Middle ear infections, known as acute otitis media (AOM), are the most common childhood illness in the US where antibiotics are routinely prescribed. According to a new study published in JAMA, using antibiotics to treat newly diagnosed acute ear infections among children is modestly more effective than no treatment, but causes adverse effects.
US researchers, requested by the American Academy of Pediatrics, to update practice guidelines for treating children's ear infections, reviewed 125 published previous on the effect of antibiotics and found that 80% of children with ear infections would recover within about 3 days without antibiotics. If all of the children were treated with antibiotics, an additional 12 would improve in 3 days, but 5 to 10% of the children would develop diarrhea.
They found no evidence that higher- priced antibiotics work better in general than generic ones and there is a wide variation in diagnosis and management of AOM, they suggested that using an otoscope may help improve the accuracy of diagnosis.
The authors concluded that doctors need to weigh the risks and benefits "before prescribing immediate antibiotics for uncomplicated AOM" and further research is needed.
Source: Diagnosis, Microbial Epidemiology, and Antibiotic Treatment of Acute Otitis Media in Children - A Systematic Review. JAMA. 2010;304(19):2161-2169. (f/t via Athens)
Thursday, November 18, 2010
Wednesday, November 17, 2010
Do you need to find information for patients?
According to NHS Evidence, a recent research shows that 53% of professionals are most likely to be looking for patient information specifically when conducting a search for health and social care information.
NHS Evidence provides access to more than 8,000 pieces of accredited patient and public information including fact sheets, patient health questionnaires and guidance on conditions, treatment choices and support to help patints and carers make informed choices.
You can browse the leaflets by subject, alphabet or publisher and you can print them.
NHS Evidence provides access to more than 8,000 pieces of accredited patient and public information including fact sheets, patient health questionnaires and guidance on conditions, treatment choices and support to help patints and carers make informed choices.
You can browse the leaflets by subject, alphabet or publisher and you can print them.
Tuesday, November 16, 2010
Using pre-surgery checklists can reduce medical errors
At the end of a long day, Dr David Ring, a hand surgeon at Massachusetts General Hospital, walked into the operating room and performed the last operation - he did a carpal-tunnel release on his trigger finger patient!
In an extraordinary open admssion of performing wrong surgery in this week's NEJM, Dr Ring said leading up to the wrong surgery were a series of events and mistakes that occurred during the course of the day, such as poor scheduling and staffing, the patient's left arm was marked at the wrist, not at the finger, and the marking was washed away etc.
Dr. Ring realized his error while dictating the report, and immediately notified both the hospital and the patient of the error. He performed the correct procedure that day without complication. However, the patient lost faith in him and sought treatment elsewhere. The hospital waived all her charges and paid a financial settlement shortly after the event.
Dr. Ring asked the case be presented at the departmental conference and published in the Case Records of the Massachusetts General Hospital because he wanted to encourage others to follow procedures that would prevent similar errors in the future. He said "I hope that none of you ever have to go through what my patient and I went through. I no longer see these protocols as a burden. That is the lesson." Dr Ring was praised for his courage by patient safety advocates and his counterparts.
In the same issue of the NEJM, a team of Dutch researchers published a study showing the dramatic effect of implementing surgical safety checklists in reducing surgical errors. Comparing hospitals that use pre-surgery checklists with those that do not, the researchers found that surgical complications fell dramatically from a level of 27% to just 17%. In- hospital mortality decreased from 1.5 to 0.8%, but the outcomes in the 5 control hospitals did not change.
In an accompanying editorial, the author said studies have shown the use of surgical checklists can have dramatic effect in reducing both complications and mortality and believed that they have "crossed the threshold from good idea to standard of care".
Studies have found that serious errors such as wrong-site surgery or wrong patient did occur, often due to simple mistakes or surgical team failing to perform pre-operation checks. Wrong-site surgery occurs in all surgical specialties, 68% of claims in the US related to orthopedic surgery. The American Academy of Orthopaedic Surgeons (AAOS) developed the "Sign Your Site" initiative in 1998 advising surgeons to mark the surgical site with their initials in order to avoid errors.
In the UK, more than 129,000 surgical incidents were reported to the National Patient Safety Agency (NPSA) in 2007. Over 1,000 resulted in severe harm and 271 death. The NPSA issued a patient safety alert in January 2009, requiring NHS organisations to implement the WHO Surgical Safety Checklist for every patient undergoing a surgical procedure. All hospitals in England and Wales must implement use of the Surgical Checklist by February 2010.
The checklist focuses on basic good practice before anaesthesia is administered, before a patient is cut open, and before a patient is removed from the operating theatre, and is designed to promote effective teamwork and prevent infection and unnecessary blood loss. NHS organisations can adapt it for their own use.
Source:
"Case 34-2010 — A 65-Year-Old Woman with an Incorrect Operation on the Left Hand". NEJM 2010; vol 11, 363:1950-1957 ( full text via Athens )
"Effect of a Comprehensive Surgical Safety System on Patient Outcomes". NEJM 2010; vol 11, 363:1928-1937 ( Netherlands trial, full text via Athens)
Editorial : "Strategies for Improving Surgical Quality — Checklists and Beyond". NEJM 2010; vol 11, 363:1963-1965 ( full text via Athens)
In an extraordinary open admssion of performing wrong surgery in this week's NEJM, Dr Ring said leading up to the wrong surgery were a series of events and mistakes that occurred during the course of the day, such as poor scheduling and staffing, the patient's left arm was marked at the wrist, not at the finger, and the marking was washed away etc.
Dr. Ring realized his error while dictating the report, and immediately notified both the hospital and the patient of the error. He performed the correct procedure that day without complication. However, the patient lost faith in him and sought treatment elsewhere. The hospital waived all her charges and paid a financial settlement shortly after the event.
Dr. Ring asked the case be presented at the departmental conference and published in the Case Records of the Massachusetts General Hospital because he wanted to encourage others to follow procedures that would prevent similar errors in the future. He said "I hope that none of you ever have to go through what my patient and I went through. I no longer see these protocols as a burden. That is the lesson." Dr Ring was praised for his courage by patient safety advocates and his counterparts.
In the same issue of the NEJM, a team of Dutch researchers published a study showing the dramatic effect of implementing surgical safety checklists in reducing surgical errors. Comparing hospitals that use pre-surgery checklists with those that do not, the researchers found that surgical complications fell dramatically from a level of 27% to just 17%. In- hospital mortality decreased from 1.5 to 0.8%, but the outcomes in the 5 control hospitals did not change.
In an accompanying editorial, the author said studies have shown the use of surgical checklists can have dramatic effect in reducing both complications and mortality and believed that they have "crossed the threshold from good idea to standard of care".
Studies have found that serious errors such as wrong-site surgery or wrong patient did occur, often due to simple mistakes or surgical team failing to perform pre-operation checks. Wrong-site surgery occurs in all surgical specialties, 68% of claims in the US related to orthopedic surgery. The American Academy of Orthopaedic Surgeons (AAOS) developed the "Sign Your Site" initiative in 1998 advising surgeons to mark the surgical site with their initials in order to avoid errors.
In the UK, more than 129,000 surgical incidents were reported to the National Patient Safety Agency (NPSA) in 2007. Over 1,000 resulted in severe harm and 271 death. The NPSA issued a patient safety alert in January 2009, requiring NHS organisations to implement the WHO Surgical Safety Checklist for every patient undergoing a surgical procedure. All hospitals in England and Wales must implement use of the Surgical Checklist by February 2010.
The checklist focuses on basic good practice before anaesthesia is administered, before a patient is cut open, and before a patient is removed from the operating theatre, and is designed to promote effective teamwork and prevent infection and unnecessary blood loss. NHS organisations can adapt it for their own use.
Source:
"Case 34-2010 — A 65-Year-Old Woman with an Incorrect Operation on the Left Hand". NEJM 2010; vol 11, 363:1950-1957 ( full text via Athens )
"Effect of a Comprehensive Surgical Safety System on Patient Outcomes". NEJM 2010; vol 11, 363:1928-1937 ( Netherlands trial, full text via Athens)
Editorial : "Strategies for Improving Surgical Quality — Checklists and Beyond". NEJM 2010; vol 11, 363:1963-1965 ( full text via Athens)
Tuesday, November 09, 2010
Could stronger statins save lives?
Statin is one of the world's biggest selling drug for lowering LDL cholesterol, a new research suggests using more potent doses of statin could prevent thousands more heart attacks and strokes.
40,000 high-risk patients were assessed for major vascular events after one year of randomisation to either regular or intensive treatment statin. The results, published in The Lancet, found that stronger treatments reduced major heart attacks and strokes by 15%. This included a 13% cut in heart-related death or non-fatal heart attacks, a 19% drop in bypass and other coronary treatments, and a 16% drop in strokes.
However, the study warned that simply raising the dose of simvastain might lead to health problem as muscle weakness and muscle damage are some of the known side effects.
Source: "Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12 064 survivors of myocardial infarction: a double-blind randomised trial". The Lancet, Early Online Publication, 9 November 2010 (full text via Athens)
40,000 high-risk patients were assessed for major vascular events after one year of randomisation to either regular or intensive treatment statin. The results, published in The Lancet, found that stronger treatments reduced major heart attacks and strokes by 15%. This included a 13% cut in heart-related death or non-fatal heart attacks, a 19% drop in bypass and other coronary treatments, and a 16% drop in strokes.
However, the study warned that simply raising the dose of simvastain might lead to health problem as muscle weakness and muscle damage are some of the known side effects.
Source: "Intensive lowering of LDL cholesterol with 80 mg versus 20 mg simvastatin daily in 12 064 survivors of myocardial infarction: a double-blind randomised trial". The Lancet, Early Online Publication, 9 November 2010 (full text via Athens)
Monday, November 08, 2010
Does vitamin E increase stroke risk?
Previous studies suggested taking vitamin E can protect the heart from coronary heart disease, but a BMJ study found that taking vitamin E could slightly increase the risk of haemorrhagic stroke - bleeding in the brain. Stroke is the third biggest cause of death in the UK
Researchers identified 9 studies with about 119,000 people randomised either to vitamin E or placebo on the outcome of stroke. They found that vitamin E increased the risk of haemorrhagic stroke by 22%, also found that vitamin E reduced the risk of ischaemic stroke by 10%. Given the small reduction in the risk of ischaemic stroke is exceeded by the incraese in the risk of haemorrhagic stroke, the researchers concluded that the widespread use of vitamin E should be avoided.
Critics say the findings are of small statistical significance, more research is needed to determine the level of Vitamin E that can become harmful. They "urge people to maintain a lifestyle of a balanced diet, regular exercise and monitoring their blood pressure to reduce their risk of a stroke."
Source: "Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials". BMJ 2010; 341:c5702 (Published 4 November 2010) free f/t.
Researchers identified 9 studies with about 119,000 people randomised either to vitamin E or placebo on the outcome of stroke. They found that vitamin E increased the risk of haemorrhagic stroke by 22%, also found that vitamin E reduced the risk of ischaemic stroke by 10%. Given the small reduction in the risk of ischaemic stroke is exceeded by the incraese in the risk of haemorrhagic stroke, the researchers concluded that the widespread use of vitamin E should be avoided.
Critics say the findings are of small statistical significance, more research is needed to determine the level of Vitamin E that can become harmful. They "urge people to maintain a lifestyle of a balanced diet, regular exercise and monitoring their blood pressure to reduce their risk of a stroke."
Source: "Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials". BMJ 2010; 341:c5702 (Published 4 November 2010) free f/t.
Alcohol is more harmful than heroin or crack cocaine
A new study, published in the Lancet, found that alcohol is the most harmful drug above heroin and crack cocaine based on harm caused to the user and others.
The investigation was led by David Nutt, former government drugs adviser sacked after criticising government policies on cannabis. The team reviewed a range of drug harms using the multicriteria decision analysis modelling, drugs were scored with 100 being the most harmful and 0 being no harm at all. They found that overall alcohol scored 72, heroin 55 and crack cocaine 54. The authors said "the present drug classification systems have little relation to the evidence of harm" and that the findings showed that ‘aggressively targeting alcohol harms is a valid and necessary public health strategy."
Some newspapers reported the DH said it is determined to prevent alcohol abuse without disadvantaging those who drink sensibly.
In an accompanying commentary, "Ranking of drugs: a more balanced risk-assessment" The Lancet, 376(9752): 1524-25, the Dutch experts said "the new data provide a valuable contribution for the re-evaluation of current drug classification in the UK", but the study did not address the polydrug use which can make some drugs much more dangerous. However this was outside the scope of the study.
Source: Drug harms in the UK: a multicriteria decision analysis. The Lancet 376(9752):1558-1565 ( full text va Athens)
The investigation was led by David Nutt, former government drugs adviser sacked after criticising government policies on cannabis. The team reviewed a range of drug harms using the multicriteria decision analysis modelling, drugs were scored with 100 being the most harmful and 0 being no harm at all. They found that overall alcohol scored 72, heroin 55 and crack cocaine 54. The authors said "the present drug classification systems have little relation to the evidence of harm" and that the findings showed that ‘aggressively targeting alcohol harms is a valid and necessary public health strategy."
Some newspapers reported the DH said it is determined to prevent alcohol abuse without disadvantaging those who drink sensibly.
In an accompanying commentary, "Ranking of drugs: a more balanced risk-assessment" The Lancet, 376(9752): 1524-25, the Dutch experts said "the new data provide a valuable contribution for the re-evaluation of current drug classification in the UK", but the study did not address the polydrug use which can make some drugs much more dangerous. However this was outside the scope of the study.
Source: Drug harms in the UK: a multicriteria decision analysis. The Lancet 376(9752):1558-1565 ( full text va Athens)
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