My lede:

More than half of the people serving on cardiovascular guideline-writing committees between 2004 and 2008 had financial conflicts, according to a March 28 Archives of Internal Medicine study that sheds new light on the pervasiveness of financial ties to industry among the experts who make the clinical recommendations that shape medical care.

The new data arrived only days after an Institute of Medicine panel proposed wide-reaching standards on how clinical guideline panels should manage and limit conflicts of interest.

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My lede:

Most physicians take part in a medical school oath ceremony, but few believe that the rite of passage has strongly shaped their sense of professionalism, according to an article published March 14 in Archives of Internal Medicine.

Nearly 80% of 1,032 practicing physicians surveyed in 2009 said they took part in a medical school oath ceremony using the original or modified version of the Hippocratic Oath, the Osteopathic Oath, the Prayer of Maimonides or the Declaration of Geneva. However, only 26% said the oath they took significantly influenced their practice of medicine or provided moral guidance in their medical careers.

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My lede:

Fifty-one patients in Washington died after taking lethal medication prescribed by physicians under the first full year of the state’s aid-in-dying law, according to a state health department report released in March.

Sixty-eight physicians wrote life-ending prescriptions for 87 patients, 51 of whom took the medication and died. As of Feb. 9, 15 died of their illnesses before taking the lethal medication, and another 15 patients were still alive. For the remaining six deaths, it is unclear whether the patients ingested the medication prescribed under the law, the report said.

The physician-assisted suicide total represents a 42% rise from the 36 doctor-aided deaths in 2009, though the law didn’t take effect until March of that year. In Oregon, the only other state with a law authorizing physician-assisted suicide, 65 patients died last year after taking life-ending medication prescribed by their doctors, according to a state report released in January. Oregon has allowed physician-assisted suicide since 1998.

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My lede:

The United Network for Organ Sharing is considering an overhaul of the nation’s allocation plan that would give more kidneys to younger, healthier patients in an effort to achieve greater survival time from each transplant.

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My lede:

The 32 million Americans expected to obtain insurance coverage by 2019 under the Patient Protection and Affordable Care Act are likely to have better access to health care. But if Canada’s experience is any guide, disparities in health outcomes will continue.

Researchers followed 14,800 Canadian patients over 10 years and studied their use of health care services and health outcomes. Although all the patients were insured under Canada’s single-payer health system, health outcomes varied by patients’ income and educational levels, said a study in the February issue of Health Affairs.

“There is evidence out there that giving people who are uninsured some health insurance coverage will reduce disparities,” said David A. Alter, MD, PhD, the study’s lead author. “The word of caution is that will not eliminate disparities.”

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My lede:

Opioid analgesics help alleviate the symptoms of patients with chronic pain, but they also are vulnerable to abuse. About 14,000 people die annually from opioid overdoses, and the medicines are implicated in more than 300,000 emergency department visits each year, according to estimates from the Centers for Disease Control and Prevention.

To reduce the overdose risk, pain specialists advise that doctors prescribing opioids to patients with chronic pain monitor them closely to ensure that they do not misuse the drugs, especially if the patients have a history of substance abuse. But a study shows that some primary care doctors are not aggressive in pursuing monitoring strategies that could help prevent misuse and diversion.

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My lede:

A third of surrogate decision-makers experience stress, guilt and other upsetting emotions related to their role in determining a loved one’s care, according to a March 1 Annals of Internal Medicine systematic review of 40 studies.

The emotional burden on surrogate decision-makers often lasts for months — and sometimes years — after the treatment choice, researchers found. One study cited in the review found that stress levels of surrogates were comparable to those of people who experienced construction disasters or lost their homes to fire.

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My lede:

American hospital intensive care units cut central line-associated bloodstream infections by about 60% over nearly a decade, saving an estimated 27,000 lives and avoiding up to $1.8 billion in medical costs, said a new report from the Centers for Disease Control and Prevention.

“This is the first national success we have for patient safety in this country,” said Peter J. Pronovost, MD, PhD. He is principal investigator of a bundle of central-line infection prevention techniques that in 2006 demonstrated success statewide in Michigan and has spread to nearly 1,000 hospitals in 43 states.

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My lede:

The game is attacker-defender. Each player spontaneously selects another person in the room to “kill” with a tag. The targeted player selects another person as a “defender,” trying at all times to use that person as a shield against the attacker. When they are killed, players die a loud, dramatic death.

The game — a warm-up exercise for six students learning improvisational skills — quickly elicits a cacophony of shouts and squeals reminiscent of playground days. But all noise and movement stops with an unexpected knock at the door, the way children go mum during a sleepover when Mom checks in to see how things are going.

“Umm, could you kind of keep the noise down a little bit?” says the young woman who knocked. “We’re taking an exam next door.”

Oops.

The place — a medical school — is what makes this improv class unusual. Chicago, birthplace of the famed Second City improv comedy troupe that has served as the training ground for John Belushi, Bill Murray and many others, also is home to what appears be to the country’s only recurring improv class that also is part of a medical school curriculum.

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My lede:

Wide regional variations in physician supply have little effect on patient perceptions of access to care and the quality of medical care patients receive, according to a new study.

An article in the February Health Affairs reported the results of a nationwide survey of more than 2,500 Medicare beneficiaries. Although the number of physicians per capita varies by 200% to 300% across the country, the surveyed patients responded similarly to questions such as whether they have a personal physician, have seen a doctor in the last year and are satisfied with their care.

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My lede:

Oncologists caring for patients with incurable cancer should have realistic conversations about treatment options and refer patients for palliative care services earlier, according to a new policy statement by the American Society of Clinical Oncology.

The recommendations come on the heels of research showing that fewer than 40% of oncologists have such candid talks with their patients and that patients who receive palliative care live longer than those who receive only oncologic care.

Honest conversation with patients whose cancer cannot be cured is “happening far less often than it should,” said Allen S. Lichter, MD, CEO of ASCO, which has more than 30,000 oncology professionals as members. “It should happen 100% of the time.”

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My lede:

Higher spending on hospital care is linked to lower death rates, according to new research analyzing a decade of cost and quality outcomes for more than 2.5 million patients at 208 California hospitals.

The study, published Feb. 1 in Annals of Internal Medicine, is the largest yet to apparently contradict well-known research published as part of the Dartmouth Atlas of Health Care. The atlas researchers have found wide regional variations in care costs without corresponding increases in quality outcomes, including mortality rates. Sixty percent more care in the highest-spending regions due to hospitalizations, physician visits, diagnostic imaging and other interventions had little apparent effect on mortality outcomes or other quality metrics for Medicare patients, Dartmouth researchers have concluded.

But in the new study, California hospitals that spent more had lower in-hospital mortality rates for Medicare patients with six common deadly conditions such as congestive heart failure and pneumonia. For example, heart attack patients at the lowest-spending quintile of hospitals from 2004 to 2008 were 19% less likely to survive their stay than counterparts at the highest-spending hospitals. The average cost of hospital care for such patients was $21,072, four times greater than at the lowest-spending hospitals.

“We’re sort of taking on the view that more [health care spending] is actually worse — that more is less,” said John A. Romley, PhD, the study’s lead author. “We’re just saying, in this context, more is more.”

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