Inexplicably, nobody is talking about the fact medical malpractice in hospitals is now the third highest cause of death in the United States. So says a study published in the BMJ. The study estimated that in 2013, 251,454 patients died as a result of negligent care, which is a number more than double the rate of deaths reported in 1999 by the Institute of Medicine (98,000) in To Err is Human, a study which led commentators more than ten years ago to conclude that the United States had a medical mistake problem that was reaching epidemic proportions. Robert M. Wachter, M.D., The End of the Beginning: Patient Safety Five Years After ‘To Err Is Human,” W4 Health Aff (Millwood) Web Exclusives 534 (2004).
In a soon to be related item, the Department of Veterans Affairs is proposing to amend regulations to allow Advanced Practice Registered Nurses to work independently without physician supervision. The American Medical Association has indicated the plan runs counter to physician-led team based care which it deems the best approach to quality of care. The American Society of Anesthesiologists opposes the attempt to replace its member with nurses in the operating room.
A study appearing in JAMA concluded that approximately 30% of antibiotic prescriptions issued in outpatient settings are unnecessary, and that this contributes to the problem of antibiotic resistant bacteria.
- Texting and emailing while driving continues to significantly threaten the lives of children, with 41.5% of students surveyed reporting engaging in this activity while driving in the past 30 days. Motor vehicle crashes account for 23% of all deaths in 10 to 24 year olds.
- Non-prescribed prescription drug use among high school students decreased. 20% of the students in 2009 reported utilizing such drugs at least once. The rate in 2015 dropped to 16.8%.
- Cigarette smoking among high school students decreased from 27.5% to 10.8% between 1991 through 2015. Nevertheless, 24.1% of the students polled also reported using e-cigarettes within the last 30 days.
- Physical fighting among high school students decreased with 42.5% of the students reporting being in a physical altercation in the last year in 1991 compared to 22.6% in 2015. Despite this, in 2015 20.2 percent of students reported experiencing in-person bullying while 15.5% of the students reported electronic bullying over the past year.
- In 1999 42.8% of high school students reported watching television more than 3 hours a day. In 2015, only 24.7% of students watched more than 3 hours of television a day, but non-school related computer use (including games) for more than three hours a day increased from 22.1% to 41.7% from 2003 through 2015.
An article published in JAMA Internal Medicine concluded that ¼ of hospital readmissions that occurred within 30 days of a prior discharge were preventable. Unnecessary readmissions were commonly caused by poor decision-making in the emergency department, failure to relay important information to outpatient providers and premature discharge of patients.
A study published in the New England Journal of Medicine concluded that financial penalties for hospitals under the Affordable Care Act resulted in decreased patient readmissions for conditions targeted for penalties.
The FDA advised that the serious adverse effects (tendon, muscle, joint and nerve injuries) associated with fluoroquinolones (Cipro, Levaquin) generally outweigh the benefits in patients with uncomplicated sinusitis, acute bronchitis and urinary tract infections.
The US Centers for Disease Control and Prevention concluded that a 28-day course of a three drug regimen should be offered to patients within 72 hours of high-risk exposure (condomless receptive or insertive vaginal or anal intercourse or percutaneous exposure to blood or body fluids) from a source of HIV infection because this protocol reduces the risk of HIV acquisition.
The American College of Physicians issued a new clinical practice guideline related to the treatment of chronic insomnia, that emphasizes the importance of the use of cognitive behavioral therapy as an initial treatment.
Idelvion, (a long-lasting recombinant factor IX-albumin fusion protein) was approved by the US Food and Drug Administration in 2016 for prophylaxis or treatment of bleeding in individuals with hemophilia B.
A study published in the New England Journal of Medicine demonstrated that testosterone treatment in men who were 65 years or older had a moderate benefit in increasing sexual function and some benefit regarding mood and depressive symptoms. The study found no measurable benefit with respect to vitality or walking distance measurements. The study also did not speak to risks of testosterone treatment in these individuals.
The FDA issued a drug safety communication warning healthcare professionals to avoid prescribing oral Ketoconazole for skin and nail infections because the risks of the therapy outweigh the potential benefits.
An article published in Cancer noted that while cancer death rates have been decreasing by a rate of approximately 1.5 percent per year, liver cancer death rates have actually increased 2.8 percent a year for men and 3.4 percent for women.
A study in the British Journal of Medicine concluded that Methylphenidate (Ritalin) increases the risk for the development of heart arrhythmias in children. While the absolute risk was still likely low, the risk-benefit balance needs to be re-evaluated given these findings, especially in children with mild ADHD.