“Don’t let Zika stop the Olympics” by Ashish Jha

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An expert panel convened by the World Health Organization just declared that there is no scientific basis for canceling, postponing or moving the 28th Summer Olympics in Rio de Janeiro in August or the Paralympics in September because of the Zika outbreak. While many of us experts have expressed concerns about how the WHO handled Ebola and other outbreaks, this time the WHO got it right.

There are ample reasons for alarm: The Zika virus continues to spread in Brazil. Zika infection during pregnancy can have devastating effects on developing fetuses, leading to severe brain damage. The risk is so substantial that the WHO has called the Zika outbreak and its effects on pregnant women a public health emergency of international concern. The Centers for Disease Control and Prevention advises pregnant women to avoid traveling to Zika-affected areas if possible.

No wonder, then, that more than 200 medical ethicists and other experts penned an open letter to the WHO, calling for the Olympics to be moved or delayed. They contend that approximately 500,000 people flying into Rio to participate in or watch the Olympic Games would accelerate the spread of the disease as these individuals returned home, leading to a worldwide Zika outbreak.

These arguments seem compelling on the surface, but they don’t stand up to scrutiny.

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via washingtonpost.com

“Hospitals Not Utilizing More Observation Services to Avoid Readmission Penalties: Study”

 

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Excerpt: “Readmission rates had been rock stable for years and years, and coincidentally they came down as observation status rose,” says Ashish Jha, MD, MPH, hospitalist at the VA Boston Healthcare System and professor of health policy at the Harvard T.H. Chan School of Public Health. “The concerning part was that we thought we were making care better by reducing readmissions, but if we were just shifting readmissions to observation, that’s not a change in care pattern—that’s a change in the classification of billing data.”

Earlier data, including an article and an analysis in the Health Affairs blog, also suggested hospitals were trading observation for readmissions, Dr. Jha says.3,4 But the new data have assuaged his concern.

“They did it right,” he says. “Previous studies lumped hospitals together in categories and were not carefully teasing apart what individual hospitals were doing, and when they looked at the individual level, we see no correlation.”

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via the-hospitalist.org

AJMC What We’re Reading: Florida Cracks Down on Opioids, Reduces Prescriptions

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Excerpt: In a guest blog for Scientific American, Ashish Jha, MD, MPH, of the Harvard T.H. Chan School of Public Health, wrote that the biggest culprit when it comes to preventable medical mistakes is our inadequate healthcare system. The recent report that medical errors are the third leading cause of death may make people think the cause is carelessness and “individual sloppiness,” but the reality is that the US healthcare system is not doing well with managing complexity.

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via ajmc.com

 

“The Real Cause of Deadly Medical Errors” by Ashish Jha

Individuals do make lethal mistakes, but the main reason for preventable medical mistakes is a health care system inadequate to the complexities of 21st-century medicine

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A few months ago, I cared for an older patient that I will call Mr. Jones. He lived alone and one afternoon, after a neighbor found him disoriented, was brought into the emergency department. Diagnosed with pneumonia, he was admitted and started on standard guidelines-based antibiotics. By next morning, he had taken a turn for the worse and was sent to the intensive care unit where he struggled and eventually died 72 hours later. Troubled by the death of a seemingly healthy man, I spoke to his daughter who lived in California. She mentioned he had been admitted to another hospital two months prior, also for pneumonia. The lab at that hospital told me his pneumonia had been caused by an unusual bacterium susceptible to only a few antibiotics—none of which we had used. And days later, when our lab confirmed that Mr. Jones’ current pneumonia was caused by the same bacteria, I knew his death had been wholly preventable. Despite our best efforts, we all missed it.

A recent report in the British Medical Journal (BMJ)estimates that 250,000 Americans die each year due to medical errors. This reportsparked a firestorm. Skeptics carefully documented why that number might be wrong. While other estimates have put the number of deaths from medical errors at 100,000 , many in the medical community believe the number of cases is much smaller. The truth depends largely on the most important question of all: what is a medical error?

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via blogs.scientificamerican.com/