Consulo Indicium - 10/18/19

Information for your Consideration…

Toto’s Perspective – Or, How My Dog Keeps Me Calm – Toto is not only the little dog in The Wizard of Oz but also my best buddy at home.  Toto is a Glen of Imaal Terrier – the newest breed to be recognized by the American Kennel Club (AKC) – and, my best buddy.  Every morning when I awaken, I am greeted with his wonderful dark eyes and steady gaze with the clear message, “Dad, it’s time to go out!”  And, so we go out.  So, what’s this got to do with health care?  There is a new study published in Circulation that found dog owners to have healthier cholesterol levels, lower blood pressures and milder stress responses than those who did not own dogs (NOTE: There was no control group of “cat owners” :-)  ).  In addition, there was a second study by a group of Swedish researchers which reported that people who suffered a heart attack or a stroke and owned a drug appeared to have a lower risk of a second heart attack or stroke than those who did not. I’m sure that Toto was aware of these studies as he is a very prescient dog.  And, even more, he’s the best four-legged companion I’ve ever had in my entire life.  If I’m lucky and Toto sticks around with me, I should live a long time…

But, What About Cats? – Not to be outdone, there was a recent article (what is it with the pet thing anyway?) on the emotion response to watching cat videos online. In a cohort of nearly 7,000 Internet users who watch cat videos (yes, it’s a growing social media phenomenon, along with dog videos.  Anyone out there watching turtle videos?), the study revealed a significant relationship between viewing, personality types and level of enjoyment in watching cat videos as a factor in happiness of the individual.  Hmmmm…I’m sure my cat – Willie Nelson hasn’t seen the study otherwise he would have put it in front of me as a counter to my focus on Toto the Wonder Dog! 

ECRI Institute Top 10 Health Tech Hazards Released – For the last 13 years, the ECRI Institute has released an annual “Top 10 Health Technology Hazards” list containing a rank order on the biggest health technology concerns of the year. The list is derived after a comprehensive review of ECRI's incident investigations plus additional medical device testing and a review of both public/private incident report databases. It’s an important list because it doesn’t just provide a Top 10 but also suggests practical strategies for the health care community to implement for reducing risks.

1. Surgical Staplers – The potential for the malfunction and misuse of surgical staplers ranked number one on the list. In a statement by the ECRI Institute, they noted "Injuries and deaths from the misuse of surgical staplers are substantial and preventable. We want hospitals and other medical institutions to be in a better position to take necessary actions to protect patients from harm." According to Medical Device Reports (MDRs) released by the US Food and Drug Administration (FDA), over the period of 2011 through 2018, there were more than 41,000 individual MDRs regarding surgical staplers and staples for internal use. The reports noted 366 deaths, more than 9000 serious injuries, and more than 32,000 malfunctions.
2. Point-of-Care Ultrasound (POCUS) – As relatively new technical devices, it appears that use is outpacing appropriate policies and practices to avoid misuse or misdiagnosis. The problems are wide ranging and it is clear this will become a major focus for FDA scrutiny in the coming year. 
3. Office-based Sterilization Procedures – ECRI noted that the failure to consistently and effectively clean, disinfect and/or sterilize contaminated items to reduce patient exposure to virulent pathogens is an ongoing problem. Training was noted as a big issue along with the use of protocols and guidelines for use of equipment. 
4. At-Home Hemodialysis – The use of central venous catheters (CVC) for at-home hemodialysis is an increasing problem because of the growth of the service. With an increase in the push for home treatment by the federal government and insurers , ECRI noted that the risks for this procedure may outweigh the benefits. Further study is on the horizon.
5. Robotic Procedures – The use of robots for surgical procedures – among other capabilities in care delivery – is growing by leaps and bounds. However, the procedures and policies related to these devices haven’t kept pace with use.  The end result is an increasing number of problems.  Specifically, the report calls out the need not only for better defined procedures but also improved training, credentialing, and privileging surgeons and operating room staff in the use of the technology.  And, I would argue that the same is needed outside of the surgical suite as well.
6. Alarm Overload – One the unintended consequences in the use of all sorts of technology is the frequency of alarms, alerts, and notifications. In many cases, the alarms overload clinicians to the point where they are ignored – either intentionally or unintentionally. 
7. Cybersecurity – While there are clearly ongoing risks in controlled environments like hospitals and clinics, there is a much more significant concern when it comes to the connected home or remote health environment. Service interruptions, device intrusions or infections and delayed- or mis-diagnosis are increasing problems.
8. MRI Use and Implants – The report found that there is an ongoing problem with missing implant data when patients are undergoing MRI scans. The lack of this type of information creates a hazard and/or delay in the use of MRI scans.  Again, protocols and training are at the top of the list of solutions.
9. Medication Errors – You would think the problem of medication errors would go away. The technology is there but, if it’s not used properly, errors can continue. 
10. Insufficient Service Management – It’s amazing what a few loose nuts, bolts or wires can do in devices that are increasingly used to manage care delivery. The possibility of injury accidents or harm to patients, clinicians, and others is on the increase and needs attention. 

For more information about the ECRI Institute and the Top 10 annual ranking check out their website. For those who are involved in the technology side of health care, the ECRI is an important resource for staying abreast of the changes and challenges in the use of technology. 

Fast Versus Slow? – A new article in JAMA Network found that walkers who dawdled was a warning sign that you might be aging faster than you think!  For some time, walking speed has been known as a predictor of life expectancy for people in the 70’s and 80’s.  Slow walking has been previously associated with an increased risk of hospitalization and dementia.  So, I guess those fast walkers at the airport are the ones who will inherit the earth.  I wonder if it counts that I was once a fast walker but now tend towards ambling.  The paper did not address this important aging issue :-) .