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White Coat Notes

Doctors say patients’ voices needed on hospital quality site

October 25, 2010

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Not familiar with the government’s Hospital Compare website? You’re not alone. You and 94 percent of Americans are unacquainted with the quality reporting site set up by the Centers for Medicare & Medicaid Services. Two doctors from Baystate Medical Center in Springfield argue that more people would find their way to the website if their feedback on the care they receive were included.

Writing in a commentary appearing in the Journal of the American Medical Association, Dr. Tara Lagu and Dr. Peter Lindenauer say there are many reasons why patients don’t consult hospitalcompare.hhs.gov. Patients sick enough to need hospital care may not have time to shop around on the Internet. Or the clinical outcome and processes listed on the site — like “Heart Attack Patients Given ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction’’ — may seem like they require a medical degree to interpret. Many patients also rely on recommendations from their doctors or family, if they have a choice in the matter. Some are restricted by where they live or what their insurance covers.

Patients do get their say on what it’s like to be a hospital patient, from how noisy or clean their room was to how well staff communicate with them. Part of Hospital Compare is culled from patient satisfaction surveys.

Lagu and Lindenauer say lessons can be learned from doctor-rating websites that have more in common with travel sites and restaurant reviews. Doctors have been leery of the sites, worried about privacy rules limiting their defense against complaints, for example. But Lagu and Lindenauer say research has shown that most of the reviews are positive and comments commonly focus on nonmedical issues, such as parking or staff courtesy.

If patient reviews were added to Hospital Compare, they would join patient satisfaction data drawn from hospital surveys that already appear on the site. Ideally, Lagu and Lindenauer write, a more dynamic system would be set up so doctors and hospitals could respond to criticism.

ELIZABETH COONEY

Marathoner's formula for not hitting the wall

Even the most experienced marathon runners hit the wall, typically around 21 miles into the 26.2-mile race, when their bodies are running on empty. A new scientific paper from an MD/PhD student at Harvard and MIT applies mathematics to the metabolic problem and comes up with a formula athletes can personalize to avoid breaking down on race day.

Writing in PLoS Computational Biology, Benjamin Rapoport, who has 18 marathons under his belt, quantifies the problem endurance athletes face. The body can burn fats and carbohydrates as fuel, but carbs are the more efficient choice. Carbs are stored in muscle and in the liver; exertion can exhaust those stores, but even the leanest runner has ample supplies of fat. The trouble is, burning fat is not a good recipe for speed.

While exercise and nutrition experts have rules of thumb for how many carbs to eat before and during the race, “No two runners are the same, so it’s really very important to be able to give individual runners personalized advice,’’ Rapoport said in an interview. His formula (found at endurancecalculator.com) uses maximum aerobic capacity, known as VO2max. That’s important because the body needs oxygen to break down carbs stored as glycogen. Leg muscle mass also matters, because that’s where carbs are stored. For men, levels typically range from 14 to 27.5 percent of body mass, and for women, they range from 18 to 22.5 percent. E.C.

Fish oil supplements no help in pregnancy, study says

Fish oils — especially one known by its chemical acronym DHA — have important roles in neurological, immune, and heart health. Pregnant women have been encouraged to eat more fish or take fish oil supplements, even though research has been mixed on the benefits. A new, more rigorous clinical trial published in the Journal of the American Medical Association found that fish oil supplements made no difference in mothers’ postpartum depression or their babies’ cognitive and language skills.

But Boston doctors say the door shouldn’t be slammed shut on the value of fish oils. Dr. Emily Oken of Harvard Medical School and Dr. Mandy Belfort of Children’s Hospital Boston, writing in an editorial also appearing in the journal, say there may be differences between DHA eaten in fish and consumed in supplements. They point to a lower risk of preterm birth: 1.09 percent in the fish oil group compared with 2.25 percent in the other group, which took vegetable oil capsules. Premature births are associated with both neurocognitive problems in children and depression in mothers.

“For now,’’ the editorial says, “pregnant women should take care to get the recommended intake of 200 [milligrams per day] of DHA, either by including low-mercury, high-DHA fish in their diets or by taking a daily . . . supplement. The benefit of higher intakes remains unclear.’’ E.C.

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