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Tag Archives: Medical Studies

Want to Avoid Appendicitis? Get Your Flu Shot.

Could appendicitis be a viral illness … or be related to a viral illness? A recent Archives of Surgery article raises some interesting questions.Researchers performed a retrospective analysis of appendicitis cases and compared them to incidence of influenza, rotavirus, and gastrointestinal infections. Using 40 years of data, they noted that general trends for appendicitis and influenza tended to parallel each other through the years, although influenza obviously had more predominance in winter months while appendicitis rates remained fairly constant throughout the year. No such correlation was found between rates of rotavirus and appendicitis. Researchers also noted that appendicitis tended to occur in “clusters” – with several citations to appendicitis outbreaks. Most interesting to me was that “perforating appendicitis” – where the appendix ruptures – and “nonperforating” appendicitis – where the appendix becomes inflamed but does not rupture – had no correlation to each other or to any of the infectious diseases studied. The researchers stated that “our epidemiologic findings suggest that patients who have perforated appendicitis have a different disease entity than those with nonperforating disease.”  The problem now is figuring out which ones will rupture and which ones won’t. This study makes me wonder whether the lack of elevated WBC count in so many appendicitis cases may be due to the viral effects of the disease. It also makes me wonder whether there is a correlation between elevated WBC counts and “perforating disease.” I wonder how many physicians have been successfully sued for being negligent in “delaying surgery” and “allowing a patient’s appendix to rupture” when the ruptured appendix may have been due to factors beyond the physician’s control. Cerebral palsy litigation comes to mind. Until we can distinguish between the two types of appendicitis – if two types of appendicitis really do exist – the emphasis will on be removing a patient’s inflamed appendix regardless of the cause of inflammation. If there are really two types of appendicitis, how many unnecessary surgeries are being performed to avoid liability for missing an appendix that perforates? Very interesting starting point for more studies. Also of interest is that a USA Today article which cited the study mentioned a USC surgeon who reported that 70 cases of CT scan-confirmed appendicitis went away when treated with antibiotics – which screws up the whole notion of the “viral illness” theory but certainly adds to the “everyone is going to die from MRSA” theory.

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Could Satisfaction Surveys Be Harming Patient Care?

A couple of weeks ago, I posted a survey about patient satisfaction surveys. To this point, 642 people responded to the survey, which is outstanding. Some of the responses were surprising. I’m getting the impression that the surveys really are more about satisFICTION that satisfaction, but you can judge for yourselves. Health care providers Of the health care providers that responded to the survey, 82% of their hospitals/employers/practices collected patient satisfaction data. 57% of those collecting data used a paid service such as Press Ganey or Rand. 23% used in-house surveys. More than two thirds of respondents did not know their survey response rate. Of those that did know, most had a response rate between 2% and 10%. 65% of respondents said that their satisfaction scores correlated below average or poorly with the opinions of the patients they treat. Regarding treatment, more than 40% of respondents had altered treatment due to the potential for a negative patient satisfaction survey. Of those that altered treatment, 67% gave treatment that was probably not medically necessary more than half of the time. Eleven percent of respondents described adverse outcomes from performing such treatment, including kidney damage from IV dye, allergic reactions to medications, hospital admits for “oversedation” with pain medications, and Clostridium difficile diarrhea. Because of the effects of patient satisfaction surveys, more than 25% of respondents performed testing and gave medications that were probably not indicated, 18% admitted patients who probably did not require admission, and 20% wrote work notes for patients that were probably not warranted. Others mentioned that they did not perform patient education that they feared would anger patients and that they spent “prolonged” amounts of time in rooms selling a treatment plan. More than 75% of respondents felt that patient satisfaction scores decreased the quality of care that they provided and nearly 90% of respondents believed that patient satisfaction scores decreased the efficiency with which they were able to evaluate and treat patients. More than half stated that patient satisfaction scores increased the amount of testing they performed. Eighty one percent of medical providers were aware of instances in which patients intentionally provided inaccurate derogatory information on a satisfaction survey and 84% felt that patients used the threat of negative satisfaction surveys to obtain inappropriate medical care. Nearly one in eight respondents had their employment threatened due to low patient satisfaction scores. Administrators Administrators seemed to agree that patient satisfaction scores do not correlate well with general opinions of patients treated in their facilities. All administrators answering the question rated the reliability of patient satisfaction scores from average to below average. The importance of satisfaction scores varied. 25% felt that scores were very important while 75% felt that scores were mildly to moderately unimportant. Administrators seemed to feel that satisfaction scores had little effect on efficiency or amount of testing performed. However, in contrast to answers given by the providers, a vast majority of administrators felt that the effect of patient satisfaction scores made it significantly less likely that providers would render inappropriate medical treatment. All administrators wanted their percentage/percentile of “excellent” scores on satisfaction surveys to be 90% or greater. Only one administrator would discount or ignore low survey scores from specific patients and only one administrator reviewed the medical records of patients who provided low satisfaction scores. Patients More than half of patients responding to this survey did not fill out satisfaction surveys after visiting a hospital or medical practice. Of those that did complete surveys, 70% did so to provide complimentary information, 23% did so to complain about care received or a specific provider, and ...

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New Medical Inventions

The Lung Flute. Interesting concept. A small reed within the contraption vibrates when a patient blows into the mouthpiece and the vibrations are transmitted into the lower lungs, changing the viscosity of sputum in the lower airways. Video of the device in action is here. Seems odd that such small device would have such a significant effect. Call me crazy, but I’d try to come up with a better name than the “lung flute”. Maybe something cool like the “mucinator” or something scientific like a “mucociliary clearance device.” I just couldn’t see writing an order for a stat “lung flute” to a patient’s bedside. . Also check out the Littman 3200 stethoscope. For a mere $700+, you can upload patient heart sounds via Bluetooth to a computer and use the included computer program to analyze the tones for arrhythmias and for murmur analysis. Video here. The device is reportedly much more sensitive than a physician’s ears at picking out abnormal heart sounds. Which leads me to the question … if this device is so much better than physicians at hearing murmurs, then why do they still put earpieces on it? They just ought to sell the handle portion with its computer screen readout. Maybe they’re planning to turn it into a hybrid device – like a telephone. Put the earpieces in your ears and talk into the bell to answer pages when you’re not listening to patients’ hearts. Or maybe it will sync up with your iTunes account so you can pretend like you’re listening intently to a murmur when you’re really jamming to Linkin Park. Wonder if they make a hack for it to check e-mail.

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Another Obesity Risk

The American Institute for Cancer Research just released a study showing that many types of cancer are linked to excess body fat and that over 100,000 new cases of cancer each year are caused by obesity. For example, each year obesity is estimated to cause 33,000 cases of breast cancer, 20,700 cases of endometrial cancer, 13,900 cases of kidney cancer, 13,200 cases of colorectal cancer, 11,900 cases of pancreas cancer and 5,800 cases of esophagus cancer. Researchers have also noted links between obesity and liver cancer, myeloma, and leukemia, but are doing more studies to confirm the links. That makes me want to go out and take a jog. Just have to make sure that I don’t get hit by a car and that I don’t get lung cancer from all the pollutants in the air.

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How To Increase Handwashing in Bathrooms

Install hidden cameras. British researchers installed electronic message boards over the entrances to toilet stalls at highway rest stops that flashed different messages as people walked inside. Then they watched more than 200,000 people to determine whether those people washed their hands after using the bathroom. No, they didn’t really install hidden cameras. Instead, they used electronic monitoring devices to determine how many people went in and out of the bathroom and how many people actuated the handles on the soap dispensers. The message boards flashed random statements such as “Wash your hands with soap,” “Don’t be a dope, wash with soap,” and “Washing hands with soap avoids 47% of disease” as people walked into the bathrooms. The researchers then compared the frequency of handwashing between control subjects who saw no message and study subjects who saw a random message. They even asked people leaving the bathrooms whether or not they saw the messages (only 1/3 reported doing so). In general, the most effective messages increased handwashing only by about 10%. Many of the messages had no effect at all. One message – “Soap adds a fresh touch” – caused women to wash their hands less than no message at all. What surprised me was that the statement that made a big impact with men (and the largest impression on me) hardly had any effect on women in the study. “Soap it off or eat it later” showed no statistical effect on womens’ handwashing. I’ll let you draw your own conclusions about that. “Soap adds a fresh touch” was one of the most effective statements at getting men to was their hands. Wimps. What’s up with British men? Maybe next they’ll do a soap commercial with men skipping through flower patches and sniffing the mountain breezes. The statement that worked best for men and women was the Orwellian “Is the person next to you washing with soap”? Be kind of funny to go into a toilet stall, pretend that you used it, purposely not wash your hands, then try to shake the hand of the guy standing at the sink next to you while that message was flashing. To me, pictures would be more compelling. Something like “We cultured your woo-hoo. Here’s what grew out” – along with a picture of a bunch of slimy bacteria. If we replicate this study in the U.S. (say at a football stadium or something), I volunteer to be on the creative team coming up with poster ideas.

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The Fall of a Tradition?

White lab coats may be on their way out. The AMA is considering a proposal to follow the lead of the British National Health System by recommending against the use of white coats by physicians. The Brits have a “bare below the elbows” policy to help prevent infections. Supposedly physician lab jackets carry too many germs and contribute to the incidence of infections – although there is little data directly linking white coats to incidence of infections. The NY Times article does cite one study in which 48% of a small sampling of physicians ties had some type of infectious organism on them. The problem that I see with the recommendation is that it is based on assumptions and not on data. The British National Health System policy went into effect a couple of years ago. Where is the data showing the drop in the number of infections? I couldn’t find anything on an internet search. Lab coats aren’t just for show. They also protect a physician’s clothing. I’ve gotten all kinds of bodily fluid splattered on my lab jacket at one time or another. Now that I usually just wear scrubs, it isn’t uncommon for me to get splashed with blood or other bodily fluids. If I do wear a lab jacket, I usually roll the sleeves up to my mid-forearm anyway. The article brought up a good point. Once the lab coats are gone, then will they then recommend that we wear tank tops to avoid the inadvertent contamination of a short sleeve onto a patient’s body? One doctor in the article asked “Are we going to go around naked?” Besides, what would I use as my nickname if white coats were banished? Somehow Dr. BareElbows just doesn’t have the same ring to it …

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