A free, online resource on the principles and interventions needed to reduce healthcare associated infections, with suggested control measures across different resource levels.
Related Guideline: Guideline for opioid therapy and chronic noncancer pain – Canadian Medical Association Journal (free)
This campaign encourages thoughtful conversation between clinicians and patients to reduce harms associated with opioid prescribing, with recommendations relevant to different specialties.
Policy Statement: Pediatric Medication Safety in the Emergency Department – American Academy of Pediatrics (free)
Commentaries: Recommendations Issued on Reducing Pediatric Medication Errors in the ED – NEJM Physician’s First Watch (free) AND Policy statement outlines ways to improve pediatric medication safety – 2 Minute Medicine (free)
Related Systematic Review: Identifying older adults at risk of harm following elective surgery: a systematic review and meta-analysis – BMC Medicine (free) AND Commentary: Age itself is not a risk factor for complications after surgery among older patients – OnMedica (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)
“Negative staff experiences are often a precursor for negative patient experiences”.
Prevalence and Economic Burden of Medication Errors in The NHS in England. Rapid evidence synthesis and economic analysis of the prevalence and burden of medication error in the UK – Policy Research Unit in Economic Evaluation of Health & Care Interventions (EEPRU) (free PDF)
Commentaries: More than 200 million medication errors occur in NHS per year, say researchers – The University of Sheffield News (free) AND Drug errors cause appalling harm and deaths, says Hunt – BBC (free)
The association between patient experience factors and likelihood of 30-day readmission: a prospective cohort study – BMJ Quality & Safety (link to abstract – $ for full-text)
Commentary: Higher patient satisfaction linked to lower readmissions – Modern Healthcare (free)
Opioid Analgesic Use and Risk for Invasive Pneumococcal Diseases: A Nested Case–Control Study – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Opioids may be associated with increased risk for serious invasive pneumococcal infections – ACP Internist (free) AND Opioids For Pain Can Exacerbate Pneumococcal Infections – MedicalResearch.com (free) AND Prescription Opioid Use Tied to Higher Pneumonia Risk – MedPage Today (free registration required)
Original article: Are quality improvement collaboratives effective? A systematic review – BMJ Quality & Safety (link to abstract – $ for full-text)
Editor’s Choice: There but for the grace of God . . . – The BMJ (free)
About liability and error in medical practice.
Related study: Working with influenza-like illness: Presenteeism among US health care personnel during the 2014-2015 influenza season – American Journal of Infection Control (link to abstract – $ for full-text) AND Commentaries: Working while sick – ACP Internist (free) AND Health worker survey reveals many work during flu illness – CIDRAP (free)
Related Infographic: Date Night with the EHR – NEJM Catalyst (free)
Related Commentary: Why Physician Burnout Is Endemic, and How Health Care Must Respond – NEJM Catalyst (free)
Commentaries: Clinical Pharmacist Intervention Can Reduce ED Visits and Hospital Readmissions – MedicalResearch.com (free) AND Pharmacist-led extended medication review and follow-up on discharge may decrease risk of readmission – 2 Minute Medicine (free)
Association Between Handover of Anesthesia Care and Adverse Postoperative Outcomes Among Patients Undergoing Major Surgery – JAMA (link to abstract – $ for full-text)
Commentary: Anesthesia Care Hand Off Mid-Surgery Associated With Substantial Risk – MedPage Today (free registration required) AND Complete Handoffs by Anesthesiologists Tied to Poor Outcomes – Medscape (free registration required)
Original article: Prolonged versus short-term intravenous infusion of antipseudomonal β-lactams for patients with sepsis: a systematic review and meta-analysis of randomised trials – The Lancet Infectious Diseases (link to abstract – $ for full-text)
Related Guideline: SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment – Task Force on Sudden Infant Death Syndrome, American Academy of Pediatrics (free)
Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era – Institute for Healthcare Improvement (free registration required)
Commentary: ACP endorses guidelines on patient referrals – ACP Internist (free)
Perspectives: To Care Is Human — Collectively Confronting the Clinician-Burnout Crisis – New England Journal of Medicine (free) AND Beyond Burnout — Redesigning Care to Restore Meaning and Sanity for Physicians (free)
Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends – Journal of the American College of Cardiology (link to abstract – $ for full-text)
See also a recent meta-analysis showing the “weekend effect” in surgical patients
Commentaries in the same issue: Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services: A Significant Step Forward and a Model for Other High-Risk Industries (free) AND What an Evidence-based Guideline for Fatigue Risk Management Means for Us: Statements From Stakeholders (free) AND Proposed Performance Measures and Strategies for Implementation of the Fatigue Risk Management Guidelines for Emergency Medical Services (free) AND Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services: A Step in the Right Direction Toward Better Sleep Health (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).
Commentaries: Older adult-friendly emergency department staff help reduce hospital admissions – American Geriatrics Society, via EurekAlert (free) AND Emergency department program for older adults cuts hospitalizations by 33 percent – Northwestern University, via EurekAlert (free)
“Q: What predicts poor outcome after elective surgery in older people?
Can Your Hip Replacement Kill You? – The New York Times (10 articles per month are free)
“Protecting a practice doesn’t always require a large investment of money, just time and employee training”.
Related White Paper: Achieving Hospital-wide Patient Flow: The Right Care, in the Right Place, at the Right Time – Institute for Healthcare Improvement (free registration required – PDF)
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”.
Original article: Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review – Journal of Advanced Nursing (link to abstract – $ for full-text)
Original article: Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults – New England Journal of Medicine (link to abstract – $ for full-text)
White Paper: Achieving Hospital-wide Patient Flow: The Right Care, in the Right Place, at the Right Time – Institute for Healthcare Improvement (free registration required – PDF) (via @brhospitalist and @TheIHI see Tweet)
Association of Hospitalist Years of Experience With Mortality in the Hospitalized Medicare Population – JAMA Internal Medicine (link to abstract – $ for full-text)
Commentary: Mortality Higher for Inpatients Seen by First-Year Hospitalists – Medscape (free registration required)
Infographic: Date Night with the EHR – NEJM Catalyst (free)
Related Commentary: Why Physician Burnout Is Endemic, and How Health Care Must Respond – NEJM Catalyst (free)
Comparative Effectiveness of Implementation Strategies for Blood Pressure Control in Hypertensive Patients: A Systematic Review and Meta-analysis – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Meta-Analysis: It Takes a Team to Optimize Hypertension Tx – MedPage Today (free registration required) AND Blood pressure control best achieved with a multilevel, multicomponent approach – American College of Physicians, via EurekAlert (free)
Commentary: Trunk Imaging Tied to Higher Nephrectomy Risk – MedPage Today (free registration required)
Safety of Magnetic Resonance Imaging in Patients with Cardiac Devices – The New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries: MRI scan safe for most people with older pacemakers, defibrillators – Reuters (free) AND Even Thoracic MRI Safe for ‘Legacy’ ICDs, Pacemaker Systems: Large Cohort Study – Medscape (free registration required) AND MRIs safe with older pacemakers, study finds – MedicalXpress (free)
“The proportion of medical procedures unsupported by evidence may be nearly half”.
Association of the Hospital Readmissions Reduction Program Implementation With Readmission and Mortality Outcomes in Heart Failure – JAMA (link to abstract – $ for full-text)
Commentaries: To Fix the Hospital Readmissions Program, Prioritize What Matters – JAMA Forum (free) AND Readmissions reduction program linked to increased mortality for heart failure patients – Cardiovascular Business (free) AND Going the Wrong Way: ACA’s Readmission Reduction Program Linked To Increased Heart Failure Deaths – MedicalResearch (free) AND Hospital quality-control program tied to rise in heart failure deaths – Reuters (free)
Association Between Treatment by Locum Tenens Internal Medicine Physicians and 30-Day Mortality Among Hospitalized Medicare Beneficiaries – JAMA (link to abstract – $ for full-text)
Commentaries: Substitute Doctors Are Becoming More Common. What Do We Know About Their Quality of Care? – Harvard Business Review (free) AND Doctor out sick? A substitute physician is no worse for patients’ health – STAT (free) AND When the Doctor’s Away – Harvard Medical School, via NewWise (free) AND Mortality rates similar, readmissions lower in hospital patients cared for by locum tenens – ACP Internist (free)
Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis – The Lancet (link to abstract – $ for full-text)
Commentaries: Atraumatic needles associated with fewer side effects for lumbar puncture – ACP Hospitalist Weekly (free) AND Atraumatic Lumbar Puncture Needles Show Major Benefit in Meta-Analysis – Physician’s First Watch (free)
Can sleep quality and burnout affect the job performance of shift-work nurses? A hospital cross-sectional study – Journal of Advanced Nursing (link to abstract – $ for full-text)
Commentary: Shift work linked to burnout in sleep-deprived nurses – Reuters (free)
Commentaries: Myocardial Injury After Noncardiac Surgery Linked With Higher 1-Year Mortality – TCTMD (free) AND Perioperative Myocardial Injury After Noncardiac Surgery – American College of Cardiology, Latest in Cardiology (free)
Related commentaries: Women harmed because vaginal mesh regulation ‘not fit for purpose’ – The Guardian (free) AND Vaginal mesh operations for prolapse should be banned, watchdog to say – The Guardian (free)
Readmissions After Revascularization Procedures for Peripheral Arterial Disease: A Nationwide Cohort Study – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Burden of Readmission High in PAD Patients Following Revascularization – TCTMD (free) AND 1 in 6 Patients Undergoing Peripheral Arterial Revascularization Readmitted Within 30 Days – Physician’s First Watch (free) AND 1 in 6 Readmitted After Peripheral Revascularization – MedPage Today (free registration required)
Commentaries: Clinician denial of certain patient requests linked with decreased satisfaction – 2 Minute Medicine (free) AND Denial of some patient requests, but not others, associated with decreased patient satisfaction, study finds – ACP Internist (free) AND Patient satisfaction surveys are worthless – Physician’s Weekly (free)
Editorial: Overlapping Surgery—Perspectives From the Other Side of the Table (free)
Commentaries: Study: Overlapping surgeries boost complication risks – Becker’s Hospital Review (free) AND Does Overlapping Surgery Increase Complication Risk After Hip Surgery? – The JAMA Network (free)
Association Between Wait Time and 30-Day Mortality in Adults Undergoing Hip Fracture Surgery – JAMA (link to abstract – $ for full-text)
Commentaries: Delaying Surgery for Hip Fracture for More Than One Day Associated with Small Increased Risk of Death – The JAMA Network (free) AND Delaying Hip Fracture Surgery for 1 Day Tied to Higher Mortality Risk – Physician’s First Watch (free) AND Emergency Hip Surgery Best Done Within 24 Hours – Medscape (free registration required)
The Value-Based Payment Modifier: Program Outcomes and Implications for Disparities – Annals of Internal Medicine (link to abstract – $ for full-text)
Related: The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care: A Systematic Review – Annals of Internal Medicine (free) AND Value-Based Purchasing: Time for Reboot or Time to Move On? by Ashish K. Jha, MD – The JAMA Forum (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)
Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European Centre for Disease Prevention and Control – Antimicrobial Resistance & Infection Control (free)
Related document: Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosain health care facilities – World Health Organization (free)
European guidelines on perioperative venous thromboembolism prophylaxis (free PDF articles):
Position Paper: Patient Safety in the Office-Based Practice Setting – American College of Physicians (free PDF)
Commentaries: ACP says patient safety must be improved in office-based practice setting – American College of Physicians, via EurekAlert (free) AND ACP: Recommendations for Improving Patient Safety in Ambulatory Settings – MPR (free)
How Hospitals Are Using Patient-Reported Outcomes to Improve Care – Harvard Business Review (a few articles per month are free)
Original article: Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis – The Lancet Infectious Diseases (link to abstract – $ for full-text)
Commentaries: 12 key points to remember: Standards for Inpatient Electrocardiographic Monitoring – American College of Cardiology, Latest in Cardiology (free) AND AHA updates practice standards for electrocardiographic monitoring – ACP Hospitalist (free)
Association of Patient Frailty With Increased Morbidity After Common Ambulatory General Surgery Operations – JAMA Surgery (link to abstract – $ for full-text)
Commentaries: Frailty Associated With Increased Risk of Complications Following Common, Outpatient Operations – The JAMA Network (free) AND Frailty tied to higher risk of complications with common surgeries – Reuters (free) AND Frailty linked to higher rate of perioperative morbidity – OnMedica (free)
Related guideline: Healthcare Personnel Attire in Non-Operating-Room Settings – Infection Control and Hospital Epidemiology (free) AND Commentaries: Goodbye to the Doctor’s White Coat? – The New York Times (10 articles per month are free) AND New infection control recommendations could make white coats obsolete – ScienceDaily (free) AND Should Doctors Still Be Allowed to Wear White Coats? You Decide – HIV and ID Observations (free)
Discontinuing Inappropriate Medication Use in Nursing Home Residents: A Cluster Randomized Controlled Trial – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: Deprescribing Intervention Improves Nursing Home Care – Medscape (free registration required) AND Multistep tool is effective for discontinuing inappropriate medication use in the nursing home setting – MedicalXpress (free)
Original article: Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives – Programme Grants for Applied Research (free)
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 occurred infrequently, but when they did, there was no observable increased risk for adverse perioperative outcomes compared with non-concurrent operations”.
Editorial: Telephone first consultations in primary care (free)
Commentaries: Phone-first GP consults ‘no panacea for reducing workload’ – OnMedica (free) AND No evidence to support claims that telephone consultations reduce GP workload or hospital referrals – University of Cambridge (free)
Related study: Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending – Health Affairs (link to abstract – $ for full-text) AND Commentaries: Telehealth Doctor Visits May Be Handy, But Aren’t Cheaper Overall – NPR (free) AND Are Virtual Doctor Visits Really Cost-Effective? Not So Much, Study Says – Health News Florida (free)
Impact of Transitional Care Services for Chronically Ill Older Patients: A Systematic Evidence Review – Journal of The American Geriatrics Society (link to abstract – $ for full-text)
Quality standards in upper gastrointestinal endoscopy: a position statement of the British Society of Gastroenterology (BSG) and Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) – Gut (free)
Commentary: Standards for Upper GI Endoscopy Released – Medscape (free registration required)
Original article: Interventions to improve hand hygiene compliance in patient care – Cochrane Library (link to abstract – $ for full-text)
Original article: Comprehensive geriatric assessment for older adults admitted to hospital – Cochrane Library (link to abstract – $ for full-text)
“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”.
Related article: Weekends affect mortality risk and chance of discharge in critically ill patients: a retrospective study in the Austrian registry for intensive care – Critical Care (free) AND Commentary: “Weekend effects” in intensive care units – On Medicine (free)
Implementing a Health System–wide Patient Blood Management Program with a Clinical Community Approach – Anesthesiology (link to abstract – $ for full-text)
Original article: Laparoscopic and robotic-assisted versus open radical prostatectomy for the treatment of localised prostate cancer – Cochrane Library (link to abstract – $ for full-text)
“Urinary and sexual quality of life-related outcomes appear similar”.
11 Drugs You Should Seriously Consider Deprescribing – Medscape Slideshow (free registration required)
Related: Canadian Deprescribing Network (CaDeN) (free) AND CaDeN Deprescribing Guidelines and Algorithms (free) AND Deprescribing guidelines for the elderly – Ontario Pharmacy Evidence Network (free) AND Deprescribing proton pump inhibitors: Evidence-based clinical practice guideline – Canadian Family Physician (free) AND Too Many Meds? America’s Love Affair With Prescription Medication – Consumer Reports (free) AND Patient often prescribed potentially futile drugs in their final months of life – Science Daily AND The Challenge of Polypharmacy: From Rhetoric to Reality – Royal Pharmaceutical Society and Royal College of General Practitioners Partnership (free PDF) Current and future perspectives on the management of polypharmacy – BMC Family Practice (free)
Should kids be sedated for dental work? – The New York Times (10 articles per month are 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)
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.
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?”
Commentaries: Smokers hospitalized for heart attacks often don’t get cessation drugs – Reuters (free) AND Smokers Hospitalized for CHD Rarely Receive Cessation Pharmacotherapy During Hospitalization – American College of Cardiology, Latest in Cardiology (free)
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)
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.
Analysis – Too much medicine: Mapping the drivers of overdiagnosis to potential solutions – The BMJ (free)
Related: Overdiagnosis, ethics, and trolley problems: why factors other than outcomes matter – The BMJ (free) AND The overdiagnosis community targets solutions – The BMJ (free) AND Are expanding disease definitions unnecessarily labelling women with polycystic ovary syndrome? – The BMJ (free) AND When technology creates uncertainty: pulse oximetry and Overdiagnosis of hypoxaemia in bronchiolitis – The BMJ (free)
A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents – JAMA Internal Medicine (link to abstract – $ for full-text)
Commentaries: Study Shows 54 Percent Drop in CAUTIs Among Nursing Home Residents – Infection Control Today (free) AND AHRQ safety program helps cut catheter infections by more than 50% among nursing home patients, JAMA study shows – Healthcare Finance (free) AND Implementing technical and socioadaptive bundles may decrease catheter-associated urinary tract infections in nursing homes – 2 Minute Medicine (free) AND Nursing homes cut urinary tract infections in half through focused effort on catheter care – Michigan University, via EurekAlert (free)
An Automated, Pharmacist-Driven Initiative Improves Quality of Care for Staphylococcus aureus Bacteremia – Clinical Infectious Diseases (link to abstract – $ for full-text)
Commentaries: Automating antimicrobial stewardship – ACP Hospitalist (free) AND Automated intervention aids treatment of Staph aureus bacteremia – CIDRAP (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
FDA Safety Alert: Liquid-filled Intragastric Balloon Systems: Letter to Healthcare Providers – Potential Risks (free)
Commentaries: Five People Die After Using Weight Loss Balloons for Obesity – Time (free) AND FDA Warns of Gastric Balloon Deaths – MedPage Today (free registration required) AND Five Deaths Tied to Intragastric Balloons, FDA Says – Medscape (free registration required)
Commentaries: C-Section Delivery Associated with Increased Risk of Complications from Hysterectomy – The JAMA Network (free) AND C-Section Now, Hysterectomy Complications Later? – MedPage Today (free registration required)
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.
Use of Alternative Medicine for Cancer and Its Impact on Survival – Journal of the National Cancer Institute (link to abstract – $ for full-text)
Commentary: Use of alternative medicine hastens death of cancer patients – Edzard Ernst (free) AND Cancer Survival Takes a Hit with Alternative Medicine – MedPage Today (free) AND Using Alternative Medicine Only for Cancer Linked to Lower Survival Rate – Yale Cancer Center, via NewsWise (free) AND ‘Alternative Medicine’ for Cancer Ups Death Risk – Medscape (free registration required)
“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”.
Alternatives to hospital admission for people aged over 65 years can be safe and reduce costs across a range of acute and chronic conditions.
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
“Experts explain the causes and solutions for common mistakes in diagnosis”.
Oral fluoroquinolones and risk of secondary pseudotumor cerebri syndrome – Neurology (link to abstract – $ for full-text)
Commentary: Fluoroquinolones May Up Risk of PTCS, a Rare But Serious Condition – MPR (free) (RT @AmeshAA see Tweet)
New issue with series of articles exploring strategies clinicians need to know to respond to adverse outcomes.
Commentaries: Emergency Visits Common After Hysterectomy, Study Finds – Medscape (free registration required) AND ~10 Percent Present to ER After Hysterectomy for Benign Disease – Physician’s Briefing (free)
“Risk factors include younger age, higher parity, Medicare or self-pay insurance, postoperative pain” (from Physician’s Briefing)
American College of Surgeons (ACS) 2017 Quality and Patient Safety Conference: Enhanced recovery pathway for colorectal surgical patients improves outcomes, reduces cost – ACS, via EurekAlert (free)
Related guideline: Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (free)
“Successful protocol shortens hospital stays, reduces patients’ risk of complications, and cuts costs up to $11,000 per procedure”
Witch Metrics in Hospital Quality Should Patients Pay Attention To? – The New York Times (10 articles per month are free)
Viewpoint: Sharing Knowledge for Health Care – JAMA Internal Medicine (free)
Related: Editorial: Sharing Medicine – A JAMA Internal Medicine Series (free) AND
Other “Sharing Medicine” articles: Sharing as the Future of Medicine – JAMA Internal Medicine (free) AND Shared Decision Making: The Importance of Diagnosing Preferences – JAMA Internal Medicine (free)
2017 ACS Quality and Safety Conference: “Strong for Surgery” Shows Promise in Reducing Smoking Rates for Patients Facing Surgery – American College of Surgeons, via NewsWise (free)
“Study suggests big drop in smoking rates when surgeons help patients quit before their operations”.
Use of Prescription Smoking Cessation Medications After Myocardial Infarction Among Older Patients in Community Practice – JAMA (link to abstract – $ for full-text)
Commentaries: Stop-Smoking Meds Underused in Post-MI Setting – MedPage Today (free registration required) AND Heart attack patients don’t adhere to smoking cessation prescriptions – Cardiovascular Business (free) AND Heart attack patients missing out on smoking cessation drugs – Reuters Health (free)
Invited Commentary: Fluoroquinolone restriction to control fluoroquinolone-resistant Clostridium difficile (free)
See article’s Algorithms and Protocols (free)
Commentary: 3 steps to restore patient trust in overlapping surgeries – FierceHealthcare (free)
This interesting viewpoint discusses the practice of scheduling overlapping surgeries, in which a qualified practitioner finishes noncritical parts of the first operation while the primary surgeon moves to the next surgery.
Effectiveness of Pharmacist Intervention to Reduce Medication Errors and Health-Care Resources Utilization After Transitions of Care: A Meta-analysis of Randomized Controlled Trials – Journal of Patient Safety (link to abstract – $ for full-text)
Source: Hospital Medicine Virtual Journal Club (free resource to find articles of interest)
Pharmacist transition of care intervention seems to be an effective strategy to reduce medication errors after hospital discharge and to reduce subsequent emergency room visits.
“Each year, the proliferation of substandard and falsified medicines puts the lives of millions of people – particularly those living in developing countries – at risk”
Venous Thromboembolism Prophylaxis in Major Orthopedic Surgery: Systematic Review Update. Comparative Effectiveness Review – Agency for Healthcare Research and Quality (free report and summary)
See also: Executive summary (free PDF)
Source: ACP Journal Wise ($ resource to find articles of interest)
Comprehensive review on the evidence regarding thromboembolism prophylaxis in major orthopedic surgery.
Original article: Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis – The Lancet Infectious Diseases (link to abstract – $ for full-text)
In this large cohort clindamycin, doxycycline, quinolones, macrolides, and phenoxymethylpenicillin were associated with congenital malformations. Amoxicillin, cephalosporins, and nitrofurantoin were not associated with birth defects.
Randomized clinical trial of comprehensive geriatric assessment and optimization in vascular surgery – British Journal of Surgery (link to abstract – $ for full-text)
Source: ACP Journal Club ($ resource to find articles of interest)
In this RCT, a comprehensive preoperative geriatric assessment and optimization before vascular surgery was associated with shorter length of hospital stay, lower incidence of complications, and patients were less likely to be discharged to a higher level of dependency.
Source: Hospital Medicine Virtual Journal Club (free resource to find articles of interest)
Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and Society of American Gastrointestinal and Endoscopic Surgeons (free)
Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score–matched observational cohort study – Canadian Medical Association Journal (free)
Source: STAT News Newsletter
“Delayed operating room access for emergency surgery was associated with increased risk of inhospital mortality, longer length of stay and higher costs”.
Longitudinal Patterns of Medication Nonadherence and Associated Health Care Costs – Inflammatory Bowel Diseases (link to abstract – $ for full-text)
In this small study, patients with increasing nonadherence over time demonstrate more than a 3-fold increase in costs compared with adherent patients.
Pictograms, Units and Dosing Tools, and Parent Medication Errors: A Randomized Study – Pediatrics (link to abstract – $ for full-text)
Commentaries: Most Parents Give Kids Wrong Doses – MedPage Today (free registration required) AND Proper tools may help prevent medicine errors at home – Reuters (free)
Commentaries: Proton pump inhibitors associated with raised mortality – OnMedica (free) AND Longtime use of heartburn drugs linked to increased risk of death – NewsMedical (free) AND People taking heartburn drugs could have higher risk of death, study claims – The Guardian (free) AND Some heartburn drugs linked with higher risk of death – CBS News (free) AND PPIs Linked to Higher Risk for Death – Medscape (free registration required)
In a large observational study, PPI use was associated with increased mortality (HR 1.25; CI 1.23 to 1.28). PPIs were also associated with increased risk compared to H2 blockers (HR 1.24; CI 1.21 to 1.27). See more on the trade-offs of PPI therapy in our July 3rd issue (see #10)
Redesigning Care for High-Cost, High-Risk Patients – Harvard Business Review (a few articles per month are free) (RT @pash22 see Tweet)
Related: Designing a High-Performing Health Care System for Patients with Complex Needs: Ten Recommendations for Policymakers – The Commonwealth Fund (free) AND Caring for High-Need, High-Cost Patients — An Urgent Priority – New England Journal of Medicine (Free) AND Multimorbidity: clinical assessment and management – NICE Guideline (free) AND Multimorbidity in Older Adults with Cardiovascular Disease – American College of Cardiology, Latest in Cardiology (Free full text) AND Focusing on High-Cost Patients — The Key to Addressing High Costs? – NEJM Catalyst (free) AND Richard Smith: The challenge of high need, high cost patients – The BMJ Blogs (free) AND Playbook: Better Care for People with Complex Needs – Institute for Healthcare Improvement (free)
Source: PracticalReviews ($)
See related article on the effect of multicomponent nonpharmacologic interventions to prevent delirium in abdominal surgery in our May 25th issue (see #5)
Delirium-friendly preprinted postoperative orders executed by regular nursing staff resulted in a significant reduction in postoperative delirium.
This viewpoint suggests a more selective use of contact precautions for the control of endemic pathogens.
Viewpoint: Monitoring Medical Devices: Missed Warning Signs Within Existing Data – JAMA (free)
Related: The lap band for weight loss is a tale of medicine gone wrong – VOX (free) Reoperation and Medicare Expenditures After Laparoscopic Gastric Band Surgery – JAMA Surgery (link to abstract – $ for full-text) AND Safety, Effectiveness of Gastric Banding Called Into Question – Medscape (free registration required) AND 1 In 5 Gastric Band Surgeries Require Corrective Operations – American Council on Science and Health (free)
The authors use the example of gastric band surgery to discuss how available data may be used more appropriately for earlier detection of problems in the safety of medical devices.
Source: EvidenceAlerts (free resource to find articles of interest)
In this meta-analysis including 19 randomized trials, probiotics given within 2 days of the first antibiotic dose (more effective than if started later) reduced the risk of Clostridium difficile infection (CDI) by >50% in hospitalized adults. 1 case of CDI would be prevented for every 23−144 patients treated with probiotics when antibiotics are started. “There was no convincing evidence of superior efficacy for any of the tested probiotic formulations, delivery methods (drink or capsule), or probiotic doses”.
The JAMA Network – For the Media: How Many Adverse Events Are Reported to FDA for Cosmetics, Personal Care? (free)
Commentaries: More Health Problems Reported With Hair And Skin Care Products – NPR (free) AND The Hidden Dangers of Makeup and Shampoo – TIME (a few articles per month are free)
Necessity is the mother of invention: an innovative hospitalist-resident initiative for improving quality and reducing readmissions from skilled nursing facilities – Journal of Community Hospital Internal Medicine Perspectives (free) (RT @HMVJC see Tweet)
In this model of care, a hospitalist-led team, including the resident on the geriatrics rotation, followed patients discharged from the hospital to the skilled nursing facility, leading to significant decrease in readmission rates.
This study compared two different approaches to measure adverse events, the “Trigger Tool system” and the “Two-stage review”
Value-Based Care Alone Won’t Reduce Health Spending and Improve Patient Outcomes – Harvard Business Review (a few articles per month are free) (RT @pash22 see Tweet)
“We believe that value-based care, implemented using lean principles and in conjunction with an ongoing, community-wide effort to address social determinants of health, can reduce health spending and deliver on the promise of better health”
“Untrained bystander CPR had better outcomes when given telephone advice from EMS services to perform continuous CPR, rather than interrupted CPR with rescue breaths”. For trained EMS professionals, “it is possible that there is little or no difference between the two approaches”.
Related report from UK: Each Baby Counts – Royal College of Obstetricians and Gynaecologists (free PDF) Each Baby Counts Homepage (free resources) AND Reducing baby deaths and brain injuries during childbirth – BBC News (free)
Every year, 2.7 million babies die in the first 28 days of life. 75% of these deaths are preventable.
“The practice of radiology is unsafe and needs to change says, Giles Maskell” (RT see Tweet)
The possible benefits of applying the “Lean” approach to oncology care delivery.
Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association (free)
News Release: Healthcare providers should individualize patient education (free)
AHA statement: Doctors’ orders should include tailored health education for patients (free)
Commentary: Sharpening the Focus on Therapeutic Patient Education and Self-management (free)
Top Ten Things to Know: Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management (free PDF)
Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis – The Lancet Infectious Diseases (link to abstract – $ for full-text)
Commentaries: Antibiotic Stewardship Programs Linked to Lower Rates of Drug-Resistant Infections – Physician’s First Watch (free) AND Review ties stewardship to sharp drop in resistant bacteria – CIDRAP (free)
Surgeon-level variation in complications among surgeons was nearly twice as great for Minimally Invasive Colectomy than for Open Colectomy, implying a need for improved training in adoption of minimally invasive techniques.
Why overtreatment and overdiagnosis can be bad for your health – CBC Radio (free text and audio)
2017 American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients With Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty (free)
Press release: New Guideline Aims to Reduce Infections in Total Hip & Knee Replacement Patients (free)
Commentaries: New medication guidelines for rheumatic disease patients having joint replacement – Hospital for Special Surgery, via EurekAlert (free) AND New Guidelines Issued on Antirheumatic Drugs for Patients Undergoing Knee or Hip Replacement – Physician’s First Watch (free)
New Choosing Wisely List: American Society of Health-System Pharmacists – Five Things Physicians and Patients Should Question (free)
Commentary: NOAC Doses: Just Stick to the Label – MedPage Today (free registration required)
“Among the 1,473 patients with a renal indication for dose reduction, 43.0% were potentially overdosed, which was associated with a higher risk of major bleeding”
Association of Adverse Events With Antibiotic Use in Hospitalized Patients – JAMA Internal Medicine (link to abstract – $ for full-text)
Commentary: Antibiotic-Associated Adverse Events Common – Medscape (free registration required)