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Tag Archives: Medical Studies

Safety of Medical Care in US

Remember that statistic from the 1999 Institute of Medicine report that trial lawyers like to throw in everyone’s face about how “up to 98,000 people in the US die each year due to medical mistakes”? It’s like TWO 737 jetliners crashing every day … and we’re doing nothing about it. So today a news story was sent to my inbox that included Saudi Arabian Ministry of Health statistics on medical malpractice. The report shows that there were 1,356 cases of malpractice in Saudi Arabia in 2009 and that “129 people died from medical mistakes in 2009.” Of course, the 129 number seemed quite low to me given the 98,000 number that is constantly cited in the press. Maybe Saudi Arabia’s population is just smaller than I thought. Nope. Saudi Arabia has a population of roughly 26 million – about 1/12 of the 310 million people in the United States.  Multiply those 129 Saudi Arabian deaths by 12 and the population adjusted death rate from medical mistakes in Saudi Arabia is 1,548 — versus 98,000 for the United States. Look at it another way. Divide 98,000 deaths from medical mistakes in the United States by a population of 310 million and you get about 316 deaths per million population in the United States due to medical mistakes. Divide 129 deaths from medical mistakes in Saudi Arabia by 26 million population and you get about 5 deaths per million population in Saudia Arabia from medical mistakes. 316 deaths per million in the US versus 5 deaths per million in Saudi Arabia. Is medical care in the United States that much worse than in Saudi Arabia — even without the benefit of safety agencies such as the Joint Commission and HospitalCompare.gov? Or do unrealistic requirements from “safety” organizations such as the Joint Commission and “quality measures” from our government actually cause more deaths from medical mistakes? Or are the Institute of Medicine’s numbers so far off that they shouldn’t be believed? I did a little more searching. This parliamentary paper from the United Kingdom pegs deaths due to medical “incidents” at about 3,500 per year in England. In a country of 52 million people, that averages out to about 67 deaths per million population – still about one fifth of the alleged United States numbers. Then I found a Canadian study showing that the range of deaths from “medical misadventures” in various industrialized countries ranges from 1 per million population to 10 per million population. The US is in the middle of the pack at about 6 deaths per million population per year – which equates to about 1,860 deaths per year from “medical misadventures” in the United States. 1,860 deaths versus 98,000 deaths Why are the numbers in that IOM paper such outliers? And why do the trial attorneys keep citing it as gospel?

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New CPR and ACLS Guidelines Published

The “ABCs” that emergency medical providers have come to know and love has now been changed to “CAB” – as in Circulation first then Airway then Breathing. Gordon Ewy finally gets well-deserved recognition for his compression-only model of CPR and its significant improvement in patient outcomes. Compress first, compress hard, ask questions later. These are just a couple of the many changes in the updated CPR/ACLS Guidelines. The entire set of guidelines is available for review and download at Circulation’s web site. Get them now for free while they are available.

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Press Ganey Article

Remember that survey that we did last fall about Patient SatisFICTION? Two of the editors at EP Monthly finally used some of the survey results to create an article about Press Ganey. Interesting reading … 2+2=7? Seven things you may not know about Press Ganey Statistics

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Urine Toxicology Pearls

Drug seekers will love this post. EMedHome.com recently published a set of pearls about urine drug testing that included several things I wasn’t aware of. Did you know that … Urine levels of “ecstasy” (MDMA) need to be quite high before they will be picked up by the urine drug screen since the tests have a low sensitivity for MDMA? Zantac, Prozac, and labetolol can all cause false positive results for amphetamines? Zoloft and Daypro can cause false positive drug screens for benzodiazepines? Several benzodiazepines are difficult to detect on urine drug screens – including Librium and Versed? Levaquin, Cipro, dextromethorphan (common in OTC cough meds), rifampin, and verapamil can all cause false positive tests for opiates? Standard urine toxicology screens do not usually detect Vicodin, Tramadol, Fentanyl and Percocet? Ingestion of one poppy seed bagel can cause a false positive opiate test? Most drugs are undetectable 3 days after use? Links to some of the cited articles are here, here, and here. By the way … if you came across this post in a web search on how to beat drug tests and now think you’ve got it made – don’t worry. There are plenty of other ways that doctors can tell whether or not you’re using drugs. I’m not giving away all of our secrets.

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Attack of the Superbugs

Antibiotics for viral infections are a big pet peeve of mine. No. Make that a huge pet peeve. Some doctors prescribe antibiotics for coughs and stuffy noses because the patients want them. If you’re one of those patients who think that antibiotics make your coughs go away, or clear up your stuffy noses, or somehow make your sinus headaches vanish, or if you’re a doctor who prescribes antibiotics for these symptoms, this post is for you. You’re killing people with your dumb demands and/or your inappropriate prescriptions. MRSA stands for methicillin resistant staphylococcus aureus. There is regular staph aureus – that bug is pretty much fading into the sunset and being replaced by staph aureus on steroids. Because so many people are requesting/using antibiotics for non-bacterial infections, the bacteria in their systems learn how to beat the antibiotics – in effect, making the antibiotics useless. For example, in our area, Levaquin is frequently prescribed by many doctors for obvious viral infections. Then, when people have a urinary tract infection, almost half of the strains of E. coli – the most common urinary tract pathogen – in our town are resistant to Levaquin and Cipro and all the other drugs in that family that would normally kick E. coli‘s butt. We have had several patients who had simple UTIs turn into serious systemic infections because they were initially treated with Cipro or Levaquin for their urinary tract infection and the antibiotics didn’t help. Now there’s a super duper bug that’s coming to a town near you. According to a recent article in Lancet Infectious Diseases, bacteria are now picking up a new gene called NDM-1 that makes the bacteria resistant to almost all antibiotics. Most of the bacterial with this gene were E. coli, but the gene can apparently can be relatively easily transferred to other bacteria. The only antibiotics that bacteria with this gene were sensitive to were tigecycline and colistin. Right now most of the isolates are in India and Pakistan, but it is only a matter of time before the super duper bugs have spread worldwide. A 2007 JAMA article showed that MRSA infections were abundant (.pdf file). An editorial accompanying the JAMA article noted that “The estimated rate of invasive MRSA is greater than the combined rate in 2005 for invasive pneumococcal disease (14.1 per 100,000), invasive group A streptococcus (3.6 per 100,000), invasive meningococcal disease (0.35 per 100,000), and invasive H influenzae (1.4 per 100,000).” In addition, the editorial noted that if the predicted number of MRSA deaths was accurate, the 18,650 MRSA-related deaths in 2005 “would exceed the total number of deaths attributable to human immunodeficiency virus/AIDS in the United States.” Currently, a study by the CDC is claiming that the incidence of MRSA is declining (I wasn’t able to find the study on the CDC’s web site) by between 17 and 27 percent in the past few years. Even if MRSA goes away – which it won’t – there are still other resistant bacteria out there that are going to become a greater part of our lives. According to this San Fransisco Chronicle article, there’s “extremely drug-resistant tuberculosis” (XXDR TB). Doctors don’t even know how to treat this disease – or if they even can treat it. Less resistant TB can cost $100,000 per year to cure. Patients with XXDR TB will probably just die. The San Fransisco Chronicle article also notes that drug-resistant infections killed more than 65,000 people last year – more than prostate and breast cancer combined. In excess of 19,000 of the patients who died from drug-resistant infections had MRSA. ...

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Stay Away From That Oxygen Stuff – It'll Kill Ya

A recent publication in the Journal of the American Medical Association is right up there with the study on how thrombolytics improve outcomes in patients with hemorrhagic strokes. Researchers found that patients who were admitted to the intensive care unit after suffering a cardiac arrest were almost twice as likely to die if they had “hyperoxia” – which was defined as a PaO2 of 300 mmHg or more. Hyperoxia patients died 63% of the time, hypoxia patients (PaO2 < 60 mmHg) died 57% of the time, and normoxia patients (PaO2 between 60 and 300) died 45% of the time. Common thinking with the docs I know is that more oxygen is better – except with COPD patients. Don’t have full access to the JAMA article, so am not sure what percentage of each group ended up actually walking out of the hospital. It is entirely possible that the patients who survived ended up in chronic vegetative states. Nevertheless, this study plus the work of Gordon Ewy in advocating “chest compression only” CPR (no mouth-to-mouth) really bring the current “standard of care” for resuscitation of cardiac arrest into question.

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