My lede:

With newly released data showing that prescription drug misuse now rivals illicit drug use as a cause of emergency department visits, the Food and Drug Administration in June released a long-awaited proposal aimed at curbing recreational use of opioid analgesics.

Physicians and advocates for pain patients hailed the FDA’s proposal for addressing the growing opioid abuse problem while not impeding legitimate access to pain treatment.

Emergency department visits related to misuse of prescription or over-the-counter drugs doubled from 500,000 in 2004 to 1 million in 2008, said the report, based on estimates from the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network. DAWN generated the estimates by reviewing data and medical charts submitted by 231 U.S. emergency departments.

Illegal drugs such as cocaine and heroin were involved in 1 million ED trips annually, a figure that stayed flat over the time period.

The whole shebang.

My lede:

Ambulatory surgical centers’ safety practices are under scrutiny as a study in the Journal of the American Medical Association found that problems in infection control are common at such centers.

The study came on the heels of a 28-count criminal indictment filed June 4 against Las Vegas gastroenterologist Dipak K. Desai, MD, and two of his endoscopy clinic nurse anesthetists. They were charged in connection with unsafe injection practices that led to a 2008 hepatitis C outbreak infecting 115 patients in southern Nevada.

The whole shebang.

My lede:

Two minutes after taking off from New York City’s LaGuardia Airport on a frigid January afternoon in 2009, US Airways Flight 1549 was struck by a flock of geese, instantly disabling the plane’s engines. Capt. Chesley B. “Sully” Sullenberger III radioed air traffic control, seeking an open runway to land the Airbus A320.

As Sullenberger looked for a place to put the plane down, first officer Jeffrey B. Skiles immediately consulted a checklist on how to restart the stalled engines. Skiles’ action showed how ingrained the checklist is in the culture of aviation, where it has been in use for more than 70 years.

Sullenberger successfully ditched the plane in the Hudson River. Then, outstanding application of emergency protocols helped the flight crew successfully evacuate the plane, saving the lives of all 155 people on board — another dramatic example of how aviation’s approach to safety yielded results that winter day.

Long before Sullenberger’s role in “the miracle on the Hudson” landed him on America’s front pages, he had been advising health care organizations on how to apply aviation’s safety lessons in medicine. His consulting group, Safety Reliability Methods Inc., is one of many firms offering aviation-based training to health care organizations eager to achieve the industry’s safety record.

“The risk of accidental death in a jet aircraft from 1967 to 1976 was 1 in 2 million,” Sullenberger noted in a speech in March to health IT professionals. “Today, it is 1 in 10 million. After 75 years, we in aviation have benefited from lessons learned at great cost — literally bought in blood — lessons we now offer up to the medical field for the taking.”

For more than a decade, doctors and hospitals have sought to learn from their counterparts in aviation. Checklists, structured communication techniques, preoperative briefings, error reporting and simulator training are just a few of the aviation safety methods they have tried to implement in the world of medicine.

However, adapting aviation’s techniques to health care has not been easy, patient safety experts say. Inherent differences between the two industries have made it a challenge to learn from aviation’s safety experience.

The whole shebang.

My lede:

More than 1,500 hospitals in 17 states reported 18% fewer central-line associated bloodstream infections than projected, according to a first-ever state-specific infection report released in May by the Centers for Disease Control and Prevention.

Infection-control professionals said the CDC data suggest that physicians and nurses at hospitals are using checklists to better implement guideline-based care and prevent bloodstream infections that kill an estimated 31,000 Americans each year.

“This progress is being led by that process of using checklists; I think it deserves a lot of credit,” said Stephen A. Streed, a board member of the Assn. for Professionals in Infection Control and Epidemiology Inc., representing more than 13,000 members who run infection-control programs.

The whole shebang.

My lede:

A Food and Drug Administration task force in May unveiled a series of 21 proposals to share publicly more information about pending or rejected drug and device applications, as well as agency enforcement actions. The move, which has drawn objections from companies fearful that greater disclosure will spill trade secrets, is part of a larger transparency drive the FDA launched last year.

The whole shebang.

My lede:

It is legal and ethical to honor patient requests to deactivate implanted cardiac devices, and physicians should take the initiative in talking with terminally ill patients and their families about turning off the devices, according to a new expert panel consensus statement released in May.

Implantable cardioverter-defibrillators, or ICDs, can impose a particularly heavy burden on terminally ill patients, continuing to send electrical shocks as the patient dies.

“His defibrillator kept going off,” one family member of a dying patient told the authors of a study in the Dec. 7, 2004, Annals of Internal Medicine. “It went off 12 times in one night.”

The whole shebang.

My lede:

New changes to Medicare and Medicaid payment could address the emotionally wrenching dilemma faced by physicians and terminally ill patients forced to choose between continuing curative treatments and taking advantage of hospice care programs’ in-home palliative, psychological and spiritual services.

The health reform law enacted in March directs state Children’s Health Insurance Programs and Medicaid plans to immediately cover “concurrent care” — a combination of curative efforts and hospice care — for children with terminal illnesses. The Congressional Budget Office estimates that the expanded coverage will cost $200 million over 10 years.

The law also calls on the Health and Human Services secretary to conduct a three-year, budget-neutral demonstration project of concurrent care for Medicare patients at 15 hospice-care sites.

The whole shebang.

My lede:

With more medical tests being ordered, the odds are greater that findings requiring follow-up action will fall through the cracks.

New recommendations in The Joint Commission Journal on Quality and Patient Safety in May highlight what physician practices and hospitals can do to reduce the risk of missing test results.

The whole shebang.

My lede:

Informed consent has long been a bedrock principle of medical ethics, but the form intended to document a patient’s understanding of a proposed intervention is too often written at a college reading level and is ambiguous about risks.

Some doctors are out to change that, bringing a personalized medical approach to informed consent.

Nine medical centers around the country — including the Mayo Clinic in Rochester, Minn., and the Henry Ford Hospital in Detroit — are testing an informed-consent process for patients undergoing nonemergent cardiac catheterization and potential angioplasty. The Web-based program draws on a national cardiovascular database to predict individualized risks of death, bleeding or restenosis.

Proponents of the effort say informed consent should include even more data, telling patients about cost, alternative treatments, and doctors’ and hospitals’ quality performance.

The whole shebang.

My lede:

Under scrutiny from politicians and physician critics, some medical specialty societies are pledging to disclose the industry funding they receive and say what that money pays for.

The promise comes as part of a code approved in April by the Council of Medical Specialty Societies, whose member organizations together represent more than 650,000 American physicians. The pressure on physician organizations to tell the public about industry support and limit the companies’ influence on their educational, research and advocacy activities has been building over the last year.

The whole shebang.

My lede:

One in five primary care physicians working in religiously affiliated health care organizations has experienced a conflict over faith-based patient care policies, according to a new study in the Journal of General Internal Medicine.

The findings, based on a nationwide survey of 446 family physicians and internists, appear to be the first to document how frequently doctors disagree with institutional policies in areas such as reproductive and end-of-life care, said Debra B. Stulberg, MD, the study’s lead author.

The whole shebang.

My lede:

Some hospitals have virtually eliminated deadly catheter-related bloodstream infections by implementing a checklist of simple preventive measures, yet an initiative to spread the success nationwide has run into some resistance.

A project funded by the Agency for Healthcare Research and Quality, On the CUSP: Stop BSI, has attracted the participation of at least 400 hospitals in 27 states. The project seeks to build on the success in Michigan, where intensive care units at more than 100 hospitals cut their median central-line infection rate to zero per 1,000 catheter days, compared with a national average of 5.2.

The whole shebang.

My lede:

It was bad enough that Seattle Grace Hospital intern Isobel “Izzie” Stevens, MD, fell in love with a patient in need of a heart transplant. But she really crossed the ethical line when she cut the wires to his left ventricular assist device so his health would deteriorate and he’d move higher on the United Network for Organ Sharing waiting list.

That behavior — portrayed by actress Katherine Heigl on the hit ABC TV medical drama “Grey’s Anatomy” — is probably the most outrageous example of scores of unethical medical actions shown on “Grey’s” and Fox TV’s “House,” according to a study in the April Journal of Medical Ethics.

The whole shebang.