Pennsylvania and New Jersey, like several other states, have passed laws in recent years requiring hospitals to report serious errors. But lots of important mistakes may still be going unreported, the Philadelphia Inquirer reports this morning. In New Jersey, for example, five of the state’s 80 hospitals didn’t report any preventable mistakes last year. And some Pennsylvania hospitals didn’t report any errors or near misses, which are also supposed to be reported. It’s unlikely the hospitals operated flawlessly. “I don’t know how many is enough, but zero is a bad number,” said James Bagian, head of the Department of Veterans Affairs’ National Center for Patient Safety, told the Inquirer. “Anybody that is supposed to report close calls and has zero reports is clueless. … Management is asleep at the switch and just waiting until they kill someone.” The laws are part of a nationwide push to recognize medical errors and improve patient safety by preventing them. But the laws aren’t in step with another big trend in medicine these days: transparency. In general, the error reports aren’t available to the public, and the agencies wouldn’t tell the Inquirer how many error reports each hospital had filed. The New Jersey Hospital Association supports reporting but opposes making the reports public. “It may present an unfair picture of what is actually going on . . . when we have some hospitals that are not reporting and other hospitals that are reporting,” a hospital association official told Inquirer.
sexta-feira, 12 de setembro de 2008
O blogueiro do The Wall Street Journal repercute matéria do Philadelphia Inquirer sobre a notificação de erros médicos. Alguns estados americanos adotaram a notificação de erros hospitalares. Lá, como cá há um pavor em dizer que há problemas nos processos de trabalho que levam a erros. Prova da estúpida onipotência do setor hospitalar e dos médicos.
quarta-feira, 10 de setembro de 2008
No blogue auxiliar Ensaios Clínicos , postei os dois abstracts publicados hoje no The New England Journal of Medicine. Trata-se da continuidade de dois ensaios clínicos sobre diabetes encerrados e publicados há dez anos, o UKPDS (United Kingdom Prospective Diabetes Study). Agora, eles avaliam o efeito do ensaio sem a intervenção, dez anos depois. Os resultados praticamente mudaram o publicado inicialmente, o que implica discutir cada vez mais o mundo dos ensaios clínicos e o mundo real. Fica para outro momento.
O título do post é homenagem ao filósofo, médico, endocrinologista e diabetólogo, Arnaldo Caleiro Sandoval, autor dessa e de outras máximas.
terça-feira, 9 de setembro de 2008
Um artigo simples, de fácil realização, publicado no Circulation pela equipe da Harvard Medical School revela que artigos financiados pela indústria são mais citados do que aqueles por outras fontes, independente da qualidade. O mesmo vale para artigo mostrando que a proposta nova é mais efetiva do que a existente.
Leitura obrigatória em seminários de médicos-residentes e pós-graduandos.
Differential Citation Rates of Major Cardiovascular Clinical Trials According to Source of Funding. A Survey From 2000 to 2005
David Conen MD, Jose Torres BA, and Paul M Ridker MD* Background—Prior work indicates that therapeutic trials funded by for-profit organizations are more likely to report positive findings than trials funded by not-for-profit organizations. What impact, if any, funding source has on subsequent dissemination of trial data is uncertain. To address this issue, we used the number of citations per publication per year to assess differences in trial dissemination according to funding source. Methods and Results—We assessed 303 consecutive superiority trials of cardiovascular medicine published between January 1, 2000, and July 30, 2005, in the Journal of the American Medical Association, The Lancet, and the New England Journal of Medicine. The primary outcome measure was the number of citations per publication per year up to December 31, 2006. Overall, the median number of citations per publication per year was 46 for trials funded exclusively by for-profit organizations, 37 for trials jointly funded, and 29 for trials funded by not-for-profit organizations (P=0.0007). Higher citation rates for trials funded by for-profit organizations were consistently observed in analyses stratified by journal and various trial design features and were most striking when the new intervention was favored over the standard of care; in this subgroup, the median number of citations per publication per year was 52 for trials funded by for-profit organizations compared with 25 for trials funded by not-for-profit organizations (P=0.0006). In marked contrast, in analyses limited to trials in which the new intervention was significantly worse than the standard of care, an inverse pattern was observed with fewer citations per publication per year for trials funded by for-profit organizations compared with not-for-profit organizations (33 versus 41; P=0.048). Higher citation rates were observed for industry-funded trials than for federally funded trials even when the trials dealt with similar issues and were published back-to-back in the same journal. Conclusions—Dissemination of clinical trial results is important for clinical practice but appears to be biased in favor of for-profit entities. Consideration should be given to more extensive promotion of clinical trial results that are funded by not-for-profit organizations.