Health Care Safety Index February/March 2016

Here are healthcare safety issues that have appeared in the news and medical journals throughout the last 60 days or so:

The American College of Chest Physicians issued new recommendations published in Chest indicating that oral anticoagulants including Apixaban, Edoxaban, Rivaroxaban, or Dabigatran are now the preferred agents for long-term anticoagulation in patients. The exceptions include patients who are pregnant, who have cancer or who have severe renal insufficiency.

In an article published in the New England Journal of Medicine, authors recommended that pregnant women scheduled to deliver between the 34th to 36th weeks of gestation by cesarean section receive a first course of antenatal corticosteroids to reduce the risk of adverse respiratory events in newborns.

The Society of Critical Care Medicine and European Society of Intensive Care Medicine issued new guidelines defining sepsis and septic shock.

In an article published in the Journal of Pediatric Orthopedics, the authors recommended an MRI to investigate the possibility of adjacent infections in pediatric patients suffering from septic arthritis. A threefold increase of an adjacent infection was present in patients with three or more of the following risk factors: age older than 4 years; symptoms longer than three days, C-reactive protein (CRP) greater than 13.8 mg/dL; platelets less than 314,000/microL; and absolute neutrophil count  higher than 8600/microL.

The FDA approved an intranasal naloxone spray (Narcan nasal spray) to reverse the effects of opioid overdose.

An article published in the Annals of Internal Medicine demonstrated that acupuncture is not effective in the treatment of hot flashes associated with menopause, although it may have a placebo effect.

A study published in JAMA Neurology suggested a possible link between proton pump inhibitors (PPIs) and risk of dementia in older adults.

The United States Multi-Society Task Force on Colorectal Cancer published new guidelines related to endoscopic surveillance for posttreatment colorectal cancer resection in Gastroenterology.

An article published in Gut concluded that Vonoprazan may be an effective option for H. pylori eradication in combination with antibiotics.

An analysis published in the Journal of Clinical Oncology concluded that Valproic Acid and Levetiracetam do not improve survival in patients suffering from Glioblastoma.

The United States Preventative Task Force concluded that there is insufficient evidence to assess the balance of benefits and harms of screening for Autism Spectrum Disorder in young children between 18 and 30 months when no concerns about autism have been raised by caregivers.

An article published in the New England Journal of Medicine recommended against using pessary to reduce the risk of preterm singleton birth.

A randomized trial published in the New England Journal of Medicine concluded that inducing labor in women 35 years or older to reduce the risk of stillbirth does not increase the risk of cesarean delivery or negatively impact maternal or fetal outcomes.

An article published in the New England Journal of Medicine concluded that Betamethasone administered to women at risk for late preterm delivery reduces the rate of neonatal respiratory complications.

An article appearing in JAMA concluded that it is not red blood transfusions, but severe anemia that increases the risk of necrotizing enterocolitis in very low birth weight infants.

The Pediatric Endocrine Society Drugs and Therapeutics Committee published new guidelines related to the monitoring of children who take oral corticosteroids for possible adrenal insufficiency in JAMA Pediatrics.

The Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition published new nutritional guidelines for critically ill adults in the Journal of Parenteral Nutrition.