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Open access

NEWS - Patient Safety & Quality

Good Documentation – JAMA (free for a limited period)

“In this narrative medicine essay, the author, who transitioned from paper and pen to computer-generated electronic health record keeping wonders whether the self-select menu items ultimately dehumanizes both the patient and the physician.” (via @JAMA_current see Tweet)

 


Abraar Karan: Changing the way we communicate about patients – The BMJ Opinion (free) (via @NUNESDOC)

“Father of 2, retired car salesman and keen on football NOT the colon cancer in Bed 4 – social history brings humanity back to the bedside” (via @hospicedoctor see Tweet)

 


Using a New EHR System to Increase Patient Engagement, Improve Efficiency, and Decrease Cost – NEJM Catalyst (free)

“Another solution might be to capitalize on patients’ vested interest in their own health care by actively engaging them in the entry of their own medical history information into the EHR.”

 


Opinion: Lessons for physicians from ‘The Bleeding Edge’: If you see something, say something – STAT (free)

“…physicians must act decisively when they identify the rare outlier in their midst. To do anything less would risk our credibility. Worse still, it could risk the lives of the people we took an oath not to harm.”

 


A Multicenter Study of Patient-Reported Infectious and Noninfectious Complications Associated With Indwelling Urethral Catheters – JAMA Internal Medicine (free)

Commentary: Foleys Aren’t Fun: Patient Study Shows Catheter Risks – University of Michigan, via NewsWise (free)

“More than half of patients surveyed while they had a urinary catheter, and again weeks later, reported a complication – and infections were only part of the problem” (from NewsWise)

 


Out-of-hours discharge from intensive care, in-hospital mortality and intensive care readmission rates: a systematic review and meta-analysis – Intensive Care Medicine (free)

Source: Critical Care Reviews Newsletter

“Out-of-hours discharge from an ICU is strongly associated with both in-hospital death and ICU readmission. Whether these increases in mortality and readmission result from patient differences, differences in care, or a combination remains unclear”.

 


A sleep prescription for medicine – The Lancet (free registration required)

“Junior doctors working a 34 h shift will make 460% more diagnostic mistakes than when well rested. Matthew Walker asks how can we change the culture of sleep within medicine?” (via @TheLancet see Tweet)

 


Rapid Recommendations: Atraumatic (pencil-point) versus conventional needles for lumbar puncture: a clinical practice guideline – The BMJ (free)

We issue a strong recommendation for use of atraumatic needles in all patients (adults and children) undergoing lumbar puncture because they decrease complications and are no less likely to work than conventional needles”

 


Trying to Put a Value on the Doctor-Patient Relationship – The New York Times (10 articles per month are free)

“In its push for profits, the U.S. health care system has made it difficult for patients to get personal attention from doctors. But what if hands-on medicine actually saves money — and lives?”

 


SAVE LIVES: Clean Your Hands 5 May 2018 – World Health Organization Campaign (free guidelines, implementation tools, infographics, videos and more)

“It’s in your hands – prevent sepsis in health care”

 



New Guide to Infection Control in The Hospital – International Society for Infectious Diseases (free)

A free, online resource on the principles and interventions needed to reduce healthcare associated infections, with suggested control measures across different resource levels.

 


Opioid Wisely – Choosing Wisely Canada (free)

Related Guideline: Guideline for opioid therapy and chronic noncancer pain – Canadian Medical Association Journal (free)

See complete lists from Choosing Wisely U.S. / Choosing Wisely UKChoosing Wisely Australia AND Choosing Wisely Canada

This campaign encourages thoughtful conversation between clinicians and patients to reduce harms associated with opioid prescribing, with recommendations relevant to different specialties.

 


Patterns and Predictors of Short-Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study – Journal of Hospital Medicine (free PDF)

Commentary: Short-term use of IV devices is common — and risky — study shows – University of Michigan, via ScienceDaily (free)

“Intravenous devices known as PICCs should be reserved for long-term use, but a new study shows 1 in 4 are used for 5 days or less” (from ScienceDaily)

 


Compassionate leadership has a pivotal role in tackling bullying in healthcare – The BMJ Opinion (free)

“Negative staff experiences are often a precursor for negative patient experiences”.

 


Editor’s Choice: There but for the grace of God . . . – The BMJ (free)

About liability and error in medical practice.

 


E-learning for health professionals – Cochrane Library (link to abstract – $ for full-text)

 


Weekend Surgical Care and Postoperative Mortality: A Systematic Review and Meta-Analysis of Cohort Studies (free)

Commentary: Evidence Supports ‘Weekend Effect’ for Mortality after Surgery – Wolters Kluwer, via NewsWise (free)

“The odds of postoperative mortality were 27 percent higher for patients admitted to the hospital on Saturday or Sunday, compared to those hospitalized on a weekday” (from NewsWise).

 


Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis – BMC Medicine (free)

Commentary : Age itself is not a risk factor for complications after surgery among older patients – OnMedica (free)

“Q: What predicts poor outcome after elective surgery in older people?

A: Frailty, cognitive impairment, depression, smoking but NOT age per se”. (via @trishgreenhalgh see Tweet)

 


Can Your Hip Replacement Kill You? – The New York Times (10 articles per month are free)

“Lawsuits are pulling back the curtain on what some doctors call the Wild West of medicine: the untested and largely unregulated medical device industry” (via @NYTHealth see Tweet)

 


What physicians can do about ransomware – ACP Hospitalist (free)

“Protecting a practice doesn’t always require a large investment of money, just time and employee training”.

 


Meta-analysis of Interventions to Reduce Adverse Drug Reactions in Older Adults – Journal of the American Geriatrics Society (link to abstract – $ for full-text)

“Interventions designed to optimize medication use reduced the risk of any and serious ADRs in older adults. Implementation of these successful interventions in healthcare systems may improve medication safety in older adults”.

 


Why American doctors keep doing expensive procedures that don’t work – VOX (free)

“The proportion of medical procedures unsupported by evidence may be nearly half”.

 


The struggle to do no harm in clinical trials – Nature (free)

“The struggle to do no harm: the unexplained deaths in #cancer immunotherapy trials” (via @EricTopol see Tweet)

 


Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently – NIHR Signal (free)

Original article: Comprehensive geriatric assessment for older adults admitted to hospital – Cochrane Library (free summary – $ for full-text) AND News Release: Comprehensive geriatric assessment for older adults admitted to hospital (free)

“Comprehensive assessment when older people are in hospital improves their chances of getting home and living independently” (RT @NIHR_DC see Tweet)

 


Outcomes In Two Massachusetts Hospital Systems Give Reason For Optimism About Communication-And-Resolution Programs – Health Affairs (link to abstract – $ for full-text)

Commentaries: After medical error, apology goes a long way – Stanford University Medical Center, via ScienceDaily (free) AND Conflict Resolution Program: ‘Cause for Optimism’ – MedPage Today (free registration required)

 


Concurrent bariatric operations and association with perioperative outcomes: registry based cohort study – The BMJ (free)

“Concurrent bariatric operations occurred infrequently, but when they did, there was no observable increased risk for adverse perioperative outcomes compared with non-concurrent operations”.

 


Comprehensive geriatric assessment for older adults admitted to hospital – Cochrane Library (free)

Original article: Comprehensive geriatric assessment for older adults admitted to hospital – Cochrane Library (link to abstract – $ for full-text)

Related: Comprehensive assessment may reduce risk of delirium after hip fracture – NIHR Signal (free)

“Older patients are more likely to be alive and in their own homes at follow-up if they received comprehensive geriatric assessment on admission to hospital”.

 


Comprehensive assessment may reduce risk of delirium after hip fracture – NIHR Signal (free)

Original article: Comprehensive Geriatric Assessment for Prevention of Delirium After Hip Fracture: A Systematic Review of Randomized Controlled Trials – Journal of The American Geriatrics society (link to abstract – $ for full-text)

“Comprehensive geriatric assessment reduced the risk of delirium by 20% in patients having hip fracture surgery” (RT @NIHR_DC see Tweet)

 


Factors Associated With Choice of Infant Sleep Position – Pediatrics (free)

Commentaries: Less than half of mothers place sleeping infants supine – 2 Minute Medicine (free) AND Most moms aren’t putting babies to sleep safely, study says – CNN (free) AND Less Than Half of Mothers Report Always Putting Babies to Sleep in Supine Position – Physician’s First Watch (free) AND Parents still failing to put babies to sleep on their backs – Reuters (free)

Placing infants in the supine position for sleep reduces the risk of sudden unexpected infant death and has been recommended by the American Academy of Pediatrics since 2005. Nevertheless, in this survey only 43,7% of mothers placed their infants exclusively in supine position for sleep.

 


When surgery is just a stitch-up – The Guardian (RT @Onisillos  see Tweet)

Related article: Use of placebo controls in the evaluation of surgery: systematic review – The BMJ (free)

“With evidence mounting that many minor operations owe their success to the placebo effect, is it time to call a halt to some routine procedures?”

 


Acute Kidney Injury After Computed Tomography: A Meta-analysis – Annals of Emergency Medicine (link to abstract – $ for full-text)

Commentary: When kidneys are injured, CT contrast isn’t the culprit – Health Imaging (free)

Related article: Risk of Acute Kidney Injury After Intravenous Contrast Media Administration – Annals of Emergency Medicine (free)

Source: Hospital Medicine Virtual Journal Club

Compared with noncontrast CT, contrast-enhanced CT was not significantly associated with either acute kidney injury, need for renal replacement therapy, or all-cause mortality.

 


Updated: Practice Parameters and Technical Standards – American College of Radiology (free)

News release: New, Revised Guidance Documents Cover 35 Radiology Topics – American College of Radiology, via NewsWise (free)

The American College of Radiology developed 3 new guidance documents and revised 32 others to advance the science of radiology and improve the quality of service to patients

 


Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis – PLOS One (free)

This systematic review and meta-analysis mostly of observational studies suggests early breastfeeding initiation is associated with increased survival. The authors acknowledge that there are many reasons for delayed breastfeeding initiation that may confound the relationship between breastfeeding initiation and mortality, but remember that randomized trials would not be considered ethical, so we must rely on high quality observational data. Based on their analysis, the authors suggest the implementation of programs that emphasize the importance of early initiation of breastfeeding, in addition to promoting exclusive breastfeeding.

 


What do hypnotics cost hospitals and healthcare? – F1000 Research (free)

Source: Hospital Medicine Virtual Journal Club

“A best estimate is that U.S. costs of hypnotic harms to healthcare systems are on the order of $55 billion, but conceivably might be as low as $10 billion or as high as $100 billion”.

 


A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission – BMJ Open (free) (RT @NIHR_DC)

Alternatives to hospital admission for people aged over 65 years can be safe and reduce costs across a range of acute and chronic conditions.

 


Too Many Meds?

5 Aug,2017

Too Many Meds? America’s Love Affair With Prescription Medication – Consumer Reports (free)

See more on “Deprescribing” in our May 8th issue (see #7), May 9th issue (see #4) and May 15th issue (see #2), and also a related article on Current and future perspectives on the management of polypharmacy

“Yes. Way Too Many Meds. Think De-prescribe”. (RT @EricTopol see Tweet)

 


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