Friday, November 27, 2009

Should healthy people use low-dose aspirin routinely?

Low-dose aspirin is widely used as secondary prevention of cardiovascular disease in people who have had heart attacks or stroke. The latest issue of the Drug and Therapeutics Bulletin (DTB) examined whether healthy people who have not had cardiovascular events should use low-dose aspirin as primary prevention.


The DTB study is not a systematic review but looked at current research evidence and expert opinion. It pointed out that although aspirin is not specifically licensed for use as primary prevention in the UK, various guidelines including NICE and SIGN recommend aspirin for primary prevention in certain groups of people such as those with type 2 diabetes and high blood pressure.


However, DTB found that current evidence does not support routine use of low-dose aspirin in these groups due to the potential risk of serious bleeds and its low effect on death rates. It says "it is hard to recommend starting aspirin for primary prevention" and concludes that "... low -dose aspirin prophylaxis should not be routinely used for primary prevention."


Source: "Aspirin for primary prevention of cardiovascular disease?" Drug and Therapeutics Bulletin 2009;47:122-125 (Relevant BNF section: 2.9)

Thursday, November 26, 2009

Burnout and medical errors among American surgeons

The American College of Surgeons commissioned a self-reporting survey in June 2008 to measure burnout and quality of life among American surgeons. Researchers asked questions including emotional exhaustion, depersonalization and personal accomplishment and others.

Just under 8000 out of the 25,000 surgeons responded to the survey, overall 40% of the respondents said they were burnout, 9% of those responded said having made a major medical mistake in the last 3 months. Researchers found that those who said they had made an error also showed more signs of depression and emotional exhaustion, however it was not clear whether the distress led to more errors or the errors caused more distress. They also found that the number of overnight calls and hours worked were not associated with the errors reported.

The results were published online on November 23 in the Annals of Surgery. The authors said that " although surgeons do not appear more likely to make errors than physicians in other disciplines, errors made by surgeons may have more severe consequences for patients due to the intereventional nature of surgical practice".

Sources: "Burnout and Medical Errors Among American Surgeons"Annals of Surgery (f/t via Athens)

How undergraduates improve compliance with handwashing

The MAPS (Measure to Achieve Patient Safety ) program was developed at UCLA Medical Centre to lead the improvement of the patient safety in the hospital as a result of the Institute of Medicine's report on the poor patient safety standards in America - patient identification and handwashing in particular.

Since 2004, 20 undergraduates and 2 student leaders have been selected each year to take part in the MAPS program. They were given training in observing compliance with handwashing guidelines and adherence to rules in patient identification. About 700-800 observations per month were reported to clinicians and departmental leads. Handwashing increased from 50% to 93% and nurses' checking of 2 patient identifiers at medication administration increased from 50% to 95%.

This program was published in Academic Medicine, the author said that MAPS program has been widely accepted by clinical staff and has made significant contribution to the UCLA's safety programs. It is also easily adaptable in other academic centres.

Source: "Observation and measurement of hand hygiene and patient identification improve compliance with patient safety practices". Academic Medicine. December 2009. 84(12):1705-1712. (f/t via Athens)