Author Interviews, JAMA, Outcomes & Safety, Yale / 20.08.2013

Leora I. Horwitz, MD, MHS Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, ConnecticutMedicalResearch.com Interview with: Leora I. Horwitz, MD, MHS Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut MedicalResearch.com: What are the main findings of the study? Answer: We interviewed nearly 400 older patients who had been admitted with heart failure, pneumonia or heart attack within one week of going home from the hospital. We also reviewed the medical records of 377 of the patients. We found, for example, that:
  • 40% of patients could not understand or explain the reason they were in the hospital in the first place;
  • A fourth of discharge instructions were written in medical jargon that a patient was not likely to understand;
  • Only a third of patients were discharged with scheduled follow-up with a primary care physician or cardiology specialist;
  • Only 44% accurately recalled details of their appointments.
In other words, we didn't do a very good job of preparing patients for discharge, and perhaps as a result, patients were pretty confused about important things they needed to know after they were home. We just published a companion paper in the Journal of Hospital Medicine last week in which we looked at the discharge summaries for the same patients - that is, the summary of the hospitalization that is meant to help the outpatient doctor understand what happened in the hospital. Turns out we were just as bad at communicating with doctors as with patients - we focused on details of the hospitalization rather than what needed to happen next or what needed to be followed up, and in a third of cases, we didn't even send the summary to the outpatient doctor. In fact out of 377 discharge summaries, we didn't find a single one that was done on the day of discharge, sent to the outpatient doctor, and included all key content recommended by major specialty societies. (more…)
Author Interviews, Breast Cancer, Radiology, Yale / 30.07.2013

MedicalResearch.com Interview with Dr. Brian Haas MD Department of Diagnostic Radiology,Yale University School of Medicine, New Haven, CT Dr. Brian Haas MD Department of Diagnostic Radiology,Yale University School of Medicine, New Haven, CT MedicalResearch.com: What are the main findings of the study? Dr. Haas: We found that tomosynthesis helped to reduce the number of women who undergo a screening mammogram and are called back for additional imaging and testing. Specifically, the greatest reductions in patients being called back were seen in younger patients and those with dense breasts. Tomosynthesis is analogous to a 3D mammogram, and improves contrast of cancers against the background breast parenchyma. (more…)
Author Interviews, Breast Cancer, Cancer Research, Radiology, Yale / 01.07.2013

MedicalResearch.com Interview with: Sarah H. O'Connell M.D. PGY-4 Yale New Haven Hospital Yale School of Medicine Department of Diagnostic Radiology MedicalResearch.com:  What are the main findings of the study? Answer: The purpose of our study was to evaluate the visibility of cancers in women at high-risk for breast cancer on 2D mammography compared to digital breast tomosynthesis. In other words, how would the use of tomosynthesis contribute to cancer visualization in this population  of patients? We evaluated the cancers seen in both high-risk patients, those with a >20% lifetime risk of breast cancer, and intermediate risk  patients, those with a 15-20% lifetime risk of breast cancer, for a total of 56 cancers. We found that 41% (23/56) cancers were better seen on tomosynthesis and 4% (2/56) were only seen on tomosynthesis. The majority of the cancers seen better or only on tomosynthesis  presented as masses rather than as calcifications alone which were better seen on 2D mammography. (more…)
Author Interviews, Heart Disease, JAMA, Yale / 25.06.2013

Dr. Kumar Dharmarajan MD MBA Yale School of Medicine Center for Outcomes Research & Evaluation (CORE)Contraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart FailureMedicalResearch.com  Interview with Dr. Kumar Dharmarajan MD MBA

Yale School of Medicine Center for Outcomes Research & Evaluation (CORE)Contraindicated Initiation of β-Blocker Therapy in Patients Hospitalized for Heart Failure MedicalResearch.com: What are the main findings of the study? We found that among a large contemporary cohort of heart failure hospitalizations, beta blockers are frequently started in patients with markers of clinical instability such as residence in an intensive care unit (ICU), volume overload requiring intravenous diuresis, and poor cardiac output requiring intravenous inotropes. Approximately 40% of patients in whom a beta blocker is started has at least one of these three potential contraindications to treatment. This finding is concerning, as recent performance measures for heart failure recommend that a beta blocker be started during hospitalization for heart failure among patients with left ventricular systolic dysfunction. However, these performance measures also state that persons in whom a beta blocker is started "should not be hospitalized in an ICU, should have no or minimal evidence of fluid overload or volume depletion, and should not have required recent treatment with an intravenous positive inotropic agent." Moving forward, we are concerned that the unselective application of the new performance measure may lead to the further use of beta blocker therapy in patients at higher risk for adverse consequences of therapy. (more…)