Tag: quality

Reading of the Week: Polypharmacy & Health – the New AJP Paper; Also, Melatonin Gummies (JAMA) & Mehler Paperny on Involuntary Care (Globe)

From the Editor

When it comes to antipsychotics, polypharmacy (the use of more than one antipsychotic) has fallen out of fashion – the psychopharmacological equivalent of bell bottoms. Providers worry about side effects and the long-term physical health implications. Are the concerns overstated? In the first selection, Heidi Taipale (of the University of Eastern Finland) and her coauthors analyze Finnish data for The American Journal of Psychiatry. The study includes almost 62,000 patients with schizophrenia with a median follow up period of more than 14 years, and they find that the use of more than one antipsychotic isn’t linked to poorer health outcomes. “The results show that antipsychotic monotherapy is not associated with a lower risk of hospitalization for severe physical health problems when compared with antipsychotic polypharmacy.” We consider the paper and its clinical implications.

Melatonin is a popular recommendation for sleep, but what’s the quality like? In the second selection from JAMA, Dr. Pieter A. Cohen (of Harvard University) and his co-authors try to answer that question with a focus on melatonin gummy products, looking at 30 brands. “The great majority of melatonin gummy products were inaccurately labeled, with most products exceeding the declared amount of melatonin and CBD.”

Gummy melatonin: colourful but what’s the quality?

In the third selection, in an essay for The Globe and Mail, journalist Anna Mehler Paperny writes about the push for more coercive care by different governments. Drawing on her personal experiences, she notes potential problems. “There is a role for coercive care. It’s arguably necessary for some people, sometimes. But used injudiciously, it can sour people on care and set them up for failure.”

There will be no Reading next week.


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Reading of the Week: Computers & Health Care – Dr. Gawande’s New Essay on “Why Doctors Hate Their Computers”

From the Editor

I’m running late – and I’m more than a bit concerned. I need to get to a meeting at the other campus, but first, I need to discharge a patient. That involves printing out a prescription and writing a short note. I’m in my fourteenth year of inpatient work, not counting residency, and I’m pretty good with prescriptions and notes. I believe I can do this. But does the EHR believe I can do this?

Many of us are frustrated with electronic health records (EHRs). In this week’s selection, we consider a new essay by Harvard University’s Atul Gawande, a surgeon, who considers EHRs and practice. Dr. Gawande talks about his own struggles with computers, and ties into the larger literature.

frustrateddocBig computer system, big problem?

We discuss his essay, and the potential and problems of EHRs. We touch on the Canadian experience and wonder about quality improvement. To that end, we look at “Getting Rid of Stuff,” just published in The New England Journal of Medicine.



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Reading of the Week: Higher Volume, Better Care? The Rasmussen Paper

From the Editor

How do we improve mental health services?

Past Readings have explored many topics from measurement-based care to better access. This week, we consider a new paper by Aalborg University’s Line Ryberg Rasmussen et al. The study authors look at volume and quality of mental health care, drawing on Danish inpatient admissions.

Their finding? “This nationwide, population-based cohort study demonstrated that patients with depression who were admitted to psychiatric hospitals with very-high-volume wards were more likely to receive care in accordance with clinical guidelines, compared with those admitted to low-volume wards.”

ptelemnursing01High volume, better care (if not better cafeteria food)?

This week, we look at the Rasmussen et al. paper and consider its implications.


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Reading of the Week: The Best of 2015 — Books, Papers, and Hope

From the Editor

This will be the last Reading of the Week for 2015. (The Readings will resume in a fortnight.)

A bit of housekeeping: the Reading of the Week is a labour of love. There is no industry support for this project – or, in fact, any funding. Still, it’s hardly my project. Many readers (particularly residents) suggested papers and made comments over this past year. I’m also deeply grateful for the support of several colleagues; Drs. David Goldbloom and Mark Fefergrad deserve particular mention. And my father and wife have been great editorial supports.

It’s a Reading of the Week tradition to close the year by highlighting the best of the past 12 months.

Looking over the Readings of this year, I’m struck by the diversity of the publications that I could draw selections from. Sure, the Readings of 2015 included papers from The New England Journal of Medicine and JAMA Psychiatry. But they also included moving personal essays that were published in newspapers; The Economist (yes, The Economist) covered mental illness and the burden of disease well and thoughtfully; the best articles on global psychiatry appeared in The New York Times.

It wasn’t that long ago that we hoped that discussion of mental illness would move out of the shadows. Today, slowly but surely, it is. And so, 2015 closes after 48 Readings and on this hopeful note.

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