Gynecology 59th Annual Clinical Meeting, held April 30-May 4, 2011 in Washington, D.C. The live activities utilized a blend of multimedia delivery formats, including patient-physician video scenarios and interactive audience polling, to address the clinical care gaps. More than 3,100 clinicians participated in the activities in five major U.S. cities. The education intervention was sponsored and administered by pmiCME, LLC, Pri-Med’s accredited provider of education for medical, pharmacy, and nursing professionals. The content was created in collaboration with Athena Education Group, LLC, a recognized medical education company with expertise educating on women’s health issues. HSDD is an underrecognized and undertreated condition that is often overlooked by HCPs. (Frank 2008)  Women with HSDD currently receive inadequate health care in part because training in sexual medicine is absent and inadequate in most medical schools. ...
Coffee-Cardiovascular Disease Link Discounted in Women

Coffee-Cardiovascular Disease Link Discounted in Women

For years, physicians have recommended that patients with cardiovascular disease (CVD) avoid certain foods and beverages, especially those that are high in cholesterol, salt, fat, and caffeine. But the few studies that have looked at the link between drinking coffee and death have had conflicting results. An international team of researchers, who published their results in the July 2011 American Journal of Clinical Nutrition, set out to assess the association between filtered caffeinated coffee consumption and all-cause and CVD mortality. The authors assessed follow-up data over a 24-year period (1980-2004) in women with CVD from the Nurses’ Health Study. In 1980, coffee consumption was assessed in 11,697 women with a food-frequency questionnaire (FFQ). The FFQ was repeated every 2 to 4 years, with follow-up ending in 2004. Of 1,159 deaths observed among the study participants, 579 were due to CVD, according to the analysis. Here were the relative risks (RR) of all-cause mortality across categories of cumulative coffee consumption: Coffee Consumption RR of All-Cause Mortality <1 cup (240 mL or 8 oz) per month 1.00 1 cup per month to 4 cups per week 1.04 5-7 cups per week 1.13 2-3 cups per day 1.01 ≥4 cups per day 1.18 The relative risks of CVD mortality across the same categories of coffee intake were: Coffee Consumption RR of CVD Mortality <1 cup (240 mL or 8 oz) per month 1.00 1 cup per month to 4 cups per week 0.99 5-7 cups per week 1.03 2-3 cups per day 0.97 ≥4 cups per day 1.25 No association was seen between caffeine consumption and both total and CVD-related mortality. View...
Payment as Motivation for Reaching Health Goals Seen as Unfair

Payment as Motivation for Reaching Health Goals Seen as Unfair

Citizens of the United States and United Kingdom do not appear to approve of the idea of payment as motivation for changing health behaviors, according to study results published in the June 13, 2011 online edition of the Journal of Medical Ethics . The main objection, according to the analysis, is that this approach is unfair. Financial incentives are increasingly being used to motivate people to remain drug-free, to stick with weight-loss plans, and to quit smoking, but evidence is limited and conflicting on the success of these programs. British researchers performed a survey of nearly 188 residents of the U.S. and U.K. to gauge their thoughts on the topic. Survey participants were informed that two types of financial incentives (weekly rewards or penalties) and two medical intervention types (weekly pills or injections) were equally effective in improving outcomes in the following contexts: Weight loss. Smoking cessation programs. Treatment adherence in a drug addiction program. Treatment adherence in a serious mental illness program. Physiotherapy after surgery. They were then asked to rate the acceptability and fairness of the four interventions. Across all five contexts, financial incentives were deemed less acceptable and less fair than medical interventions. When comparing rewards to penalties, the researchers found that context played a role in preference. Both U.S. and U.K. participants preferred rewards over penalties for weight loss and treatment adherence for serious mental illness. Among U.S. participants, this “relative preference [was] moderated by perceived responsibility of the target group.” When members of the target group were less responsible for their health condition, participants more strongly supported funding for interventions. Download Study Results Physician’s...

The American Society of Hypertension 2011

New research presented at the annual scientific meeting of American Society of Hypertension from May 21-24 in New York City addressed important issues in the management of high blood pressure. The features below highlight just some of the studies that emerged from the meeting. » Managing Hypertension in the Elderly » Intensive BP Control, Fracture Risk, & Diabetes  » Overcoming Clinical Inertia  Managing Hypertension in the Elderly The Particulars: Aggressive treatment of older patients with hypertension has been largely avoided due to a lack of outcomes data and concerns over potential side effects by adding medications. Recent studies have helped begin a change in this mindset. Data Breakdown: Investigators conducted a study in 183,054 patients aged 70 and older with treated hyper­tension. Patients were separated into groups based on achieved systolic blood pressure (BP) at 6 months prior to death or last available measurement. Significantly increased rates of all-cause death were seen in those who achieved systolic BP measurements of 140 to 149 mm Hg (17%) and in those with systolic BPs of 150 mm Hg or higher (40%) when compared with those in lower BP ranges. Higher mortality rates were also associated with systolic BP measurements below 130 mm Hg, with relative increases ranging between 22% and 408%. Take Home Pearl: Among patients aged 70 and older, a systolic BP measurement of 130 to 139 mm Hg appears to be associated with the lowest mortality risk. Intensive BP Control, Fracture Risk, & Diabetes [back to top] The Particulars: Physicians have historically been concerned that intensive blood pressure (BP) control in high-risk patients with type 2 diabetes may increase the rate of falls,...
The Shifting Treatment Landscape in Atrial Fibrillation

The Shifting Treatment Landscape in Atrial Fibrillation

Atrial fibrillation (AF) is a disorder found in approximately 2.2 million Americans, and the number of people with AF in the United States is expected to double over the next 30 to 40 years (Figure). Published data have estimated that about 15% of all strokes occur in people with AF, and the risk factors for stroke in patients with nonvalvular AF are substantial. The likelihood of developing AF increases with age, and data suggest that 3% to 5% of people 65 and older have the condition. “AF impacts the elderly substantially because they typically have more comorbidities,” says Gerald V. Naccarelli, MD. “This has raised concern over how to manage these patients.” According to the National Heart, Blood, and Lung Institute, AF is more common in people with coronary heart disease, heart failure, rheumatic heart disease, structural heart defects (eg, mitral valve disorders), pericarditis, congenital heart defects, and sick sinus syndrome. AF also is more common in people with heart attacks or who have just had surgery. Other conditions that increase AF risk include hyperthyroidism, obesity, hypertension, diabetes, and lung disease (Table 1). “The increasing incidence of AF has raised awareness of the importance of stratifying stroke risk,” Dr. Naccarelli says. “The key for clinicians is to determine who should receive anticoagulation and who should not [Table 2]. Unfortunately, studies show that about half of people with AF who are candidates to receive vitamin K antagonists (VKAs), such as warfarin, are not receiving the drug. Of that half, only two-thirds of these patients are actually taking VKAs as prescribed.” Emerging Drugs VKAs, most notably warfarin, have long been used...
Massachusetts Healthcare Reform Law Gains Support

Massachusetts Healthcare Reform Law Gains Support

The Massachusetts health reform law—the principal piece of which is the requirement for all state residents to have health insurance—has acted as a guinea pig for the rest of country, but a new report shows that it has gained support in the last 2 years. According to a new poll by Harvard School of Public Health and The Boston Globe, support for the 2006-enacted legislation is up 10% since a 2009 poll, rising from 53% to 63% during the 3-year period. Of respondents to the current poll (conducted May 24-26, 2011), 21% opposed it, 6% said they weren’t sure if they support it, and 9% had not heard or read about the law. When asked if they wanted the law to continue during difficult financial times in the state, 74% said “yes,” with 51% saying they wanted it to continue with some changes and 23% wanting it to continue as is. Just 9% of residents were in favor of repealing the law, which was down 1% from the number of respondents who were in favor of a repeal of the law in the 2009 poll. At roughly the same time that the aforementioned poll findings were released, study results were printed in the May 13, 2011 online issue of Annals of Emergency Medicine that showed little impact on emergency department (ED) use in the state following implementation of the law. While low-severity ED visits—defined as those that could have been treated by a primary care physician—dropped slightly from 43.8% in 2006 to 41.2% in 2008, the total number of ED visits actually increased at the 11 hospitals included in...
Physicians’ Salaries a Drop in the Healthcare Bucket

Physicians’ Salaries a Drop in the Healthcare Bucket

Based on a compilation of data from the AMA, CMS, and Medical Group Management Association (MGMA), Jackson Healthcare—a healthcare staffing and technology company—has found that physician compensation accounts for only about 8% of total annual healthcare costs in the United States. In 2009, overall U.S. healthcare spending was $2.5 trillion, according to the latest estimates from CMS. Of that total, $505 billion accounts for physician and clinical services. Physician compensation accounted for 37% of total collections ($186 billion; 7.5% of total U.S. healthcare spending), according to MGMA. When Jackson Healthcare used the AMA’s most recent statistics on the number of physicians practicing in the United States along with 2009 salary figures from a 2010 MGMA report, it determined that the annual aggregate physician salaries total $216 billion, representing 8.6% of total U.S. healthcare costs. ”At 8% of total healthcare costs, if physicians worked for free, we would still have a serious cost problem,” said Richard Jackson, chairman and CEO of Jackson Healthcare. ”What this figure shows is that physician pay is not the primary contributor to healthcare costs.” Physician’s Weekly wants to know… In your opinion, what can be done to help spread the word to the public, and would doing so help alleviate negative perceptions about physicians in regard to salaries and reimbursement? What do you feel are the primary contributors to healthcare costs? What can be done to eliminate or reduce these costs, if...

Examining Chronic Cancer Pain in Survivors

Recent data from the National Cancer Institute suggest that more than 60% of people diagnosed with cancer will be alive within 5 years of their diagnosis, and about one in three individuals will experience cancer at some point in their life. Clinical studies have shown that many patients with cancer also experience significant pain, either from the cancer itself or from the treatments that are required to eliminate the disease. Most cancer survivors who have pain report that it is relieved only some of the time. The consequences of poorly treated pain are profound, ranging from poor sleep and mood to reduced function and even an increased risk of death. As Americans continue to age at an increasing pace, the incidence of pain accompanying cancer is expected to rise. The healthcare system is likely to be burdened substantially because of these important quality-of-life (QOL) issues. Trending Pain in Cancer Survivors In the May 1, 2011 issue of Cancer, my colleagues and I from the University of Michigan Health System published a study that examined cancer-related chronic pain and its impact on QOL in African-American and Caucasian cancer survivors. The study, which was sponsored by the Lance Armstrong Foundation, focused on current and past pain, health, and QOL in survivors of breast, colorectal, lung, and prostate cancer, as well as multiple myeloma. About one in five cancer survivors (19.5%) experienced current pain, and two in five (42.6%) reported pain within the past 2 years since being diagnosed with their cancer. The pain was worse for African Americans and women than for Caucasians and men. “When necessary and appropriate, both pharmacologic and...

The American Psychiatric Association 2011 Annual Meeting

The American Psychiatric Association’s 2011 annual meeting was held May 14-18 in Honolulu. The features below highlight some of the news emerging from the meeting. » Depression Screening May Reduce Future Clinic Visits » Examining Atypical Antipsychotic Use in Children » Sulfonylureas May Have Antidepressant Effects » Type of Media Affects Sleep Patterns for Teens » Views on Depression From PCPs & Psychiatrists  Depression Screening May Reduce Future Clinic Visits The Particulars: The United States Preventive Services Task Force has recommended screening patients with certain physical diagnoses for depression on the basis of previous studies showing an increased risk. However, little evidence is available demonstrating that these screenings lead to improved outcomes. The recommendation has recently been criticized for its lack of proven cost-effectiveness. Data Breakdown: Researchers screened patients with certain physical diagnoses—including cardiovascular diseases, type 2 diabetes, COPD, and obesity—for depression. The PHQ-9 was administered to study participants. Patients whose screening results indicated at least mild depression showed no significant difference in the number of visits during the following year, compared with the year before. However, among those with negative screenings, the average number of visits declined after the screening. In the year before screening, the average number of clinic or hospital visits was 2.8 for non-depressed patients, compared with 2.7 after the screening. About 30% of positive screens led to actual contact with a nurse or psychiatrist. Among patients who had follow-up engagement, 44% had full remission and 29% had significant improvement in PHQ-9 scores. Take Home Pearls: Depression screening in patients with chronic physical diseases appears to reduce subsequent clinic visits. However, more research is needed as this finding...
Malpractice Payments at All-Time Low?

Malpractice Payments at All-Time Low?

A report from Public Citizen, a self-touted advocacy group, finds that both the frequency and value of medical malpractice payment appeared to drop for the seventh straight year in 2010. The report notes that they decreased to the lowest level on record by most measures. Based on an analysis of newly released data from the National Practitioner Data Bank, Public Citizen says that 10,195 payments for medical malpractice were made in 2010, totaling about $3.35 billion. However, the report has been criticized by some, particularly tort reform supporters. These individuals say that Public Citizen’s conclusions are based on skewed information. Judge the full report for yourself on the Public Citizen site, and then give us your thoughts on the findings. Physician’s Weekly wants to know… Do you feel that Public Citizen’s information is accurate, or do you feel the data is skewed? Does Public Citizen have anything to gain by using skewed data? Why would the American Medical Association and Physician Insurers Association of America dispute this data? Do you think malpractice litigation is a cost-driver in healthcare? Do you think malpractice payments are...
Migrants’ Health Needs at Odds with National Policies

Migrants’ Health Needs at Odds with National Policies

According to the first article in a six-part series from PLoS Medicine, attention to migrants’ health remains limited. Even in places where migration health policies exist, “they operate primarily in isolation at national levels and cover only fragmented snapshots of people’s movement, with few binding regional or global health protection agreements to respond to the true scope of contemporary migration,” write the study authors. Researchers in the PLoS Medicine study paid particular attention to what they call a chasm between those who provide health services to migrants and those who make policies regarding migrants’ rights. “At the same time that clinicians are treating more diverse migrant groups, policymakers are attempting to implement restrictive or exclusive immigration-related health policies that contradict public health needs and undermine medical ethics that operate on the ground,” they stated. For these reasons the research team—which is from Britain—reported that development and implementation of policies that respond to migrant groups’ diversity, differential health risks, and service access are needed. To make real advances in the protection of both individuals and public health, interventions must target each stage of the migration process and reach across borders, they added. Services should be based on human rights principles that foster accessible care for individual migrants. Take a look at the full article, and tell us what you think. Physician’s Weekly wants to know… Does the report seem valid to you, and if so, how should it be interpreted? Do you think it is time for decision-makers from the migration and health sectors to sit at the same table with those from other sectors like those in development, humanitarian...

Strategies to Manage Traction-Table Complications

Traction tables are used in different types of procedures for the hip and femur, including fracture fixation, hip arthroscopy, and less-invasive arthroplasty. Although there is a relatively low incidence of traction table-related complications, usage is not without risks. Complications range from the relatively benign, such as transient post­operative groin numbness, to the catastrophic and life-threatening, such as injuries to the perineal integument and soft tissues, neurologic impairment, and iatrogenic compartment syndrome of the well leg. Although severe events are rare, they have serious implications to patient safety. Reviewing the Current Literature In the November 2010 Journal of the American Academy of Orthopaedic Surgeons, my colleagues and I published a review that assessed the medical literature relating to traction-table complications after surgery. In our analysis, several key themes emerged. First, greater awareness by surgeons of these events—especially for potentially catastrophic events—is critical to improving patient safety and quality. Second, certain positions on traction tables should be avoided—especially the hemilithotomy position—to avoid complications. Third, efforts should be made to ensure that positioning and draping permit ongoing evaluation of the uninjured extremities and the overall condition of patients. For example, reduce the use of shower curtains or drapes since these make it difficult for surgeons to see the well leg or check the abdomen in trauma patients. “Although there is a relatively low incidence of traction-table related complications, usage is not without risks.” Specific types of patients and situations can increase the likelihood of traction-table complications. Patients with complex fracture patterns and older individuals appear to be at greater risk for these complications. Complex fractures often require longer surgery durations. This can put...

Physical Activity Recommendations for Patients With Diabetes

This Physician’s Weekly feature on physical activity recommendations for patients with diabetes was completed in cooperation with the experts at the American Diabetes Association. The CDC estimates that 25.8 million Americans have diabetes and another 79 million have prediabetes, a condition characterized by A1C, fasting glucose, or oral glucose tolerance levels that are higher than normal but not high enough to be classified as diabetes. Research has shown that regular physical activity (PA) may prevent or delay diabetes and its complications, but most people with type 2 diabetes are not physically active. “PA is central to the management and prevention of type 2 diabetes and prediabetes,” says Sheri R. Colberg, PhD, FACSM. “It helps treat associated glucose, lipid, and blood pressure control abnormalities, and aids in weight loss and weight maintenance.” She adds that medications used to control type 2 diabetes should augment lifestyle improvements rather than replace them. Help for Healthcare Providers In the December 2010 issues of Diabetes Care and Medicine & Science in Sports & Exercise, the American Diabetes Association and the American College of Sports Medicine issued guidelines on exercise for people with type 2 diabetes as a joint position statement. The recommendations, which were developed by Dr. Colberg and a panel of experts, are the first that were created jointly with the two organizations. They incorporated evidence-based data from published clinical studies and trials into the recommendations. “The presence of diabetes complications should not be used as an excuse to avoid participation in PA.” “Research has established the importance of PA to health for all individuals, but these guidelines provide specific advice for those whose diabetes may limit vigorous or other...
Nation "Drowning" in Swimmer’s Ear Costs

Nation "Drowning" in Swimmer’s Ear Costs

According to the CDC’s May 20, 2011 Morbidity and Mortality Weekly Report, nonhospitalized acute otitis externa (AOE) visits cost the United States healthcare system as much as $500 million each year and about 600,000 clinician hours annually. Looking at national ambulatory care and emergency department databases, the study found that in 2007, an estimated 2.4 million visits (8.1 per 1,000 population) resulted in an AOE diagnosis. The researchers conducting the study estimated that 1 in 123 people was affected by AOE during 2007, accounting for 1 in 324 emergency department visits and 1 in 481 ambulatory care visits. From 2003 to 2007, the highest estimated annual rates of ambulatory care visits for AOE were among those between the ages of 5 and 9 years (18.6%) and aged 10 to 14 (15.8%). That’s not to say that children are the only ones affected by AOE; 53% of visits were among those aged 20 and older (5.3%). Gender didn’t seem to play a role, with women accounting for 54% of AOE visits. Aside from a larger proportion of AOE visits among those aged 20 to 39, similar demographic distribution was seen among emergency department visits. Naturally, incidence was highest during summer months—when Americans are most likely to be swimming—and in states in the South (9.1%, compared with 4.3% in the West), where weather is more likely to be warm and humid. Rates did not differ between rural and urban areas. The authors of the study noted that AOE is easily preventable. What can physicians do to help their patients prevent these occurrences? Based on suggestions from the CDC, it behooves physicians...
Surgeons Don’t Need Sleep, Do They?

Surgeons Don’t Need Sleep, Do They?

A 6-year prospective study from a team of Canadian researchers has found no evidence that the length of sleep for consultant surgeons during the night before performing a surgery has an effect on postoperative outcomes. The finding is based on information collected between January 2004 and December 2009 on sleep hours of six consultant surgeons aged 32 to 55 who worked in the London Health Sciences Centre in Ontario. The prospective study cohort consisted of patients undergoing coronary artery bypass, valve, combined valve-coronary artery bypass, and aortic surgery. Michael Chu, MD, and colleagues used their own institutional multivariable model to calculate predicted risk of death and/or any of 10 major complications: 1. Use of postoperative intra-aortic balloon pump. 2. Stroke or delirium. 3. Reoperation for bleeding. 4. Arrest or permanent pacemaker. 5. New renal failure. 6. Septicemia. 7. Mediastinitis. 8. Sternal dehiscence. 9. Respiratory failure. 10. Postoperative myocardial infarction. The interaction among surgeon age, sleep hours, and postoperative outcomes was examined using additional pre-specified analyses. The study group split 4,047 consecutive surgeries into those performed by a consultant who received 0 to 3 hours of sleep (83), 3 to 6 hours of sleep (1,595), or more than 6 hours of sleep (2,369). For the three groups, mortality rates were 3.6% (3), 2.8% (44), and 3.4% (80), respectively. Observed versus expected major complication ratios were similar: 1.20 in the 0 to 3 hours group, 0.95 in the 3 to 6 hours group, and 1.07 in the 6 hours or more group. Additionally, no significant links were seen between surgeon age, hours of sleep, and occurrence of death or any major...

Reducing Cardiovascular Medication Errors

In-hospital medication errors contribute significantly to the estimated 44,000 to 98,000 deaths that are caused each year by medical errors. Cardiovascular medications are one of the most common drug classes that have historically been associated with medication errors. Hospitals have improved since a 2002 medications error position statement was released by the American Heart Association (AHA), most notably advances in electronic medical records and procedures to avoid confusing “look-alike” and “sound-alike” drugs at the prescription, pharmacy, and administration levels.  “It’s everyone’s responsibility to be vigilant and ensure that the right patient receive the right medication, the right dose, and the right delivery route.” While modest improvement has occurred, other areas are still lacking enhancements. For example, the ED is an area where it’s easy for clinicians to make medication errors because of the speed at which patients receive care. Older patients are often at higher risk because of age-related changes in how their bodies metabolize drugs. They may also take multiple medications, many of which can interact with cardiovascular drugs. Furthermore, there continues to be errors made in the fields of stroke—because of the use of blood thinners and anti-clotting drugs—and cardiac catheterization, where problems frequently occur as patients are transitioned from departments within the hospital. 8 Critical Recommendations In the April 13, 2010 issue of Circulation, an AHA writing committee released a new scientific statement to help reduce medication errors among hospitalized heart and stroke patients. Eight recommendations were unveiled for medication safety in acute cardiovascular care: 1. An accurate weight should be obtained on admission. 2. Estimated creatinine clearance should be calculated with the Cockcroft-Gault formula on admission and as...
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