Archive for November 2009

Guideline concordant therapy for HCAP

In this multi-institutional survey of 855 physicians, when presented with hypothetical patients with either community acquired (CAP) or health care associated (HCAP) pneumonia, 78% chose correct antibiotics for CAP, but only 9% chose correct antibiotics for HCAP. Continued education is needed to improve guideline concordance for patients with HCAP (abstract).

Why am I doing this?

Troy Ahlstrom writes... Assume one will question leadership’s motivation.  State your good intentions clearly and avoid allowing others to infer ill will. Last month, we ruminated on the foundation of credible leadership, integrity.  This month, we survey how we get from that foundation to actually carrying out a program as an organization.  The all important intermediary step is demonstration of intent.  Our intentions or motives comprise the inseparable link between who we are and what we must accomplish as leaders of an organization. (more…)

Incidental findings on chest CTA requiring follow up

In this single institution cross-sectional analysis of 589 chest CTA's ordered for suspected PE, only 9% had a PE, 33% had other findings to explain the symptoms, and 24% had an incidental finding that required follow up (primarily a new nodule or new adenopathy). Given that almost a quarter of patients that receive a CTA for PE will have an incidental finding requiring follow-up, systematic procedures for ensuring this follow-up will be required (abstract).

PE without DVT

In this observational cohort of 247 trauma patients who underwent both CTA (pulmonary arteries) and CTV (pelvic/leg veins), of the 46 with PE, only 7 (15%) also had a DVT. Possible explanations include complete embolism, insensitivity of CTV, upper extremity source, or de novo pulmonary artery thrombus. Regardless, a high percentage of trauma patients with PE will have no detectable DVT (abstract).

Jail Time for a Medical Error, Redux: The Case of Eric Cropp

Two years ago, I wrote about the case of Julie Thao, the Wisconsin nurse sent to prison for a medication error. I argued then that – although Julie bypassed some safety rules – she most certainly did not deserve jail time. Along comes another case involving jail time for a medical mistake, this one featuring an Ohio pharmacist named Eric Cropp. I became aware of Eric’s case through the efforts of Michael Cohen, the endlessly energetic president of the Institute for Safe Medication Practices (and 2005 winner of a MacArthur “Genius” Award), who has championed Eric's cause. Eric was the lead pharmacist at Cleveland’s Rainbow Babies and Children’s Hospital on February 26, 2006. The pharmacy, understaffed that day, received a rush order for chemotherapy for a 2-year-old girl, Emily Jerry, who was undergoing treatment for a spinal malignancy. An unlicensed and distracted (by press accounts, she was planning her wedding…