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Posted byLaurence Kirwan
at
15:25
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Posted byLaurence Kirwan
at
15:40
Greenwich Hospital Earns an “A” in Patient Safety Rankings
GREENWICH, Conn. – Greenwich Hospital has been named one of the four safest hospitals in Connecticut by a national patient advocacy group.
The hospital received an “A” on safety issues in a ranking system known as the “Hospital Safety Score” released by the Leapfrog Group, a nonprofit organization run by employers and other large purchasers of health benefits.
The Hospital Safety Score gives hospitals a letter grade from A to F based on their performance on 26 publicly available hospital safety measures. The measures used to determine the grades include rate of infections, falls, medical and medication errors, complications and other factors, in addition to adhering to safety practices, such as electronic prescriptions and physician orders, proper staffing levels and hand hygiene.
According to Stephen Jones, MD, chief safety officer at Greenwich Hospital, the stellar grade “reaffirms that the journey we started three years ago to become the safest hospital possible is succeeding.” Dr. Jones said a “culture of safety that permeates every level of the organization has enabled Greenwich Hospital to become a statewide leader.”
“Every hospital employee – from the chief executive officer to our caregivers at the bedside to those individuals who work behind the scenes – is responsible for keeping patients safe,” he added. “Everyone here feels empowered to make a difference and do the right thing when it comes to patient safety.”
Guiding the Leapfrog Group effort was a nine-member Blue Ribbon Panel comprised of the nation’s leading patient safety experts. The rankings included 2,652 hospitals nationwide. The scores are intended to help consumers make informed decisions when choosing a hospital, Leapfrog Group officials said.
About 100,000 Americans die every year from preventable errors in hospitals, reports the Department of Health and Human Services. Greenwich Hospital focuses on best medical and nursing practices – methods scientifically proven to yield the best patient outcomes – that enhance patient safety. These include:
• A single electronic medical record that enables the entire healthcare team to easily access critical and up-do-date patient information
• Continuous quality improvement initiatives to identify opportunities for change
• Evidence-based methods to maintain an infection-free environment, including hand hygiene protocols, standardized procedures for inserting and maintaining invasive devices, administering antibiotics before some types of surgery, and mobilizing patients soon after surgery
• An innovative cleaning program to sanitize all equipment and surfaces throughout the hospital
• Procedures for sterilizing surgical and procedural instruments that exceed industry standards
• Special patient lifting equipment and frequent “comfort rounds” by nurses and nursing assistants to prevent falls
• Electronic medication prescriptions and a computerized physician order entry system to reduce medication errors
• Medication safety technology, including a bedside verification system using barcode technology combined with an electronic medication administration record that lists all of the medicines ordered for a patient
At Greenwich Hospital, some 130 employee “safety champions” continuously promote safe practices in clinical and nonclinical settings. A leadership team conducts weekly visits to discuss safety initiatives with physicians, nurses and other employees throughout the hospital. The “Safest Hospital” committee meets regularly to discuss patient safety issues and recommendations.
“We want every hospital to receive an ‘A’ grade,” said Dr. Jones, adding that the patient safety ranking “was not a competition. This is about creating an environment where patients everywhere are safe. Greenwich Hospital is certainly proud to be setting the bar for patient safety.”
For more information about the Hospital Safety Score, visit www.hospitalsafetyscore.org.
Posted byLaurence Kirwan
at
17:28
Confused
Wednesday, 30 May 2012
A story for our times. A French company manufactures Breast Implants. Despite concerns about the company raised by the FDA in 2000 and published work in the USA in 2006 and then later concerns communicated to the MHRA in 2010, the implants continue to be approved in the UK and used by Private and NHS Surgeons alike. In 2012. they are withdrawn by the British Authorities after the French close the company down. It turns out that since 2001, the company has used industrial grade instead of medical grade silicone in its implants. That's the easy part.
Now comes the confusing part. The British Regulatory Authorities and Advisory Panels state that the implants do not need to be removed unless causing problems and if they do, it is the moral responsibility of the Private Physicians to remove and replace them. The Government and some professional bodies, blames the private medical industry for deceptive advertising and for preying on unsuspecting gullible women. Presumably the NHS was doing the same thing?
Now the British Parliament, supported by some professional associations, comes to the conclusion that the main problem is that false advertising encourages women to have a body dysmorphic disorder and that all women considering breast implants should have a mental health evaluation first. So the problem is that a bad company makes bad implants and the solution is that women having breast augmentation need a psychiatric evaluation.
The analogy would be that every time a major car company has a recall for a manufacturing defect, they would insist that drivers attend driving school and suggest that they stop driving. Perhaps, undergo a course of psychotherapy to cure them of the urge to drive? This would apply only to women drivers who are known anecdotally to be notoriously bad. Women who buy a faulty car in the first place, cannot then be trusted to be on the roads in any responsible capacity. Women across the country support this position wholeheartedly and line up to dispose of their cars. They burn their driving licenses publicly whilst demonstrating in front of car factories. They broadcast the evil manner in which these businesses advertise and prey on the insecurities of women creating in them a desire to drive; an artificial desire created solely by the media and the car manufacturers.
After women are banned from driving, it transpires that the accident and death rate on the roads increase and that men are actually far worse at driving. The Statistics bear this out annually. The facts are ignored. This is just a story. Any relationship to real individuals or events is unintentional and coincidental.
Posted byLaurence Kirwan
at
20:16
WASHINGTON | Tue Dec 27, 2011 1:20pm EST
(Reuters) - As early as 2000, U.S. health authorities raised concerns about the French breast implant maker at the heart of a scandal affecting hundreds of thousands of women worldwide. That was almost 10 years before the company came under scrutiny from European regulators.
The U.S. Food and Drug Administration sent an investigator to inspect a plant run by the manufacturer, Poly Implant Prothese (PIP), at La Seyne Sur Mer in southeastern
France in May 2000. Shortly afterward, the FDA sent the company's founder, Jean-Claude Mas, a warning letter saying the implants were "adulterated" and citing at least 11 deviations from good manufacturing practices.
The problems had to do with PIP's saline implants, a different line from the silicone implants that French authorities ordered off the market in 2010 for using industrial-grade silicone instead of medical-grade silicone, leading to the French company's bankruptcy. Still, the plant inspected by the FDA was used to manufacture the silicone implants for PIP.
The French government last week recommended that women in France who have PIP's silicone gel-filled implants get them removed by their surgeons after the implants appeared to have an unusually high rupture rate. Other countries, including Britain and
Brazil, said women should visit their surgeons for checks.
A critical question is why the FDA's warning did not trigger greater scrutiny of PIP's activities by regulators in France and elsewhere.
France's drug and medical device regulator, AFSSAPS, told Reuters on Tuesday that it had not found evidence that the FDA had informed them of the 2000 letter sent to PIP.
"The FDA wouldn't be obliged to send it to us if there wasn't a health risk," said a spokeswoman. "Therefore there doesn't seem to be a reason why we would have been informed."
The FDA warning letter was made public in 2000. The agency said it also routinely exchanges non-public information with foreign regulators with whom it has confidentiality commitments, including France. But the FDA could not immediately comment on whether it had shared information with France in 2000.
Posted byLaurence Kirwan
at
19:49
Once again an 'Expert' gives opinions and cites scientific studies. On BBC3 Documentary "Are my Fake Breasts Safe" aired on 21 May 2012, Emma Kenny references the Plastic Surgery scientific literature. She says that the benefits of breast augmentation are short lived psychologically, the desire to have breasts implants is a response to external pressures and that patients have psychoneuroses which distinguish them from other women. Also states that for one fifth of the cost, a course of psychological counselling will 'correct' a woman's desire to have breast augmentation. In fact, the scientific literature (detailed and referenced in the previous Blog entry), says the opposite. Where is her evidence to support her claims? Sad that the BBC will air this without checking facts.
Does it have to be your boobs or your brains? Why do some women such as Emma Kenny, suggest that the desire to have breast implants implies a lack of intelligence and that it is inconsistent with feminism? What is feminism? Are breasts implants inconsistent with wanting to feel like a woman?
Bra fillets are suggested as the alternative to implants. Gemma interviews the very first breast implant recipient who still has her original implants, whilst mentioning that there is a necessity to change implants every 10 years. The whole tone is negative and ignores the 10.5 million women worldwide with breast implants. I doubt that Emma Kenny's claims of the efficacy of psychological counselling and the underlying psychopathology of the recipients will gain any traction in the well educated and well informed patient population who research the issue thoroughly. Hopefully, they will also read this blog. I invite Ms. Kenny to post her scientific references, to which she refers, on her own Blog and to publicise them on TV.
Contemporary decision making and perception in
patients undergoing cosmetic breast augmentation.
Walden JL. Panagopoulous G.
Shrader SW.
Aesthetic Surgery Journal. 30(3):395-403, 2010 May. UI: 20601563
BACKGROUND:
Today's breast augmentation (BA) patient obtains information from a variety of
sources that may positively or negatively influence her decision. OBJECTIVES:
The authors evaluate the decision-making process of patients undergoing BA,
including how they seek information regarding the procedure, potential
complications, the medical device itself, referral sources, and surgeon(s).
METHODS: A written 36-item, blinded survey developed for this study was
administered to all patients who underwent aesthetic primary BA by the senior
author (JW) over a 12-month period in her metropolitan private practice.
Patients were included only if they had undergone surgery after Food and Drug
Administration approval of silicone implants and had at least four months of
follow-up. Patients were excluded if they underwent reconstruction, revision,
augmentation/mastopexy, or implant exchange. Data were analyzed utilizing
descriptive statistics; frequencies of responses were calculated with SPSS
(version 16). RESULTS: Of 153 mailed surveys, 100 respondents returned
completed questionnaires (65%). Mean age was 30 years (range, 20-50 years).
Eighty-eight patients were in the workforce, eight were students, and three
were homemakers. Thirty-three percent had completed some graduate work or had a
graduate degree, and 41% had a college degree. In terms of how patients began
their informational searches, 41% began with Google, 18% began with a BA portal
Web site, and 1% went through referral from a primary care provider
(PCP)/OB-GYN. The primary influence in a patient's decision to have BA was her
own desire to change her appearance (36%), and second was her plastic surgeon's
Web site (16%). On a graded scale of 10 factors ranking importance (1 = not at
all and 5 = extremely), 52% said that their plastic surgeon's Web site very
much or extremely influenced their decision. Of respondents, 82% had silicone
implants (18% saline). The most influential factor in
choosing implant filler was the feel of the silicone versus saline implants
(for 41%), followed by the plastic surgeon's explanation of the difference
(29%) and recent FDA approval (13%). Primary sources of information for
possible complications were the plastic surgeon and BA portal sites. When asked
what the worst complication could be, patients reported capsular contracture
(37%), implant rupture or leak (22%), and infection (20%). The most powerful
influence on choice of surgeon for BA was the plastic surgeon's Web site (49%);
meeting the doctor in consultation was next (14%), followed by BA portal sites
(9%). Thirty-six percent of respondents consulted with a psychiatrist or
psychologist at some point in their lives, with depression, anxiety, and stress
management as top-ranked reasons (in that order). CONCLUSIONS: The Internet
(specifically Google, the plastic surgeon's Web site, and portal Web sites) is
very important to patients ages 20 to 50 in their search for information on BA.
Educational and reality TV may have less influence on this particular group
than was previously thought. Patients are well educated, are part of the
workforce, and seem to be independent and private thinkers when it comes to
their decision making. Referral sources such as the PCP assume a much smaller
role in the search for information than in days past.
The reported incidence of increased suicide levels are evaluated as follows:
Contemporary decision making and perception in
patients undergoing cosmetic breast augmentation.
Walden JL. Panagopoulous G.
Shrader SW.
Aesthetic Surgery Journal. 30(3):395-403, 2010 May. UI: 20601563
BACKGROUND:
Today's breast augmentation (BA) patient obtains information from a variety of
sources that may positively or negatively influence her decision. OBJECTIVES:
The authors evaluate the decision-making process of patients undergoing BA,
including how they seek information regarding the procedure, potential
complications, the medical device itself, referral sources, and surgeon(s).
METHODS: A written 36-item, blinded survey developed for this study was
administered to all patients who underwent aesthetic primary BA by the senior
author (JW) over a 12-month period in her
The
psychological aspects of cosmetic breast augmentation. [Review] [73 refs]
Sarwer
DB.
Plastic
& Reconstructive Surgery.
120(7 Suppl 1):110S-117S, 2007 Dec. UI: 18090820
BACKGROUND:
The psychological aspects of cosmetic breast augmentation have been the focus
of a great deal of empiric study over the past 40 years. METHODS: Studies
investigating the preoperative characteristics and psychosocial status of women
interested in breast augmentation are reviewed. Investigations of postoperative
satisfaction and psychosocial changes are discussed. The results of the seven
epidemiologic studies that have identified a relationship between cosmetic
breast augmentation and suicide are detailed. RESULTS: Methodologic limitations
of the studies investigating the preoperative psychosocial status of breast
augmentation candidates make it difficult to draw firm conclusions about the
potential psychological differences between these women and those not
interested in breast augmentation. Postoperative
satisfaction rates are high, and several studies suggest that patients
experience improvements in body image following surgery. The effects of breast
augmentation on other areas of psychological functioning are less clear. Based
on the seven epidemiologic studies published to date, the suicide rate
among women with cosmetic breast implants is two to three times the expected
rate. CONCLUSIONS: The literature in this area should be used to guide the
psychosocial assessment and management of cosmetic breast augmentation
patients. There currently
is little evidence to support a recommendation that all women who present for
cosmetic breast augmentation be required to undergo a psychiatric evaluation
before surgery. Given the relationship between breast implants and suicide,
however, it is recommended that women with a history of psychopathology who
present for breast augmentation, or those who are suspected by the plastic
surgeon of having some form of psychopathologic abnormality, should undergo a
mental health consultation before surgery. [References: 73]
Posted byLaurence Kirwan
at
04:21
LITERATURE SEARCH – DR. LAURENCE KIRWAN
BREAST AUGMENTATION – PSYCHOLOGICAL BENEFITS
March 31, 2011
Contemporary decision making and perception in
patients undergoing cosmetic breast augmentation.
Walden JL. Panagopoulous G.
Shrader SW.
Aesthetic Surgery Journal. 30(3):395-403, 2010 May. UI: 20601563
BACKGROUND:
Today's breast augmentation (BA) patient obtains information from a variety of
sources that may positively or negatively influence her decision. OBJECTIVES:
The authors evaluate the decision-making process of patients undergoing BA,
including how they seek information regarding the procedure, potential
complications, the medical device itself, referral sources, and surgeon(s).
METHODS: A written 36-item, blinded survey developed for this study was
administered to all patients who underwent aesthetic primary BA by the senior
author (JW) over a 12-month period in her metropolitan private practice.
Patients were included only if they had undergone surgery after Food and Drug
Administration approval of silicone implants and had at least four months of
follow-up. Patients were excluded if they underwent reconstruction, revision,
augmentation/mastopexy, or implant exchange. Data were analyzed utilizing
descriptive statistics; frequencies of responses were calculated with SPSS
(version 16). RESULTS: Of 153 mailed surveys, 100 respondents returned
completed questionnaires (65%). Mean age was 30 years (range, 20-50 years).
Eighty-eight patients were in the workforce, eight were students, and three
were homemakers. Thirty-three percent had completed some graduate work or had a
graduate degree, and 41% had a college degree. In terms of how patients began
their informational searches, 41% began with Google, 18% began with a BA portal
Web site, and 1% went through referral from a primary care provider
(PCP)/OB-GYN. The primary influence in a patient's decision to have BA was her
own desire to change her appearance (36%), and second was her plastic surgeon's
Web site (16%). On a graded scale of 10 factors ranking importance (1 = not at
all and 5 = extremely), 52% said that their plastic surgeon's Web site very
much or extremely influenced their decision. Of respondents, 82% had silicone
implants (18% saline). The most influential factor in
choosing implant filler was the feel of the silicone versus saline implants
(for 41%), followed by the plastic surgeon's explanation of the difference (29%)
and recent FDA approval (13%). Primary sources of information for possible
complications were the plastic surgeon and BA portal sites. When asked what the
worst complication could be, patients reported capsular contracture (37%),
implant rupture or leak (22%), and infection (20%). The most powerful influence
on choice of surgeon for BA was the plastic surgeon's Web site (49%); meeting
the doctor in consultation was next (14%), followed by BA portal sites (9%).
Thirty-six percent of respondents consulted with a psychiatrist or psychologist
at some point in their lives, with depression, anxiety, and stress management
as top-ranked reasons (in that order). CONCLUSIONS: The Internet (specifically Google, the
plastic surgeon's Web site, and portal Web sites) is very important to patients
ages 20 to 50 in their search for information on BA. Educational and reality TV
may have less influence on this particular group than was previously thought.
Patients are well educated, are part of the workforce, and seem to be
independent and private thinkers when it comes to their decision making.
Referral sources such as the PCP assume a much smaller role in the search for
information than in days past.
18.
The
psychological aspects of cosmetic breast augmentation. [Review] [73 refs]
Sarwer
DB.
Plastic
& Reconstructive Surgery.
120(7 Suppl 1):110S-117S, 2007 Dec. UI: 18090820
BACKGROUND:
The psychological aspects of cosmetic breast augmentation have been the focus
of a great deal of empiric study over the past 40 years. METHODS: Studies
investigating the preoperative characteristics and psychosocial status of women
interested in breast augmentation are reviewed. Investigations of postoperative
satisfaction and psychosocial changes are discussed. The results of the seven
epidemiologic studies that have identified a relationship between cosmetic
breast augmentation and suicide are detailed. RESULTS: Methodologic limitations
of the studies investigating the preoperative psychosocial status of breast
augmentation candidates make it difficult to draw firm conclusions about the
potential psychological differences between these women and those not
interested in breast augmentation. Postoperative
satisfaction rates are high, and several studies suggest that patients
experience improvements in body image following surgery. The effects of breast
augmentation on other areas of psychological functioning are less clear. Based
on the seven epidemiologic studies published to date, the suicide rate
among women with cosmetic breast implants is two to three times the expected
rate. CONCLUSIONS: The literature in this area should be used to guide the
psychosocial assessment and management of cosmetic breast augmentation
patients. There currently
is little evidence to support a recommendation that all women who present for
cosmetic breast augmentation be required to undergo a psychiatric evaluation
before surgery. Given the relationship between breast implants and suicide,
however, it is recommended that women with a history of psychopathology who
present for breast augmentation, or those who are suspected by the plastic
surgeon of having some form of psychopathologic abnormality, should undergo a
mental health consultation before surgery. [References: 73]
27.
The efficacy of breast augmentation: breast size
increase, patient satisfaction, and psychological effects.
Young VL. Nemecek JR.
Nemecek DA.
Plastic & Reconstructive Surgery. 94(7):958-69, 1994 Dec. UI: 7972484
In
this study designed to quantify the degree of breast enlargement produced by
augmentation mammaplasty, 112 women who underwent breast augmentation were
interviewed. The size increase that typically resulted from various implant
volumes was measured by comparing preoperative and postoperative bra sizes. For
the study group as a whole, the average increase was two bra sizes (either
increased cup size or a combination of increased cup size and chest
circumference), regardless of the implant volume inserted. Patients also were asked a
series of questions to evaluate the impact of the surgery on various
psychological parameters, including body image, feelings of self-confidence,
and interpersonal relationships. Along with having a very positive body image,
the group reported decreased self-consciousness (86 percent) and heightened
self-confidence (88 percent); in addition, 95 percent said they felt better
about themselves after surgery. The women's satisfaction with the results of
augmentation and the success of surgery in meeting their expectations also were
measured. Eighty-six percent reported being completely or mostly satisfied with
the postoperative results, 86 percent felt the operation was a complete
success, and 95 percent said that augmentation met their expectations.
28.
Personality
characteristics of women seeking breast augmentation. Comparison to
small-busted and average-busted controls.
Shipley RH. O'Donnell JM.
Bader KF.
Plastic
& Reconstructive Surgery.
60(3):369-76, 1977 Sep. UI: 896994
The
results of a study, contrasting 28 women seeking cosmetic breast augmentation
with 28 small-busted control women and 28 average-busted controls, suggest the average woman desiring surgical breast augmentation is as
psychologically stable as other women. She differs from other women only in
limited areas--primarily in her negative evaluation of her breasts and her
greater emphasis on dress and physical attractiveness.
31.
Women's psychosocial outcomes of breast
augmentation with silicone gel-filled implants: a 2-year prospective study.
Cash
TF. Duel LA. Perkins LL.
Plastic & Reconstructive Surgery. 109(6):2112-21; discussion 2122-3, 2002
UI: 11994621
This study examined the experiences of 360 women
receiving bilateral breast augmentation with Dow Corning's Silastic MSI
(textured) or Silastic II (smooth) gel-filled mammary implants. Before surgery,
the women completed a quantitative assessment of their surgical expectations
and concerns. At 6, 12, and 24 months postoperatively, they rated their
satisfaction with surgery and its specific psychosocial outcomes, their
concerns, and benefits-to-risks appraisals of the augmentation. The women
reported very high levels of satisfaction with the procedure and its
psychosocial outcomes, which did not change over time. Throughout the 2-year
period, over 90 percent of the women were satisfied with surgery and their
resultant body-image changes. Their concerns about risks, reported by 19
percent before surgery, declined after surgery and remained subsequently
stable. Most participants (75 to 85 percent) reported that the benefits of
surgery exceeded its risks. Postoperative events such as significant capsular
contracture that compromised aesthetic results diminished aspects of
satisfaction, whereas less obvious events did not. Systematic analysis of
attrition (i.e., missing assessments) did not indicate any biases because of
complications or psychosocial outcomes. Evaluation of a possible impact of the publicity
surrounding the Food and Drug Administration's voluntary moratorium on the use
of silicone gel-filled breast implants, which occurred during the study,
revealed a limited effect, if any, on women's psychosocial outcomes.
Findings are discussed in relation to the study's methodological strengths and
limitations and with respect to the broader context of patient care.
33.
Factors that influence the decision to undergo
cosmetic breast augmentation surgery.
Didie
ER. Sarwer DB.
Journal of Women's Health. 12(3):241-53, 2003 Apr. UI: 12804355
BACKGROUND: This study examined the factors that
motivate women to seek cosmetic breast augmentation surgery. METHODS:
Twenty-five breast augmentation surgery candidates completed measures of body
image dissatisfaction, sociocultural influences on physical appearance, marital
and sexual satisfaction, and self-report questionnaires that assessed other
motivations for surgery. Thirty physically similar women who were not
interested in breast augmentation also completed the measures. RESULTS:
Replicating previous studies, breast augmentation candidates, compared with
controls, reported greater dissatisfaction with their breasts. The two groups,
however, did not differ on overall body image dissatisfaction or greater awareness
or internalization of sociocultural influences on physical appearance. Breast
augmentation patients reported more positive sexual functioning compared with
controls. CONCLUSIONS:
Overall, breast augmentation patients appeared to be motivated by their feelings
about their breasts rather than direct or indirect influence from external
sources, such as romantic partners or sociocultural representations of beauty.
These findings provide new information on the motivations behind breast
augmentation and dispute several stereotypes about the factors that influence
the pursuit of this surgery.
34.
Breast
augmentation should be on the NHS: a discussion of the ethics of rationing.
Horner
B.
Annals of
the Royal College of Surgeons of England.
84(2):82-3, 2002 Mar. UI: 11995769
Every NHS clinician is under constant
pressure to match limited resources to increasing demands. The GMC provides
guidelines about how we should ration: 'you should always seek to give priority
to the treatment of patients solely on the basis of clinical need'. However,
this gives no indication as to what is 'need'. Often, in its application,
certain assumptions are made about the nature of clinical need. To examine some
of these assumptions in more detail, I will argue the case for a treatment that
is on the borderline of the remit of NHS care--breast augmentation.
Posted byLaurence Kirwan
at
03:56
