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Entries in Patients (30)

Thursday
Jan032013

Too Many Doctors Can Hurt a Patient in 'Bystander Effect'

Comstock/Thinkstock(NEW YORK) -- An acutely ill man with mysterious symptoms -- a nasty rash, kidney and lung failure -- was admitted to Yale-New Haven Hospital where he was treated by 40 of its finest doctors.

But because so many cared for him, two of the attending residents say, the 32-year-old patient actually got sicker.  That's because of the so-called "bystander effect," they say in an article published Thursday in the New England Journal of Medicine.

Authors Dr. Robert R. Stavert and Dr. Jason P. Lott argue that because of changes in health care, more specialists get involved, leading to "decay in coordination of care."

The psychological phenomenon, also known as "Genovese syndrome," was first coined in 1964 after Catherine "Kitty" Genovese, 28, was stabbed to death in New York City as others appeared to have been aware of the attack and did nothing, although the number of bystanders has become a matter of dispute.

One witness told police at the time, "I didn't want to be involved."

A large body of research now shows that humans are less likely to offer help in an emergency when others are present.  The key factor is "diffusion of responsibility" -- the larger the group, the less likely an individual will act.

"We have talked a lot about the broader issues of healthcare -- and not just within our field -- and it really struck a chord," Stavert, a resident in dermatology at Yale, told ABC News.  "We came to realize that the people involved were really excellent doctors and all worked with really good intentions but it became apparent the pitfalls people could fall into."

The patient the Yale team treated spent 11 days in intensive care, but nine sub-specialty units were tending to his case, causing "more of a handoff" of responsibility, the authors wrote.

"Our inability to easily name his disease process quickly created ambiguity about 'ownership' of the patient," they say.  "While our team sat in a remote rounding room pondering potential causes of the patient's rash, another team of intensivists gathered in the ICU hallways to debate his ventilator settings, while yet another consultation team sat at a distant ICU desk, struggling to understand his multi-organ failure."

The patient had more than 25 diagnostic lab tests and two imaging procedures daily, many of them "duplicative and unnecessary."

"This cloud of medical purgatory lifted only when acute decompensation occurred, forcing the doctor-of-the-moment to act decisively," they wrote.

"This happens all the time in medicine," said Lott, who, in addition to being a resident in dermatology at Yale, is a clinical fellow at the Robert Wood Johnson Foundation.  "You make your best guess and keep your fingers crossed and it turns out for the best."

Copyright 2013 ABC News Radio

Saturday
Dec222012

Bionic Suit Helps Paralyzed Patients Walk Again

Ekso Bionics(LOS ANGELES) -- Patients paralyzed by spinal cord injuries are taking their precious first steps at a Southern California hospital with the help of a battery-powered bionic suit that was first designed to help soldiers carry heavy loads.

“Mentally it’s a wonderful feeling to be upright and moving,” said Aaron Bloom, who was paralyzed two years ago in an accident.

The 27-year-old was told he would never walk again, but with each step in the Ekso Bionic Suit  at Huntington Memorial Hospital, he’s defying the odds.

“Right now, I don’t really need anybody holding me. I can lift my hands up and put a little weight on these crutches and feel pretty comfortable,” he said.

The suit, which costs $150,000, is strapped on over a person’s clothes. Foot plate sensors help locate the center of gravity so the person wearing the suit can maintain their balance as they take each step. A computer is worn on the back to help drive the hip and knee motors.

The entire suit weighs 45 pounds, but the load is transferred to the ground so the patient does not bear the weight, according to Ekso Bionics, the company behind the breakthrough technology.

It took Bloom weeks of practice to feel comfortable using the suit. He knows it’s not a perfect solution, but for now, it is hope.

“I have no doubt in my lifetime that there will be some sort of solution for spinal cord injuries,” he said. “I firmly believe that I will be able to walk in the future. It’s just a matter of time.”

Copyright 2012 ABC News Radio

Monday
Dec102012

Heart Surgeon Gives Patients Infection When Glove Rips

Jochen Sand/Thinkstock(LOS ANGELES) -- A heart surgeon at Cedars-Sinai Medical Center accidentally gave cardiac infections to five patients because his latex gloves tore during surgery, hospital officials confirmed.

Of the five patients who were diagnosed with endocarditis, or an infection of the heart chamber lining and valves, four of them had to return to the hospital for a second operation, according to a story first published in the Los Angeles Times. The patients survived and are still recovering.

“Because our ultimate goal is to have zero hospital acquired-infections, any hospital-acquired infection at Cedars-Sinai is unacceptable,” a hospital statement read.

“Endocarditis in general is a problem in that it describes an infection inside the heart, and when we have an infection inside the heart, bacteria from the infection is pumped all over,” said Dr. Mark Adelman, the chief of vascular surgery at NYU Langone  Medical Center. “It’s a particularly bad infection.”

Adelman, who has not been involved in the Cedars-Sinai case, said valve replacement infections can be especially problematic because the new valves are artificial and have no blood vessels to carry antibiotics to the infection.

“Usually the valve has to be removed,” he said. “Artificial materials don’t have blood vessels running through them, so there are little cracks and crevices that don’t see much blood flow. They’re difficult to sterilize.”

According to the National Institutes of Health, endocarditis can require a second valve replacement surgery when the infection results in heart failure, results in other organ damage or when blood clots break off into little pieces to cause strokes. Complications can include brain abscesses as well.

Cedars-Sinai called the incident a “very unusual occurrence,” according to the Los Angeles Times. Administrators told the newspaper that the nature of valve replacement surgery can lead to microscopic rips in the surgeon’s gloves because he has to tie more than 100 knots and use thick sutures, both of which put extra stress on the gloves.

“It’s just like tying your shoes a thousand times; it wears a lot on your fingers,” Adelman said, adding that heart surgeons have to sew the heart muscle with strong knots and sutures because the heart is an organ that is constantly moving. “The gloves definitely degrade. They have to be thick enough that they protect from transmitting infections, but then you have to feel tissues.”

Although surgeons will sometimes wear double gloves, it’s not mandated and can sometimes make the surgery more difficult because thick gloves don’t allow surgeons’ fingers to be as sensitive or as nimble, Adelman said.

He said he’s been asked why surgeons scrub their hands if they’re going to wear gloves. The answer is twofold: Surgeons scrub their hands and wear gloves to protect the patient, but they wear the gloves to protect themselves. It’s possible that a patient could spread a disease to a surgeon, too.

The California Department of Public Health has an open investigation at Cedars-Sinai, department spokesman Ralph Montano said. Because the department’s investigation is ongoing, Montano could not elaborate on the details.

Hospitals nationwide reported 529,038 surgical site infections to the Centers for Disease Control and Prevention in 2010.

News of the endocarditis infections comes less than a month after Cedars-Sinai announced that it reduced surgical site infections by more than 60 percent for colorectal procedures because of new protocols.

Copyright 2012 ABC News Radio

Tuesday
Dec042012

Superhero Window Washers Swoop into Wisconsin Children’s Hospital

Carla David/Ministry Health(STANLEY, Wis.) -- The young patients of Ministry St. Joseph’s Children’s Hospital got a big surprise Monday as Spider-Man, Batman, and Captain America all appeared to swoop down from the sky, right outside their windows.

What they were witnessing was not a comic come to life, but a kind collaboration between Brite-Way window cleaning service and some workers at Ministry St. Joseph’s.

“We got the idea from a hospital in Pittsburgh,” secretary of environmental services Julie Schafer told ABC News. “Brite-Way has been doing our windows for years and we reached out to them, and they were happy to do it.”

Tim Taggart, a supervisor at Brite-Way/Tim’s Maintenance, spent the day dressed as Batman and said he really got to play the part.

“We did some flips down the building and a lot of turns and stuff.  You can do just about anything while attached to the rigging,” Taggart told ABC News. “The kids really seemed to like it and that made it all worth it.”

Taggart said he and his crew repelled from the roof, down to an outdoor patio area where thrilled children waited to greet their favorite superheroes.

Since not all of the children were able to make it out to the spectacle, the superheroes made a trip inside to greet them. One of those children was Lakken Burzynski.

“Lakken isn’t really into superheroes,” Lakken’s mother, Katie Burzynski, told ABC News, “but she really thought it was neat.”

At home now in Stanley, Wisc., Lakken had been at St. Joseph’s since Friday. Katie said the window washers weren’t allowed into Lakken’s room, so they chatted with her using FaceTime on an iPad.

“Then they came to her window and waved hello, it was really something neat and different,” Burzynski said.

According to Schafer, the hospital and window washing company agree this is something they should do again.

“We’d like to do it every year, now. And hopefully this is something Brite-Way can do at all the hospitals they serve. The kids really deserve it.”

Copyright 2012 ABC News Radio

Tuesday
Jun122012

How Hospital Noise Harms Patient Health

Pixland/Getty Images(NEW YORK) -- Noisy hospitals have long been a major complaint among patients. Now, new research purports to show how hospital noise can possibly harm them.

The small study, published Monday in the Journal of the American Medical Association, found that as the overall level of noise increased in the hospital, sleep was more likely to be disrupted. When the patients' sleep was disrupted, their heart rates increased.

Researchers at Harvard Medical School studied 12 healthy adult volunteers in a sleep laboratory, using noises pre-recorded in an actual hospital -- medical monitor alarms, telephones, staff conversations, and outside traffic -- for three nights. They analyzed how the noises affected the patients' sleep and heart rate by using brain monitoring equipment and heart rate monitors.

Of the sounds that were used, sounds from medical equipment designed to alert medical staff, such as alarms, were more disruptive than the sounds of the environment or human voices. When the patients' sleep was disturbed, their heart rates increased -- even if they did not wake up.

Dr. Orfeu Buxton and Dr. Jo Solet, two of the study's authors, said they "have heard what the patients have been saying in patient satisfaction reports, which is that there is too much noise in the hospital," and they launched the study in order to better understand the types and volume of sounds that caused the most disruption while understanding how noise affects the patient.

Previous research had already shown that noise disrupts sleep -- and that these disruptions are linked to high blood pressure, higher rates of heart disease, impaired immune function, increased memory problems and depression.

"This is the first study that has actually recorded a hospital environment and systematically quantified the response of the brain and the heart rate to these sounds," Buxton said.

A noisy hospital environment that causes disturbed sleep "may lead to increased use of medicines like sedatives that have side effects such as increased falls and increased rates of delirium. This can lead to a longer hospital stay," he said.

The authors also suggest that hospital administrators need to address three key issues to create a restful environment -- the acoustics of the hospital, the routines of hospital staff, and eliminating the noises from medical equipment.

"Eighty percent of alarm monitors in patient rooms and on hospital floors have no clinical relevance," Buxton said.

Some hospitals are already ahead of the noise-canceling curve. Susan Alves-Rankin and Jason Phillips, who works in the department of Patient Services and Service Excellence at the University of California San Francisco Medical Center, say their hospital is one such institution.

"We built a brand new hospital and took many steps to reduce noise," Alves-Rankin said, adding that the changes include noise-reducing flooring from Sweden and a silent nurse calling system to eliminate electronic noises. They are currently piloting a program using special sound masking devices in their noisiest hospital units to decrease noise and increase privacy.

Other efforts to reduce noise range from using sound absorbent materials during the design and construction phase of new hospitals to educating staff about being aware of their noise levels. At the new Shapiro Cardiovascular Center at Brigham Women's Hospital in Boston, special acoustical insulation and ceiling tiles were used during construction.

Several hospitals are using traffic light indicators to make staff more aware of their noise levels. When noise escalates, the traffic light changes from green to yellow; and when noise is too loud, the light turns red. Other hospitals have noise reduction campaigns in place.

"[The campaigns] are not only a satisfier for patients, but our staff is happy about having some more restful periods as well," said Tom Moore of the University of Iowa Hospitals.

Dr. Vineet Arora of the University of Chicago, who studies the sleep quality of patients in the hospital setting, says "we need to generalize the findings [of this study] to real patients in an actual hospital setting" and change the culture of the hospital where "patients are empowered to talk to their doctors about their sleep needs."

The hope is that when patients have a quiet environment where they can sleep and heal, patient outcomes may improve. When the dial on hospital noise is turned down, Solet says, "we can expect decreased lengths of stay and lower rates of re-admission."

Copyright 2012 ABC News Radio

Friday
Apr062012

Hospitals Working to Improve Patient Stays, Experiences

Thomas Northcut/Digital Vision/Thinkstock(NEW YORK) -- Imagine lying in a hospital bed, afraid, stuck repeatedly with needles to draw blood for tests you don't understand.  Next to you lies another patient -- in a bed so close that each of you hears everything the other has to go through.

This is the reality for many hospitalized adults in the U.S.

In a New York Times editorial, Dr. Perri Klass, professor of journalism and pediatrics at New York University, laments this state of affairs and offers wisdom from the pediatric community to illustrate how small changes could make a big difference.

Among these changes, she suggests, are drawing blood with smaller needles and letting family members stay with patients in the hospital to allay the fear of being alone.

While Dr. Klass acknowledges that change takes time, she raises an important question: When will adult medicine catch up?

ABC News reached out to hospitals across the country to find out how they are working to improve patients' experiences.  Some of what we heard was just what the doctor -- Dr. Klass, that is -- had ordered.  Many institutions are now using smaller needles and tubes when they draw blood, both to improve comfort and conserve valuable blood for the patient.

The Baptist Hospital East in Louisville, Ky., for example, often uses smaller "butterfly" needles in the emergency room and intensive care unit.  This is especially important when it comes to elderly patients with smaller veins, they said.

Dr. Matthew Weissman of the Ryan-NENA Community Health Center in New York takes his approach to drawing blood a step further.  Not only does he tailor needle size to the patient, he tries to cut down on blood draws altogether by bundling laboratory tests together, and he makes sure to carefully explain every test that he runs.

In the ICU at Stanford Hospital in Palo Alto, Calif., they are using smaller needles to prevent unnecessary pain.  And if a patient needs a loving hand to hold to get through the pinch, their relatives will be there morning, noon and night.  The ICU has made limited visiting hours a thing of the past.

The hospital's administrators said in an email that they meet regularly with their partner facility, Lucile Packard Children's Hospital, to discuss policies, procedures and what works best for patients.

And improving patients' experience is moving beyond simply instituting new hospital policies.  Many hospitals are literally paving the way to let loved ones stay by a patient's side.  New hospital construction is increasingly focused on patient privacy and accommodations for patients and their families.

But perhaps the biggest sign that the times are changing is what has transpired at The Christ Hospital in Cincinnati.  There, efforts to improve the patient experience have managed to change the age-old practice of physician "rounds," or the daily gathering when doctors discuss a patient's care.

Instead of rushed updates on a patient's disease, half-answered questions about changing medications, and confusion over test results, the team staged a daily group conversation involving the doctors, nurses, the patient and their family.

Preliminary data show the new strategy is working.  More than 90 percent of doctors and nurses surveyed felt that rounding with the patients and families was an improvement over the old system.

Copyright 2012 ABC News Radio

Thursday
Jan262012

Protein-Free Diet May Make Surgery Less Risky

Jupiterimages/Thinkstock(CAMBRIDGE, Mass.) -- Doctors usually tell their patients not to eat or drink the night before surgery.  But there’s new evidence that food consumed weeks before an operation could affect how the body responds to the stress of surgery.

A new study found that mice fed a protein-free diet seemed to be protected from complications after surgery.  The findings, published in the journal Science Translational Medicine, could give scientists new insight into how to prevent common complications from surgery -- such as heart attacks and strokes -- in humans.

Harvard researchers studied two groups of mice, feeding one group a protein-free diet for up to two weeks before surgery, and letting the other group eat normally.  The researchers then operated on the mice, using techniques that put their kidneys and livers under added stress.

About 40 percent of the mice who ate normally died after the surgery; all of the mice on the protein-free diet survived.

Previous studies in animals have shown that restricting the diet is one way to help the body cope with stress and stay healthy.  Study author James Mitchell, an assistant professor at the Harvard School of Public Health, said he and his team were hoping to find out just which elements of the diet can help or hinder the body’s response to stress.

“Surgery, by its nature, is traumatic to the body,” Mitchell told ABC News.  “With changes to the diet, we’re getting the body ready for an acute stress like surgery.  If we can do that, the complications might be less severe or there might be fewer complications.”

Although the study tested only mice, the trauma their bodies experienced after the surgery is similar to what humans can experience, said Dr. Stavros Memtsoudis, an anesthesiologist at the Hospital for Special Surgery in New York City.

“But the human body is very complex, more complex than mice.  How one change affects all other organs is very unknown,” Memtsoudis said.  “Nevertheless, this opens up a whole new concept that should be investigated.  Nutrition is a very nuanced intervention before surgery that should be paid attention to.”

Copyright 2012 ABC News Radio

Wednesday
Jan042012

Hospital Readmission Rate Among Heart Attack Patients Higher in US

Pixland/Thinkstock(DURHAM, N.C.) -- Heart attack patients in the U.S. are more likely to be readmitted to the hospital within 30 days of surgery than patients in Canada, Australia and several other European countries, a new study revealed.

The research, published in the Journal of the American Medical Association, analyzed data from more than 5,700 patients in more than 15 countries.  Duke researchers found that 14 percent of American patients who experienced a ST segment elevation myocardial infarction (a severe type of heart attack that occurs when a coronary artery becomes at least partially blocked by a blood clot) were readmitted to the hospital, as opposed to an average of 9 percent in other countries.

There were two strong predictors of these results, said Dr. Manesh Patel, senior author of the study at Duke University Medical Center. Patients with multi-vessel disease were more likely to be readmitted because they were higher risk patients. The second strong predictor for any reason was if the patient was being treated in the United States.

“This isn’t telling us to stay in the hospital longer, but it does open up a conversation about how other countries perform differently,” said Patel.  “This will be important as we move forward with health care reform and figure out ways to provide sufficient care.”

“We do a great job of opening up a patient’s artery, but we need a more coordinated system in place that helps patients follow lifestyle changes, instead of the episodic nature of U.S. health care,” continued Patel.

American doctors are more aggressive in treating patients, said Dr. Christopher Cannon, professor of medicine at Harvard Medical School.  If patients experience any ischemia (reduced blood supply to the heart) post-surgery, doctors tend to want to readmit the patient to the hospital.

“I think also that U.S. patients demand top level care, so if there is a question of chest pain following a [heart attack], they get readmitted for evaluation just to be safe,” said Cannon.

Copyright 2012 ABC News Radio

Tuesday
Dec132011

ER Docs See Patients with Unimaginable Items in Unlikely Places

Medioimages/Photodisc/Thinkstock(NEW YORK) -- One winter night, Dr. Melissa Barton was the attending physician in the emergency department of the Detroit Medical Center.  Making her rounds, she picked up a chart for a new patient and read the woman's chief complaint: "eye in the vagina."

The patient told Barton she had been expecting a fight with some neighbors outside her house.  Wearing only a sweatshirt and spandex pants, she needed somewhere to stow her prosthetic eye for safe-keeping.

"Those things are pretty expensive and hard to replace," Barton said.  "So that's where it went, along with her driver's license."

Unfortunately, it got stuck.

Dr. Gary Vilke, a professor of clinical emergency medicine at the University of California San Diego Medical Center, saw a patient who had four Barbie doll heads stuck in his rectum.

"When you looked at his x-ray, they were looking at you, like a totem pole," Vilke said.

Ask a handful of emergency medicine specialists about cases like these, and you'll get a cascade of stories about patients with strange objects ingested or inserted in unlikely places. Vegetables, light bulbs, tools, even cellphones and reading glasses have wound up illuminated on x-rays or described on medical charts in U.S. emergency departments.

For many unlucky patients, an inserted or ingested foreign object is the result of a one-in-a-million accident or a single bout of bad judgment or curiosity.  While there is little data detailing just how many patients wind up in U.S. emergency departments with objects stuck in their orifices, doctors say they see these patients more often than you might think.

"There's usually a good story every week or two, everything from the unique to the bizarre to the gross," said Vilke, who has practiced emergency medicine for 20 years.

Copyright 2011 ABC News Radio

Thursday
Oct272011

Hospital Room Designed for the Patient, by the Patient

Hemera Technologies/Thinkstock(SAN DIEGO) -- You may not know that famed architect Michael Graves is in a wheelchair, although many of us know his name, because we buy his well-designed home products sold at Target stores.

At TedMed, an annual conference focusing on health and medicine, Graves told his story of paralysis.  From his wheelchair, Graves shared that in 2003 he had been running around the world, traveling nonstop to create his incredible designs, when he got a sinus cold he could not get rid of.  He could not ignore it, because the next day it had spread and became a pain in his back.  He had no choice but to take himself to the hospital, and by the next morning, he was paralyzed.  Doctors told him he had something that only four other people in the world had.  His sinus infection had gone to his brain and then his spine, resulting in paralysis.  It’s still not clear what the infection was.

Graves spent months in the hospital undergoing rehab.  He learned quickly how poorly designed the hospital room was for a wheelchair-confined person.  Tasks like shaving and reaching the sink were troublesome for him.

Graves knew he had to do something. While he still designs buildings and products, he has gone on to design furniture -- tables, chairs, tools for the hospital room that meet patients’ needs.  His furniture designs are simple and make sense -- a table with a handle and two levels, so you can separate your tissues and medicines from your newspaper and candy.

He also designed a simple trash can that could fit under the bedside table.  Another of his designs is a chair with holes in the back, so that when a patient puts a sheet on it before sitting down (something, he said, patients often do to keep the chair germ free) it doesn’t come off with the patient when the patient stands up.

Copyright 2011 ABC News Radio







ABC News Radio