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New Delhi, August 02, 2018 :
DAMA vs LAMA after Stenting
A new study of more than 2 million PCI procedures shows that patients who discharged against medical advice (DAMA) are uncommon but are twice as likely to be readmitted with an acute myocardial infarction (MI) as those discharged home. If DAMA patients are readmitted with MI, the mortality rate is double that of non-DAMA patients readmitted with MI.
Data from the Paris registry show that mortality risk is “stratospheric in the first 7 days” after PCI if dual antiplatelet therapy (DAPT) is discontinued.
So it may be that patients are just simply not surviving to be readmitted with a myocardial infarction. We see only those patients that survive to discharge. What we do not see are the patients who discharge themselves against medical advice that die in the community.
DAMA represents up to 2% or so of all hospital discharges and is associated with a higher likelihood of worse outcomes.
The present study is published in July 23 in JACC Cardiovascular Interventions. Predicting DAMA.
Breastfeeding
An estimated 78 million babies – or three in five – are not breastfed within the first hour of life, putting them at higher risk of death and disease and making them less likely to continue breastfeeding, say UNICEF and WHO. Most of these babies are born in low- and middle-income countries.
Surgical errors
Every year an estimated 4,000 people who undergo surgery are injured by surgical errors. These preventable mistakes are called “never events” because they never should have happened.
Common surgical errors include: Leaving surgical equipment (e.g., sponges or instruments) inside a patient; using unsterile surgical instruments; performing surgery on the wrong body part; performing the wrong procedure; performing surgery on the wrong patient; damaging nerves during procedure; cutting or puncturing organs that were not involved in the procedure; failing to administer an appropriate dose of anesthesia.
There are a number of reasons why surgical errors occur. They include:
- A surgeon may not have performed a particular procedure very often and simply lacks the skill to perform the surgery properly.
- Failure to communicate properly is often a major factor in wrong-procedure, wrong-site and wrong-patient surgeries.
- Insufficient pre-operative planning
- Surgeons may not perform certain steps during the procedure, incorrectly concluding that they are not necessary.
- Fatigue: Surgeons often work long shifts.
- Negligence: Failure to make sure that all instruments are properly sterilized and equipment is functioning properly.
- A bad outcome does not necessarily prove that a mistake was made or that medical malpractice occurred.
Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI
HealthySoch
