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Large-scale adverse events deserve disclosure, study says
Hospitals, physician practices and other health care organizations should disclose adverse events that affect numerous patients, even when most patients may not be harmed, a new study shows. These large-scale adverse events -- usually involving poor infection-control practices or defective equipment -- are ones in which some patients may experience harm while most escape unfavorable consequences, said the study, published Sept. 1 in The New England Journal of Medicine. "We think disclosure should occur in virtually every case," said study lead author Denise M. Dudzinski, PhD, associate professor in the Dept. of Bioethics and Humanities at the University of Washington School of Medicine. "There are some cases in which the risk of harm is higher, and there's a greater obligation to disclose, because of the high likelihood that some patients will need treatment." There also may be "a higher obligation to disclose if the case involved a breakdown that was a deviation from standard [Read more]
20-state health reform lawsuit likely to go forward
A federal judge says he is likely to rule that a 20-state lawsuit against the national health reform has legal grounds to go to trial. Attorneys for the federal government asked U.S. District Judge Roger Vinson of the Northern District of Florida to dismiss a lawsuit filed by a coalition of 20 states. They argued that the lawsuit is premature because states cannot prove they will be harmed by the health reform law's requirement for individuals to have health insurance, which takes effect in 2014. The states' complaint asks the court to block the individual insurance requirement because they argue that Congress does not have the constitutional authority to penalize citizens for not having health insurance. After hearing arguments from both sides on Sept. 14, Vinson said he would rule on the motion to dismiss the lawsuit as soon as Oct. 14, said Ryan Wiggins, spokeswoman for Florida Attorney General Bill McCollum, one of the attorneys arguing the states' case. She said McCollum doe [Read more]
Diet and exercise counseling may help prevent recurrent strokes
Treating patients with metabolic syndrome and counseling them on diet, exercise and weight loss might help prevent a recurrent stroke or a transient ischemic attack, according to new recommendations by the American Heart Assn. and the American Stroke Assn. The secondary stroke prevention guidelines were published online Oct. 21 in the AHA's journal Stroke. The recommendations, updated from 2006, aim to prevent recurrent incidents in stroke survivors and patients who had transient ischemic attacks. Suggestions for metabolic syndrome are among the key updates for primary care physicians, said AHA President Ralph Sacco, MD. Metabolic syndrome is characterized by a group of risk factors, including abdominal obesity, elevated blood pressure and insulin resistance. The syndrome increases patients' risk for vascular disease and affects about half of those who have an ischemic stroke, according to the guidelines. "We want clinicians to begin to recognize [metabolic syndrome], to know [Read more]
Reforming Medicare payment system creates divide among doctors
While the majority of physicians agree that Medicare payments are inequitable and unfair, there is little consensus about how to reform the system, according to a study published in the Oct. 25 Archives of Internal Medicine. Researchers examined survey responses from 1,222 physicians. Nearly 80% of respondents indicated that Medicare payments are unsatisfactory. Among doctors who accepted Medicare, 40% "strongly agreed" and 38% "somewhat agreed" that under Medicare some procedures are compensated too highly and others are compensated at rates insufficient to cover costs. Of the three payment reform proposals researchers asked about, physicians showed the highest support for the use of incentives to improve quality ( Regarding cost-shifting of payments, 42% supported it, while 46% opposed it. Most doctors supported a shift in payments toward counseling and management compared with only 17% of surgeons. Support for shifting p [Read more]
Surgical diversity initiative has double bonus
A commercially sponsored training program designed to help minority physicians improve their odds of landing competitive fellowship training spots also has meant that more minority graduates are pursuing academic medicine, a new study shows. Of the 42 graduates of the Diverse Surgeons Initiative now in practice, 57% hold positions as full-time faculty members in academic surgery departments, according to the study published in the October Journal of the American College of Surgeons. Experts have pointed to the lack of diversity among medical school faculty as one reason why there is a shortage of minority physicians. "Our main goal for this program was to provide qualified underrepresented minority residents with the fundamental skills that would enable them to excel in their surgical careers," said Paris D. Butler, MD, MPH, the study's lead author and surgical resident at the University of Virginia Health System in Charlottesville. "There are many potential factors for the short [Read more]
Routine depression screenings of teens could prevent recurrence, study finds
Conducting regular depression screenings for adolescents who have had major depressive disorder could prevent the condition from recurring, according to new research. A study published online Nov. 1 in the Archives of General Psychiatry found that nearly all adolescents treated for major depression will recover. But almost half will have a recurrence within five years. The findings indicate "that there's a very high chance a person is going to get better. ... Doctors can convey that hopefulness to families and patients. But physicians have to be aware that [depression] could occur again," said lead study author John Curry, PhD, professor of medical psychology in the Dept. of Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, N.C. Curry encourages physicians to screen such patients for depression symptoms, such as trouble sleeping and eating, during regular office visits. Major depressive disorder is one of the most prevalent psychiatric conditions [Read more]
Long shifts, nights on call lead to depression and burnout in surgeons
The more hours surgeons work each week, the more depressed and burned out they are, according to newly published survey data. Surgeons working 80 hours or more a week had the most problems. Nearly 40% reported being depressed, and more than 10% said they made a major medical error in the last three months, said the study, published in the November Journal of the American College of Surgeons. Nearly two-thirds of the surgeons who worked 80 hours a week said they had conflicts between work and personal obligations in the last three weeks. "There was a highly significant correlation with increasing hours and increasing nights on call associated with a detrimental impact on surgeons in almost every setting, both professionally and personally," said the study, based on a 2008 survey of 7,905 U.S. surgeons. "These trends were statistically significant in virtually every parameter surveyed: increased burnout rate, decreased quality of life, decreased career satisfaction, and increased w [Read more]
Vitamin D and exercise may help prevent falls in elderly
Prescribing a vitamin D supplement and recommending exercise for patients 65 and older could reduce their risk of falling, according to a recent evidence review. The review, published in the Dec. 21, 2010, issue of Annals of Internal Medicine, was commissioned by the U.S. Preventive Services Task Force to help the agency update its recommendation for preventing falls in the elderly. Before the guidelines are published, a draft will be posted for public comment online. The task force does not have recommendations on primary care physicians counseling patients on fall prevention. But in 1996, the task force reviewed the effectiveness of counseling to prevent household and recreational injuries, including falls, by age group. "There are interventions that are successful in preventing falls in older adults. ... That's important news, because falls are so common" in this age group, said lead review author Yvonne Michael, ScD, associate professor in the Dept. of Epidemiology and Bio [Read more]
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