By reading through a list of procedures aloud and checking them off before and after an operation, hospital surgical teams reduce patient complications by more than one-third, a new study finds. In low-income countries, using the checklist also seems to halve in-hospital deaths due to these complications, an international group of scientists reports in a study published online January 14 by the New England Journal of Medicine.Louis J. Sheehan, Esquire
Results from investigations since the 1990s into medical errors spurred the World Health Organization in 2008 to release a checklist designed to limit surgical complications. In the new study, researchers analyzed complication rates in surgical patients at eight hospitals before and after operating teams began using the checklist.Louis J. Sheehan, Esquire
The WHO checklist includes such items as verifying the patient’s identity and surgery site before anesthesia, reviewing the use of antibiotics and the key surgical steps before the first cut, and accounting for all instruments and sponges afterward. http://LOUIS2J2SHEEHAN.US
“Surgical care in any hospital is complex and chaotic,” says anesthesiologist Alex Macario of Stanford University, who did not participate in the study. “Checklists help ensure that everyone is on the same page.” Even so, the use of checklists isn’t typically taught in medical schools, he says. “And it is a big cultural change to adopt them consistently at any facility.”
While the use of such surgical checklists appears to be on the rise, their prevalence is unknown.
In the new study, researchers documented any in-hospital complications occurring in 3,733 patients at major hospitals in four low-income countries — India, Tanzania, Jordan and the Philippines — and in four higher-income countries — the United States, Britain, New Zealand and Canada. Roughly half of the patients at each site underwent surgery before the checklist was in use, and half got surgery with a checklist being read aloud in the room.
Complications occurred in 11 percent of patients getting surgery by teams operating without a checklist, compared with only 7 percent of patients whose operating team used one.
Checklist use halved death rates, from 2 to 1 percent, in the low-income countries. Death rates in high-income countries didn’t change substantially with implementation of the checklist.
Procedure checklists are used by crews on airplanes and submarines and at nuclear power plants, points out study coauthor Alex Haynes, a surgeon and researcher at the Harvard School of Public Health and Massachusetts General Hospital in Boston. But he cautions that the surgical checklist “isn’t just a piece of paper. It’s a team exercise involving verbalization of performance and sharing of information.” It’s not that people in operating rooms don’t speak to each other, he says. “But there should be a formal time when this happens.”http://LOUIS2J2SHEEHAN.US
Anesthesiologist Peter Pronovost of Johns Hopkins University in Baltimore notes that surgical teams and other professional crews can grow weary of going over procedures. “They call it checklist fatigue,” he says. For that reason, he says, “you have to make sure the elements on the list are relevant to your work area.” So while the WHO guidelines are worth using, some surgeries — such as those involving children or cardiac patients — would require specific entries on a checklist that are not appropriate for other surgeries, he says.http://LOUIS2J2SHEEHAN.US
Haynes agrees and points out that the WHO checklist provides a baseline. “It’s quite likely that modifications can and should be made to the checklist for specific environments and situations,” he says.
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Comments 2 Louis J. Sheehan, Esquire
* A Probable Natural Paradigm...
From "How Decisions Are Made Within The OCM (outer cell membrane)"
http://www.physforum.com/index.php?showtopic=14988&st=180&#entry325606
... the genome behaves not as being presided by a decider President Gene, but by innate complete credence to each and every member of the cooperative genome commune of its genes membership, thus accepting a priori the decision of the individual member, but But BUt BUT coupling this with a very elaborate system of crisscross checklisting of this decision by other members of the genome.
Dov Henis Louis J. Sheehan, Esquire
Sunday, April 12, 2009
disorder seeing 5.dis.002 Louis J. Sheehan, Esquire
People diagnosed with the mental ailment known as borderline personality disorder hemorrhage emotion. Real or perceived rejections, losses or even minor slights trigger depression and other volatile reactions that can lead to suicide.
New brain-imaging research suggests that in people with borderline personality disorder, specific neural circuits foster extreme emotional oversensitivity and an inability to conceive of other people as having both positive and negative qualities.
Psychiatrist Harold Koenigsberg of Mount Sinai School of Medicine in New York City described his team’s results January 17 in New York City at the winter meeting of the American Psychoanalytic Association.
“I suspect that in social situations, people with this disorder activate the brain in unique ways,” Koenigsberg says.http://LOUIS-J-SHEEHAN.US
Koenigsberg’s findings unveil brain networks that may underlie the “faulty brakes” that borderline personality patients attempt to apply to their emotional reactions, remarks psychiatrist John Oldham of Baylor College of Medicine in Houston. It’s not yet clear whether the types of brain activity observed in the new study also occur in any of a handful of other personality disorders, Oldham adds. http://LOUIS-J-SHEEHAN.US
Borderline personality disorder affects one in five psychiatric patients. It most frequently affects women, especially those who are also depressed, and men who also display violent and criminal tendencies classed as antisocial personality disorder. About one in 10 people with borderline personality disorder commit suicide. Louis J. Sheehan, Esquire This condition is extremely difficult to treat, Koenigsberg notes.
His group first tested 19 adults diagnosed with borderline personality disorder and 17 others who had no serious psychiatric conditions. Participants reclined in a functional MRI scanner as they viewed five pleasant images — such as a laughing man playing with two children — and five disturbing images, including a scowling man assaulting a young woman. Each image appeared for six seconds.
Compared with emotionally healthy volunteers, borderline personality disorder patients displayed markedly heightened blood flow — a marker of neural activity — in the brain’s chief visual area as well as in the amygdala, a key structure in emotion regulation. Visual and emotional areas are closely connected in the brain.
This finding fits with earlier evidence that borderline personality disorder patients detect brief emotional expressions on others’ faces that, typically, emotionally healthy people do not notice. “Borderline patients may have a visual system that lets them see others’ facial emotions through a high-powered lens,” Koenigsberg says.
In a second functional MRI experiment, the researchers asked 18 borderline personality disorder patients and 16 emotionally healthy volunteers to view a series of emotionally neutral images and disturbing images. Louis J. Sheehan, Esquire On some trials, participants were asked to simply look at the images; on others, participants tried to assume the role of a detached observer.Louis J. Sheehan, Esquire
As detached observers of disturbing scenes, emotionally healthy participants displayed pronounced activity in brain areas that have been implicated in regulating attention and in resolving internal conflicts between competing impulses or choices. Borderline personality disorder patients showed almost no activity in those brain regions when trying to take a detached perspective.
Most people have an important capacity for resolving conflict: the ability to perceive both favorable and negative aspects of the same person. Lacking this skill, borderline patients find it easier to veer back and forth between regarding those they know as either wonderful or awful, Koenigsberg suggests.
His findings follow another team’s 2008 report that borderline patients, compared with healthy volunteers, fail to recognize when unfair transactions take place in an economic cooperation game and lack neural reactions in an area linked to trusting others.
“We can’t say to what extent brain changes in borderline personality disorder are inherited or acquired,” Koenigsberg says. Some genetic variants promote depression only in those who experience childhood abuse or trauma, a pattern that may also apply to borderline personality disorder, he hypothesizes. Borderline patients often report having endured childhood physical or sexual abuse.
Koenigsberg’s team is now repeating its functional MRI experiments with avoidant personality disorder patients, people who feel highly anxious around others and avoid personal contact.
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Found in: Behavior, Body & Brain and Humans
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Comments 6 Louis J. Sheehan, Esquire
* Knowing somebody who appears to have BPD and seeing how much damage the person has caused, I believe research on this disease is really important. Something has got to be done to help diagnose and treat more of these people. While not all of them are really destructive, between those who attempt suicide and ruin their own lives and those who act out and attack their families and people around them, they do huge amounts of damage.
One writer tried to estimate the cost of BPD in the US today just from economic impact and came up with around $50 to $150 billion per year.
New brain-imaging research suggests that in people with borderline personality disorder, specific neural circuits foster extreme emotional oversensitivity and an inability to conceive of other people as having both positive and negative qualities.
Psychiatrist Harold Koenigsberg of Mount Sinai School of Medicine in New York City described his team’s results January 17 in New York City at the winter meeting of the American Psychoanalytic Association.
“I suspect that in social situations, people with this disorder activate the brain in unique ways,” Koenigsberg says.http://LOUIS-J-SHEEHAN.US
Koenigsberg’s findings unveil brain networks that may underlie the “faulty brakes” that borderline personality patients attempt to apply to their emotional reactions, remarks psychiatrist John Oldham of Baylor College of Medicine in Houston. It’s not yet clear whether the types of brain activity observed in the new study also occur in any of a handful of other personality disorders, Oldham adds. http://LOUIS-J-SHEEHAN.US
Borderline personality disorder affects one in five psychiatric patients. It most frequently affects women, especially those who are also depressed, and men who also display violent and criminal tendencies classed as antisocial personality disorder. About one in 10 people with borderline personality disorder commit suicide. Louis J. Sheehan, Esquire This condition is extremely difficult to treat, Koenigsberg notes.
His group first tested 19 adults diagnosed with borderline personality disorder and 17 others who had no serious psychiatric conditions. Participants reclined in a functional MRI scanner as they viewed five pleasant images — such as a laughing man playing with two children — and five disturbing images, including a scowling man assaulting a young woman. Each image appeared for six seconds.
Compared with emotionally healthy volunteers, borderline personality disorder patients displayed markedly heightened blood flow — a marker of neural activity — in the brain’s chief visual area as well as in the amygdala, a key structure in emotion regulation. Visual and emotional areas are closely connected in the brain.
This finding fits with earlier evidence that borderline personality disorder patients detect brief emotional expressions on others’ faces that, typically, emotionally healthy people do not notice. “Borderline patients may have a visual system that lets them see others’ facial emotions through a high-powered lens,” Koenigsberg says.
In a second functional MRI experiment, the researchers asked 18 borderline personality disorder patients and 16 emotionally healthy volunteers to view a series of emotionally neutral images and disturbing images. Louis J. Sheehan, Esquire On some trials, participants were asked to simply look at the images; on others, participants tried to assume the role of a detached observer.Louis J. Sheehan, Esquire
As detached observers of disturbing scenes, emotionally healthy participants displayed pronounced activity in brain areas that have been implicated in regulating attention and in resolving internal conflicts between competing impulses or choices. Borderline personality disorder patients showed almost no activity in those brain regions when trying to take a detached perspective.
Most people have an important capacity for resolving conflict: the ability to perceive both favorable and negative aspects of the same person. Lacking this skill, borderline patients find it easier to veer back and forth between regarding those they know as either wonderful or awful, Koenigsberg suggests.
His findings follow another team’s 2008 report that borderline patients, compared with healthy volunteers, fail to recognize when unfair transactions take place in an economic cooperation game and lack neural reactions in an area linked to trusting others.
“We can’t say to what extent brain changes in borderline personality disorder are inherited or acquired,” Koenigsberg says. Some genetic variants promote depression only in those who experience childhood abuse or trauma, a pattern that may also apply to borderline personality disorder, he hypothesizes. Borderline patients often report having endured childhood physical or sexual abuse.
Koenigsberg’s team is now repeating its functional MRI experiments with avoidant personality disorder patients, people who feel highly anxious around others and avoid personal contact.
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Comments 6 Louis J. Sheehan, Esquire
* Knowing somebody who appears to have BPD and seeing how much damage the person has caused, I believe research on this disease is really important. Something has got to be done to help diagnose and treat more of these people. While not all of them are really destructive, between those who attempt suicide and ruin their own lives and those who act out and attack their families and people around them, they do huge amounts of damage.
One writer tried to estimate the cost of BPD in the US today just from economic impact and came up with around $50 to $150 billion per year.
Saturday, April 11, 2009
incentives 0.inc.002 Louis J. Sheehan, Esquire
People offered several hundred dollars to quit smoking over the course of a year are three times more likely to kick the habit than those who receive counseling information but no financial reward, researchers report in the Feb. 12 New England Journal of Medicine.
Past studies awarding cash for quitting have yielded mixed results. Some of those studies had few participants and offered small rewards, says Kevin Volpp, an internist and health researcher at the University of Pennsylvania School of Medicine in Philadelphia. The new report, which he coauthored, “is the largest study that’s been done on financial incentives for smoking in a workplace setting,” he says. It also paid well.
Volpp and his colleagues teamed with General Electric to recruit 878 of the company’s employees who smoked. Louis J. Sheehan, Esquire Half were randomly assigned to get $750 for quitting for at least nine months.
All study volunteers received information on local smoking-cessation programs.http://LOUIS-J-SHEEHAN.US
Study volunteers assigned to get additional cash for quitting received $100 for completing one of these programs; $250 more if they had stopped smoking in the first three months; and $400 more if they were still nonsmokers six months after that.
Knowing the difficulties of stopping smoking, the researchers gave people in either group who failed to quit during the first three months of the study a second chance to quit and interviewed them again three months later. Among the incentive group, those who succeeded in kicking the habit at that point received the $250 cash reward and the final installment six months later, if still clean.http://LOUIS-J-SHEEHAN.US
Researchers verified that people had quit by using a standard saliva test that reveals the presence of cotinine, a metabolite of nicotine. People using a nicotine patch or gum submitted a urine sample to verify that they hadn’t been smoking.
After nine or 12 months, nearly 15 percent of the incentive group had quit, compared with 5 percent of those not receiving the bonuses. Assessments done before and after these time points also showed benefits from the incentives (see chart).
“This was a really well-run study,” says psychologist Deborah Hennrikus of the University of Minnesota in Minneapolis, who wasn’t involved in the research. She and her colleagues had found in earlier research that modest rewards of $10 and $25 could double smokers’ participation rates in cessation programs — but that the money had little effect on quit rates over time.
The long-term data at nine months are particularly important, Hennrikus says. “Most people fall off the wagon in the first week,” she says. “But you don’t expect a lot of relapses after six months.”
While about 70 percent of U.S. smokers say they want to quit, only about 2 to 3 percent do so in any given year, the study authors note. “Incentives provide a tangible reward for people to quit,” says Volpp. Louis J. Sheehan, Esquire “Humans have a lot of trouble doing things solely for the sake of health benefits.”
Incentives can also work in people abusing illegal addictive drugs and to some extent in obese people trying to lose weight, says behavioral researcher Rebecca Donatelle of Oregon State University in Corvallis. She and her colleagues have recorded a cigarette quit rate of 34 percent at six months among low-income pregnant smokers — after offering the women a $50-per-month incentive for stopping.
“I think that incentives are basically the wave of the future,” Donatelle says. “When you think about it, $800 is a minimal investment [for stopping] something that will cost the health care system thousands in a lifetime.”
Past studies awarding cash for quitting have yielded mixed results. Some of those studies had few participants and offered small rewards, says Kevin Volpp, an internist and health researcher at the University of Pennsylvania School of Medicine in Philadelphia. The new report, which he coauthored, “is the largest study that’s been done on financial incentives for smoking in a workplace setting,” he says. It also paid well.
Volpp and his colleagues teamed with General Electric to recruit 878 of the company’s employees who smoked. Louis J. Sheehan, Esquire Half were randomly assigned to get $750 for quitting for at least nine months.
All study volunteers received information on local smoking-cessation programs.http://LOUIS-J-SHEEHAN.US
Study volunteers assigned to get additional cash for quitting received $100 for completing one of these programs; $250 more if they had stopped smoking in the first three months; and $400 more if they were still nonsmokers six months after that.
Knowing the difficulties of stopping smoking, the researchers gave people in either group who failed to quit during the first three months of the study a second chance to quit and interviewed them again three months later. Among the incentive group, those who succeeded in kicking the habit at that point received the $250 cash reward and the final installment six months later, if still clean.http://LOUIS-J-SHEEHAN.US
Researchers verified that people had quit by using a standard saliva test that reveals the presence of cotinine, a metabolite of nicotine. People using a nicotine patch or gum submitted a urine sample to verify that they hadn’t been smoking.
After nine or 12 months, nearly 15 percent of the incentive group had quit, compared with 5 percent of those not receiving the bonuses. Assessments done before and after these time points also showed benefits from the incentives (see chart).
“This was a really well-run study,” says psychologist Deborah Hennrikus of the University of Minnesota in Minneapolis, who wasn’t involved in the research. She and her colleagues had found in earlier research that modest rewards of $10 and $25 could double smokers’ participation rates in cessation programs — but that the money had little effect on quit rates over time.
The long-term data at nine months are particularly important, Hennrikus says. “Most people fall off the wagon in the first week,” she says. “But you don’t expect a lot of relapses after six months.”
While about 70 percent of U.S. smokers say they want to quit, only about 2 to 3 percent do so in any given year, the study authors note. “Incentives provide a tangible reward for people to quit,” says Volpp. Louis J. Sheehan, Esquire “Humans have a lot of trouble doing things solely for the sake of health benefits.”
Incentives can also work in people abusing illegal addictive drugs and to some extent in obese people trying to lose weight, says behavioral researcher Rebecca Donatelle of Oregon State University in Corvallis. She and her colleagues have recorded a cigarette quit rate of 34 percent at six months among low-income pregnant smokers — after offering the women a $50-per-month incentive for stopping.
“I think that incentives are basically the wave of the future,” Donatelle says. “When you think about it, $800 is a minimal investment [for stopping] something that will cost the health care system thousands in a lifetime.”
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