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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_467"
                     title="FDA Unveils New Safety Plan for Medical Imaging"
                     score="0.014"
                     href="http://www.medpagetoday.com/Radiology/DiagnosticRadiology/tb/18398?impressionId=1265793358272"
                     
      &lt;p&gt;WASHINGTON  --  The Food and Drug Administration (FDA) says it wants to issue new safety requirements for manufacturers of computed tomography (CT) and fluoroscopic devices to reduce unnecessary radiation from medical imaging.&lt;/p&gt;
&lt;p&gt;The FDA&apos;s plan focuses on three procedures with high radiation doses: CT, nuclear medicine studies, and fluoroscopy. These are the greatest contributors to total radiation exposure within the U.S. population, the FDA said. That&apos;s because they require much higher radiation doses than other radiographic procedures, such as standard X-rays, dental X-rays, and mammography.&lt;/p&gt;
&lt;p&gt;&quot;The amount of radiation Americans are exposed to from medical imaging has dramatically increased over the past 20 years,&quot; Jeffrey Shuren, MD, director of the FDA&apos;s Center for Devices and Radiological Health, said in a prepared statement. &quot;The goal of FDA&apos;s initiative is to support the benefits associated with medical imaging while minimizing the risks.&quot;&lt;/p&gt;
&lt;p&gt;While the three procedures have led to early diagnosis of disease, they expose patients to ionizing radiation that may increase lifetime cancer risk  --  although there is debate within the medical community about the extent of the danger.&lt;/p&gt;
&lt;p&gt;Radiologist Joseph Schoepf, MD, director of Cardiovascular Imaging at the Medical University of South Carolina, lauded the FDA&apos;s initiative and said it would restore the public&apos;s trust in imaging.&lt;/p&gt;
&lt;p&gt;&quot;It is important to note, however, that an increase in cancer mortality [from radiation] has not been observed,&quot; he added. &quot;On the contrary, cancer mortality has dramatically decreased over the past decades, in step with increased utilization of medical imaging.&quot;&lt;/p&gt;
&lt;p&gt;The &lt;em&gt;Archives of Internal Medicine &lt;/em&gt;recently published results from two studies indicating that &lt;a href=&quot;http://www.medpagetoday.com/Radiology/DiagnosticRadiology/17530&quot; mce_href=&quot;http://www.medpagetoday.com/Radiology/DiagnosticRadiology/17530&quot; target=&quot;_blank&quot; title=&quot;CT&amp;#8200;Scans&amp;#8200;May&amp;#8200;Deliver&amp;#8200;Higher-than-Expected&amp;#8200;Radiation&amp;#8200;Doses&quot;&gt;CT scans deliver much higher doses of radiation &lt;/a&gt;than previously thought. The FDA has noted that a patient would have to get 400 standard chest X-rays to be exposed to the same level of radiation as just one CT abdomen scan.&lt;/p&gt;
&lt;p&gt;In an accompanying editorial, the journal&apos;s editor, Rita Redberg, MD, wrote that the studies &quot;make us question if we have gotten carried away in our enthusiasm&quot; for CT.&lt;/p&gt;
&lt;p&gt;It&apos;s becoming clear, she said, that the large doses of radiation from CT scans will lead to additional cancers, which must be taken into account when physicians consider CT for their patients.&lt;/p&gt;
&lt;p&gt;By working with healthcare providers and other federal agencies, the FDA says it hopes to promote safer use of medical imaging and increase patient awareness of their radiation exposure. Part of that involves pushing providers to justify their radiation procedures and optimize the radiation dose in each one.&lt;/p&gt;
&lt;p&gt;&lt;span&gt;Schoepf, who serves on several American College of Radiology committees that discuss the proper used of various imaging procedures, approved of the FDA&apos;s goal but cautioned against restrictions that would hinder clinicians.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&quot;There is indeed a need for enhanced transparency, better patient education, more dialogue between patients and their healthcare providers, and increased involvement of the patient in the decision process leading up to an imaging study,&quot; Schoepf said.&lt;/p&gt;
&lt;p&gt;&lt;span&gt;&quot;What is often forgotten in this discussion is that serious injury or death, resulting from missing a potentially life-threatening diagnosis if no imaging is performed, is a much greater, more imminent, and very real risk.&quot;&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;In its statement, the FDA said it wants to boost efforts to develop at least one national registry of radiation doses that will capture information from a variety of imaging studies that can be used to establish benchmarks for healthcare facilities to use with patients.&lt;/p&gt;


 &lt;p&gt;Donald Frush, MD, a radiologist at Duke Medical Center and expert in CT radiation doses in children, said that radiation doses for CT examination vary widely, depending on the size of the patient and the body area scanned, among other things.&lt;/p&gt;
    &lt;p&gt;&quot;However, sometimes this variation is not necessary, and the dose may be excessive,&quot; Frush said.&lt;/p&gt;

&lt;p&gt;The ACR launched a similar registry about a year ago, according to spokesman Shawn Farley. The database is intended as a guide so a radiologist can quickly see how levels of radiation delivered in other practices and hospitals compare to what he or she is delivering.&lt;/p&gt;
&lt;p&gt;&quot;Now that the FDA has come out in favor of doing that, we&apos;re hoping that will put a little more weight behind the process and make more facilities want to take part in this,&quot; Farley told &lt;em&gt;MedPage Today. &lt;/em&gt;&lt;/p&gt;


 &lt;p&gt;Schoepf noted that European governments already require a permanent record of radiation exposure for each patient.&lt;/p&gt;
    &lt;p&gt;As a result, manufacturers of radiation equipment, most of whom sell their products in Europe, already have that capability, he said. So it shouldn&apos;t be difficult to implement the same standard in the U.S.&lt;/p&gt;
    &lt;p&gt;&quot;Radiation exposure should be no secret,&quot; Schoepf said.&lt;/p&gt;


&lt;p&gt;The FDA will hold a public meeting March 30 and 31 to hear comments on what types of safety requirements to establish for manufacturers of CT and fluoroscopic devices. Requirements might include: &lt;ul&gt; &lt;li&gt;That the radiation device display, record, and report equipment settings and radiation dose&lt;/li&gt; &lt;li&gt;Alerting users when the dose exceeds the optimal dose for most patients&lt;/li&gt; &lt;li&gt;Increased training for users&lt;/li&gt; &lt;li&gt;Ability to capture and transmit radiation dose information to a patient&apos;s electronic medical record in addition to national dose registries &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_421"
                     title="BLOG: Super Sound Bite Sunday"
                     score="0.009"
                     href="http://www.medpagetoday.com/Blogs/18323?impressionId=1265793358272"
                     
      I love football.&lt;br&gt;
&lt;br&gt;
I loved it when I was a kid shivering in the bleachers watching my brothers play high school ball for a team that could never quite seem to level the playing field. &lt;br&gt;
&lt;br&gt;
I loved it when I was a teenager cheering a team from that same high school, a team that often defined a winning season as 3-6. &lt;br&gt;
&lt;br&gt;
I loved watching college ball when I was in college (my college didn&apos;t have a team, but when you&apos;re in college you can always find a team to support). &lt;br&gt;
&lt;br&gt;
I loved it when I lived in NY and was a &lt;a href=&quot;http://www.pro-football-reference.com/teams/nyg/1977.htm&quot; target=&quot;_blank&quot;&gt;Giants&apos;&lt;/a&gt; fan  (no joy there), in Washington as a &lt;a target=&quot;_blank&quot; href=&quot;http://www.pro-football-reference.com/teams/was/1980.htm&quot;&gt;Redskins&lt;/a&gt; fans (damn Cowboys), and finally in Cleveland where the &lt;a target=&quot;_blank&quot; href=&quot;http://en.wikipedia.org/wiki/The_Drive&quot;&gt;&amp;quot;Brownies&amp;quot;&lt;/a&gt; have broken my fan&apos;s heart over and over and over. &lt;br&gt;
&lt;br&gt;
So it is not surprising that Super Bowl Sunday is a special day for me and for my family as well. When our kids were little we would all gather in our family room for an afternoon of super Sunday punditry followed by &amp;quot;the game&amp;quot;, &amp;quot;the half-time show&amp;quot;, and, finally, &amp;quot;the call from the White House.&amp;quot;&lt;br&gt;
&lt;br&gt;
And, of course, the Super Sunday menu -- should it be crab legs and subs? chili and natchos? pizza and wings?&lt;br&gt;
&lt;br&gt;
But over the years, aside from offering us an excellent opportunity to test our knowledge of Roman numerals -- XLIV (let&apos;s see the L = 50,  X = 10, but X to the left of L means 50-10, so that&apos;s 40, V is 5, and whereas VI is 6, IV is 4, so Super Bowl 44) -- the football played in many of these games has been a little short of memorable. &lt;br&gt;
&lt;br&gt;
Not to worry. TV, like nature, hates a vacuum almost as much as it abhors low ratings. So Madison Avenue has been the &amp;quot;guarantee&amp;quot; if the football was boring, the commercials would supply the excitement. &lt;br&gt;
&lt;br&gt;
And they have -- who can forget &lt;a href=&quot;http://en.wikipedia.org/wiki/Super_Bowl_advertising&quot; target=&quot;_blank&quot;&gt;Mean Joe Green or the Bud Bowl or &amp;quot;When I grow up&amp;quot;&lt;/a&gt;?&lt;br&gt;
&lt;br&gt;
But then the commercials crossed the line into my world, the world of medical news -- actually you could say they stepped over the line -- when &lt;a href=&quot;http://www.time.com/time/magazine/article/0,9171,996064-1,00.html&quot; target=&quot;_blank&quot;&gt;Christopher Reeve walked across the stage in 2000.&lt;/a&gt;&lt;br&gt;
&lt;br&gt;
Whoa. Not a good idea.&lt;br&gt;
&lt;br&gt;
And this year it looks like we have another &apos;not a good idea&apos; scenario. &lt;br&gt;
&lt;br&gt;
I&apos;m talking not only about about the &lt;a href=&quot;http://abcnews.go.com/WN/tim-tebow-super-bowl-ad-cbs-air-controversial/story?id=9667638&quot; target=&quot;_blank&quot;&gt;Tim Tebow ad sponsored by Focus on Family&lt;/a&gt;, a conservative group that opposes abortion but also the pre-emptive strike delivered by &lt;a href=&quot;http://www.youtube.com/watch?v=utcxpuHF7jg&amp;feature=player_embedded&quot; target=&quot;_blank&quot;&gt;Planned Parenthood&lt;/a&gt;.&lt;br&gt;
&lt;br&gt;
Dueling commercials may be a great way to sell cell phones or beer or hamburgers or cars, but I don&apos;t think its a good way to address serious issues such as treatment of spinal injuries or women&apos;s reproductive choices. &lt;br&gt;
&lt;br&gt;
These are not only serious issues but also explosive issues that deserve thoughtful, measured discussion. Not the &amp;quot;Hey, grab me a beer and pass the chips. Uh-oh, what&apos;s this? An ad about abortion.&amp;quot; &lt;br&gt;
&lt;br&gt;
Bring back the &lt;a target=&quot;_blank&quot; href=&quot;http://www.digibarn.com/collections/movies/digibarn-tv/xerox-monks/index.html&quot;&gt;Xerox monks. &lt;/a&gt;&lt;br&gt;
&lt;br&gt;
&lt;br&gt;
&lt;br&gt;
&lt;br&gt;
&lt;br&gt;
&lt;br&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_420"
                     title="BLOG: What Reporters Missed at the NIH Colon CA Screening State-of-the-Science Conference"
                     score="0.009"
                     href="http://www.medpagetoday.com/Blogs/18336?impressionId=1265793358272"
                     
      &lt;p&gt;This week the National Institutes of Health convened an &amp;quot;&lt;a href=&quot;http://consensus.nih.gov/2010/colorectalmedia.htm&quot; target=&quot;_blank&quot;&gt;NIH State-of-the-Science Conference on Enhancing Use and Quality of Colorectal Cancer Screening.&lt;/a&gt;&amp;quot;&lt;/p&gt;
&lt;p&gt;The only story I could find on it was &lt;a href=&quot;http://www.dispatch.com/live/content/local_news/stories/2010/02/05/COLON.ART_ART_02-05-10_A1_9TGGNB8.html?sid=101&quot; target=&quot;_blank&quot;&gt;in the &lt;i&gt;Columbus Dispatch&lt;/i&gt;&lt;/a&gt;.  &lt;/p&gt;
&lt;p&gt;But I&apos;ve seen no news coverage about what a friend who attended the conference reported to me.  &lt;/p&gt;
&lt;p&gt;I&apos;ve now verified with various attendees that there were clear new
signs of the turf war between gastroenterologists -- keepers of the
traditional colonoscopy approach -- and radiologists - who are more
inclined to favor the new kid &amp;quot;virtual colonoscopy.&amp;quot; &lt;/p&gt;
&lt;p&gt;More than just &amp;quot;inside baseball&amp;quot; about &amp;quot;inside your colon,&amp;quot; this is another war over evidence in health care. &lt;/p&gt;
&lt;p&gt;The NIH panel was not charged with judging the relative value of different colon cancer screening methods.  &lt;/p&gt;
&lt;p&gt;But it sounds like some of the parties who attended had a different
expectation and so the conference they got was not the conference they
wanted. &lt;/p&gt;
&lt;p&gt;I&apos;m told that radiologists were upset -- demanding at least more
recognition of the benefits of virtual colonoscopy (or CT colonography)
if not a downright endorsement. Some stated their disapproval of the &lt;a href=&quot;http://www.ahrq.gov/clinic/uspstf08/colocancer/colors.htm&quot; target=&quot;_blank&quot;&gt;U.S. Preventive Services Task Force statement&lt;/a&gt; that &amp;quot;the evidence is insufficient to assess the benefits and harms of computed tomographic colonography (&lt;em&gt;ed. note: and fecal DNA testing, for that matter&lt;/em&gt;).&amp;quot;
And they&apos;re upset about the subsequent decision by the Centers for
Medicare &amp;amp; Medicaid Services not to cover the newer test.&lt;/p&gt;
&lt;p&gt;Radiologists wanted more recognition of the large &lt;a href=&quot;http://www.acrin.org/PROTOCOLSUMMARYTABLE/PROTOCOL6656/tabid/146/Default.aspx&quot; target=&quot;_blank&quot;&gt;American College of Radiology Imaging Network  trial&lt;/a&gt;. &lt;/p&gt;
&lt;p&gt;I&apos;m told that there were several radiologists who got up and
basically screamed at the panel members for being in the &amp;quot;dark ages&amp;quot;.
They cited the &lt;a href=&quot;http://www.cancer.org/docroot/PED/content/ped_2_3x_ACS_Cancer_Detection_Guidelines_36.asp&quot; target=&quot;_blank&quot;&gt;American Cancer Society recommendations&lt;/a&gt;
that conflict with the USPSTF on the virtual colonoscopy and also
evoked what they called the &amp;quot;mammography disaster,&amp;quot; referring to the
USPSTF mammography recommendations released last November -- another
time the USPSTF and Cancer Society disagreed. &lt;/p&gt;
&lt;p&gt;One of the speakers at the NIH conference said that the Cancer
Society does not use a formal process for evaluating the evidence, does
not provide details about how they come to their conclusions and
includes only sub-specialists on their panel -- raising questions about
conflict of interest in their recommendations. &lt;/p&gt;
&lt;p&gt;So even though that&apos;s not what the meeting was about, there was
scuffling over screening method vs. screening method, turf wars, and
conflict of interest in the setting of guidelines or recommendations. &lt;/p&gt;
&lt;p&gt;So this one isn&apos;t over. &lt;/p&gt;
&lt;p&gt;And it&apos;s difficult to understand why this didn&apos;t get news coverage. It sure sounded newsworthy to me. &lt;/p&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_419"
                     title="AAPM: Help for Pain and Mood in Fibromyalgia (CME/CE)"
                     score="0.009"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18334?impressionId=1265793358272"
                     
      &lt;p&gt;SAN ANTONIO  --  Patients with fibromyalgia and comorbid depression had significant improvement in both conditions when treated with duloxetine (Cymbalta), according to pooled data from four clinical trials presented here at the American Academy of Pain Medicine meeting.&lt;/p&gt;
&lt;p&gt;The magnitude of improvement in pain was consistent across all severity levels of depression. Conversely, patient mood improved to a similar extent across the range of pain severity.&lt;/p&gt;
&lt;p&gt;Analysis of treatment effect showed that 60% to 70% of the benefit for pain and mood resulted from a direct effect of the drug. The remaining 30% to 40% of improvement arose from an indirect effect.&lt;/p&gt;
&lt;p&gt;&quot;Improvement in pain and improvement in major depressive disorder are positively correlated,&quot; Lauren B. Marangell, MD, of Eli Lilly &amp;amp; Co. in Indianapolis, and colleagues reported in a poster presentation.&lt;/p&gt;
&lt;p&gt;&quot;Improvement in pain reflected greater direct treatment effect with an indirect effect of improved mood, indicating that the improvement seen with duloxetine in fibromyalgia is not solely a mood effect. Improvement in mood was found to reflect a greater direct treatment effect, with an indirect effect of pain improvement.&quot;&lt;/p&gt;
&lt;p&gt;&quot;These data support the independent analgesic properties of duloxetine in the treatment of fibromyalgia.&quot;&lt;/p&gt;
&lt;p&gt;As many as a third of patients with fibromyalgia have comorbid major depression, and as many as 70% have a history of major depression. Sorting out the association between the two conditions is complicated by the fact that the pain can obscure the depression and lead to underdiagnosis and undertreatment, the researchers wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, major depression can intensify as pain interferes with daily activities, and comorbid depression can lead to increased pain complaints, intensity, and duration among patients with fibromyalgia, they noted.&lt;/p&gt;
&lt;p&gt;In an effort to clarify the clinical course of patients with both conditions, Marangell and colleagues analyzed data from four placebo-controlled clinical trials of duloxetine in patients with fibromyalgia. They limited the analysis to patients who had comorbid major depression at enrollment and who received 60 to 120 mg of duloxetine.&lt;/p&gt;
&lt;p&gt;The investigators performed two path analyses to determine the direct and indirect treatment effects on pain and on depression.&lt;/p&gt;
&lt;p&gt;The study involved 350 patients with fibromyalgia and comorbid depression, 147 randomized to placebo, and 203 to duloxetine. Baseline characteristics included a median Hamilton depression (HAMD) score of 15 and a Brief Pain Inventory (BPI) average of 6 to 7.&lt;/p&gt;
&lt;p&gt;The analysis showed that about half of the patients with a HAMD score above or below the median had &amp;#8805;30% improvement in pain score.&lt;/p&gt;
&lt;p&gt;Moreover, 35% to 40% of patients treated with duloxetine had &amp;#8805;50% improvement in pain score whether they had a low (HAMD &amp;lt;15) or high (HAMD &amp;#8805;15) depression scores.&lt;/p&gt;
&lt;p&gt;All of the differences from placebo were statistically significant (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) except for &amp;#8805;30% improvement in patients with a low depression score at baseline.&lt;/p&gt;
&lt;p&gt;Patients&apos; depression improvement by baseline pain severity did not differ significantly between patients treated with duloxetine or placebo.&lt;/p&gt;
&lt;p&gt;Response was defined as a 50% reduction in the HAMD or Beck Depression Inventory. Moderate pain was defined as a BPI score &amp;#8804;4 to &amp;lt;7, and a score of 7 or higher was severe.&lt;/p&gt;
&lt;p&gt;About 35% to 40% of duloxetine patients met depression response criteria, regardless of baseline pain severity. About 25% to 30% of placebo-treated patients also met response criteria for depression.&lt;/p&gt;
&lt;p&gt;Path analysis showed that 68.7% of pain improvement was attributable to a direct treatment effect of duloxetine and 31.3% to an indirect effect on major depression.&lt;/p&gt;
&lt;p&gt;A direct treatment effect of duloxetine accounted for 59.9% of mood improvement, and the remaining 40.1% of improvement was related to the drug&apos;s effect on pain.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by Eli Lilly and Boehringer Ingelheim.&lt;/p&gt;&lt;p&gt;Marangell and several co-investigators are employees of Eli Lilly.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_418"
                     title="Consumer Group Calls for More Sleep for Residents"
                     score="0.009"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/tb/18332?impressionId=1265793358272"
                     
      &lt;p&gt;WASHINGTON  --  More that a year after the Institute of Medicine (IOM) issued a &lt;a href=&quot;http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/12004&quot; mce_href=&quot;http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/12004&quot; target=&quot;_blank&quot; title=&quot;IOM&amp;#8200;Calls&amp;#8200;for&amp;#8200;Mandatory&amp;#8200;Naps&amp;#8200;and&amp;#8200;Other&amp;#8200;New&amp;#8200;Sleep&amp;#8200;Rules&amp;#8200;for&amp;#8200;Residents&amp;#8200;&quot;&gt;report &lt;/a&gt;calling for mandatory naps for medical residents, the organization responsible for implementing  --  or rejecting  --  the IOM&apos;s controversial recommendation has yet to make a decision.&lt;/p&gt;
&lt;p&gt;The Accreditation Council for Graduate Medical Education (ACGME), which has formed a work safety task force, has said it will release its recommendations on the 2008 report in the upcoming months, collect comments, and schedule a board of directors vote no sooner than fall.&lt;/p&gt;
&lt;p&gt;In the meantime, the consumer advocacy group Public Citizen is trying to rally support behind adoption of the IOM report, which recommends, among other things, that residents take a five-hour nap for every 16 hour shift. Current standards allow residents to work for 30 hours straight.&lt;/p&gt;
&lt;p&gt;The IOM report determined that standards adopted in 2003  --  which mandated a maximum of 80 hours of work a week, when averaged over a four-week period, and no more than 30 hours straight  --  are not easing the problem of overworked and overtired resident physicians.&lt;/p&gt;
&lt;p&gt;As part of its campaign, Public Citizen launched a Web site this week, &lt;a href=&quot;http://www.wakeupdoctor.org&quot; mce_href=&quot;http://www.wakeupdoctor.org&quot; target=&quot;_blank&quot;&gt;www.wakeupdoctor.org&lt;/a&gt;, to promote safer work hours and more supervision for medical residents.&lt;/p&gt;
&lt;p&gt;In a press call Thursday  --  led by Sidney Wolfe, MD, director of Health Programs for Public Citizen  --  physicians and patient advocates said that current work schedules of residents are dangerous and criticized ACGME for failing to have taken any action.&lt;/p&gt;
&lt;p&gt;&quot;Resident physicians find it very hard to concentrate as exhaustion sets in, especially when operating or evaluating patients beyond 16 hours in a single day on a regular basis,&quot; said John Ingle, MD, an ear, nose, and throat surgery resident at the University of New Mexico Health Sciences Center in Albuquerque, N.M. &quot;During times of extreme fatigue, I find myself less compassionate toward my patients and less tolerant of my colleagues.&quot;&lt;/p&gt;
&lt;p&gt;&quot;My body is not made to work 30 hours or more,&quot; said Dan Henderson, a third-year medical student at the University of Connecticut. &quot;If I&apos;m truly going to do no harm as I pledged, I need a system to protect patients against errors caused by my fatigue. If ACGME isn&apos;t willing to do the right thing, hopefully consumers and lawmakers will be ready to step in.&quot;&lt;/p&gt;
&lt;p&gt;A sleep specialist went through a list of the dangers of sleep-deprivation in a medical setting:&lt;/p&gt;
&lt;p&gt;&quot;Resident physicians working 30-hour shifts make 36% more medical errors caring for women in the intensive care unit ... including 460% more serious diagnostic mistakes than those scheduled to work for 16 hours,&quot; said &lt;span&gt;Chuck &lt;span&gt;Czeisler&lt;/span&gt;, MD, of Harvard and Brigham and Women&apos;s Hospital.&lt;/span&gt;&lt;/p&gt;
&lt;p&gt;&quot;They are 73% more likely to stab themselves with a scalpel or needle,&quot; he said.&lt;/p&gt;
&lt;p&gt;Czeisler cited a survey that found after a year of working &quot;marathon shifts&quot; one in five residents admitted to making a fatigue-related mistake that injured a patient, and one in 20 said they made a fatigue-related mistake that resulted in the death of a patient.&lt;/p&gt;
&lt;p&gt;However, not everyone is sold on those statistics.&lt;/p&gt;
&lt;p&gt;Perry Pugno, MD, a director of a family practice residency program for 20 years, asserted that no definitive study has proven that the 2003 guidelines aren&apos;t working. He said most sleep studies are performed in a lab or in the transportation industry, and questions their applicability to the hospital setting.&lt;/p&gt;
&lt;p&gt;Besides, he said, &quot;Many people come to work in many industries sleep deprived. Restricting the hours of work doesn&apos;t necessarily mean you&apos;re going to get a well-rested person during the period you&apos;re going to be working.&quot;&lt;/p&gt;
&lt;p&gt;He doubts that residents would be willing or able comply with the 2008 IOM recommendation that they take an uninterrupted nap for five hours between every 16 hour shift. It&apos;s nearly impossible to take a nap in the middle of an intense work shift, said Pugno, who is now the director of the Division of Medical Education at the American Academy of Family Physicians.&lt;/p&gt;
&lt;p&gt;As other critics of the IOM report point out, if more residents are forced to work shorter shifts, they will be handing off the care of their patients to another resident, physician, or nurse more often. And medical errors are more likely to occur when the care of the patient is transferred, Pugno said.&lt;/p&gt;
&lt;p&gt;He recently co-authored a paper that presented results from a survey of 265 residency program directors that asked their opinions of the IOM recommendations. More than 60% disagreed or strongly disagreed with them.&lt;/p&gt;
&lt;p&gt;The long hours serve to educate, Pugno said, and to help build intimate doctor-patient relationships that mandatory nap time would sever. He also said that most directors of residency programs are sympathetic to the sleep needs of their residents and schedule shifts accordingly.&lt;/p&gt;
&lt;p&gt;Cost is also a major issue in implementing the IOM recommendations. In the 2008 report, the IOM authors estimated the changes they recommended  --  which also included greater supervision of residents and transportation home for bleary-eyed residents after a long shift  --  would cost $1.7 billion annually.&lt;/p&gt;
&lt;p&gt;&lt;/p&gt;

    </recommendedItem>
</recommendedContent>