Patient Safety Blog

If you've been on an airplane recently, and if your trip lasted for more than seven hours, you may remember that the flight attendants warned you at the beginning of the trip about the risk of getting deep vein thrombosis (DVT) and told you to do exercises with your calf muscles to keep this from happening.

DVT is the formation of a blood clot in a "deep vein," a vein that is deep inside the body (as opposed to veins that are close to the body's surface). Usually DVT occurs in a leg vein. If the clot embolizes--that is, if it starts traveling through the blood stream--there is the risk of it blocking arteries within other organs and severely damaging them. Often the lungs are affected, and when this happens the blood clot is called a pulmonary embolism. DVT is sometimes also called deep venous thrombosis.

Often people get DVT by sitting in one place for a long time, such as on plane rides, which is why flight attendants give you that warning. Sitting in one place for a long time can be bad for circulation, while exercise increases it and discourages formation of blood clots.

All of this has been common knowledge among medical professionals for some time. But a new study shows that the risk of DVT on long plane flights is greater than was previously confirmed: on long-haul airplane flights (7 hours or longer), the risk of DVT is roughly tripled. In the study, the mean age of the participants was 40, which makes the researchers suspect that the risk is actually greater in the general population. They do not recommend drugs to pre-empt DVT for most travelers, but say that such measures may be warranted in rare cases of extremely high-risk individuals. Ordinary passengers should take care to follow the crew's instructions for calf exercises, and also get up and walk around every so often.

For more information:

Medline: Deep Venous Thrombosis

National Heart, Lung and Blood Institute: Animation demonstrating deep vein thrombosis

Dvt.net: Protection and Treatment, with prevention guides, checklists and suggestions for in-flight fitness.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Travel Risks

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If you're accustomed to taking many pain-killers for your headaches, and if your headaches have been increasing in frequency and intensity, then over-medication might be the cause.

At any given time, more than three million Americans are suffering from headaches they are inflicting on themselves, according to Dr. Stephen D. Silberstein, a professor of neurology and director of the Jefferson Headache Center at Thomas Jefferson University in Philadelphia. “If a patient’s headaches have grown markedly worse or more frequent, the problem is almost always medication overuse,” Dr. Silberstein said.

The pattern seems to be that a patient starts getting headaches, takes too many pills to cope and as a result keeps getting more headaches thanks to the side-effects of the pills.

Which head-ache medications are causing this? Those that include caffeine and butalbital. The worst offenders seem to be those that contain both, Aspirin, caffeine and butalbital is the generic common combination of drugs found in many headache treatments--Fiorinal, for example, or Floricet. But, as the doctors cited in the articles note, any pain-killer can be taken to excess. It may be difficult for headache sufferers to cut back on pain-killers but research suggests that doing so will reduce tension headaches in the long run.

Other resources on the subject of these treatments and their side-effects:

Medline: Aspirin, caffeine and butalbital

RxList: Floricet and Floricet Side-effects

Medicine.net: Side-effects of butalbital/acetaminophen/caffeine

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: General

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Going to a hospital and getting even sicker is an all-too-common occurrence for many in the U.S.A., thanks to the high hospital infection rates.

Indiana University School of Medicine researcher Dr. Bradley Doebbeling is using a $400,000 grant to study this problem and come up with solutions. The study will take eighteen months and will require participating hospitals to come up with better hand hygiene policies and screen patients for MRSA (methicillin-resistant Staphylococcus aureus). MRSA is the most common example of what is known as a “superbug,” a strain of bacteria resistant to antibiotics.

Participating hospitals will also have to record the number of patients who get MRSA—something federal and state governments do not require hospitals to do.

The hospitals in the study say that they are already noticing results. This is unsurprising considering how straightforward the study’s experimental policies are: hand-washing and screening. Learning that such basic measures help prevent sickness is hardly a massive discovery.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Standard of Care--Hospitals

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Imagine having to go to the hospital tomorrow for a procedure that the doctors tell you is simple and practically risk-free. You’re not worried. Your loved ones are not worried.

The trouble is, the procedure ends up killing you. Through some mistake or miscommunication or broken link in the healthcare system, you die while receiving what ought to be a low-risk medical treatment.

This scenario is not nearly as uncommon as it should be. However, there is a rising tide of activism and reform coming from those who suffer such incidents. Consumers Advancing Patient Safety (CAPS) is one of the many groups involved in such work. Among their other activities, they invite those who have suffered through breakdowns in the healthcare system to share their stories with CAPS so they can reach a wider audience and help each other to understand that what happened to them was not a fluke but an indication of systemic flaws.

The most recent such story CAPS has published is an interview with Helen Haskell, who in 2000 lost her 15-year-old son Lewis Blackman to a medical error caused by an inappropriate medication given during a relatively routine surgery.

The chief point to take away from Helen Haskell’s story is that there are multiple levels of doctors in a hospital. Lewis was mostly treated by residents, who are fully trained doctors in the sense that they have graduated from medical school, but are still considered in training for whatever specialty they have chosen. Care by residents is standard and safe—but when Helen wanted to speak to a more senior doctor, she was unable to do so. Hospital bureaucracy can get in the way of patients getting the information they need. In addition, patients can often get confused about who is treating them and at what level of training that person is: is he or she a nurse, or a medical student, or a resident, or an intern, or a fellow? It is not always easy to tell.

Another key point is the concept of “rapid response teams” that can be called in if a patient or family member believes that something seriously wrong is happening. Helen Haskell believes such a team would certainly have saved her son’s life. In any case, it would give patients recourse if their concerns are ignored.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Medical Error

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ConAgra, the world's largest popcorn supplier, has announced on Tuesday September 4th that it will stop using diacetyl--a synthetic butter flavoring.

Diacetyl has been linked to lung disease in workers, who developed severe symptoms (extreme wheezing, for example) after inhaling the vapors of this synthetic butter while on the job. The disease is known as bronchiolitis obliterans and can cause death or leave patients with no hope but lung transplants.

In dropping diacetyl, ConAgra---which produces the popular Act II and Orville Redenbacher brands of popcorn--is following in the footsteps of Pop Weaver, another large popcorn supplier, which pulled diacetyl one month previously.

For more information on diacetyl and its effects, see the following links:

Preventing Lung Disease in Workers Who Use or Make Flavorings (National Institute for Occupational Safety and Health)

Bronchiolitis Obliterans: The Disease Explained

Food Navigator

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Product Safety

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This may fall into the category of stating the obvious, but a study published on Tuesday September 4th founds that doctors who graduate medical school with poor communication skills are more likely to get complaints from patients down the road in their careers.

The researchers tested and scored medical school graduates, who knew that they were being watched and graded (and who still often communicated poorly), and then tracked them and the complaints made against them. Lower scores correlated strongly with a greater number of complaints.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Communication

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