Diagnosis-related claims -- not surgical or medication errors -- are the most costly of all, researcher says
By Denise Mann
MONDAY, April 22 (HealthDay News) -- Missed or wrong diagnoses made up the lion's share of U.S. malpractice payouts -- which totaled nearly $39 billion -- during the past 25 years, finds a new study of more than 350,000 claims.
"These are the most common and the most costly of all malpractice claims," said study author Dr. David Newman-Toker, an associate professor of neurology at the Johns Hopkins University School of Medicine, in Baltimore. "We have to pay attention to this because it is too big of a problem to ignore."
In the new study, researchers analyzed diagnosis-related claims from a national data bank from 1986 to 2010. Of all the claims, diagnostic errors led the pack, accounting for about 35 percent of the total payments of $38.8 billion (after adjusting for inflation). The study only reviewed claims that involved a malpractice payout, not those that did not get this far in the process.
Diagnosis-related errors were the leading cause of claims that were associated with death and disability. Most diagnostic errors occurred in outpatients, but those that occurred while a person was in the hospital were more likely to be fatal, the study showed.
The researchers estimated that the number of misdiagnosis-related claims that cause preventable, permanent damage or death may be as high as 160,000 each year.
The new finding appeared online April 22 in BMJ Quality & Safety.
"We really have to make it a priority to measure and track diagnostic errors on an ongoing basis as we do other mistakes such as infection and wrong-site surgery," Newman-Toker said. "They are completely underrepresented in terms of what we pay attention to."
Errors can happen anywhere along the way. "It can be wrong diagnosis, no diagnosis or delayed diagnosis," he said. "If you get the diagnosis wrong, the chances of getting the therapy right are greatly reduced."
Sometimes, these mistakes can be fatal right off of the bat. "If someone has a headache, and you say 'take two aspirin and call me in the morning,' but the headache is really a brain aneurysm, the patient could die before morning," Newman-Toker added.
Patients are not powerless. "Even great doctors make mistakes," he said. "Ask, 'is there anything else this can be?'" he advised. "If the doctor says 'no' [then] ask 'why?' and an answer such as 'because it's the only thing it could be' is not good enough."
Dr. David Troxel, medical director of The Doctors Company, a malpractice insurer based in Napa, Calif., said the study "provides valuable information to caregivers about medical errors."
"I believe that the disclosure of this information will enhance patient safety," Troxel said. "Patients can also play an important role in reducing the incidence of diagnostic errors by providing their doctor with an accurate medical history, adhering to the prescribed follow-up plan, keeping return visit appointments to discuss abnormal test results and asking questions to clarify instructions they don't clearly understand."
Malpractice attorney Michael Sacopulos, CEO for the Medical Risk Institute in Terre Haute, Ind., said he was surprised by the extent of the new findings. "Maybe things get off course right at the beginning, but this has not been studied as much as other errors that result in malpractice suits," he said.
Still "medicine is an art and not a science so this will happen," Sacopulos said. "Patients need to be persistent with physicians because so often the doctor will make a diagnosis and over time, it becomes clear that it was wrong. The first attempt may not be accurate. Think of it as a work in progress instead of being written in stone."
Learn more about patient safety at the National Patient Safety Foundation.
SOURCES: David Newman-Toker, M.D., Ph.D., associate professor, neurology, Johns Hopkins University School of Medicine, Baltimore; David Troxel, M.D., medical director, The Doctors Company, Napa, Calif.; Michael Sacopulos, chief executive, Medical Risk Institute, Terre Haute, Ind.; April 22, 2013, BMJ Quality & Safety, online
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For those with the gene, drugs appeared to extend survival without spread of disease by several months
By Maureen Salamon
MONDAY, April 22 (HealthDay News) -- Lung cancer patients carrying a rare gene mutation may experience delayed disease progression with drugs often taken by those with breast cancer, a new study suggests.
European researchers found that patients with non-small cell lung cancer who took drugs targeting so-called HER2 proteins -- which result from gene mutations in less than 5 percent of lung cancers -- experienced an extra five months of progression-free survival.
"We were favorably surprised by the outcome of patients and the promising activity of drugs that are usually dedicated to breast cancer patients," said study author Dr. Julien Mazieres, a professor of pulmonology at Larrey Hospital in Toulouse, France. "We do think that all lung [cancers] should be tested for HER2 as is done in France."
The study was published April 22 in the Journal of Clinical Oncology.
Non-small cell is the most common type of lung cancer -- the type seen in about 85 percent of lung cancer cases, according to the American Cancer Society. More than 200,000 Americans are diagnosed with lung cancer each year and 158,000 die from it, according to the U.S. Centers for Disease Control and Prevention.
HER2-positive cancer tests positive for a protein called human epidermal growth factor receptor 2, which feeds the growth of cancer cells and is caused by a gene mutation.
Mazieres and his colleagues identified this mutation in 65 non-small cell lung cancer patients, administering anti-HER2 drugs such as Herceptin (trastuzumab), which also is used to target HER2 in breast cancer patients.
Half of the patients were already at stage 4 lung cancer when diagnosed, while others were at earlier stages of the disease. Notably, most participants with the gene mutation were women, more than half of whom had never smoked.
The extra five months of progression-free survival experienced by patients undergoing HER2 therapies "is a big deal in the cancer business," said Dr. Norman Edelman, chief medical officer of the American Lung Association.
"It's not absolutely a new finding, but it's another study in what is a very exciting field now in cancer," Edelman said. "Up until now, we've treated cancers ... using an elephant gun. This new field looks at the genetic makeup of individual tumors to see if we can attack them in a specific way, not a general way."
Although only a small percentage of lung cancer patients carry this gene mutation, Edelman recommended that all patients be tested for it.
"It's useful and it's being done," he said. "If I had somebody I cared about who I thought had lung cancer, I would say to only go to a center where they're doing this testing. The odds are strong they will not be benefited [by anti-HER2 drugs], but lung cancer is a devastating disease."
Mazieres and Edelman agreed that future research in this area should focus on large clinical trials, which are costly but can tease out various genetic abnormalities that are important to tumor growth.
The U.S. National Library of Medicine has more about lung cancer.
SOURCES: Julien Mazieres, M.D., Ph.D., professor, pulmonology, Larrey Hospital, Toulouse, France; Norman Edelman, M.D., chief medical officer, American Lung Association; April 22, 2013, Journal of Clinical Oncology
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By Rosilyn Rayborn, Social Media Specialist
By now you’ve seen the headline: Angelina Jolie has publicly announced that she underwent a preventive double mastectomy after genetic testing revealed that she carried the "faulty" BRCA1 gene that gave her an 87 percent risk of breast cancer.
This information, coupled with Angelina witnessing her own mother’s 8-year struggle with ovarian cancer led to her decision.
“My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer," Angelina wrote in her New York Times piece.
This is not the first time a public figure has opened up about preventive mastectomy. In January, Miss America contestant, Allyn Rose, made headlines with her plan to pursue the procedure after the pageant. While Rose doesn’t carry the “faulty” BRCA1 or BRCA2 genes, she did witness her mother, grandmother and aunt succumbing to breast cancer.
"My mom would have given up every part of her body to be here for me. If there's something that I can do to be proactive, it might hurt my body, it might hurt my physical beauty, but I'm going to be alive," Rose said in an interview.
According to the Annals of Surgical Oncology, the number of women opting for preventive mastectomies increased 10-fold between 1998 and 2007 and because of the display of bravery and shown by Jolie and Rose, we can expect this number to rise.
While there are physicians who are on both sides of the argument when it comes to who should get the procedure, what both of these women have done for the state of breast cancer awareness is tremendous. By placing this issue at the forefront of the news media they’ve initiated the conversation.
Because of Angelina Jolie and Allyn Rose, women around the world know that the double mastectomy procedure is a viable option and they can seek more information to decide if it’s the right choice for them.
And by seeing women who are known for their beauty and femininity choose their health first, women are also receiving the message that their womanhood is not something that can be stripped away with the removal of their breasts.
"I do not feel any less of a woman," Jolie wrote. "I feel empowered that I made a strong choice that in no way diminishes my femininity."
Thank you to these women for speaking up and adding more depth to the conversation around breast cancer awareness. Your ounce of prevention just made an immeasurable impact in the fabric of our culture.
Click here to read Angelina Jolie’s full New York Times article about her decision to undergo a preventive double mastectomy.
Angelina Jolie photo via IMDB. Allyn Rose photo via NBC Bay Area
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Health care outcomes improved for 71 percent of contextual factors that were addressed by PCDM
FRIDAY, April 19 (HealthDay News) -- Patient-centered decision making (PCDM) is associated with improved health care outcomes, according to a study published in the April 16 issue of the Annals of Internal Medicine.
Saul J. Weiner, M.D., from the Jesse Brown Veterans Affairs Medical Center and University of Illinois at Chicago, and colleagues examined whether encounters involving PCDM are associated with improved health care outcomes compared with encounters characterized by inattention to patient context. Seven hundred seventy-four patients audio recorded encounters with their 139 resident physicians; these were screened for contextual red flags such as deteriorating self-management of a chronic condition. When a contextual factor was identified, physicians were scored based on their adaptation of the care plan to address the issue.
Of the 548 contextual red flags, 208 contextual factors were confirmed, and outcome data were available for 157. The researchers found that physician attention to contextual factors (asking about them and addressing them in care plans) varied based on the presenting contextual factor. Health care outcomes improved in 71 percent of the 96 contextual factors that were addressed by PCDM and in 46 percent of the 61 factors that were not addressed by PCDM (P = 0.002).
"These findings suggest that an emphasis on promoting and assessing PCDM may be a productive strategy for advancing patient-centered health care outcomes," the authors write.
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Simulation study found lack of ventilation exposed more patients to potential of airborne diseases
FRIDAY, April 19 (HealthDay News) -- Closed windows in large hospital wards may increase patients' risk of getting an infection, a new study suggests.
British researchers used carbon dioxide as a tracer gas to simulate how airborne infections spread in a traditional hospital ward, which typically includes two rows of up to 30 beds.
The carbon dioxide represented potentially infectious exhaled breath, and was released by popping carbon dioxide-filled balloons. Carbon dioxide detectors were placed where beds might be located in a functioning ward.
"By measuring the concentration of the gas over time, we were able to quantify the exposure at each bed and therefore the potential risk to a patient in that bed," study team member Laura Pickin said in a University of Leeds news release. "We were also able to use the same data to measure the overall ventilation rate in the ward."
When the windows were open, ventilation in the ward was generally good and the risk of airborne infection low. But the danger of infection increased fourfold when the windows were closed, according to the study in the current online issue of theBuilding and Environment Journal.
"These wards are still in operation and, although they have often been subdivided into smaller areas with six to eight beds, their ventilation and structure is still fundamentally the same," lead investigator Cath Noakes, from the University of Leeds' School of Civil Engineering, said in the news release.
With natural ventilation from windows, the wards are safe. But that changes when the windows are closed during the winter or permanently sealed to lower energy costs.
"Some of these wards were designed by the Victorians, and our results show that they knew what they were doing. But there is a danger that we could be adapting our buildings to improve efficiency without thinking how it might affect patients," Noakes said.
The National Patient Safety Foundation explains what you can do to prevent hospital infections.
-- Robert Preidt
SOURCE: University of Leeds, news release, April 16, 2013
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No decrease in mammography screening noted for women aged 40 to 49, 50 to 74 years
MONDAY, April 22 (HealthDay News) -- There has been no change in mammography screening rates among women aged 40 years or older following publication of the 2009 U.S. Preventive Services Task Force (USPSTF) recommendations, according to research published online April 19 in Cancer.
Lydia E. Pace, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues examined the impact of the 2009 USPSTF recommendations on mammography screening patterns among women age 40 to 49 years and 50 to 74 years. Data on mammography use were reviewed for 27,829 women aged 40 years or older from the National Health Interview Survey for 2005, 2008, and 2011.
The researchers observed a non-significant increase in mammography screening rates, from 51.9 percent in 2008 to 53.6 percent in 2011 (P = 0.07), after adjustment for race, income, education level, insurance, and immigration status. There were no declines noted among any age groups. The screening rates were 46.1 percent in 2008 and 47.5 percent in 2011 among women aged 40 to 49 years (P = 0.38), and the corresponding rates were 57.2 and 59.1 percent for women aged 50 to 74 years (P = 0.09).
"In conclusion, we observed no decrease in mammography rates for women aged >40 years after publication of the USPSTF recommendations in 2009," the authors write. "Whether through their impact on patients, providers, or both, it seems that the vigorous policy debates and coverage in the media and medical literature have limited adoption of these recommendations."
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EmCare’s marketing team earned eight awards in various categories for the 2013 Healthcare Advertising Awards.
EmCare’s was in the graphic design categories for:
- EmCare’s Recruiting ad in the “Magazine Single Ad” category
- EmCare’s “Recruiting Quality” Ad Series for the “Magazine Ad Series” category
- The EmCare Integrated Sales Brochure in the “Brochure” category
- The graphic designs for Qualitas in the “Logo/Letterhead Design” category
- Mouse Pad Calendar design in the “Imprinted Materials” category
EmCare’s clinical newsletter, EmPressions, earned honors in the newsletter category.
EmCare’s marketing team is made up of Vice President Steve Schaumburg, Marketing and Tradeshows Manager Nicole Herlehy, Marketing Manager Kim Mills, Social Media Specialist Rosilyn Rayborn, Graphic Design Manager Doug Simpler and Marketing Communications Manager Jennifer Whitus.
The Healthcare Advertising Awards is the oldest, largest and most widely respected healthcare advertising awards competition. The awards are sponsored by Healthcare Marketing Report, the leading publication covering all aspects of healthcare marketing, advertising and strategic business development. Nearly 4,000 submissions were received for this year’s competition.
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'Cryoablation' might offer therapeutic option for cancer patients whose disease has spread
By Alan Mozes
SUNDAY, April 14 (HealthDay News) -- A method designed to target, freeze and destroy a tumor's cellular function seems effective in combating lung tumors, a small ongoing study finds.
At least in the short-run -- meaning three months after the procedure -- the intervention known as "cryoablation" appeared to kill all targeted tumors that had spread to the lung from elsewhere, preliminary results suggest.
However, some patients developed new tumors in that time period, the researchers noted.
The study authors cautioned that while the initial findings are encouraging, the treatment should not be seen as a cure for this type of metastatic (spreading) lung disease. Rather, they said that for certain patients who may not be eligible for more standard surgical approaches, the therapy has potential as an alternative means for offering an improved quality of life for a longer period of time.
"'Promising' is the perfect way to describe our findings," said study lead author Dr. David Woodrum, an interventional radiologist at the Mayo Clinic in Rochester, Minn. "But whether or not this minimally invasive approach would ultimately become a primary method of treatment in the future will depend on the long-term results of this trial, which is still under way. At this point I would say that cryoablation has the most applicability as a kind of last-ditch treatment for patients who are not good surgical candidates for a variety of reasons."
Woodrum and his colleagues are scheduled to discuss their findings Sunday in New Orleans at the annual meeting of the Society of Interventional Radiology. Funding for their work was provided by Galil Medical, a medical device manufacturer based in Arden Hills, Minn.
Because this study was presented at a medical meeting, the conclusions should be considered preliminary until published in a peer-reviewed journal.
The U.S. National Cancer Institute points out that while cryoablation (also known as cryosurgery) is a well-known practice, researchers are still in the process of assessing its long-term benefits.
The procedure is performed by an interventional radiologist on patients coping with metastasized lung tumors, the researchers noted. Using CT-imaging equipment, the physician inserts a small needle-like instrument directly into the tumor to deliver the freezing power (at temperatures as low as minus 100 degrees Celsius) of liquid nitrogen to cancer cells, while sparing healthy surrounding tissue.
To date, the team behind the new study has used the procedure to tackle a total of 36 tumors in 22 American and French patients --13 men and nine women -- whose average age was 60. Fifteen patients had just one tumor, while the rest had two or more. None of the patients was deemed eligible for standard surgical interventions.
The targeted tumors were less than 3.5 centimeters (about 1.4 inches), which Woodrum described as being "small to medium in size."
The procedure was performed under either general anesthesia or conscious sedation, and lasted anywhere from 45 minutes to nearly three hours. Typically, patients were able to return home the following day.
The result: Among the 15 patients seen roughly three months post-procedure, tumor control was found to be 100 percent, although six patients were found to have developed new lung tumors in the interim.
Among five patients seen six months after the procedure, tumor control continued to be 100 percent.
The authors noted that side effects were minimal, typically involving air or fluid around the lungs after the procedure, and in all cases were resolved quickly.
The team concluded that cryoablation appears to be both safe and effective, at least in the short-term. But they acknowledged that more research needs to be done to track the treatment's impact over the long haul.
"It would be overreaching to say that we're curing cancer with this," Woodrum said. "But this is one of many therapy options that is looking to turn cancer into a chronic fight, and to give patients for whom the choices are limited a chance at a good quality of life with minimal treatment complications."
For his part, Dr. David Carbone, a professor and director of the James Thoracic Center at the Ohio State University Wexner Medical Center, said that the findings regarding cryoablation are "not incredibly novel," given that the procedure has been around for years.
"And I would say that there are multiple different technologies for doing this kind of very localized approach," he added. He mentioned stereotactic radiosurgery -- which targets the tumor with high-power X-rays -- as another way to go.
"While I've done cryoablation myself in the past, it's not what I typically do," Carbone noted. "Stereotactic is noninvasive and doesn't require general anesthesia, so that's what I'd tend to do, although certainly what approach is ideal will depend on a particular patient's situation and symptoms. But there's no situation in which cryoablation would be the only theoretical option."
For more about cryoablation, visit the U.S. National Cancer Institute.
SOURCES: David Woodrum, M.D., Ph.D., interventional radiologist, department of radiology, Mayo Clinic, Rochester, Minn.; David Carbone, M.D., Ph.D., professor and director, James Thoracic Center, Ohio State University Wexner Medical Center, Columbus, Ohio; April 14, 2013, presentation, Society of Interventional Radiology meeting, New Orleans
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Scientists could distinguish physical from emotional pain, discomfort in study
By Amy Norton
WEDNESDAY, April 10 (HealthDay News) -- For the first time, scientists say they've found evidence that physical pain may leave a distinct "signature" in the brain that can be picked up with specialized MRI scans.
The study looked only at short-term pain in healthy people, but researchers hope the findings will lead to better understanding of complex conditions such as chronic severe headaches or fibromyalgia.
When researchers exposed healthy volunteers to a painful dose of heat, it left a reliable pattern of brain activity that could be viewed on functional MRI (fMRI) -- a type of imaging that charts changes in blood flow through the brain.
That so-called "neurologic signature" was able to predict people's subjective pain ratings with more than 90 percent accuracy, and it distinguished heat-induced pain from other feelings -- like warmth, and even emotional pain.
Experts said the findings, reported in the April 11 New England Journal of Medicine, hint at a way to objectively measure people's pain. Right now, that's done subjectively -- often, by having patients rate their pain on a scale of 1 to 10.
But the point is not to catch patients in a lie, stressed lead researcher Tor Wager, an associate professor of psychology and neuroscience at the University of Colorado at Boulder.
"This is not a pain lie-detector test, and it should not be used that way," Wager said. "People in pain need to be believed."
A pain expert not involved in the study agreed, but said objective measures might be useful in getting more information. "There are times when a patient isn't able to communicate about pain effectively -- for example, after a stroke," said Dr. Jing Wang, an assistant professor of anesthesiology at NYU Langone Medical Center, in New York City.
In other cases, patients' descriptions of their pain might not be completely reliable, such as when they have a mental illness. Both Wang and Wager said it would be helpful to have a way to complement patients' pain reports with an objective measure -- which in many cases might suggest that patients are in more pain than they are letting on, or in more pain than a doctor believes.
"We know that right now many people have their pain undertreated," Wager noted.
But scientists are a long way from using fMRI scans to gauge pain, according to Wang at NYU. "This is a comprehensive, meticulous study," he said, but added that it's also an early step.
One big caveat is that the study volunteers were all healthy and exposed to just one type of pain -- short-lived pain from heat applied to the skin. Wang said researchers need to see whether this same brain "signature" would appear in people with chronic pain conditions, or pain after surgery, for example.
And since fMRI scans are expensive, Wang noted, studies would have to show that the imaging actually benefits patients before it would be routinely used in the real world.
The study involved a total of 114 healthy young adults who took part in different phases of the research. First, Wager's team found that fMRI scans were able to pick up a reliable pain signature in the brain when volunteers had painful heat applied to their forearms.
The researchers then found that the signature was different and stronger than brain activity that popped up in response to the sensation of warmth, or to anticipation or remembrance of the pain.
More interesting, Wager said, was that the signature seemed to be unique to physical pain. In one set of experiments, the researchers had heartbroken volunteers who'd recently gone through a breakup look at a photo of their ex-partner. That did trigger activity in brain regions related to physical pain, but the signature linked to heat-induced pain remained distinct.
Wager agreed that much more work needs to be done, and his team is already looking at whether the neurologic signature holds up in other types of pain.
For his part, Wang pointed out that pain comes in many different forms, with causes ranging from inflammation to nerve damage. And chronic pain, in particular, is very complex, study author Wager noted.
Whether fMRI is ever used to diagnose pain, studies like this could help researchers gain a better understanding of the "biology of pain," Wang said. "Our understanding of pain is still fairly rudimentary."
A better understanding of pain, Wager said, will hopefully lead to better ways to manage it.
Learn more about managing chronic pain from the American Chronic Pain Association.
SOURCES: Tor Wager, Ph.D., associate professor, psychology and neuroscience, University of Colorado at Boulder; Jing Wang, M.D., Ph.D., assistant professor, anesthesiology, NYU Langone Medical Center, New York City; April 11, 2013, New England Journal of Medicine
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Join us in celebrating National Nurses Week, May 6-12!
EmCare is proud to recognize the nearly 3.1 million registered nurses nationwide for their dedication, commitment and tireless effort to promote and maintain clinical quality.
Because EmCare understands the important role of nurses, our nurse executives provide unparalleled support and consultation for nurse leaders at client hospitals to help them achieve goals for process improvement, clinical outcomes and patient satisfaction.
Watch the video below to learn more about how EmCare’s nurse executives and Directors of Clinical Services, help other nurses reach their goals.
Visit the American Nurses Association web site for more information about National Nurses Week!
Feeling inspired? EmCare has nationwide career opportunities for nurses.
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