The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia

Even with new diagnostic modalities, autopsy remains an important tool for quality and safety assurance. A systematic review of reports from 1996 to 2002 found autopsies detected, on average, 23.5% of clinically missed diagnoses involving the principal or underlying cause of death, and 9% of errors that would or could have affected the patient's outcome. We surveyed pathology laboratories and hospital administrators across Australia, and found a decline in the hospital autopsy rate from 21% (210/1000 deaths) in 1992-93 to 12% (118/1000 deaths) in 2002-03. This decrease is in adult autopsies (66% of all autopsies in 1992-93; 39% in 2002-03). Perinatal autopsies increased from 29% to 58% of all autopsies in this period, mainly due to more examinations of fetuses less than 20 weeks' gestation. Factors contributing to this decline may include community attitudes, clinicians' reluctance to request autopsy (partly because of administrative burdens in making the request), hospital concern about legal action if a misdiagnosis is detected, and funding priorities. Reversing this decline will require cooperative action at several levels of the healthcare system, and from government bodies.     

主要发达国家医疗健康大数据政策分析

通过对主要几个发达国家医疗健康大数据政策的调研,从战略规划、基础设施建设、关键技术研发、人才培养、隐私保护等若干方面比较分析美国、英国、法国、日本、韩国、新加坡政府的医疗健康大数据政策,总结分析了共性特点及各自特色。最后从进一步完善我国医疗健康大数据配套政策方面提出五点建议：转换思维、建立运行机制、构建建设标准、搭建共享平台和重视人才培养。     

Indoor air quality a major public-health issue, workshop told.

Indoor pollution is a major public-health issue, say representatives from government and the medical profession who participated in a recent workshop in Ottawa. Researchers are certain that indoor pollution causes many of the allergy-related problems and asthma, bronchitis, rhinitis, coughing and others respiratory problems experienced by North Americans. They urge physicians to learn about indoor air quality and to educate patients to improve their environment, particularly with respect to second-hand smoke, dust mites and mould.     

Palpitation in pregnancy: experience in one major hospital in Kuwait

Background

Increased heart rate is a normal physiological adaptation occurring during pregnancy. Some women have severe tachycardia requiring medical attention. Aim of this study is to determine the number of women with benign symptomatic palpitations who receive treatment.

Methods

We performed a retrospective chart review of all women who were referred to our obstetric-medicine clinic for evaluation of palpitation from January 2009 to December 2009 in one major maternity hospital in Kuwait.

Results

A total number of 27 women were identified. Of these, only 7 (25.9%) were given treatment for palpitation. Two were started on digoxin, 3 given propranolol, 1 woman on both propranolol and digoxin and 1 was started on verapamil. Eighteen women had normal deliveries with healthy babies.

Conclusion

Palpitation is a common symptom during pregnancy. However, only a small number of patients receive treatment despite safety of drugs that are used to control tachycardia.     

ATV Accidents continue to be a major public health issue in West Virginia

All-terrain vehicle (ATV) riding continues to be a major public health problem in West Virginia because the state leads the nation in the rate of deaths from ATV incidents and has significantly higher death rates than all five of the bordering states. Annually, there are 24 deaths a year in West Virginia due to ATV accidents and thousands of nonfatal injuries. Sporting events using ATVs such as motocross racing have added to the burden of caring for patients who are injured in recreational activities. We report a case study of 10 patients treated over an 18-hour period in a state trauma center for injuries received while riding ATVs casually and in competition. The addition of these 10 patients to the other 108 patients seen in the ED during this period totally disrupted patient flow, caused significant delays in care of the non-trauma patients, and tied up the Radiology Department and operating rooms for an extended period.     

Choice is not the issue. The misrepresentation of healthcare in bioethical discourse

The principle of respect for autonomy has shaped much of the bioethics' discourse over the last 50 years, and is now most commonly used in the meaning of respecting autonomous choice. This is probably related to the influential concept of informed consent, which originated in research ethics and was soon also applied to the field of clinical medicine. But while available choices in medical research are well defined, this is rarely the case in healthcare. Consideration of ordinary medical practice reveals that the focus on patient choice does not properly grasp the moral aspects involved in healthcare. Medical decisions are often portrayed as if doctors and patients in confidence confront specific decisions about examinations or treatment, yet the reality often involves many different participants, with decisions being made over time and space. Indeed, most of the decisions are never even presented to patients, as it would be unethical to suggest something that is not medically justifiable. The options patients do confront are somewhat arbitrarily constructed within the narrow framework of both what is deemed to be medically appropriate and how the healthcare system is organised practically. While the autonomy discourse has proven valuable, a failure to distinguish between the fields of medical research and clinical medicine has generated a focus on patient choice that does not reflect what is really at stake in healthcare settings. This is alarming, because the current discourse misrepresents medical practice in a way that actually contributes to bioethical self-delusion.     

The weight of evidence suggests that soft drinks are a major issue in childhood and adolescent obesity

There is much to be gained by reducing children's intake of soft drinks and little - except excess weight - to be lost.