AAMC recently hosted its first-ever “Virtual Grand Rounds” at the James and Sylvia Earl Simulation to Advance Innovation and Learning (SAIL) Center. Guest speaker Mark Pinsky, a dentist, international airline captain and aviation expert, discussed how surgeons can apply aviation methodologies to surgical processes. He presented a concept of adapting the use of aviation checklists as an organizational tool to empower each member of the surgical team to organize thoughts, identify errors and increase situational awareness. Combining such systematic solutions with simulation practice could have a positive impact on improving quality and outcomes. (JADA, 2010) Click here to read full text.
News You Can Use
In the news, (BMJ, May 3) . The article explains that the 1999 Institute of Medicine (IOM report is limited and outdated. The results were contested by Leape in 1993, a chief investigator of the 1984 Harvard study which published an article arguing that the study’s estimate was too low, contending that 78% rather than 51% of the 180,000 iatrogenic deaths were preventable. Similarly, the Inspector General of the USDHHS Office examining the health records of hospital inpatients in 2008, reported that 180,000 deaths due to medical error a year among Medicare beneficiaries alone, a rate of 1.13%. If this rate is applied to all registered US hospital admissions in 2013, it translates to over 400,000 deaths a year, more than four times the IOM estimate. The ICD-10 coding system has limited ability to capture most types of medical error. At best, there are only a few codes where the role of error can be inferred, such as the code for anticoagulation causing adverse effects and the code for overdose. When a medical error results in death, both the physiologic cause of the death and the related problem with deliver of care should be captured. Data should be shared nationally and internationally to improve safety, much in the way scientists share data about disease. Click here to read full-text.
Direct-to-consumer advertisements continue to urge patients who take warfarin for atrial fibrillation to ask their doctors about the benefits of one or another of the newer anticoagulants. This review (Medical Letter, April 11) addresses the efficacy, bleeding and reversibility of direct oral anticoagulants. The article concludes that “the direct oral anticoagulants dabigatran (Pradaxa), apixaban (Eliquis), eoxaban (Savaysa, and rivaroxaban (Zarelto) have been at least as effective as warfarin (Coumadin, and others) in preventing stroke or systemic embolism in patients with nonvalvular atrial fibrillation, and they may appear to be safer. Patients well-controlled on warfarin (INR stable in the therapeutic range) could stay on it. For all others, one of the direct oral anticoagulants might be a better choice. Head-to-head comparisons of the new drugs are lacking.” Click here to read full text.
In a series of “online first” articles, and also reported in this weeks news, the NEJM has made the following articles available: Zika virus infection in pregnant women in Rio de Janeiro – preliminary report; Zika virus and birth defects – Reviewing the evidence for causality; Zika virus infection with prolonged maternal viremia and fetal brain abnormalities; Zika virus and microcephaly; Evidence of sexual transmission of Zika virus ; Zika virus associated with microcephaly. Click here to read this compendium of articles.
In a series of “online first: articles published in the NEJM this week, the focus is on Zika virus in the United States. The articles in this set include: Zika virus as a cause of neurologic disorders and Zika virus associated with meningoencephalitis. Click here to read full text.
This early online article and editorial (JAMA Intern Med) concludes, “Higher adherence to a Mediterranean diet is associated with a lower risk for hip fractures. These results support that a healthy dietary pattern may play a role in maintaining bone health in postmenopausal women.” Click here to read article and editorial.
Effect of mindfulness-based stress reduction vs. cognitive behavioral therapy or usual care on back painby jmiller on March 22, 2016
From this week’s JAMA (Mar 22/29), article concludes, “Among adults with chronic low back pain, treatment with MBSR or CBT, compared with usual care, resulted in greater improvement in back pain and functional limitations at 26 weeks, with no significant differences in outcomes between MBSR and CBT. These findings suggest that MBSR may be an effective treatment option for patients with chronic low back pain.” Click here to read full text.