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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The goal is to deliver “parsimonious care,” says the American College of Physicians’ updated ethics manual. The college also offers guidance for online behavior.

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The Laser Spine Institute, a Tampa, Fla.-based endoscopic spine ambulatory surgery center with locations in seven cities, has a sophisticated approach to getting out the word about its treatments for back and neck pain. The institute’s website features videos of its physicians talking about the minimally invasive procedures and includes links to their frequent appearances in news media and the institute’s active social media accounts.

Now the institute, like many other health care organizations, is expanding its marketing beyond the public and aiming at physicians in the community who might send them new patients. To help in the effort, the 25-doctor group is looking to hire four new representatives — called physician liaisons or physician relations associates — who have at least five years’ experience as drug or device-company detailers. The new hires will visit doctors in their offices and discuss how the institute’s services could benefit their patients.

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The Joint Commission has issued a sentinel-event alert saying drowsy health professionals are likelier to be involved in adverse events than their well-rested counterparts. The commission advised the more than 6,500 hospitals and other health care organizations it accredits to take steps to mitigate the risks of such fatigue.

The December 2011 action comes amid more pushback against the Accreditation Council for Graduate Medical Education’s resident work-hour restrictions, with research published in December 2011 linking the limitations with more complications among neurosurgery patients.

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The past decade saw high-profile private and publicly funded initiatives targeted at the patient safety hazards affecting inpatients, including hospital-associated infections and wrong-site surgeries. Now experts are calling for a similar effort focused on the dangers that afflict outpatients.

In 2000, the Agency for Healthcare Research and Quality set an ambulatory care research agenda to help fill the gap. But the subsequent 10 years amounted to a “lost decade” as outpatient safety research and initiatives took a back seat to problems in hospitals, say the patient safety experts who produced a December 2011 report reviewing about 100 outpatient safety studies from 2000 to 2010.

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Most hospitals say the Centers for Medicare & Medicaid Services’ no-pay policy for hospital-acquired conditions has pushed them to make greater efforts to prevent health care-associated infections. But a study says preventing one item on the no-pay policy has gotten less of a push: catheter-associated urinary tract infections.

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Kansas City, Mo. — Thirty years after the disaster, Joseph F. Waeckerle, MD, still prays that he made the right calls.

The 1981 collapse of the interior skywalk system in the Hyatt Regency in Kansas City killed 114 people and injured 216 under the crushing weight of concrete and steel. Dr. Waeckerle directed the rescue effort and decided with just a few moments’ review who could be rescued and who could be offered only a morphine drip and advised to make peace with God.

Dr. Waeckerle and others at the scene had to determine how to save the most lives and limbs with little assurance that their judgments would be well-regarded in the aftermath.

A medical disaster is when the need for care outstrips the available resources — medicines, equipment, personnel. Such a chasm between demand and supply stretches far beyond a hectic day in the emergency department and requires a shift in ethical thinking because not every patient can get the care he or she would be entitled to under normal circumstances.

Which patients get the highest priority? What obligation do physicians have to respond to patient need in disasters? What should physicians do to prepare?

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