More than 80% of patients believe it is important to have their end-of-life wishes in writing, yet less than a quarter of them have accomplished that planning, said a survey of nearly 1,700 California adults released in February.

“With end-of-life treatment, there is a clear gap between wishes and actions,” said Mark D. Smith, MD, president and CEO of the California HealthCare Foundation, which commissioned the survey. “People consistently stress they want to die comfortably and without pain. If so, the single most important thing they can do is talk to their loved ones and physicians, and put their wishes in writing, something most Californians aren’t doing.”

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The Supreme Court of Georgia has struck down — on First Amendment grounds — a state law intended to prevent assisted suicide. Reversal of the law means that a physician and three others who were charged with helping a man take his own life in 2009 are free from prosecution.

The wording of the law was too broad, encompassing not just the act of assisting a suicide but also related and constitutionally protected speech acts, the state Supreme Court ruled on Feb. 6.

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For patients with HIV, strictly adhering to their regimen of antiretroviral drugs is not just critical but life-sustaining. So when patients admit to drug noncompliance, doctors are faced with how to help them take their drugs as prescribed.

But rather than engaging in open-ended conversations to address barriers to adherence such as side effects, patient misunderstanding and scheduling, physicians tend to ask yes-or-no questions and tell patients what to do, said a study published online Jan. 31 in the journal AIDS and Behavior.

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For more than a decade, patient safety leaders have urged medicine to shift from an approach that shames and blames individual doctors and nurses for medical errors to a “culture of safety” where open discussion and reporting about adverse events, mistakes, disruptive behavior and unsafe conditions are prized rather than punished.

This less-punitive model of medical-error prevention, inspired by the aviation industry’s safety record since the 1980s, is a key element of the Joint Commission requirements hospitals must follow to get paid by Medicare. And a growing body of evidence is showing that higher safety culture scores are correlated with better clinical outcomes and lower rates of hospital-acquired conditions.

Yet data released in February by the Agency for Healthcare Research and Quality show that most physicians, nurses, pharmacists and other health professionals working in hospitals believe their organizations are still more interested in punishing missteps and enforcing hierarchy than in encouraging open communication and using adverse-event reports to learn what’s gone wrong.

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Many of the country’s largest companies are telling hospitals to send a message to physicians and other health professionals who refuse influenza immunization: “You’re fired.”

“Transmission of seasonal influenza between health care workers and patients is a significant patient and worker safety issue. Failure to prevent the transmission of seasonal flu between health care workers and patients also increases health costs,” said Helen Darling, president and CEO of the National Business Group on Health, at a Feb. 2 news conference. The organization represents 340 U.S. companies, 68 of which are listed on the Fortune 500.

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Women seeking to avoid medical interventions and gain control of the birth process are increasingly choosing to deliver their babies at home, but medical experts warn that the option is accompanied by elevated neonatal mortality, even in low-risk births.

The news came shortly after an Australian home-birth advocate died following the delivery of her child at home, shedding a grave light on women’s choices about where to give birth.

Births taking place at home grew by 28% between 2004 and 2009, with nearly 30,000 home deliveries happening in 2009. Home births, which were 0.56% of all U.S. deliveries in 2004, accounted for 0.72% of all deliveries in 2009. That is the highest rate since at least 1990, when birth certificates were changed to allow additional detail about out-of-hospital births, said a data brief published in January by the National Center for Health Statistics.

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The annual checkup is geared toward doing a physical exam, taking a patient’s history and using the opportunity to deliver counseling or other preventive services that might be difficult to squeeze in during other office visits.

Yet even during these encounters, patients are nearly as likely to miss out as they are to receive guideline-based prevention, says an American Journal of Preventive Medicine study published in February.

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A parent’s anguished online plea for an organ transplant for her developmentally disabled daughter and new research on kidney transplantation eligibility among elderly patients have refocused attention on the vexing decisions that face physicians who determine which patients are suitable for transplantation.

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Amid scrutiny from regulators and researchers about potential abuse of the Medicare hospice benefit, data released in January show that patient lengths of stay in hospice fell slightly in 2010.

The average length of stay in hospice care decreased to 67.4 days, down from 69.5 in 2008, according to data collected by the National Hospice and Palliative Care Organization, which represents about two-thirds of the nation’s more than 5,000 for-profit and nonprofit hospices.

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The Food and Drug Administration’s communications to physicians and patients about the newly discovered dangers of approved medications often miss the mark, said a systematic review of 49 studies covering 16 medicines.

Researchers examined cases from 1990 to 2010 in which the FDA added warnings to labels, issued public health advisories or wrote letters to physicians and other prescribers to inform them of unanticipated drug risks. But these actions often did not achieve their aim or resulted in unintended consequences, said the review published online in January in the journal Medical Care.

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A team-based approach to primary care can help patients with depression and other chronic conditions better achieve their clinical goals, said a study in Annals of Family Medicine’s January/February issue.

More than 200 patients with depression and at least one other chronic condition such as diabetes, hypertension or high cholesterol were studied in a randomized controlled trial. The study was conducted at 14 primary care clinics that are part of the Group Health Cooperative integrated system based in Seattle.

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Physicians, nurses and other health professionals who work in hospitals soon may be getting a one-size-fits-all list of what adverse events they should report to improve patient safety.

That is the principal recommendation of a report released in January by the Dept. of Health and Human Services’ Office of Inspector General. The Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services already have pledged to deliver such a must-report adverse events list.

The OIG’s study found that 86% of harmful inpatient adverse events are not captured by hospitals’ incident-reporting systems, with physicians and other health professionals often choosing not to report the patient harm cases because they did not believe they were supposed to. Health professionals reported only two of the 18 most serious events identified — those that involved permanent disability or death, the study said.

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