A study showed that some doctors, particularly surgeons, are not explaining the risk of specific outcomes that matter most to patients. Overlooked risks that led to a legal claim or complaint included chronic pain, sexual dysfunction, visual or hearing loss, and the need for re-operation.

Lead author Dr Marie Bismark from the University of Melbourne School of Population Health said the study revealed that doctors may routinely underestimate the importance patients place on understanding certain risks in advance of treatment.

‘Increasingly, doctors are expected to advise and empower patients to make rational choices by sharing information that may affect treatment decisions, including risks of adverse outcomes,’ she said.

‘However, doctors, especially surgeons, are often unsure which clinical risks they should disclose and discuss with patients before treatment and this is reflected in this study.’

The authors found that the most common justifications doctors gave for not telling patients about particular risks before treatment were that they considered such risks too rare to warrant discussion, or that the specific risk was covered by a more general risk that was discussed.

‘It is not necessary, or helpful, for doctors to provide a laundry list of all possible risks. Instead, doctors should focus on discussing those risks which are likely to matter most to the patient before them,’ she said.

From a sample of nearly 10,000 patient complaints and malpractice claims from Australia between 2001 and 2008, researchers identified 481 disputes involving alleged deficiencies in obtaining informed consent.

The authors found that 45 (9%) of the cases studied were disputed duty cases

Leading clinicians and health researchers from across Europe say much greater emphasis must be placed on the scientific evidence for the effectiveness of treatments and other healthcare interventions to ensure patients receive the best care available. The call is contained in a Science Policy Briefing published by the European Medical Research Councils, which also made ten key recommendations on how to improve the quality of research and healthcare in Europe. The briefing,

University of Michigan heart researchers are shedding light on a new method for steadying an abnormal heart rhythm.
Irregular heart rhythms, or arrhythmias, set the stage for a common, debilitating disorder called atrial fibrillation that puts adults as young as age 40 at risk for fatigue, fainting, cardiac arrest, and even death.
Medications can help, but doctors also use catheter ablation in which electrical impulses are delivered to a region of the heart to disrupt the arrhythmia.
However, half of patients require more than one ablation to see results. In a laboratory study, the U-M used photodynamic therapy, a technique long used in cancer research, to disrupt the specific cells causing the arrhythmia.
The study suggests cell-specific cardiac ablation could help patients avoid complications, and get closer to an arrhythmia-free life without having to undergo repeat hospital visits.
Chemists in the U-M Department of Chemistry and electrophysiologists at the U-M Center for Arrhythmia Research collaborated on the study that will require further examination before it is available in the hospital setting.
‘This cell-selective therapy may represent an innovative concept to overcome some of the current limitations of cardiac ablation,’ says lead study author Uma Mahesh Avula, M.D., research fellow at the U-M Center for Arrhythmia Research.
The heart consists of different types of cells such as myocytes, fibroblast, adiopocytes and purkinje fibres, which are all needed for normal cardiac activity.
The new study is the first of its kind to use photodynamic therapy and nanotechnology to ablate only the cardiac myocytes responsible for arrhythmias. In current ablative techniques, all cardiac cells receive ablative energy, which can lead to complications such as puncturing the heart muscle, bleeding or stroke.
‘Current ablation techniques are severely limited by its non-specific nature of cellular damage. Besides this lack of cellular discrimination markedly increases the required energy amounts and prolongs procedure times, all of which reduces overall ablation results,’ Avula says.
Catheter ablation has emerged as an important treatment option that requires careful assessment, planning and execution for optimal success rates. Advances over the past 20 years have made the treatment safer, but it remains highly complex.
‘Approaches that could simplify and shorten the procedure may contribute to more patients being treated,’ Avula says.
Rather than radiofrequency energy, the most common type used in cardiac ablation, the U-M team introduces the use of PDT in cardiac electrophysiology to target specific cell types. Targeted PDT, which was pioneered in the labs of study senior author U-M chemist and engineer Raoul Kopelman, Ph.D., is extensively used in cancer research for selectively killing cancerous cells.
The disruption induced by PDT is confined to cells that have been photosensitised, while adjacent non-photosensitised cells are unaffected. The U-M has applied for a patent for this technology.
‘We think this approach will decrease the extent of unwanted cell injury, inflammation, and ablation-related tissue damage, and pave a way for the development of more effective therapies for cardiac arrhythmias,’ says study senior author J

A recent study in The Lancet found that the benefits of taking statins are greater than the increased risk of developing diabetes experienced by some patients In a randomised, double-blind JUPITER trial, 17 603 men and women without previous cardiovascular disease or diabetes were randomly assigned to rosuvastatin 20 mg or placebo and followed up for up to 5 years for the primary endpoint (myocardial infarction, stroke, admission to hospital for unstable angina, arterial revascularisation, or cardiovascular death) and the protocol-prespecified secondary endpoints of venous thromboembolism, all-cause mortality, and incident physician-reported diabetes. In this analysis, participants were stratified on the basis of having none or at least one of four major risk factors for developing diabetes: metabolic syndrome, impaired fasting glucose, body-mass index 30 kg/m2 or higher, or glycated haemoglobin A1c greater than 6%. Although statins increased the likelihood of developing diabetes in patients already at risk of the condition, these people were still 39% less likely to develop cardiovascular disease while taking the drug. Patients who were not already at risk of developing diabetes experienced a 52% reduction in cardiovascular disease when taking statins and had no increase in diabetes risk. The benefits of taking statins far outweigh the side effects for the majority of people who need to take them.

A Kansas State University professor’s research improving post-surgery pain treatment and osteoarthritis therapy in dogs may help develop better ways to treat humans for various medical conditions.
From the use of hot and cold packs to new forms of narcotics, James Roush, professor of clinical sciences, is studying ways to lessen pain after surgery and improve care for small animals, particularly dogs. He is working with the clinical patients who come to the College of Veterinary Medicine’s Veterinary Health Center.
Because humans and dogs experience some diseases in similar ways, his research may improve how doctors and physicians understand human health, too.
‘Several of our projects have human applications, particularly one involving intra-articular prolotherapy,’ Roush said.
Here’s a closer look at three of Roush’s current projects:
* A recent project with Ralph Millard, former Veterinary Health Center resident, focuses on ways that hot packing and cold packing affect tissue temperature in beagles and beagle-sized dogs after surgery.
After surgery in both humans and dogs it is common to put a cold pack or hot pack on tissue to prevent and reduce swelling. How long the pack is used and what type of cold or hot pack is used depends on the type of injury and surgery. Roush said that no studies have looked at how deep in the tissue the packs affect temperature and how long the packs must be applied so that the tissue reaches a desired temperature.
The researchers studied the temperature and tissue depth that hot and cold packing affected and the time it took to reach that temperature.
‘We found that you don’t really need to cold pack anything longer than 10 minutes because there is not a great change in temperature after that,’ Roush said.
When tissue is cold packed, it will stay cold for a while after the ice pack is removed. But when tissue is hot packed and the pack is removed, the tissue temperature will return to normal much more quickly. Leaving the hot or cold pack on the tissue longer than 10 minutes will extend the time that the tissue stays at the same hot or cold temperature, Roush said. There just will not be a great change in temperature after 10 minutes.
The same technique of hot and cold packing after surgery is also used in humans. Although more research in humans is needed, Roush said there is a strong possibility that a similar 10-minute time frame for hot and cold packing may apply to humans as well.
For another project, Roush and Matt Sherwood, Veterinary Health Center resident, are using a mat system to study lameness and osteoarthritis in dogs. When dogs step on the mat, it measures the pressure in their step.
The mat system is a useful clinical tool for evaluating and developing treatment of lameness, Roush said. Roush and Sherwood are using the mat for measuring lameness and determining in which leg the lameness is worse.
‘We’ve designed the study to help improve osteoarthritis treatment,’ Roush said. ‘We will also use it to measure clinical patients when they come in for regular checkups. We can measure their recovery and a variety of other aspects: how they respond to non-steroidal anti-inflammatories, how they respond to narcotics or how they respond to a surgical procedure that is designed to take that pressure off the joint.’ Kansas State University