May 14th, 2011 by Mary Knudson in Opinion
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I’ve been working for a couple of months on an in-depth article on personal defibrillators that are implanted beneath the skin of a person’s chest to shock a heart that starts shaking, thereby restoring its normal beating and preventing sudden death. Discussing these defibrillators is extremely complex, which is why I am spending so much time on researching and writing the article intended to help patients and their families make an informed decision by learning the truth about the devices known as implantable cardioverter defibrillators (ICDs) — the good and the bad, your life saved vs nothing happening or the accompanying risks and harm you may receive. So when I heard that a new study would be presented at the annual scientific meeting this week of the Heart Rhythm Society, a professional organization of cardiologists and electrophysiologists who use cardiac devices in their patients, I made sure to get an advance copy of what would be presented and interview the lead author.
Potentially such a study would be of interest to physicians and to patients considering getting an ICD because it looked at all shocks the defibrillators gave the heart in patients who took part in the clinical trial, including those sent for life-threatening rhythms and in error. For several reasons, I felt the study is not ready to report to the public. It is only an abstract. The full study has not yet been written, let alone published in a peer-reviewed journal or even accepted for publication. Patients with defibrillators who received shocks were matched to only one other patient who was not shocked, but the two patients were not matched for what other illnesses or poor quality of health they had. Yet they were matched to see who lived the longest and the study looked at death for all causes, not just heart-related. One critical question the study sought to answer was this: Do the shocks themselves cause a shortened life (even if they temporarily save it) or is a shortened life the result of the types of heart rhythms a person experiences? Read more »
*This blog post was originally published at HeartSense*
May 10th, 2011 by Linda Burke-Galloway, M.D. in Health Tips
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If a pregnant woman finds herself scratching and itching during the third trimester, these symptoms should not be ignored. Each year, approximately 0.1 to 15% of pregnant women are affected by a liver disorder called Intrahepatic Cholestasis of Pregnancy or (ICP). ICP patients tend to develop symptoms of itchiness of their hands and feet that becomes progressively worse and then spreads all over their body. The itchiness usually worsens at night and if untreated can cause jaundice and several life-threatening complications to the unborn fetus. When a pregnant woman complaints of itchiness (pruritus) all over her body, the first order of business is to determine whether a rash is present. If a rash is absent, ICP should be suspected.
The liver is the largest gland in the body and in addition to filtering harmful substances such as alcohol it is also responsible for processing fats, carbohydrates and proteins. To process fat, the liver makes bile salts. In ICP, bile salts are increased which contributes to the symptoms of itchiness. Affected women will not only be plagued by pruritus but their unborn babies are at risk for stillbirth, preterm labor, fetal distress and abnormal heart rates. South American women and especially those from Chile have a greater risk of developing ICD as do women from South Asia and Sweden. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
May 10th, 2011 by BarbaraFicarraRN in Health Tips
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Thanks to Laura Landro for shining light on unsafe injections in her WSJ blog, “Unsafe Injection Practices Persist Despite Education Efforts.”
Landro writes:
“A new push is underway to eliminate unsafe injection practices, which remain a persistent safety problem despite years of efforts to educate clinicians about the risks of re-using needles, syringes and drug vials.
In the U.S., failure to follow safe practices in delivering intravenous medications and injections has resulted in more than 30 outbreaks of infectious disease including hepatitis C, and the notification of more than 125,000 patients about potential exposure just in the last decade, according to health-care purchasing alliance Premier Inc.”
As a registered nurse this is unthinkable. Learning to administer injections safely is “patient care 101.” There is no excuse for any health care professional to unsafely inject patients.
Patients in the hospital, ambulatory surgical centers or outpatient settings, should expect that their nurses, doctors and other clinicians are administering injections safely. Read more »
*This blog post was originally published at Health in 30*
May 8th, 2011 by Bryan Vartabedian, M.D. in Opinion
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Doctors are preoccupied with consumer review sites and the potential for bad press. Often the first impulse is to put the law on your side. Consider, for example, Dr. Kimberly Henry, cosmetic surgeon who last year initiated legal action against at least 12 reviewers from sites such as Yelp.com and DoctorScorecard.com.
While she may feel some sense of satisfaction in her quest for justice, I’m guessing many read the reviews to see what the fuss is all about.
Actions like these reflect a fundamental misunderstanding of modern reputation management. Physicians who react against patient dialog should understand the Streisand Effect. The Streisand Effect is an online phenomenon in which the attempt to remove or hide information is met with the unintended consequence of greater attention.
Instead of a prohibitive, reactive position against patient comments, doctors should consider a preemptive, proactive approach to dialog. Andy Sernovitz had it right when he suggested, ‘the solution to pollution is dilution.’ Work for good ink. It’s hard to get worked up about 10 poor reviews when you have 350 great reviews.
When physicians take action against patient reviews or even work to prevent reviews they raise a glaring red flag. We’re unlikely to win the battle against public dialog.
*This blog post was originally published at 33 Charts*
April 3rd, 2011 by Bryan Vartabedian, M.D. in Opinion
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Patient care is increasingly under third party control. And as a consequence I make fewer decisions regarding the brand of medication used in my patients.
So the role of a pharmaceutical rep comes into question. If I don’t choose which medication my patients will use, why would a representative call on me? And as American medicine becomes more centralized and standardized, I wonder how and why industry will connect with treating physicians. Pharma it seems is asking the same question: Of the core medications I prescribe, I see far fewer reps these days and our relationships are markedly different from a decade ago.
I don’t miss the pitch. But I find the element of human support to be important. For example, recently the FDA issued a black box warning for the concomitant use of Remicade and 6-MP. My representative visited to be sure that I was aware of the changes in the product insert. Sure the information was in my mailbox – along with 6 inches of pulp spam. It’s basic attenionomics: I’m more likely to hear a person than a letter. Read more »
*This blog post was originally published at 33 Charts*
