Even well-educated, well-to-do patients have trouble asking their physicians questions about treatment options or expressing their medical preferences and values, said a study drawing on focus groups with older adults in the San Francisco Bay Area.

Clear themes emerged from six focus group sessions with 48 patients in Palo Alto, Calif., the study said. Patients said they wanted to have a more active role in making medical decisions with their physicians, but feared upsetting them. The patients, all of whom were 40 or older, said they did not feel as though their physicians listened to or respected what they had to say.

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Eight leading pharmaceutical companies have approved 10 recommendations aimed at improving transparency to address what they call a “credibility gap” that faces industry-funded clinical research.

“Some observers, including some journal editors and academic reviewers, maintain a persistent negative view of industry-sponsored studies,” said an article in May’s Mayo Clinic Proceedings, co-written by 11 drug industry representatives and medical journal editors.

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The 2008 “no-pay” rule adopted by the Centers for Medicare & Medicaid Services to encourage hospitals to stop medical complications has led to consistently funded infection control departments, more collaboration with physicians and other front-line staff, and higher compliance with evidence-based guidelines.

More than 80% of infection-control professionals believe the CMS policy has led to greater focus on the health care-associated infections targeted under the rule, said a study published in the May American Journal of Infection Control. The study reported results of a survey of 317 infection preventionists at a nationally and industrially representative sample of hospitals. The journal is published by the 14,000-member Assn. for Professionals in Infection Control and Epidemiology.

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When actor Dennis Quaid’s 12-day-old twins developed infections in 2007, he and his wife took them to a Los Angeles hospital. But a medical error nearly killed the babies when they received 1,000 times the intended dose of heparin.

Look-alike packaging on the 10,000-unit strength and 10-unit strength vials of heparin and a failure to keep the higher-concentration vials out of patient-care areas contributed to the mistake, patient safety experts said.

Yet the same error had occurred only 14 months earlier at an Indianapolis hospital, when six infants got heparin overdoses and three of them died. The case received widespread news coverage, but it was not enough to spare the Quaid family its ordeal.

Quaid says hospitals should not need to see a serious error in their own facilities before taking preventive action to protect patients. He has joined with patient safety and aviation experts to call for an agency akin to the politically insulated, independent National Transportation Safety Board to investigate cases of medical harm and report deidentified findings to physicians, hospitals and the public.

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The vast majority of elderly patients are not being screened for mood disorders, problems with falls or performance of daily activities such as housework, says a poll of more than 1,000 adults 65 and older released in April.

In the nationwide survey, patients responded to specific questions about the last year of care they received, such as whether their physician asked if they had fallen or were sad, anxious or depressed.

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Having a family member in the trauma room does not impact the quality of care a child receives, said a study presented at the Pediatric Academic Societies Annual Meeting in April.

Researchers reviewed video and audio recordings of 145 trauma evaluations of patients 15 and younger to evaluate how well physicians followed evidence-based assessment protocols. For the 86 children who had relatives in the trauma room, 97% had their abdomens examined for injury according to protocol. That compares with 98% of the 59 children with no family present. Meanwhile, the median time for assessing the children’s airway was less than a minute for both groups.

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Patients on dialysis are subject to much more intensive medical care in the last month of life than are patients dying of cancer or heart failure, said an analysis of Medicare data that is raising concerns about the end-of-life care that patients with end-stage renal disease receive.

Nearly 80% of Medicare patients on dialysis were hospitalized in the 30 days before death and spent twice as many days in the hospital as patients dying of cancer, said a research letter published April 23 in Archives of Internal Medicine that was based on data from nearly 100,000 patients from the U.S. Renal Data System and Medicare between 2004 and 2009.

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The Wisconsin Medical Society is leading a statewide initiative to dramatically improve the rate at which patients complete advance care planning by training nonphysician health professionals to facilitate discussions with patients and encouraging community discussions of an often taboo subject.

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The recognition comes in the best how-to article category, for a story I wrote on how physicians can help ease the strain experienced by family members called upon to make end-of-life care decisions for their loved ones. While the story is obviously geared toward doctors, it may be helpful as a primer on the topic for nonphysicians. Check it out.

Daily remote monitoring of patients with chronic conditions appears to be ineffective in reducing rehospitalizations and emergency department visits, according to the most recent randomized controlled trial of the technology.

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Nearly 80% of physicians at an academic medical center said they experienced a personal crisis within the past year, yet most said they would not seek support from physician-health services or employee-assistance programs.

The 108 surgeons, anesthesiologists and emergency physicians surveyed said they experienced a wide range of stressful events, such as serious illnesses or deaths in their families and severe adverse events in their patients. But most they said they were unlikely to turn to institutional sources of support, with 40% saying they would be willing to consult physician-health services and 29% open to using employee-assistance programs. About a third of the doctors had never even heard of these services, said an Archives of Surgery study published in March.

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On a mild, gray day in February, fatigue lined the face of Anthony Parish, a slight, 39-year-old man who has been through a lot. He had a cancerous portion of his lung removed and struggled with postoperative pain. Chemotherapy treatments caused abscesses in his mouth that ruined his teeth and repeatedly sent him to the emergency department for relief, delivered in the form of painkillers and antibiotics.

Despite his health problems, Parish voiced hope on that midwinter morning. His medical team had developed a plan to help alleviate his dental pain. By the end of the month, his infected teeth would be removed and replaced with dentures. He still has intermittent chest pain, but he is learning to cope with it.

Parish is one of about 950 patients identified by Spectrum Health System in Grand Rapids, Mich., as having used their hospital EDs 10 times or more during the previous year. These patients accounted for more than 20,000 total visits and at least $40 million in costs during that period. In November 2011, Spectrum launched the Center for Integrative Medicine, a $1 million multispecialty clinic modeled on a pilot program that slashed ED use by nearly 90%, to help patients like Parish address the source of the problems that keep bringing them back to the ED.

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The National Quality Forum in April added four “efficiency” measures that could be combined with quality metrics as part of the Medicare value-based purchasing plan set to start in 2015.

These metrics join four measures previously endorsed in January and represent the multistakeholder group’s first efforts to measure the intensity of medical services that the health system provides, as well as the total costs. The work is being done under contract with the Dept. of Health and Human Services.

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