ASH Clinical News May 2016 | Page 29

CLINICAL NEWS

Big Pharma , Big Campaign Donations

Pharmaceutical companies are spending big in the 2016 presidential election cycle , according to data from the Center for Responsive Politics and the Federal Election Commission .

Through the end of 2015 , the pharmaceutical industry ranked as the 15th most generous industry in terms of donations , spending a total of $ 951,018 on various presidential candidates ’ campaigns .

$

951,018

In the same time period , the overall health industry ( including health-care professionals , hospitals , health maintenance organizations , and pharmaceutical companies ), donated more than $ 9.5 million across all presidential candidates ’ campaigns .

Source : Center for Responsive Politics and Federal Election Commission report , February 11 , 2016 .

Know Your IVCs

Despite limited evidence of their clinical benefit , inferior vena cava ( IVC ) filters remain a popular treatment option for pulmonary embolism ( PE ).

8,928

From 1999 to 2010 , the number of IVC placements during PE-related hospitalizations rose from 5,003 to 8,928 .

However , since PE hospitalizations also increased over that same time period ( from 31,746 to 54,392 ), the overall rate of IVC filter placement did not change drastically : from 157.6 to 164.1 placements per 1,000 PE hospitalizations .

5,003 1999 2005

2010

When Pushy Patients Attack …

Source : Bikdeli B , Wang Y , Minges KE , et al . Venal caval filter utilization and outcomes in pulmonary embolism : Medicare hospitalizations from 1999 to 2010 . J Am Coll Cardiol . 2016 ; 67:1027-35 .

Doctors may get sucked into the emotional pull of clinical encounters more often than they think , according to a study that analyzed how patients ’ behaviors affected doctors ’ diagnostic performance .

Parental Guidance

Parents often catch medical errors that their child ’ s doctor missed , according to a prospective study of two general pediatric units at a children ’ s hospital .

383 parents who had a child admitted to the hospital were asked to complete a written survey of whether their child experienced any safety incidents during his or her hospital stay . Physicians then reviewed the incidents to determine if they met standard definitions of medical errors and preventable adverse events ( AEs ).

“ Many of these events were not otherwise documented in the medical record ,” the authors noted . “ Families are an underused source of data about errors , particularly preventable AEs . Hospitals may wish to consider incorporating family reports into routine safety surveillance systems .”

Source : Khan A , Furtak SL , Melvin P , et al . Parent-reported errors and adverse events in hospitalized children . JAMA Pediatr . 2016 April 4 . [ Epub ahead of print ]

34 parents ( 8.9 %) reported 37 safety incidents

8.9 %

62 % 30 %

23 ( 62 %) were determined to be medical errors

7 ( 30 %) were deemed “ preventable AEs ”

Study authors created six vignettes in which patients were depicted as “ difficult ” ( i . e ., frequently demanding tests and procedures , expressing low expectations of their doctor , and ignoring clinical recommendations ) or “ neutral .”

When medical residents were treating these types of “ difficult ” patients compared with “ neutral ” patients :

• Mean diagnostic accuracy went down , from 64 % to 54 %

• Diagnosis of a complex medical case was 42 % more likely to be wrong

• Diagnosis of a simple medical case was 6 % more likely to be wrong

“ The fact is that difficult patients trigger reactions that may [ interfere ] with reasoning , adversely affect judgment , and cause error ,” the authors concluded . “ Interestingly , the confrontation with difficult patients does not cause the doctor to spend less time on such cases .”

Source : Schmidt HG , van Gog T , Schuit SCE , et al . Do patients ’ disruptive behaviours influence the accuracy of a doctor ’ s diagnosis ? A randomised experiment . BMJ Qual Safety . 2016 March 7 . [ Epub ahead of print ]

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