The Los Angeles Times (11/29, Bensinger, Vartabedian) reported, "Amid widening concern over acceleration events, Toyota has cited "floor mat entrapment.'" Reports, however, are pointing "to another potential cause: the electronic throttles that have replaced mechanical systems." The automaker "says the gas pedal design" in "more than 4 million...Toyota and Lexus vehicles makes them vulnerable to being trapped open by floor mats." Last week, Toyota "announced a costly recall to fix the problem." The article noted that "accounts from motorists...interviews with auto safety experts and a Times review of thousands of federal traffic safety incident reports all point to another potential cause: the electronic throttles that have replaced mechanical systems in recent years."
The AP (11/25, Thomas) reported, "As a temporary step, Toyota will have dealers shorten the length of the gas pedals beginning in January while the company develops replacement pedals for their vehicles," stated the US Transportation Department, adding that "new pedals will be available beginning in April, and some vehicles will have brake override systems installed as a precaution." According to the Chicago Tribune (11/26, Zimmerman), "the announcement dramatically expands the scope and likely expense of the recall, which was announced Sept. 29. Toyota initially had focused on the possibility that improperly installed floor mats might be causing the unintended acceleration problems, and it urged owners of affected vehicles to remove the mats until they could be replaced."
The Detroit Free Press (11/26, Gardner) reported, "It's unclear whether these steps will contain or reduce Toyota's legal exposure from lawsuits already filed. 'It helps in that it looks like they're trying to do something,' said Carl Tobias, a University of Richmond law professor specializing in product liability law. 'In the end, it comes down to: When did the company know about the issue and did it take action voluntarily?'"
On the front page of its business section, the New York Times (11/26, B1, Vlasic, Bunkley) reported, "Several lawsuits have been filed against Toyota, including a class-action suit in California. 'We feel that Toyota has known about this problem for a long time,' said David Wright, whose firm filed the class-action case on Nov. 5 in Los Angeles." The Wall Street Journal (11/27, B2, Linebaugh) also reported the story.
Monday, November 30, 2009
Tuesday, November 24, 2009
Nine Percent of Surgeons Have Made ‘Major’ Errors Recently
WALL STREET JOURNAL 11-24-09
By Jacob Goldstein
A survey to measure burnout and quality of life among surgeons turned up a detail that caught our eye: Nine percent of surgeons said they were concerned they had made a “major medical error” in the past three months.
The authors of the paper, published by the Annals of Surgery, point to why this is noteworthy.
Although surgeons do not appear more likely to make errors than physicians in other disciplines, errors made by surgeons may have more severe consequences for patients due to the interventional nature of surgical practice.
Those who said they had made an error also showed more signs of depression and emotional exhaustion, the authors found. It wasn’t clear whether the distress made errors more likely, errors made distress more likely, or both.
The survey was commissioned by the American College of Surgeons, and some of the results relating to burnout and career satisfaction were published earlier this year. Overall, 40% of those who responded were “burned out,” according to the authors, and 30% showed symptoms of depression.
Surveys were sent to nearly 25,000 surgeons, and just under 8,000 responded. Response bias is always a concern in interpreting survey results — do those who respond differ in some important way from those who don’t? But it’s unclear which way response bias cuts in this case. Burned-out surgeons could be apathetic and less likely to respond than others, or particularly interested in quality-of-life issues and more likely to respond, the authors write.
WSJ's blog on health and the business of health.
By Jacob Goldstein
A survey to measure burnout and quality of life among surgeons turned up a detail that caught our eye: Nine percent of surgeons said they were concerned they had made a “major medical error” in the past three months.
The authors of the paper, published by the Annals of Surgery, point to why this is noteworthy.
Although surgeons do not appear more likely to make errors than physicians in other disciplines, errors made by surgeons may have more severe consequences for patients due to the interventional nature of surgical practice.
Those who said they had made an error also showed more signs of depression and emotional exhaustion, the authors found. It wasn’t clear whether the distress made errors more likely, errors made distress more likely, or both.
The survey was commissioned by the American College of Surgeons, and some of the results relating to burnout and career satisfaction were published earlier this year. Overall, 40% of those who responded were “burned out,” according to the authors, and 30% showed symptoms of depression.
Surveys were sent to nearly 25,000 surgeons, and just under 8,000 responded. Response bias is always a concern in interpreting survey results — do those who respond differ in some important way from those who don’t? But it’s unclear which way response bias cuts in this case. Burned-out surgeons could be apathetic and less likely to respond than others, or particularly interested in quality-of-life issues and more likely to respond, the authors write.
WSJ's blog on health and the business of health.
Friday, November 20, 2009
ACOG Releases New Cervical Screening Guidelines into Politically Charged Environment
New clinical management guidelines for cervical cytology screening advise that screening should begin at age 21, not at the age of first sexual intercourse.
The guidelines, released in the American College of Obstetricians and Gynecologists' ACOG Practice Bulletin, say the change is "based on the potential for adverse effects associated with follow-up of young women."
Initially, screening is recommended every 2 years. For women over 30 who have had three consecutive negative screenings, screening may occur at 3-year intervals. Women with certain risk factors may require more frequent screenings: those infected with HIV, the immunosuppressed, those with in utero exposure to DES, women with a history of cancer or cervical intraepithelial neoplasia.
Screening can be discontinued for most women between 65 and 70, or who have had a hysterectomy for benign indications and no history of high-grade CIN.
The guidelines also give recommendations on HPV screening.
Both the New York Times and the Washington Post report that release of the cervical screening guidelines and those on mammography within the same week was a coincidence. Both recognized that the ACOG guidelines would add fuel to the political firestorm over health care reform.
ACOG Practice Bulletin (Free PDF)
New York Times story (Free)
Washington Post story (Free)
The guidelines, released in the American College of Obstetricians and Gynecologists' ACOG Practice Bulletin, say the change is "based on the potential for adverse effects associated with follow-up of young women."
Initially, screening is recommended every 2 years. For women over 30 who have had three consecutive negative screenings, screening may occur at 3-year intervals. Women with certain risk factors may require more frequent screenings: those infected with HIV, the immunosuppressed, those with in utero exposure to DES, women with a history of cancer or cervical intraepithelial neoplasia.
Screening can be discontinued for most women between 65 and 70, or who have had a hysterectomy for benign indications and no history of high-grade CIN.
The guidelines also give recommendations on HPV screening.
Both the New York Times and the Washington Post report that release of the cervical screening guidelines and those on mammography within the same week was a coincidence. Both recognized that the ACOG guidelines would add fuel to the political firestorm over health care reform.
ACOG Practice Bulletin (Free PDF)
New York Times story (Free)
Washington Post story (Free)
Thursday, November 19, 2009
80% Uninsured Trauma Patients Die vs Insured Patients!
Legally, it’s not supposed to matter whether emergency room patients have insurance or not. The Emergency Medical Treatment and Active Labor Act, passed by Congress in 1986, guarantees that all people brought to the emergency room receive all the treatment they require, independent of their ability to pay.
And yet, a study just published in the Archives of Surgery found that patients lacking insurance are 80% more likely to die from traumatic injuries than those with private insurance, including commercial health plans, health maintenance organizations, and Medicaid.
Trauma physicians said they were surprised by the findings, even though a slew of studies had previously documented the ill effects of going without health coverage. Uninsured patients are less likely to be screened for certain cancers or to be admitted to specialty hospitals for procedures such as heart bypass surgery. Overall, about 18,000 deaths each year have been traced to a lack of health insurance. –LA Times
While the researchers from Harvard University and Brigham and Women's Hospital in Boston were expecting to find some disparity in risk between insured and uninsured trauma patients, they were shocked at just how large the disparity was.
The researchers offered several possible explanations for the findings. Despite the federal law, uninsured patients often wait longer to see doctors in emergency rooms and sometimes visit ERs at several hospitals before finding one that will treat them. Other studies show that, once they're admitted, uninsured patients receive fewer services, such as CT and MRI scans, and are less likely to be transferred to a rehabilitation facility. –LA Times
CHILDREN ARE VICTIMS AS WELL:
11-19-09 Featured in Journal Watch:
Mortality and Insurance Status — The Safety Net Has Holes
Uninsured children with blunt or penetrating trauma have higher mortality rates than their privately insured counterparts.Journal Watch Pediatrics and Adolescent Medicine summary
And yet, a study just published in the Archives of Surgery found that patients lacking insurance are 80% more likely to die from traumatic injuries than those with private insurance, including commercial health plans, health maintenance organizations, and Medicaid.
Trauma physicians said they were surprised by the findings, even though a slew of studies had previously documented the ill effects of going without health coverage. Uninsured patients are less likely to be screened for certain cancers or to be admitted to specialty hospitals for procedures such as heart bypass surgery. Overall, about 18,000 deaths each year have been traced to a lack of health insurance. –LA Times
While the researchers from Harvard University and Brigham and Women's Hospital in Boston were expecting to find some disparity in risk between insured and uninsured trauma patients, they were shocked at just how large the disparity was.
The researchers offered several possible explanations for the findings. Despite the federal law, uninsured patients often wait longer to see doctors in emergency rooms and sometimes visit ERs at several hospitals before finding one that will treat them. Other studies show that, once they're admitted, uninsured patients receive fewer services, such as CT and MRI scans, and are less likely to be transferred to a rehabilitation facility. –LA Times
CHILDREN ARE VICTIMS AS WELL:
11-19-09 Featured in Journal Watch:
Mortality and Insurance Status — The Safety Net Has Holes
Uninsured children with blunt or penetrating trauma have higher mortality rates than their privately insured counterparts.Journal Watch Pediatrics and Adolescent Medicine summary
Tuesday, November 17, 2009
INSURANCE COMPANY PROFIT VS DEATH?
The insurance industry recently reported that $80 Billion is paid each year for Mammogram screening for Breast Cancer and PSA screening for Prostate Cancer. According to their financial reports the costs don't justify the return, meaning- by the number of lives saved by early detection of Cancer.
Is it "OK" for the Insurance Industry take away our individual right to obtain preventative screening for cancer? Is it "Ok" for the Insurance Industry to use the medical studies for justification of these "new restrictions" so they can pay less for preventative screenings and increase their profit margins even further? Lord help you if you are diagnosed with Cancer. You can be assured that your insurance company will also Deny life saving treatment under ambiguous exclusion clauses such as; "Investigational or Experimental Treatment."
At what point do we say, "NO" to Insurance companies who only see human beings a profit margins and expendable for the sake of their bottom line.
What do you think? I welcome your comments on this very hot topic.
USPSTF Recommends Against Routine Mammography for Women in Their 40s
The U.S. Preventive Services Task Force now recommends against routine screening mammography for average-risk women aged 40 to 49. This represents a change from the USPSTF's 2002 recommendation statement, which advocated for routine screening starting at age 40.
Among the task force's other updates, published in Annals of Internal Medicine:
Screening mammography should be performed every 2 years for average-risk women aged 50 to 74.
Evidence is insufficient to recommend for or against screening in women 75 or older.
Clinicians should not teach women how to perform breast self-exams.
Evidence is insufficient to make recommendations on using clinical breast exams in addition to mammography.
Evidence is insufficient to recommend for or against using digital mammography or MRI instead of film mammography.
In Journal Watch Women's Health, Dr. Andrew Kaunitz says that because the updated guidelines recommend less screening, women may be confused or even outraged. He calls for consistent "frank discussions" with patients about the benefits and risks of screening mammography.
(The American College of Radiology has spoken out against these guideline changes.)
Annals of Internal Medicine article (Free)
Annals of Internal Medicine editorial (Subscription required)
Journal Watch Women's Health clinical practice guideline watch (Free)
American College of Radiology statement opposing USPSTF's changes (Free)
Is it "OK" for the Insurance Industry take away our individual right to obtain preventative screening for cancer? Is it "Ok" for the Insurance Industry to use the medical studies for justification of these "new restrictions" so they can pay less for preventative screenings and increase their profit margins even further? Lord help you if you are diagnosed with Cancer. You can be assured that your insurance company will also Deny life saving treatment under ambiguous exclusion clauses such as; "Investigational or Experimental Treatment."
At what point do we say, "NO" to Insurance companies who only see human beings a profit margins and expendable for the sake of their bottom line.
What do you think? I welcome your comments on this very hot topic.
USPSTF Recommends Against Routine Mammography for Women in Their 40s
The U.S. Preventive Services Task Force now recommends against routine screening mammography for average-risk women aged 40 to 49. This represents a change from the USPSTF's 2002 recommendation statement, which advocated for routine screening starting at age 40.
Among the task force's other updates, published in Annals of Internal Medicine:
Screening mammography should be performed every 2 years for average-risk women aged 50 to 74.
Evidence is insufficient to recommend for or against screening in women 75 or older.
Clinicians should not teach women how to perform breast self-exams.
Evidence is insufficient to make recommendations on using clinical breast exams in addition to mammography.
Evidence is insufficient to recommend for or against using digital mammography or MRI instead of film mammography.
In Journal Watch Women's Health, Dr. Andrew Kaunitz says that because the updated guidelines recommend less screening, women may be confused or even outraged. He calls for consistent "frank discussions" with patients about the benefits and risks of screening mammography.
(The American College of Radiology has spoken out against these guideline changes.)
Annals of Internal Medicine article (Free)
Annals of Internal Medicine editorial (Subscription required)
Journal Watch Women's Health clinical practice guideline watch (Free)
American College of Radiology statement opposing USPSTF's changes (Free)
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