Over the past year, the ICU at my hospital has been field-testing a more open approach. We are not the first to do so. Geisinger Medical Center in Danville, PA, went to an open ICU policy nearly a decade ago, found it extremely disruptive and soon reverted to only 30 minutes of visiting six times a day. On a second attempt, however, Geisinger developed an extensive communication program for both families and staff, and open ICU visitation has been successful since 2003. A 1997 study found that open ICU visitation practices had a beneficial effect on 67% of patients and 88% of families. I am surprised by how well the open policy at our hospital has worked over the past six months. I have become comfortable seeing family members stretched on recliners in the ICU during my early-morning visits. They update me on how the night went for the patient. One ICU specialist said, "I don't have to chase down families to update them on what is happening." Some ICUs are also inviting families to participate when a team of a dozen professionals, including doctors, nurses, pharmacists and social workers, decide on the plan for the patient.
A new report scrutinizing the risks of eight common vaccines is over 600 pages long, combs through more than 1,000 research papers, and is the best analysis of suspected vaccine-caused medical problems that's ever been done, says the high-powered committee that wrote it. Even so, it's not likely to end the contentious debate about vaccine safety in Washington state, which has the highest rate in the nation of children who enter school without the required vaccines. A hotly contested law passed this year bars parents from simply signing to exempt their children; starting this fall, they must include a doctor's certification that they've been informed of vaccines' risks and benefits. Ideally, worried parents would be able to turn to such a report for answers. In some cases, the committee, convened by the Institute of Medicine of the National Academy of Sciences, delivered the goods. In 14 cases the panel examined, it found convincing evidence some vaccines can cause rare adverse events in certain people, including seizures, brain inflammation and fainting. Those problems were, in most cases, experienced by people with immune-system deficiencies. The committee also found the evidence doesn't support any connection between autism and the MMR vaccine for mumps, measles and rubella (German measles).
Barbara Swansburg was volunteering for a rare Saturday morning shift at the Sawtelle Family Hospice House in Reading when she was asked to feed the new patient in Room 7. "I got up there and gave him his Danish and orange juice, and I came out of the room and said, 'I know this man, where do I know him from?" When she returned to the hospice the next day for her regular Sunday visit, she asked a nurse the patient's name. It was Dr. Richard Heidbreder. Thirteen years ago, Heidbreder, a radiation oncologist at Winchester Hospital, treated Swansburg for breast cancer. She had gone to him after a bad experience with another doctor. "I was still pretty fragile and [Dr. Heidbreder] picked up all the pieces," said Swansburg, 73, of Tewksbury. "He was very compassionate, very caring, and took all the time explaining [the treatment]. It was a very nice visit, and from then on, too." A year later, Swansburg was in remission. She'd see Heidbreder at an annual gathering for cancer survivors, but hadn't attended for a few years. Meanwhile, Heidbreder, 59, of Reading, had been diagnosed with amyotrophic lateral sclerosis, also known as Lou Gehrig's disease, in the summer of 2008. Weakness in his arms forced him to retire as medical director of Winchester Hospital's radiation oncology service in November 2009. In June, he moved into the hospice house. As soon as she learned who he was, Swansburg told the hospice's volunteer coordinator she'd like to come in Monday, Wednesday, and Friday evenings to feed Heidbreder. "I wanted to give back something,'' she said.
Shands HealthCare at the University of Florida has suspended its liver and pancreas transplant programs after the sudden departure of three of its four organ transplant surgeons. The Gainesville transplant center took the action Friday and over the weekend tried to notify all 125 patients waiting for new organs. "If you have a busy transplant program, and you lose even a couple surgeons, it's a major blow," said Kevin Behrns, MD, chairman of surgery at UF's College of Medicine. He is working to recruit multi-organ surgeons who are trained to transplant livers, pancreases and kidneys. Patients waiting for a new liver or pancreas will be placed on another hospital list until Shands can reopen its program, he said. The move should not delay their treatment. The United Network for Organ Sharing is working with Shands to connect patients to other transplant centers. The nearest ones are the Mayo Clinic in Jacksonville, Florida Hospital in Orlando and Tampa General Hospital.
Peek inside any American family's medicine cabinet and you're likely to find a drug that was tested in a foreign country. Pharmaceutical companies have been shifting research overseas for years and the number of foreign trials has skyrocketed. The Department of Health and Human Services reports more than a 2,000% increase in the number of foreign trials for U.S. drugs over the past two decades. In 2008, about 80% of drug applications approved by the Food and Drug Administration contained data from foreign clinical trials. The growth in developing countries and emerging economies in particular has been "explosive" said Arthur Caplan, MD, director of the Center for Bioethics at University of Pennsylvania's Perelman School of Medicine. Caplan explained the appeal of holding clinical trials in developing countries and the ethical issues raised by this research trend.
A one-page list of 56 common medical tests and procedures could shake up the way doctors deliver care at Beth Israel Deaconess Medical Center. Why? Because there's a price next to each item. Such lists are very unusual. Most doctors have no idea what they are spending when they order care for patients -- and finding out is an eye-opening experience. "I didn't realize that the prices were as high as they actually were, although I knew that there were some pretty extreme examples," said David Ives, a primary care doctor and the medical director of Affiliated Physicians Group, the largest group of private doctors that admits patients to Beth Israel. "One [price] that really pissed me off," Ives said, "was that when you send someone to an ear, nose and throat [specialist], something like 80 to 90 percent of the time they get a flexible scope of their sinuses." Ives says using this flexible cord with chip camera is rarely better than having the doctor look up a patient's nose or down their throat, but it costs 10 times more than the physical exam.