Thursday, February 28, 2008

C. diff news from the UK

From today's BBC News - Dramatic rise in C. diff deaths
The number of deaths linked to hospital bug Clostridium difficile has soared in England and Wales, figures from the Office for National Statistics show.

Between 2005 and 2006 the number of death certificates which mentioned the infection rose by 72% to 6,480, most of which were elderly people.

In over half of cases, it was listed as the underlying cause of death.

It is thought that some of the increase may be due to more complete reporting on death certificates.

During the same time period, deaths due to MRSA (Methicillin-resistant Staphylococcus aureus) remained fairly steady.

Brian Duerden, chief microbiologist at the Department of Health, notes that the NHS has launched a number of efforts to reduce nosocomial infections since 2006, including clinician education about hand-washing, a bare-below-the-elbows dress code, and other hygiene and monitoring provisions.


More on Google Health

Via the Wall Street Journal's Health blog - Google Unveiling Personal Health Records Service - apparently the service will be revealed at a session of the Healthcare Information and Management Systems Society meeting in Orlando today.
Patients will be able to enter basic medical data into an online repository, and invite their doctors to electronically submit information as well, the WSJ says.
(also a full WSJ article on the topic, which briefly talks about Microsoft's HealthVault too)

A brief overview of today's presentation in Orlando here at Wired News and here at InfoWorld

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Thursday, February 21, 2008

Keeping up with C. diff

The BioMed Central journal Critical Care this month includes a review and a commentary piece discussing developments in our understanding of Clostridium difficile and associated colitis.
Described as a good reference for clinicians faced with this issue, the authors Carolyn V Gould and L Clifford McDonald, from the Centers for Disease Control, detail the pathogenesis, diagnosis and possible treatment strategies in this most topical of hospital-acquired infections. The onus is on healthcare professionals to maintain awareness of the changing epidemiology of the disease, as well introducing measures to reduce the risk to patients.


Google Health

On the Google Blogscoped blog it is being reported that Google has been making progress with their health record application, Google Health. This has been in the making for awhile now, as over the past year Google has been speaking quite publicly about their efforts. As the Google Blogscope reports, the login page for Google Health listed these features of the system:

* Build online health profiles that belong to you
* Download medical records from doctors and pharmacies
* Get personalized health guidance and relevant news
* Find qualified doctors and connect to time-saving services
* Share selected information with family or caregivers

Google is often criticized with regards to their privacy policies as it remains nebulous exactly how much information they store and capture about any one individual's activities in their applications (more on privacy concerns discussed on ZDNet and Search Engine Land). However, the company seems strongly committed to developing this tool.

This week, Google Health is making news again, as the Cleveland Clinic announces a partnership with Google to pilot Google Health for personal health records.

More on the partnership:
- the Cleveland Clinic press release
- Wall Street Journal's Health blog
- New York Times coverage
- Wired News coverage (AP wire)

Monday, February 18, 2008

Patient portals

An item in this month's Surgery News newsletter from the American College of Surgeons
Patient portals: not the open floodgates physicians fear (PDF) summarizes a presentation at this year's ACS congress by Dr. Gretchen Purcell about the MyHealthAtVanderbilt site and other electronic patient portals.

Two studies referenced in the article:
Bergmo TS, Kummervold PE, Gammon D, Dahl LB. Electronic patient-provider communication: will it offset office visits and telephone consultations in primary care? Int J Med Inform. 2005 Sep;74(9):705-10. PubMed record

Lin CT, Wittevrongel L, Moore L, Beaty BL, Ross SE. An Internet-based patient-provider communication system: randomized controlled trial. J Med Internet Res. 2005 Aug 5;7(4):e47. PubMed record

Wednesday, February 06, 2008

An attending's perspective on information in medicine

This week’s JAMA has an interesting piece written from the perspective of an attending physician, considering how the role of the mentor in clinical medicine has evolved with increasing availability of information (mentions PDAs, UpToDate, PubMed, among other things).

An excerpt:
It has become increasingly clear to me that with the information revolution in full throttle, the role of the clinical attending has changed drastically and continues to evolve. Besides using rounds to discuss many of the social, ethical, and professional issues surrounding a patient's care, I increasingly find myself teaching less about the current state of information and more about how things have changed and how our understanding of an illness or treatment has evolved to where it is currently. I teach about multiple portals—how there is no single way to approach a case and how the one we choose may not be the only or even the best strategy despite our attempts to get the facts right and review the relevant data. I have the distinct impression that my mentors possessed a degree of certainty that in hindsight I am not sure was warranted. In this era of evidence-based medicine, I am more likely to point out how scanty the evidence actually may be when making a decision. Although I may refer to the "classic" article in a particular field, all too often I will point out how in retrospect it looks much less convincing than when it was first published just 10 years ago. Rather than giving my team answers, I am more likely to ask them to formulate a question that interests them regarding a specific case, then investigate the data, and report back to the group. The group can then try to digest this information and place it in the context of the case at hand.
Horowitz HW. The Interpreter of Facts. JAMA 2008;299: 497-498.