Avoiding medical errors in the hospital: practical tips

CNN has a nice article titled, "Nurses offer tips for surviving a hospital stay."

People don't seem to realize how dangerous the hospital can be for a patient. As many as 98,000 people die in U.S. hospitals each year as a result of medical errors, according to an Institute of Medicine report. Some 99,000 people die each year from infections acquired in the hospital, according to data from the Centers for Disease Control and Prevention (CDC).

Here are the 5 tips mentioned in the article:

1. Bring in a list of the medications you're taking
2. Make sure the hospital gets your name right
3. Ask about every medication they give you
4. Make sure everyone washes hands
5. If you think something's wrong, don't back down

Let me add my own hospital safety tips:

• If you have a drug allergy, mention that fact each time you receive a medication.
  
• Request a current list of medications that you are receiving in the hospital each day (keep that medical student busy).
• If you're not receiving a medication that you normally take at home, ask them about that! (how will you know this unless you have a list from home and you can compare that to your list in the hospital?)
  
• If you're having surgery on an arm/leg, make sure they mark the correct limb with a marker. You don't want to wake up with the wrong limb missing!

To read the CNN story, click here.

Dr. Nancy: Should doctors be on salary? Survey results are in!

Should doctors be on salary? Today, MSNBC featured survey results from a Sermo posting about physicians being on salary. The data got presented on the Dr. Nancy Show, hosted by Dr. Nancy Snyderman. Also appearing on the show was Sermo Founder, Dr. Daniel Palestrant who debuted the Sermo survey results on the issue of healthcare reform and physician salaries and Dr. William F. Streck, President and CEO of Bassett Healthcare.

Visit msnbc.com for Breaking News, World News, and News about the Economy

419 Scam on Facebook

If you're on Facebook, make sure to never give (or send) money to anyone who solicits money from you. Last month, my Facebook account got compromised and someone logged into my account and started soliciting money from my list of friends. Most of my contacts were aware of the "419 scam" so they quickly disconnected. Allow me summarize by quoting CBS5 news:

Facebook has a name for the latest scam, it's called the "419" scam and works like this: A hacker takes over a users' identity and sends messages to the users' friends. The messages claim that the user is stuck in London or another foreign city, after being mugged of their cash, credit cards and phone and requests friends to wire money so the user can get back home.

You may think that people are familiar with the 419 scam on Facebook, but I'm sure you'll find people who have no idea what you're talking about. Therefore, I hope you'll join me in raising public awareness about these types of dangerous scams on Facebook.

Related posts:

• My Facebook account got hacked!

• Reflections on a compromised Facebook account

• Tips on managing online passwords

New Frontiers in Schizophrenia and Bipolar Disorder Research

Here's a video from the Department of Brain and Cognitive Sciences at MIT. The title of this video is: "New Frontiers in Schizophrenia and Bipolar Disorder Research" and the presenter is Dr. Edward Scolnick, Director, Psychiatric Disease Program and the Stanley Center for Psychiatric Research at the Broad Institute. At the Broad Institute, Edward Scolnick, MD works to identify risk genes for bipolar disorder and schizophrenia.

Plasmapheresis leading to more kidney transplants

There is an inspiring story on CNN where seven kidney transplants were performed over four days at Georgetown University Hospital and Washington Hospital Center. The transplant teams were led by Dr. Keith Melancon, director of the kidney and pancreas transplant program at Georgetown University Hospital, and Dr. Jimmy Light, director of transplantation services at Washington Hospital Center.

The recipients had been on dialysis. Six of the seven kidney recipients and five of the seven donors were African-American. Minority groups are at higher risk for kidney problems, but they also receive fewer kidneys because of the lack of suitable matched organs. According to CNN, the use plasmapheresis, or plasma exchange, allowed all seven patients to match closely enough with their donors to allow the transplants. In plasmapheresis, a machine removes antibodies from a patient's blood that can cause organ rejection.

The use of plasmapheresis is significant, Melancon said, because it increases the chances of African-Americans to receive life-saving organs.

I know several people who have donated a kidney. Would you be willing to donate a kidney for a loved one? Probably. Would you be willing to donate a kidney for a complete stranger? Perhaps you may be motivated if someone else was willing to donate a kidney for someone you loved. This type of "kidney swap" has been known to happen. If you don't match for your loved one but someone else does, then perhaps you can donate for another individual and have someone else donate for your loved one. Seems confusing, doesn't it?

The Medical Fusion conference

Are you a physician interested in career change or opportunities in non-clinical careers? Are you frustrated with your medical career and interested in learning about career options for medical professionals? Do you wonder what else you could be doing with your medical training?

The Medical Fusion conference (www.MedFusionConf.org) is a new event that is focused on physician career change. Experts from around the country have been recruited to teach on non-clinical jobs, physician entrepreneurship, venture capital, medical journalism, medical informatics, and opportunities for physicians in the pharmaceutical industry, law, and television.

This life-changing event will take place November 13-15, 2009 at the Wynn Las Vegas. Participants will receive a special room rate at the Wynn for $199 per night and tuition is only $599 for twenty hours of lecture, much lower than many CME events. Register online as a reader of this blog and enter the code "JKBLOG" to receive a $25 discount.

Why continue the frustration? Learn how to use your talents and training in new and interesting ways. Be taught by physicians who have successfully bridged the gap between clinical and non-clinical careers such as:

• Dr. Michael VanRooyen, Co-Director of the Harvard Humanitarian Initiative and co-founder of four start-up companies
• Dr. Mike Woo-Ming, former Family Physician who retired from clinical medicine at age 35 and now runs many successful internet marketing companies
• Dr. Julie Silver, Chief Editor of Books at Harvard Health Publications and author of 14 books
• Dr. Ken Kamler, surgeon and best-selling author who is a consultant for the Discovery Channel and columnist for National Geographic Adventure
• Dr. Joe Smith, Vice President of Emerging Technology at Johnson & Johnson
• Dr. Mark Crockett, expert in medical informatics and President of the Emergency Care Division of Picis
• Dr. Mark Kroll, medical device inventor and expert in medical technology

Come to Vegas in November and learn from the best. Visit the Medical Fusion conference website at www.MedFusionConf.org and see why so many physicians are turning to Medical Fusion to begin their new careers. Make this event your first step to a new and exciting career change. Register online as a reader of this blog and enter the code "JKBLOG" to receive a $25 discount.

The early registration tuition rate for Medical Fusion ends on September 15th. After September 15th the tuition goes up to $799 for physicians and $649 for non-physicians.

FDA: Cancer Warnings Required for TNF Blockers

Here is the latest news from the FDA regarding TNF blockers and the risk of cancer:

FDA: Cancer Warnings Required for TNF Blockers

The U.S. Food and Drug Administration is requiring stronger warnings in the prescribing information for a class of drugs known as TNF blockers. The warnings, which include an updated boxed warning, highlight the increased risk of cancer in children and adolescents who receive these drugs to treat juvenile rheumatoid arthritis, the inflammatory bowel disorder, Crohn’s disease, and other inflammatory diseases.

In addition, the FDA is working with manufacturers to explore new ways to further define the risk of cancer in children and adolescents who use these drugs.

TNF blockers target and neutralize tumor necrosis factor-alpha (TNF-α), a protein that, when overproduced in the body due to chronic inflammatory diseases, can cause inflammation and damage to bones, cartilage and tissue. The drugs in this class include

• Remicade (infliximab),
  
• Enbrel (etancercept),
  
• Humira (adalimumab),
  
• Cimzia (certolizumab pegol) and
  
• Simponi (golimumab).

Today’s action is based on the completion of an investigation first announced by the FDA in June 2008. An analysis of U.S. reports of cancer in children and adolescents treated with TNF-blockers showed an increased risk of cancer, occurring after 30 months of treatment on average. About half of the cancers were lymphomas, a type of cancer involving cells of the immune system. Some of the reported cancers were fatal.

Additional required updates to the prescribing information include incorporation of reports of psoriasis associated with the use of TNF blockers.

Can you list who manufacturers the medications listed above? Eventually, I think we're going to realize that there's an increased risk of cancer with many of the biologic agents that are out there. The irony is that many biologic agents (different classes of drugs with varying mechanisms of actions) are also used to treat cancer. As we learn more about biologic agents, we may eventually complete the cancer circle. The more we understand about what causes cancer, the better we may be able to treat cancer.

DNA testing in children, talents, and privacy in China

In China, scientists (probably along with some government officials) are performing genetic tests in young kids to identify skills and talents by analyzing their DNA. That's right, no personal privacy issues here. Submit a DNA sample to see what talents your parents should cultivate. Is this ethical? This is a fascinating video.

Swine flu deaths around the world exceeding 1,100

According to this CNN story, the World Health Organization is reporting that global swine flu deaths are exceeding 1,100. We know that H1N1 is an unstoppable pandemic. This virus has spread in six weeks like how the common flu virus spreads in six months! We're waiting for effective vaccines and I'm sure we'll see them. The question in my mind is: will we have enough vaccines?

So who should get the vaccine?

The priority groups include pregnant women, health care and emergency services personnel, children, adolescents and young adults from six months to 24 years of age, household and caregiver contacts of children younger than six months and healthy adults with certain medical conditions.

Even though there are strong public health campaigns to get people vaccinated, we know that some simply won't receive the vaccine. Either they will refuse it, or they won't have access to medical care. Some won't make it a priority and they won't get the swine flu vaccine in time. Will we have enough anti-viral therapies for all those who don't receive a vaccine?

FDA Approves Livalo (pitavastatin)

Here's a recent FDA new drug alert: FDA Approves New Cholesterol-Lowering Drug

The U.S. Food and Drug Administration today approved the 4 milligram maximum dose of Livalo (pitavastatin), a drug intended to improve blood cholesterol levels in persons with elevated or abnormal blood cholesterol levels.

Like other statins, Livalo is intended for patients when diet and exercise fail to lower their cholesterol levels. Statins improve elevated blood cholesterol levels primarily by inhibiting a liver enzyme called HMG Co-A reductase, thus reducing the liver's ability to make cholesterol.

"Elevated or abnormal cholesterol levels are associated with an increased risk for heart disease and stroke," said Eric C. Colman, M.D., deputy director, Division of Metabolism and Endocrinology Products, in the FDA’s Center for Drug Evaluation and Research. “Today’s approval offers patients and their health care professionals another alternative way to treat high cholesterol.”

Livalo was approved on the basis of five clinical trials comparing its efficacy and safety to that of three currently marketed statins.

The most frequently reported adverse reactions from taking Livalo were muscle pain, back pain, joint pain and constipation.

Livalo is manufactured by Kowa Pharmaceuticals America Inc. of Montgomery, Ala.

So, can you name all the statins that are currently out there? We have: lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), atorvastatin (Lipitor), and rosuvastatin (Crestor). Now, we can add to that mix: pitavastatin (Livalo).

Blame the chimps for malaria?

If malaria came from the chimps, then what does that tell us about the origins of malaria? Understanding the origins may someday lead to a cure. However, a cure for malaria could result in a problem with population control since malaria acts as a "natural" way to control the world's population. Worldwide, malaria infects 500 million people every year and kills between 1 million and 3 million. Undoubtedly, it's a huge public health problem. However, if a cure for malaria reaches developing nations, then we may start seeing more countries enforcing birth-controlling policies such as China's one-child policy.

A story on CNN highlights the research that traces the roots of malaria to chimps. Here's an interesting snippet:

According to Nathan Wolfe and his team, malaria jumped to humans from our closest ancestors: chimpanzees. This finding, he says, unlocks one of the biggest medical mysteries confronting humans.

"We can actually understand, we can actually re-create the story that explains a fundamental and important part of our history," Wolfe said. "For me, this is the microbiological equivalent of discovering the origins of HIV."

Understanding the origin -- and the genetic behavior -- of a pathogen is the holy grail in the world of infectious disease.

So, we know that many viral infections jump from animals to humans. We've seen this happen with SARS, bird flu, swine flu, and even HIV. It's definitely interesting to see that malaria (which is not a viral infection) may have also jumped from animals to humans.

What do you know about mesothelioma?

How many people do you know who have mesothelioma? The annual incidence of mesothelioma in the U.S. is approximately 3300 new cases per year. Fortunately, the incidence is declining because we've done a better job to control for asbestos exposure. However, many people live with a long history of asbestos exposure because of certain types of occupations.


From a public health standpoint, mesothelioma is a significant health burden because mesothelioma prognosis is often quite poor. The median survival of patients with mesothelioma is between 6 and 18 months. Considering that advances in modern medicine have not significantly improved survival, we're faced with an illness that we still can't treat very effectively. Mesothelioma is often classified into three broad histologic subtypes:

1. epithelioid,
2. sarcomatoid, and
3. biphasic (mixed)

Mesothelioma doesn't just occur in the chest. There are other forms, such as peritoneal mesothelioma that occurs in the abdominal space. This type often rapidly spreads within the abdomen and is causes problems as the disease affects abdominal organs. So what types of treatments are currently available? You have surgery, radiation, chemotherapy, and a variety of combinations. Recently, investigators have also been exploring the role of gene therapy. That's the area that I find most fascinating because we may potentially see some novel treatment approaches that combine gene expression profiling and prognostication. By engineering viruses to carry certain genes. For instance, the administration of AdHSVtk could transduce the tumor cells, enabling them to express viral thymidine kinase, and thus make them sensitive to the normally nontoxic antiviral drug ganciclovir. This type of bioengineering research sounds very interesting to me.

EHRs leading to fewer medical errors

Since we're all human, we (as healthcare professionals) can make medical errors. Thanks to advances in electronic health records (EHRs), hospitals and clinicians are making fewer errors by leveraging automated alerts, alarms, and other features that prevent medical errors. Watch this CNN video that highlights "a close-up look at how one system is using electronic medical records to deliver better care and make fewer mistakes."

How should doctors receive education about new drugs?

We have seen so many new drugs and even new classes of drugs emerge over the last ten years. How do most physicians learn about new drugs? Many (certainly not all) community practitioners would say they learn what they need to know from the drug reps. Others indicate continuing medical education or CME activities as their main source of information regarding new drugs. Back in the "old days," docs would also attend many promotional/marketing dinners and social functions to learn about new medications. Those days are ending as PhRMA code regulations get stricter.

So what is the most effective way for physicians to learn about new drugs? They are so busy and easily overwhelmed by their workload that many have a difficult time keeping up with the latest science, the latest medical news, or even urgent FDA alerts and warnings.

Most of the clinical studies evaluating new drugs are performed by the drug manufacturer. Most of the CME activities that include any information related to new drugs are often underwritten by pharmaceutical companies, but the educational content is developed independently to be fair-balanced and is not influenced by industry. You won't see certified-CME activities that focus only on a single drug (maybe the only exception is when that's the only drug that's out there for a specific condition).

If a new drug comes out, do doctors really know how to use it safely and effectively? How can they accomplish this unless they receive fair-balanced education that highlights the clinical utility of such new agents? This becomes especially important when we're talking about brand new classes of drugs that have entirely new mechanisms of actions and pharmacological profiles.

There has been a lot of talk recently about industry-supported CME (certified continuing medical education). Some think that it's a bad idea for industry to support CME. Others feel that the lack of industry support may have a significant negative impact on physician continuing education. Why? Because the availability of fair-balanced educational programs may shrink considerably. What would happen if physicians only get exposed to marketing/promotional messages about new drugs and they don't get exposed to fair-balanced continuing education about those same products?

Public Insurance Plan

CNN Money.com has another article on healthcare reform. This one is titled, "Health reform follies: How to keep up" and it's a special report in the "Fixing Healthcare" section of CNN Money.com.

I'd like to focus on the section that discusses a public option. Let's begin with a small snippet:

Those who want a public insurance plan want it fiercely, saying it's the only thing that can force private insurers to reduce costs and be more competitive. Those who oppose it are equally fierce, saying it would result in a government takeover of the heath care system.

Where do you stand on this issue? Do you want to see a public insurance plan that's available for everyone and anyone? Is that really the right answer?

Two major bills that lawmakers will consider -- the tricommittee bill from the House and the bill put out by the Senate Health committee -- propose a public health insurance option. That public plan would compete with private insurers on a health insurance exchange -- or insurance supermarket -- that the bills also propose.

If we see a public plan emerge, will physicians choose to accept this plan? Already, we see many healthcare professionals who choose to only accept cash. They no longer wish to deal with the headaches of chasing reimbursement from insurance companies. As a result, they state that they no longer accept any forms of insurance and they use a fee-for-service model. If this trend continues, then the presence of a public insurance plan will yield no benefit for consumers who need outpatient medical care.

At the end of the day, will such public insurance plans mainly be for hospital admissions and major catastrophes? Maybe the government will take over all the hospitals. Sometimes I wake up in the middle of the night wondering if all of this is a dream.

Free medical school in Florida!

Wow, the University of Central Florida (UCF) is a brand new medical school and it has arranged to offer its entire inaugural class full scholarships totaling $7 million. This isn't just a publicity stunt. It's the real deal! 40 fortunate medical students will graduate without being burdened by school loans for tuition. Here's a snippet:

All 40 students of this charter class that begins Monday have received full scholarships totaling $7 million, donated entirely by members of the community -- including individuals, hospitals, banks and law firms.

Why can't I be so lucky? Would you turn down acceptance at Harvard to attend UCF if you could get a free ride? Read the CNN Money.com story here. Things like this don't happen every day.

Top posts in July 2009 on Medicine and Technology

July was a really busy month on MedicineandTechnology.com and I saw some serious peaks in traffic because I hosted Grand Rounds and because my Facebook account got hacked. Never give anyone money on Facebook.

The top referring websites for this month were 1) Medscape (thanks to Colin for the article), 2) Twitter (thanks to my 17,000+ followers), 3) Pajamas Media (thanks to Glenn Reynolds AKA Instapundit for telling people about Grand Rounds), and 4) CNN (thanks to Sphere, my blog posts often appear at the bottom of health-related CNN articles).

Here were the top posts for July:

1. Grand Rounds July 14, 2009: Technology and Healthcare

2. Is Canada's health system better?

3. Jobs for Physicians with No Residency Experience

4. Things are getting ugly between Sermo and the AMA

5. Non-Clinical Medical Opportunities for Physicians and Other Clinicians

6. Medical treatment based on the color of your skin

7. CNBC debate between Gov Dean and Sermo

8. Fake NASA moon landings?

9. After Obama's speech last night, will more physicians look for non-clinical careers?

10. My Facebook account got hacked!

In July, so much traffic came from referring sites so search engines only represented 13% of my site traffic.

Dr. Gupta’s ‘Four Months to Fitness’ initiative

I love how CNN's Dr. Sanjay Gupta is leveraging social media like Twitter. He's creative, innovative, and I believe he can make a significant public health impact through his "Four Months to Fitness" initiative. He says that his upcoming birthday (Twitter hashtag #1023) motivated him to launch the fitness forum with viewers. He wants himself, and America, to get in the best shape of their lives. To read more about this program, make sure you have a Twitter account and read the story here.