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General interest items edited by Janice Flahiff

[Press release] Do no harm: Pediatrician calls for safely cutting back on tests, treatments


http://www.eurekalert.org/pub_releases/2014-10/aaop-dnh100314.php

From the October 2014 press release

SAN DIEGO – When parents take a sick or injured child to the doctor or emergency room, they often expect tests to be done and treatments given. So if the physician sends them on their way with the reassurance that their child will get better in a few days, they might ask: “Shouldn’t you do a CT scan?” or “Can you prescribe an antibiotic?”

What families — and even doctors — may not understand is that many medical interventions done “just to be safe” not only are unnecessary and costly but they also can harm patients, said Alan R. Schroeder, MD, FAAP, who will present a plenary session at the American Academy of Pediatrics (AAP) National Conference & Exhibition. Titled “Safely Doing Less: A Solution to the Epidemic of Overuse in Healthcare,” the session will be held from 11:30-11:50 a.m. PDT Monday, Oct. 13 in Ballroom 20 of the San Diego Convention Center.

Dr. Schroeder, chief of pediatric inpatient services and medical director of the pediatric intensive care unit at Santa Clara Valley Medical Center in San Jose, Calif., will discuss some of the reasons why doctors provide unnecessary care (i.e., barriers to safely doing less), including pressure from parents and a fear of missing something.

“We all have cases where we’re haunted by something bad happening to a patient. Those tend to be cases where we missed something,” he said. “We tend to react by doing more and overtreating similar patients.”

He also will give examples of where overuse commonly occurs in pediatrics, such as performing a CT scan on a child with a minor head injury, and the negative consequences.

“You may find a tiny bleed or a tiny skull fracture, and once you’ve found that you’re compelled to act on it. And generally acting on it means at a minimum admitting the child to an intensive care unit for observation even if the child looks perfectly fine,” Dr. Schroeder said. “The term for that is overdiagnosis. You detect an abnormality that will never cause harm.”

Finally, he will suggest ways to minimize overtesting and overtreatment, highlighting the Choosing Wisely campaign. More than 60 medical societies including the AAP have joined the initiative and have identified more than 250 tests and procedures that are considered overused or inappropriate in their fields.

“I’ve devoted much of my research to identify areas in inpatient pediatrics where we can safely do less — which therapies that we are doing now are unnecessary or overkill,” Dr. Schroeder said.

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The American Academy of Pediatrics is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

October 17, 2014 Posted by | Health News Items | , , , , , , , | Leave a comment

[Reblog] The hallucinated demons of intensive care « Mind Hacks

The hallucinated demons of intensive care 

From the 7 January 2014 article at Mind Hacks

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http://www.maquet.com/images/
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I’ve got an article in The Observerabout the psychological impact of being a patient in intensive care that can include trauma, fear and intense hallucinations.

This has only been recently recognised as an issue and with mental disorders being detected in over half of post-ICU patients it has sparked a serious re-think of how ICU should be organised to minimise stress.

Some of the most spectacular experiences are intense hallucinations and delusions that can lead to intrusive and surreal flashbacks that can have effects long after the person has become medically stable.

Wade interviewed patients about the hallucinations and delusions they experienced while in intensive care. One patient reported seeing puffins jumping out of the curtains firing blood from guns, another began to believe that the nurses were being paid to kill patients and zombify them. The descriptions seem faintly amusing at a distance, but both were terrifying at the time and led to distressing intrusive memories long after the patients had realised their experiences were illusory.

Many patients don’t mention these experiences while in hospital, either through fear of sounding mad, or through an inability to speak – often because of medical breathing aids, or because of fears generated by the delusions themselves. After all, who would you talk to in a zombie factory?

One of the interesting aspects is how standard ICU care is incredibly stressful and uncomfortable experience. I quote Hugh Montgomery, a professor of intensive care medicine, who says “If you think about the sort of things used for torture you will experience most of them in intensive care”!

Anyway, more at the link below.
Link to ‘When intensive care is just too intense’ in The Observer.

 

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January 23, 2014 Posted by | health care, Psychology | , , | Leave a comment

Researchers propose social network modeling to fight hospital infections

This image shows a Intensive Care Unit.

This image shows a Intensive Care Unit. (Photo credit: Wikipedia)

 

From the 22 October 2013 EurkAlert

 

Researchers propose social network modeling to fight hospital infections

 IMAGE: This is an illustration of dense (left) and sparse (right) patient ICU social networks. Patients in the circle that share a nurse are connected by lines (links), while patients that…

 

Click here for more information. 

COLLEGE PARK, Md. – Two researchers at the University of Maryland’s Robert H. Smith School of Business have teamed up with a researcher at American University to develop a framework to help prevent costly and deadly infections acquired by hospitalized patients. According to the Department of Health and Human Services (HHS), these transmissions strike one out of every 20 inpatients, drain billions of dollars from the national health care system and cause tens of thousands of deaths annually.

The research of Sean Barnes, Smith School assistant professor of operations management; Bruce Golden, the Smith School’s France-Merrick Chair in Management Science; and Edward Wasil of American’s Kogod School of Business, utilized computer models that simulate the interactions between patients and health care workers to determine if these interactions are a source for spreading multi-drug resistant organisms (MDROs). Their study shows a correlation of a “sparse, social network structure” with low infection transmission rates.

This study comes in advance of HHS’ 2015 launch and enforcement of a new initiative that penalizes hospitals at an estimated average rate of $208,642 for violating specific requirements for infection control. In response, the study’s authors have introduced a conceptual framework for hospitals to model their social networks to predict and minimize the spread of bacterial infections that often are resistant to antibiotic treatments.

The authors manipulated and tracked the dynamics of the social network in a mid-Atlantic hospital’s intensive care unit. They focused on interactions between patients and health care workers – primarily nurses – and the multiple competing factors that can affect transmission.

“The basic reality is that healthcare workers frequently cover for one another due to meetings, breaks and sick leave,” said Barnes. “These factors, along with the operating health care-worker-to-patient ratios and patient lengths of stay, can significantly affect transmission in an ICU… But they also can be better controlled.”

The next step is to enable hospitals to adapt this framework, which is based on maximizing staff-to-patient ratio to ensure fewer nurses and physicians come in contact with each patient, especially high-risk patients.

“The health care industry’s electronic records movement could soon generate data that captures the structure of patient-healthcare worker interaction in addition to multiple competing, related factors that can affect MDRO transmission,” said Barnes.

The study, “Exploring the Effects of Network Structure and Healthcare Worker Behavior on the Transmission of Hospital-Acquired Infections,” appears in a recent issue of the peer-reviewed IIE Transactions on Healthcare Systems Engineering. The study was partially funded by the Robert H. Smith School of Business Center for Health Information and Decision Systems.

 

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A full copy of the study is available at: http://www.tandfonline.com/doi/abs/10.1080/19488300.2012.736120?journalCode=uhse20#.UmV9WPmsjlN

 

 

 

October 23, 2013 Posted by | health care, Medical and Health Research News | , , , | Leave a comment

Hospital delirium: not as negligible as previously thought

 

University of NE Medical Center in midtown Omaha

University of NE Medical Center in midtown Omaha (Photo credit: Wikipedia)

 

My sister, a nurse practitioner, posted this on Facebook. Something to keep in mind if you have a loved one in ICU..

 

From the 6 August article at Nebraska Live Well

 

Medical professionals once thought patient delirium was a benign byproduct of landing in an intensive care unit.

Now they know otherwise.

Delirium caused by medications, illness and other sources can lead to permanent confusion and death, say experts in ICU delirium.

The Nebraska Medical Center has tested a new set of strategies to combat and diminish hospital delirium. Although the results haven’t been compiled yet, scientists and medical practitioners hope the protocol will make a difference in patients’ conditions in the hospital and after release.

We used to think it just goes away,” Michele Balas, a faculty member at the University of Nebraska Medical Center, said of delirium. Balas, whose doctorate is in nursing, has overseen the research.

Delirium can affect people for the rest of their lives, she said, and may cause depression, memory loss and post-traumatic stress disorder, and affect the cognitive functions required for such simple tasks as balancing a checkbook or following a recipe.

Sedation, sometimes used when patients are on ventilators or are delirious, makes it impossible for them to regain alertness and get up, Balas said. Prolonged bed rest can cause pneumonia and blood clots,

The strategy, called ABCDE, involves getting patients off sedation as soon as possible (Awakening); removing them from ventilators for at least a while so they breathe on their own (Breathing); communication and coordination (C) among doctors, nurses and others; delirium monitoring by staffers (D); and early mobility (E), or getting them up and moving as soon as possible, even patients on ventilators

 

 

 

 

August 8, 2012 Posted by | health care | , , | Leave a comment

Infections in ICUs Plummeting, Too Many Remain in Hospitals and Dialysis Clinics

Infections in ICUs Plummeting, Too Many Remain in Hospitals and Dialysis Clinics

http://www.cdc.gov/media/releases/2011/p0301_vitalsigns.html

ICUs show that preventing infections is possible; other health care settings must adopt prevention practices

From the press release

The number of bloodstream infections in intensive care unit patients with central lines decreased by 58 percent in 2009 compared to 2001, according to a new CDC Vital Signs report. During these nine years, the decrease represented up to 27,000 lives saved and $1.8 billion in excess health care costs. Bloodstream infections in patients with central lines can be deadly, killing as many as 1 in 4 patients who gets one….

“Preventing bloodstream infections is not only possible, it should be expected. Meticulous insertion and care of the central line by all members of the clinical care team including doctors, nurses and others at the bedside is essential. The next step is to apply what we’ve learned from this to other health care settings and other health care-associated conditions, so that all patients are protected,” said Thomas R. Frieden, M.D., M.P.H., CDC director.

In addition to the ICU findings, the report found that about 60,000 bloodstream infections in patients with central lines occurred in non-ICU health care settings such as hospital wards and kidney dialysis clinics. About 23,000 of these occurred in non-ICU patients (2009) and about 37,000 infections occurred in dialysis clinics patients (2008).

“This reduction is the result of hospital, local, state and national medical and public health efforts focused on tracking infection rates and then using that information to tailor and evaluate prevention programs,” said Denise Cardo, M.D., director of CDC’s Division of Healthcare Quality Promotion. “The report findings point to a clear need for action beyond ICUs. Fortunately, we have a prevention model focused on full collaboration that can be applied broadly to maximize prevention efforts.”

Infections are one of the leading causes of hospitalization and death for hemodialysis patients. At any given time, about 350,000 people are receiving hemodialysis treatment for kidney failure. Seven in 10 patients who receive dialysis begin that treatment through a central line….

March 18, 2011 Posted by | Consumer Health | , , , , , , , | Leave a comment

   

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