Author Interviews, Critical Care - Intensive Care - ICUs, Infections, Outcomes & Safety / 20.01.2014

Allan J. Walkey, M.D., M.Sc Boston University School of Medicine Pulmonary Center Boston, MassachusettsMedicalResearch.com Interview with: Allan J. Walkey, M.D., M.Sc Boston University School of Medicine Pulmonary Center Boston, Massachusetts MedicalResearch.com: What are the main findings of the study? Dr. Walkey: Thank you for the interest in our study.  Current evidence-based treatments for severe sepsis (ie, infection+systemic inflammatory response+ end organ dysfunction) include specific processes of care rather specific therapeutics.  These processes include early administration of antibiotics, early fluid resuscitation, and lung protective ventilation strategies.  We hypothesized that hospitals with more ‘practice’ at treating patients with severe sepsis may have more effective care processes leading to improved patient outcomes.  We examined more than 15,000 severe sepsis admissions from 124 US academic medical centers. Our findings supported our hypothesis. After adjustment for patient severity of illness and hospital characteristics, mortality in the highest quartile severe sepsis case volume hospitals was 22% and  mortality in lowest severe sepsis case volume hospitals was 29%.  The 7% absolute mortality difference would result in an estimated number needed to treat in high severe sepsis volume hospitals to prevent one death in low case volume hospitals of 14 (though we advise caution in interpretation of a number needed to treat in an observational study). Costs and length of stay were not different across levels of severe sepsis case volume.  Results were robust to multiple subgroup and sensitivity analyses. (more…)
Author Interviews, Baylor College of Medicine Houston, JAMA, Outcomes & Safety, Surgical Research / 17.01.2014

MedicalResearch.com Interview with: Daniel A. Anaya, MD, FACS Associate Professor of Surgery - Surgical Oncology Michael E. DeBakey Department of Surgery Baylor College of Medicine Chief, General Surgery & Surgical Oncology SectionDirector, Liver Tumor Program Michael E. DeBakey VA Medical Center Houston, TX 77030 and Dr. Courtney J. Balentine, MD First author and surgical resident at Baylor College of Medicine MedicalResearch.com: What are the main findings of the study? Dr. Anaya:  That a good proportion of patients having colorectal operations will need additional assistance to recover during the postoperative period, resulting in being discharged to other facilities (nursing facilities, skilled care, etc) after surgery, and that hospitals where a higher-volume of colorectal operations are performed are more likely to discharge patients back to home after surgery. (more…)
Author Interviews, Brigham & Women's - Harvard, Health Care Systems, JAMA, Medical Research Centers, Outcomes & Safety / 17.01.2014

Elliot Wakeam MD Center for Surgery and Public Health Brigham and Women's Hospital Boston MA 02115MedicalResearch.com Interview with Elliot Wakeam MD Center for Surgery and Public Health Brigham and Women's Hospital Boston MA 02115 MedicalResearch.com: What are the main findings of the study? Dr. Wakeam: Our study examined failure to rescue (FTR), or death after postoperative complications, in safety net hospitals. Prior work has shown that hospital clinical resources can improve rescue rates, however, despite having higher levels of technology and other clinical resources that should lead to better rates of patient rescue, safety net hospitals still had greater rates of death after major complications. (more…)
Author Interviews, BMJ, Outcomes & Safety / 16.01.2014

Sunita Vohra MD MSc FRCPC FCAHS Director, CARE Program Director, PedCAM Network, AIHS Health Scholar Professor, Dept of Pediatrics Faculty of Medicine & Dentistry University of Alberta Edmonton Continuing Care Centre, Edmonton, Alberta CanadaMedicalResearch.com Interview with: Sunita Vohra MD MSc FRCPC FCAHS Director, CARE Program Director, PedCAM Network, AIHS Health Scholar Professor, Dept of Pediatrics Faculty of Medicine & Dentistry University of Alberta Edmonton Continuing Care Centre, Edmonton, Alberta Canada MedicalResearch.com: What are the main findings of the study? Dr. Vohra: Our main findings were: (i) relative to how often systematic reviews evaluate the effectiveness of health interventions, the systematic review of harms is quite neglected; and (ii) even when systematic reviews do aim to evaluate harms, there is considerable room for improvement in reporting. (more…)
Author Interviews, General Medicine, Hand Washing / 10.01.2014

Caroline Landelle, PharmD, PhD Infection Control Unit, Centre Hospitalier Universitaire (CHU) Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris–Est Créteil, FranceMedicalResearch.com Interview with: Caroline Landelle, PharmD, PhD Infection Control Unit, Centre Hospitalier Universitaire (CHU) Albert Chenevier–Henri Mondor, Assistance Publique–Hôpitaux de Paris, Université Paris–Est Créteil, France MedicalResearch.com: What are the main findings of the study? Dr. Landelle: The main findings point to the fact that nearly one in four healthcare workers’ hands are contaminated with Clostridium difficile spores after routine care of patients infected with the bacteria, before performing hand hygiene. This is the first study focusing upon the carriage of viable C. difficile spores on healthcare workers’ hands. C. difficile exist in 2 possible forms: vegetative and spore. Vegetative forms of C. difficile are killed when exposed to air, whereas their spores are resistant to oxygen, desiccation, and most disinfectants, and may persist in the hospital environment for long periods of time; thus, bacterial spores could be the principal form of transmission. Furthermore, contamination of exposed healthcare workers’ hands is statistically associated with direct exposure to fecal soiling and contact without the use of gloves. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Hospital Readmissions, Medical Research Centers / 31.12.2013

Dr. Jacques Donzé MD PhD Research Associate Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital Harvard Medical School, Boston, MA 02115, USADivision of General Internal Medicine, Bern University Hospital, 3010 Bern, SwitzerlandMedicalResearch.com Interview with: Dr. Jacques Donzé MD PhD Research Associate Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital Harvard Medical School, Boston, MA 02115, MedicalResearch.com: What are the main findings of the study? Dr. Donzé: In a large retrospective cohort study, we identified the primary diagnoses of 30-day potentially avoidable readmissions in medical patients according to the most common comorbidities. Interestingly, almost all of the top five diagnoses of potentially avoidable readmissions for each comorbidity were possible direct or indirect complications of that comorbidity. Patients with cancer, heart failure, and chronic kidney disease had a significantly higher risk of potentially avoidable readmission than those without those comorbidities. Also, when readmitted, patients with chronic kidney disease had a 20% higher risk of having the readmission be potentially avoidable. (more…)
Author Interviews, Blood Pressure - Hypertension, Compliance, JACC, Outcomes & Safety, UT Southwestern / 10.12.2013

Dr. Wanpen Vongpatanasin, MD Professor of Medicine Director, Hypertension Section Cardiology Division UT Southwestern Medical CenteMedicalResearch.com Interview with; Dr. Wanpen Vongpatanasin, MD Professor of Medicine Director, Hypertension Section, Cardiology Division UT Southwestern Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Vongpatanasin: We found that more than 50% of patients with resistant hypertension were non-adherent to at least one drug prescribed by their primary care physicians for blood pressure control. When we provided this information back to the patients, as part of care in our hypertension specialty clinic, we found that many patients report difficulty taking prescribed medications due to either associated side effects or cost of the medication. When we adjusted patient's medications to fit their needs, BP levels were substantially improved during subsequent visits without increasing the number of medications. (more…)
Author Interviews, General Medicine, Hospital Readmissions, Sleep Disorders / 06.12.2013

Dr. Takatoshi Kasai, MD, PhD Department of Cardiology and Cardio-Respiratory Sleep Medicine, Juntendo University School of Medicine, Tokyo, JapaMedicalResearch.com Interview with: Dr. Takatoshi Kasai, MD, PhD Department of Cardiology and Cardio-Respiratory Sleep Medicine, Juntendo University School of Medicine, Tokyo, Japan MedicalResearch.com: What are the main findings of the study? Dr. Kasai: Sleep disordered breathing, determined using predischarge nocturnal pulse oximetry, is prevalent and is an independent predictor of the combined end point of readmission and mortality in hospitalized patients with left ventricular systolic dysfunction after acute decompensated heart failure. (more…)
AHRQ, Author Interviews, Electronic Records, Hospital Readmissions, University of Pennsylvania / 28.11.2013

Craig A Umscheid, MD, MSCE, FACP Assistant Professor of Medicine and Epidemiology Director, Center for Evidence-based Practice Medical Director, Clinical Decision Support Chair, Department of Medicine Quality Committee Senior Associate Director, ECRI-Penn AHRQ Evidence-based Practice Center University of Pennsylvania Philadelphia, PA 19104MedicalResearch.com Interview with: Craig A Umscheid, MD, MSCE, FACP Assistant Professor of Medicine and Epidemiology Director, Center for Evidence-based Practice Medical Director, Clinical Decision Support Chair, Department of Medicine Quality Committee Senior Associate Director, ECRI-Penn AHRQ Evidence-based Practice Center University of Pennsylvania Philadelphia, PA 19104 MedicalResearch.com: What are the main findings of the study? Dr. Umscheid: We developed and successfully deployed into the electronic health record of the University of Pennsylvania Health System an automated prediction tool which identifies newly admitted patients who are at risk for readmission within 30 days of discharge.  Using local data, we found that having been admitted to the hospital two or more times in the 12 months prior to admission was the best way to predict which patients are at risk for being readmitted in the 30 days after discharge. Using this finding, our automated tool identifies patients who are “high risk” for readmission and creates a “flag” in their electronic health record (EHR). The flag appears next to the patient’s name in a column titled “readmission risk.” The flag can be double-clicked to display detailed information relevant to discharge planning.  In a one year prospective validation of the tool, we found that patients who triggered the readmission alert were subsequently readmitted 31 percent of the time. When an alert was not triggered, patients were readmitted only 11 percent of the time.  There was no evidence for an effect of the intervention on 30-day all-cause readmission rates in the 12-month period after implementation. (more…)
Author Interviews, BMJ, Hospital Readmissions / 21.11.2013

Kumar Dharmarajan MD MBA Fellow in Cardiovascular Medicine Columbia University Medical CenterMedicalResearch.com Interview with: Kumar Dharmarajan MD MBA Fellow in Cardiovascular Medicine Columbia University Medical Center MedicalResearch.com: What were the main findings of the study Dr. Dharmarajan: In the United States, 1 in 5 older patients is readmitted to the hospital within 30 days of hospital discharge. However, there is great variation in rates of 30-day readmission across hospitals, and we do not know why some hospitals are able to achieve much lower readmission rates than others. We therefore wondered whether top performing hospitals with low 30-day readmission rates are systematically better at preventing readmissions from particular conditions or time periods after discharge. For example, are hospitals with low 30-day readmission rates after hospitalization for heart failure especially good at preventing readmissions due to recurrent heart failure or possible complications of treatment? Similarly, are top performing hospitals especially good at preventing readmissions that occur very soon after discharge, which may signify poor transitional care as the patient moves form the hospital back home? (more…)
Author Interviews, Heart Disease, Hospital Readmissions, JACC, Outcomes & Safety / 18.10.2013

Saul Blecker, MD, MHS Department of Population Health, NYU School of Medicine, New York, NY Department of Medicine, NYU School of Medicine, New York, NYMedicalResearch.com Interview with: Saul Blecker, MD, MHS Department of Population Health, NYU School of Medicine Department of Medicine, NYU School of Medicine, New York, NY   MedicalResearch.com: What are the main findings of the study? Dr. Blecker: Inpatient quality of care has focused primarily on patients with acute heart failure, commonly identified by principal discharge diagnosis code. However, patients with heart failure are commonly hospitalized for other causes and should benefit from many of the same treatments. We found that in our sample, as compared to patients with a principal diagnosis of heart failure, heart failure patients hospitalized with a non–heart failure diagnosis had lower rates of guideline-concordant care, including assessment of left ventricular function and prescription for an ACE inhibitor or ARB, at time of discharge. This is important as our study suggests that these therapies were associated with reduced mortality for patients hospitalized with heart failure, regardless of the reason for hospitalization. (more…)
Author Interviews, Hand Washing, JAMA, MRSA / 07.10.2013

Anthony Harris, MD, MPH Department of Epidemiology and Public Health Professor University of Maryland School of Medicine Acting Medical Director of Infection Control University of Maryland Medical CenterMedicalResearch.com Interview with: Anthony Harris, MD, MPH Department of Epidemiology and Public Health Professor University of Maryland School of Medicine Acting Medical Director of Infection Control University of Maryland Medical Center     MedicalResearch.com: What are the main findings of the study? Dr. Harris: The aim of the study was to understand if wearing disposable gowns and gloves for all patient contact in the ICU could help prevent the spread of MRSA and similar antibiotic-resistant bacteria. Secondarily we wanted to make sure this type of patient isolation did not result in any harm to patients. The results of the study were that gowns and gloves worn by healthcare workers for contact with all patients in the ICU did not decrease the number of patients who acquired VRE but did decrease MRSA about 40 percent.  Also, wearing gloves and gowns did not adversely impact patient care.  For our goal of studying all types of infection, we did not find a benefit to universal gown and glove use. However, for transmission of MRSA alone, the intervention decreased transmission by about 40 percent. Although previous studies have showed isolation is associated with falls, bed sores and other adverse events, we found gowns and gloves did not produce more of these negative events. (more…)
Hospital Acquired, Infections, Outcomes & Safety, Pediatrics / 07.10.2013

MedicalResearch.com Interview with: Elias Iosifidis, MD, PhD Pediatric Infectious Disease Fellow Aristotle University of Thessaloniki Hippokration Hospital Thessaloniki, Greece MedicalResearch.com: What are the main findings of the study? Dr. Iosifidis: A large outbreak of VRE colonization was found in neonates hospitalized in an intensive care unit (Neonatal Intensive Care Unit, NICU) after the implementation of an active surveillance program. Both high incidence of VRE colonization (or “colonization pressure”) and antibiotic use promoted VRE spread according to the results of the case control study. No proven sources of VRE were found (in local hospital or even in local livestock). A multifaceted management was implemented and included enhanced infection control measures, active surveillance cultures, cohorting of colonized patients, daily audits and optimization of antibiotic therapy. Although the outbreak had a biphasic pattern (monoclonal first wave followed by a polyclonal second wave) strict adherence to the aforementioned bundle of actions was proved essential for reducing VRE colonized cases. During the study period no new VRE infection occurred in neonates. (more…)
CMAJ, Cognitive Issues, General Medicine, Hospital Readmissions, Outcomes & Safety / 19.09.2013

Mark W. Ketterer, PhD, ABPP Senior Bioscientific Staff Henry Ford Hospital/A2 Detroit, MI 48202 Clinical Professor of Psychiatry & Behavioral Neurosciences Department of Psychiatry Wayne State UniversityMedicalResearch.com Interview with: Mark W. Ketterer, PhD, ABPP Senior Bioscientific Staff Henry Ford Hospital/A2 Detroit, MI 48202 Clinical Professor of Psychiatry & Behavioral Neurosciences Department of Psychiatry Wayne State University MedicalResearch.com: What are the main findings of the study: Dr. Ketterer:  A survey of 84 patients admitted to Henry Ford Hospital found 54% to have Moderate-Severe Cognitive Impairment (CI). (more…)
Author Interviews, CMAJ, Infections, Outcomes & Safety, Urinary Tract Infections / 18.09.2013

MedicalResearch.com Interview with: Mohamad Fakih, MD, MPH Medical Director, Infection Prevention and Control St John Hospital and Medical Center MedicalResearch.com: What are the main findings of the study? Dr. Fakih: Urinary catheters are commonly used in the hospital.  Although they help in the management of the sickest patients, they also present a risk for infection and other harms to the patient. The Centers for Medicaid and Medicare Services (CMS) have made catheter associated urinary tract infections (CAUTI) publicly reportable, and no longer reimburse hospitals for these infections if they occur in hospital setting. The definition of CAUTI is based on the surveillance definition of the National Healthcare Safety Network (NHSN) by the Centers for Disease Control and Prevention (CDC). We looked at clinician practice, including the Infectious Diseases specialist’s impression and compared them to the NHSN definition. We found a significant difference between what clinicians think is a urinary catheter infection and give antibiotics for it compared to the NHSN definition. The NHSN definition predicted clinical infection by the Infectious Diseases specialist in only about a third of the cases. We also found that Infectious Disease specialists considered patients to have true CAUTI in only half of what clinicians treated as CAUTI. (more…)
Author Interviews, Outcomes & Safety / 13.09.2013

MedicalResearch.com Interview with: Cori L. Ofstead, MSPH President and CEO OFSTEAD & ASSOCIATES 400 Selby Avenue, Suite V |Blair Arcade West Saint Paul, MN 55102-4520 MedicalResearch.com: What are the main findings of the study? Dr. Ofstead: Our researchers found evidence that endoscope reprocessing lapses, which involved a failure to properly clean and disinfect endoscopes after patient use, were very common.  These lapses occurred in hospitals, clinics, and ambulatory surgery centers, and involved various steps of the process.  In many cases, the reprocessing problems persisted for months or years before being discovered. Over the past several years, thousands of patients have been exposed to contaminated endoscopes, which had significant implications for both patients and their medical providers. For example, we found quite a few cases where exposed patients had to be notified that proper procedures were not followed.  In some cases, testing confirmed transmission of pathogens with an increase in morbidity and mortality. (more…)
Health Care Systems, Outcomes & Safety / 12.09.2013

MedicalResearch.com Interview with: Lauren Doctoroff, MD Hospitalist, Hospital Medicine Program Beth Israel Deaconess Medical Center Medical Director, HCA Post Discharge Clinic and PACT Transitional Care Program Instructor, Harvard Medical School Boston, MA 02215MedicalResearch.com Interview with: Lauren Doctoroff, MD Hospitalist, Hospital Medicine Program Beth Israel Deaconess Medical Center Medical Director, HCA Post Discharge Clinic and PACT Transitional Care Program Instructor, Harvard Medical School Boston, MA 02215 MedicalResearch.com What are the main findings of the study? Dr. Doctoroff: A dedicated post discharge clinic, staffed by hospitalists, led to a shorter interval to a clinic visit for patients after discharge.  Patients with resident primary care doctors and those who are African American were most likely to use the clinic.  The care provided in the clinic, in terms of testing, was consistent with the remainder of the practice. (more…)
Author Interviews, Duke, Heart Disease, Outcomes & Safety, Surgical Research / 05.09.2013

Marco D. Huesch, MBBS, Ph.D., Assistant professor at the USC Sol Price School of Public Policy Adjunct professor with Duke’s School of Medicine and Fuqua School of Business.MedicalResearch.com Interview with: Marco D. Huesch, MBBS, Ph.D. Assistant professor at the USC Sol Price School of Public Policy Adjunct professor with Duke’s School of Medicine and Fuqua School of Business. MedicalResearch.com: What are the main findings of the study? Answer: This study asked whether ‘learning by doing’ works backwards too, as ‘forgetting by not doing’. In an nutshell, the answer is ‘no’ among the Californian cardiac surgeons I examined with short breaks of around a month. (more…)
Author Interviews, BMJ, Outcomes & Safety, Rheumatology / 30.08.2013

MedicalResearch.com Interview with: Mwidimi Ndosi, PhD, MSc, BSc (Hons), RN. Academic & Clinical Unit for Musculoskeletal Nursing (ACUMeN) Leeds Institute of Rheumatic and Musculoskeletal Medicine University of Leeds England MedicalResearch.com: What are the main findings of the study? Answer: The aims of this study was to determine the clinical and cost-effectiveness of nurse-led care for people with rheumatoid arthritis. The main findings were: (i)             Patients seeing clinical nurse specialists for their rheumatoid arthritis follow-up care do not get an inferior treatment. (ii)           Nurse-led care is safe and in some aspects presents added value to patients (iii)          Nurse-led care represents good value for money in terms of disease management for people with RA. (more…)
Author Interviews, Hospital Readmissions / 27.08.2013

Allan Garland, MD, MA Co-Head, Section of Critical Care Medicine Associate Professor of Medicine and Community Health Sciences University of Maniitoba 820 Sherbrook St / GF-222 Winnipeg, Manitoba R3A 1R9MedicalResearch.com Interview with: Allan Garland, MD, MA Co-Head, Section of Critical Care Medicine Associate Professor of Medicine and Community Health Sciences University of Maniitoba 820 Sherbrook St / GF-222 Winnipeg, Manitoba R3A 1R9   MedicalResearch.com: What are the main findings of the study? Answer:   Our study evaluated consequences of leaving the hospital against medical advice (AMA).  It is a large, population-based analysis, that evaluated all hospitalizations from which patients were discharged alive, among all adults in the Canadian province of Manitoba over a 19 year period; this was over 1.9 million hospitalizations.  Outcomes assessed were hospital readmission and death over 6 months after the event.  Specifically, we compared these outcomes for those who left the hospital against medical advice, compared to those who remained in the hospital until their doctors felt it was safe to be discharged -- and these comparisons adjusted for a variety of patient and illness characteristics. Among the 1.9 million hospitalizations, there were 21,417 that ended with the patients leaving against medical advice, this is 1.1% of the total.  Without adjustment for other variables, leaving against medical advice was associated with double the rate of unscheduled hospital readmission within 30 days (24.0 vs. 12.1%); after adjustment, the odds of unscheduled hospital readmission within 30 days was 3-fold higher for someone who left against medical advice compared to one who did not.  After adjustment, the odds of death at 90 days were 2.51-fold higher for those who left against medical advice. (more…)
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, Cost of Health Care, Heart Disease, Outcomes & Safety / 20.08.2013

Dr. Finlay McAlister Division of General Internal Medicine Patient Health Outcomes Research and Clinical Effectiveness Unit University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont.MedicalResearch.com Interview with: Dr. Finlay McAlister Division of General Internal Medicine Patient Health Outcomes Research and Clinical Effectiveness Unit University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont. MedicalResearch.com: What are the main findings of the study? Answer: Heart Failure carries a high risk of readmission/death in the first 30 days after hospital discharge (approximately 20%) - even in this cohort of patients with first time diagnosis of heart failure who were discharged home to the community.  Patients who do not have an outpatient physician follow-up visit in the first 30 days after discharge have poorer outcomes at 30 days, 3 months, 6 months, and 12 months.  Although outcomes are similar for patients who see an unfamiliar or a familiar physician in that first 30 days, over the longer term follow-up with a familiar physician is associated with better outcomes than follow-up with unfamiliar physician(s). (more…)
Author Interviews, Hand Washing, Outcomes & Safety / 01.08.2013

Clare Rock, MD Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore, MD, 21201MedicalResearch.com Interview with: Clare Rock, MD Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore, MD, 21201 Summary paragraph: Dr. Rock: Hand hygiene is an essential step in infection prevention and a focus on improving and sustaining hand hygiene compliance is needed.  However, it remains unclear whether or not hand hygiene is required prior to non-sterile glove use.  Our study would support that it is not a necessary step and a potential waste of healthcare worker time. (more…)
Author Interviews, Outcomes & Safety / 24.07.2013

MedicalResearch.com Interview with: Lillian S. Kao, MD, MS Associate Professor, Department of Surgery The University of Texas School of Medicine at Houston Houston, Texas 77030 MedicalResearch.com: What are the main findings of the study? Dr. Kao: -The internal validity (methodological rigor) and external validity (generalizability) of quality improvement (QI) studies of implementation of surgical antibiotic prophylaxis measures are poor. -Studies demonstrating large positive effect on compliance were often performed in settings where the baseline compliance was extremely low (i.e., less than 20%), thus further limiting their generalizability. -Very few studies evaluated the effect of the QI interventions to increase appropriate antibiotic prophylaxis use on surgical site infections (SSIs). Moreover, those studies that included SSI as an outcome measures were usually underpowered to identify a significant effect. -The majority of studies failed to report metrics relating to the quality of the implementation of the interventions to increase antibiotic prophylaxis compliance. Effectiveness of evidence-based measures is dependent upon their implementation. For example, did all of the targeted groups adopt the intervention? Or were the QI interventions sustained beyond the initial measurement or study period? (more…)
Author Interviews, Cost of Health Care, Medicare, Outcomes & Safety / 23.07.2013

MedicalResearch.com Interview with: Alai Tan, MD, PhD Assistant Professor, Dept. of Preventive Medicine & Community Health Sr. Biostatistician, Sealy Center on Aging Univerisity of Texas Medical Branch 301 University Blvd., Galveston, TX  77555-0177 MedicalResearch.com: What are the main findings of the study? Dr. Tan: The study developed and validated sex-specific Cox proportional-hazards models with predictors of age and comorbidities to predict patient life expectancy using Medicare claims data. The predictive model was well-calibrated and showed good predictive discrimination for risk of mortality between 5 and 10 years. (more…)
Author Interviews, Mayo Clinic, Outcomes & Safety / 23.07.2013

MedicalResearch.com Interview with Dr. Vinay Prasad, MD Medical Oncology Branch, National Cancer Institute National Institutes of Health, 10 Center Dr 10/12N226, Bethesda, MD20892. MedicalResearch.com: What are the main findings of the study? Dr. Prasad: We reviewed all original articles in the New England Journal of Medicine over ten years.  1344 articles tested some medical practice-- which is a screening or diagnostic test, medication, procedure or surgery.  Only 27% or 363 articles tested current medical practice.  And of these articles 146 (40%) contradicted current standard of care, constituting a medical reversal. (more…)
Author Interviews, BMJ, Hospital Acquired, Infections, Outcomes & Safety / 19.06.2013

Marin L. Schweizer Ph.D. Assistant Professor University of Iowa Carver College of Medicine, Iowa City, IA, USAMedicalResearch.com Interview with: Marin L. Schweizer Ph.D. Assistant Professor University of Iowa Carver College of Medicine Iowa City, IA, USA MedicalResearch.com: What are the main findings of the study? Dr. Schweizer: A clinical bundle that includes nasally screening cardiac and orthopedic surgery patients for S. aureus (both methicillin-resistant S. aureus and methicillin-susceptible S. aureus), decolonizing carriers, and changing antibiotic prophylaxis for MRSA carriers, can significantly reduce the number of gram-positive surgical site infections, S. aureus surgical site infections and MRSA surgical site infections. (more…)
Author Interviews, JAMA, Nutrition, Outcomes & Safety, Vegetarians / 06.06.2013

MedicalResearch.com eInterview with: Michael J. Orlich, M.D. Program Director Preventive Medicine Residency Loma Linda University www.lluprevmedres.org Research Fellow, Adventist Health Studies www.adventisthealthstudy.org MedicalResearch.com: What are the main findings of the study? Dr. Orlich: The main findings were these. Vegetarians, as we defined them, had reduced risk of death during the study period compared to non-vegetarians. This was true also for particular vegetarian diets including for vegans, lacto-ovo-vegetarians, and pesco-vegetarians.  Reduced risk was seen in particular for deaths related to disease of the heart, kidneys, and diabetes. Findings were stronger in men than women. (more…)
Author Interviews, Cost of Health Care, Outcomes & Safety / 04.06.2013

James D. Chambers, PhD, MPharm Assistant Professor The Center for the Evaluation of Value and Risk in Health Institute for Clinical Research and Health Policy Studies TuftsMedicalCenter www.cearegistry.org MedicalResearch.com: What are the main findings of the study? Dr. Epstein: Using cost-effectiveness evidence to help inform the allocation of expenditures for medical interventions in Medicare has the potential to generate substantial aggregate health gains for the Medicare population with no increases in spending. Reallocating expenditures for interventions in Medicare using cost-effectiveness evidence led to an estimated aggregate health gain of 1.8 million quality-adjusted life years (QALYs), a measure of health gain that accounts for both quality and quantity of life. (more…)
Hand Washing, Outcomes & Safety / 30.05.2013

Sarah Edmonds, Scientist at GOJO.MedicalResearch.com eInterview with: Sarah Edmonds, Scientist at GOJO. MedicalResearch.com: What are the main findings of the study? Answer: Implementation of electronic hand hygiene compliance monitoring with a clinical hand hygiene program significantly increased hand hygiene compliance rates, with rates during the study period being 92% higher than at baseline. MedicalResearch.com: Were any of the findings unexpected? Answer: While not necessarily unexpected we did find that electronic compliance monitoring alone may not be sufficient to raise compliance rates for a sustained period of time. After the clinical program concluded there was a significant drop in compliance rates so it is important to continue to monitor hand hygiene rates and continue to promote the program to sustain increased hand hygiene compliance. (more…)