Breast Cancer, JAMA, Outcomes & Safety / 03.04.2014

Dr. Lydia Pace, MD, MPH Division of Women’s Health, Brigham and Women’s Hospital Boston, MassachusettsMedicalResearch.com Interview with: Dr. Lydia  Pace, MD, MPH Division of Women’s Health, Brigham and Women’s Hospital Boston, Massachusetts MedicalResearch.com: What are the main findings of the study? Dr. Pace: We reviewed the existing literature about the benefits and harms of mammography, focusing on the reduction of breast cancer deaths associated with mammography, as well as the two most often-discussed harms: false positive results and overdiagnosis. We also reviewed the literature about interventions to help patients make informed decisions. We found that the literature suggests that routine screening mammography does reduce mortality associated with breast cancer, across all age groups. However, it is also associated with high rates of false positive results, and considerable rates of overdiagnosis. Overdiagnosis is the most concerning potential risk of mammography screening. Overdiagnosis is the detection of a tumor through screening that would never have caused problems for a patient. It occurs either because of a very slow-growing tumor, or because a woman has medical problems (or is old enough) such that she will likely die of another cause before the cancer became apparent. Overdiagnosis is concerning because we cannot know when a cancer is overdiagnosed, and thus a patient who is overdiagnosed will receive unnecessary treatment for cancer. The scientific literature on mammography is complex, and there are important limitations to the studies both of mammography’s benefits and harms. However, we feel that the best available data suggest that among 10,000 50 year old women undergoing annual mammography for 10 years, 5 deaths will be averted through screening mammography, while about 6130 women will experience at least one positive result. Furthermore, there is about a 19% chance that, if that woman is diagnosed with cancer detected by a mammogram, that cancer is one that would never have caused her problems. Lastly, our review showed that we need more studies to guide us in how an individual woman’s risk should dictate her mammography decisions, and how to support women in making those decisions. However, we know that most women with higher risk for breast cancer will experience higher benefit from mammography screening. (more…)
Author Interviews, Outcomes & Safety, Stroke / 02.04.2014

Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016.MedicalResearch.com Interview with: Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, Associate Professor of Medicine, New York University School of Medicine New York, NY 10016. MedicalResearch.com: What are the main findings of your study? Dr. Bangalore: Patients with transient ischemic attack (TIA) are at increased risk of future full blown stroke, making institution of secondary prevention measures critical Our data from 858,835 patients from 1545 sites indicate that hospital adherence to evidence-based secondary prevention discharge measures was consistently less for patients with transient ischemic attack when compared with those with ischemic stroke, thus representing a missed opportunity at instituting preventive measures to reduce the risk of future stroke. (more…)
Author Interviews, Outcomes & Safety, Surgical Research / 28.03.2014

dr_najma_ahmedMedicalResearch.com Interview with: Dr. Najma Ahmed Trauma and Acute Care Surgeon, St. Michael's Hospital Residency Training Director, General Surgery, University of Toronto   MedicalResearch.com: What are the main findings of this study: Dr. Ahmed: The main findings if the study were that the recent reduction of resident duty hours to much less than 80 hours decreases health outcomes in patients, has adverse educational outcomes for residents and does not improve wellness in surgery. (more…)
Author Interviews, Brigham & Women's - Harvard, Cancer Research, Medical Research Centers, Outcomes & Safety / 18.03.2014

MedicalResearch.com Interview with: Dr. Atul Shinagare MD Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115Dr. Atul Shinagare MD Department of Radiology and Center for Evidence-Based Imaging, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 MedicalResearch.com: What are the main findings of the study? Answer: We evaluated 100 randomly selected patients from a cohort of 1771 patients evaluated for asymptomatic hematuria in 2004 at our institution in order to assess physician adherence to the 2001 American Urological Association (AUA) guidelines for evaluating patients and its impact on the diagnosis of urologic cancer. We found that most (64%) patients were not evaluated according to the guidelines, that there was substantial variation in the evaluation, and that the evaluation depended largely on the type of hematuria and physician specialty. Only 5% of patients were found to have urologic cancer, and all of them were evaluated according to the guidelines. No additional urologic cancers were diagnosed in patients in whom guidelines were not followed; however, since not all patients were tested thoroughly, occult malignancies may have been present. (more…)
Author Interviews, BMJ, Heart Disease, Outcomes & Safety, Surgical Research / 17.03.2014

Dr Tahir Hamid MRCP (UK), FESC Department of Cardiology, Royal Albert Edward Infirmary NHS Trust, Wigan, UKMedicalResearch.com Interview with: Dr Tahir Hamid MRCP (UK), FESC Department of Cardiology, Royal Albert Edward Infirmary NHS Trust,  Wigan, UK MedicalResearch.com: What are the main findings of the study? Dr. Hamid: Traditionally patients undergoing diagnostic and interventional coronary artery procedures are kept Nil-by-mouth, but until yet there exists neither evidence nor clear guidance about the benefits of this practice in such patients. In our study performed at two National Health Services (NHS) institutes, we demonstrated in our 1916 patients, that such procedures could be undertaken without the need for being 4-6 hours fasting. None of our patients had major complications leading to pulmonary aspiration or emergency cardiac surgery. (more…)
Author Interviews, NEJM, Outcomes & Safety, Surgical Research / 13.03.2014

David R. Urbach, M.D From the Institute for Clinical Evaluative Sciences Department of Surgery Institute of Health Policy, Management and Evaluation University of Toronto, the University Health Network Toronto, ON M5G 2C4, CanadaMedicalResearch.com Interview with: David R. Urbach, M.D From the Institute for Clinical Evaluative Sciences Department of Surgery Institute of Health Policy, Management and Evaluation University of Toronto, the University Health Network Toronto, ON M5G 2C4, Canada MedicalResearch.com: What are the main findings of the study? Dr. Urbach: After surgical safety checklists were adopted by hospitals in Ontario, surgical outcomes—death after surgery, complications, length of stay, readmissions—did not improve substantially. (more…)
Author Interviews, BMJ, Outcomes & Safety, Surgical Research / 06.03.2014

MedicalResearch.com Interview with: Mr. Aneel Bhangu West Midlands Research Collaborative, Academic Department of Surgery Queen Elizabeth Hospital Birmingham UK MedicalResearch.com: What are the main findings of the study?  Mr. Bhangu:  Out study was based on a novel collaborative approach, spanning 95 centres in the UK. It was led by surgical trainees, who form a natural network and work in a rotational pattern. These networks will mature to allow a future of clinical research to be embedded into routine NHS care. Our study found no increase in complications based on weekend operating. It’s possible that patients present differently at weekends, or that surgeons select less complex patients to operate upon. A key secondary finding is that patients operated on at weekends were less likely to undergo laparoscopy. This means that they are exposed to different processes of care, which may introduce risk. This may be a surrogate marker for other differences in weekend care that require exploration. (more…)
Author Interviews, BMJ, General Medicine, Outcomes & Safety / 06.03.2014

Karen Yeung Professor of Law Centre for Technology, Ethics Law & Society King's College London London WC2R 2LSMedicalResearch.com Interview with: Karen Yeung Professor of Law Centre for Technology, Ethics Law & Society King's College London London WC2R 2LS MedicalResearch.com: What are the main findings of the study? Professor Yeung: This study found a gap in existing legal regulation of healthcare quality in the UK.  While patients receiving treatment under mental health legislation are protected by the criminal law against wilful neglect or ill treatment, other patients are not subject to the same level of protection, although many such patients are just as vulnerable as those who are mentally incapacitated.  Hence we argue that a new criminal offence of 'wilful neglect or ill treatment' of patients in the healthcare sector is needed. (more…)
Author Interviews, Infections, Outcomes & Safety, Pharmacology, Urinary Tract Infections / 28.02.2014

Dr. Jerome A. Leis, MD, MSc Sunnybrook Health Sciences Centre Toronto, ON, M4N 3M5, CanadaMedicalResearch.com Interview with: Dr. Jerome A. Leis, MD, MSc Sunnybrook Health Sciences Centre Toronto, ON, M4N 3M5, Canada MedicalResearch.com: What are the main findings of the study? Dr. Leis: We know that positive urine cultures from patients who lack signs and symptoms of urinary tract infection are a trigger FOR unnecessary antibiotic prescriptions in hospitals. This problem has not improved despite many educational initiatives.  We identified a subset of patients in our hospital where only 2% of all urine specimens sent to the laboratory were associated with symptomatic infection and decided to no longer routinely report positive results from these specimens on the electronic medical record, unless a special telephone request was made.  We found that with this simple change, unnecessary antibiotic prescriptions declined markedly and this did not require any education of care providers. Most importantly, based on our safety audits, patients who had a urinary tract infection all received appropriate treatment. (more…)
Author Interviews, HPV, Outcomes & Safety / 13.02.2014

Craig Meyers, Ph.D. Distinguished Professor Department of Microbiology and Immunology H107 The Penn State College of Medicine Hershey, PA 17033MedicalResearch.com Interview with: Craig Meyers, Ph.D. Distinguished Professor Department of Microbiology and Immunology H107 The Penn State College of Medicine Hershey, PA 17033 MedicalResearch.com: What are the main findings of the study? Dr. Meyers: The human papillomavirus type 16 (HPV16) is the most common HPV type associated with human cancer. It has always been assumed that HPV16 was susceptible to commonly used disinfectants. However, this has never been tested. We developed the only reproducible method to grow authentic HPV in the laboratory. Our studies show that highly resistant virus; more so than other non-enveloped viruses previously tested. Simply stated that any materials in a healthcare facility that rely on disinfectants (those presently used by healthcare facilities) do absolutely nothing to HPV. This suggests the possibility of risk of infection from inanimate objects, particularly those use in healthcare and dental clinics that depend on disinfectant treatment. Additionally it has been reported that at any one time 20% of individuals with anogenital HPV infections have the virus on their fingertips and the common hand sanitizers do nothing to inactivate the virus. (more…)
Author Interviews, BMJ, Outcomes & Safety / 13.02.2014

Professor Yi Min Xie, FTSE, FIEAust Director, Centre for Innovative Structures and Materials Deputy Head of School, Research & InnovationMedicalResearch.com Interview with: Professor Yi Min Xie, FTSE, FIEAust   Director, Centre for Innovative Structures and Materials Deputy Head of School, Research & Innovation School of Civil, Environmental and Chemical Engineering Royal Melbourne Institute of Technology (RMIT University) Melbourne 3001, Victoria Australia MedicalResearch.com: What are the main findings of the study? Professor Yi Min Xie: This study examined acupuncture needles of two of the most popular brands in the world. Significant surface irregularities and defects at needle tips were found, especially of needles from one of the two brands. The main conclusion of the study was that acupuncture needle manufacturers, including the well established ones, should review and improve their quality control procedures for the fabrication of acupuncture needles. (more…)
Author Interviews, Outcomes & Safety / 01.02.2014

Joseph D. Restuccia, DrPH, MPH Professor and Deans Research Fellow Operations and Technology Management Department Health Sector Management Program Boston University School of Management Boston, MA 02215MedicalResearch.com Interview with: Joseph D. Restuccia, DrPH, MPH Professor and Deans Research Fellow Operations and Technology Management Department Health Sector Management Program Boston University School of Management Boston, MA 02215 MedicalResearch.com: What are the main findings of the study? Dr. Restuccia: The study resulted in three major findings regarding quality improvement activities in VA.
  • The first is that of the three general categories, to date VA hospitals have devoted the most substantial effort to quality improvement activities (QIAs) related to prevention.
  • The second is that a strong alignment of goals between senior medical center leadership and inpatient medicine service leadership is the greatest predictor of an institution’s use of QIAs.
  • The third is that the medical centers that employ hospitalists, physicians who specialize in the practice of hospital medicine, show the strongest QIA adoption across all three categories. (more…)
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, 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, 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…)
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, 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…)