Open access

NEWS - Patient Safety & Quality

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)


Discover and defeat your diagnostic errors – ACP Internist (free) (RT @acpinternist  see Tweet)

“Experts explain the causes and solutions for common mistakes in diagnosis”.


Iatrogenesis in Pediatrics – AMA Journal of Ethics (free) (RT @JournalofEthics)

New issue with series of articles exploring strategies clinicians need to know to respond to adverse outcomes.


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”.


Risk Factors for Emergency Department Visits After Hysterectomy for Benign Disease – Obstetrics & Gynaecology (free PDF)

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)

See other Enhanced Recovery After Surgery (ERAS) Guidelines and Reviews in our collection and in the ERAS Society Website.

“Successful protocol shortens hospital stays, reduces patients’ risk of complications, and cuts costs up to $11,000 per procedure”


Effects of control interventions on Clostridium difficile infection in England: an observational study – The Lancet Infectious Diseases (free)

Invited Commentary: Fluoroquinolone restriction to control fluoroquinolone-resistant Clostridium difficile (free)

“Very important finding! Restricting fluoroquinolones more important than infection control measures to prevent CDI” (RT @sanjaysaint see Tweet)


Viewpoint: The Evolving Story of Overlapping Surgery – JAMA (free) (RT @pash22 see Tweet)

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.


Poor-Quality Medicine: A Global Pandemic – Devex (free)

“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.


Use of antibiotics during pregnancy and the risk of major congenital malformations: A population based cohort study – British Journal of Pharmacology (link to abstract – $ for full-text)

Commentary: New study finds link between certain antibiotics during pregnancy and risk for birth defects – News Medical (free)

Related article: Use of antibiotics during pregnancy and risk of spontaneous abortion – Canadian Medical Association Journal (free)

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.


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