Archive for October 2010

Reading List: Halloween Edition

Public Policy Contributor Brad Flansbaum writes… I have come across some topical material that might have some interest for SHM blog readers and thought I would pass it along. It goes without saying, you can read it while “inspecting” your child’s trick or treat bag; just don’t get chocolate on the keyboard. (more…)

No need to repeat Cdiff PCR

In this large cohort of patients tested for Cdiff by PCR, repeat testing of patients (that were initially test negative) was rarely helpful, as 97.5% of the repeat tests were also negative. The authors recommend not to do repeat testing within 7 days, unless the patient has evidence of a new infection (abstract).

Hospital mortality declining in key conditions

According to the AHRQ, hospital mortality rates have significantly declined for CHF, AMI, pneumonia, and stroke, dropping 60%, 47%, 55%, and 35% respectively from 1994 to 2007. These are likely a result of improvements in process measures as mandated by regulatory agencies, so is very encouraging to witness the fruits of our collective labor (AHRQ report)

Cilostazol vs ASA for secondary stroke prevention

This industry funded trial randomized patients with recent stroke (with 6 months) to either cilostazol (100mg bid) or ASA (81mg qday) for a mean of 29 months. The incidence of stroke was significantly lower in the cilostazol group (Hazard ratio 0.74, CI 0.56-0.98), as was the incidence of bleeding (0.77% vs 1.78%). The issue with this drug is cost, BID dosing, and side effects (headache, diarrhea, palpitations, tachycardia, and dizziness). It remains to be seen if the cost and side effect profile outweigh the benefits (reduction of stroke and bleeding) (abstract)

Teamwork Training in Healthcare: More Than Just Kumbaya

One of the central tenets of the patient safety movement is that modern medicine is a team sport. Unfortunately, its players – particularly physicians – were trained and socialized to be free-spirited individualists. We need the Celtics of the 80s; what we have is a collection of young John McEnroes. While this theory has been generally accepted, there is less agreement regarding how to change things. When I speak about safety culture, many of the questions I’m asked focus on how we are going to train future generations of medical students and residents to be “different” (translation: not like the prima donnas I have to deal with in my daily practice). It’s as if people are fatalistic about the ability to transform the culture of today’s practitioners; perhaps the next crop of physicians will do, and be, better. Those of us who aren’t resigned to a biological solution to this…