42 | CLEVELAND JEWISH NEWS | CJN.ORG
HEALTH
MAY 13, 2016
Read more health news at cjn.org/health
University Hospitals celebrates 150 years JONAH L. ROSENBLUM | STAFF REPORTER jrosenblum@cjn.org
of awe-inspiring,” said Dr. Dan Simon, president of University Hospitals’ Case Medical Center. Dr. Fred Rothstein, Simon’s predene of the top cancer centers in cessor, said, “It’s pretty amazing when the nation, according to U.S. you really get into all the details that News & World Report. One of the you really lose track of over time, the top three neonatolpeople that have come through and have ogy hospitals in the impacted the lives of hundreds and country, by the same thousands and hundreds of thousands ranking. A cuttingof people. It’s pretty overwhelming edge center of mediwhen you start to think about it from cal research in The that perspective.” Harrington DiscovUH will commemorate its milestone ery Institute. with an event May 14 at the Cleveland Who would’ve Convention Center. thought that UniverRothstein Rothstein and Simon stressed the sity Hospitals, begun importance of UH being an academic as a house on Wilson medical center. Street in 1866, would The impetus came from the indusend up housed in trialist Samuel Mather, who served as a endless glossy facilihospital trustee for 47 years, including ties across Northeast 32 years as board chairman. After visitOhio? ing Johns Hopkins hospital and medi“To think that cal school in Baltimore in 1891, Mather 150 years later, we’re became convinced of the synergy now 18 hospitals created when healing and learning are with 26,000 employSimon combined. That led to the 1895 affiliation ees, 40 ambulatory 2 1/28/16 PM with Case Western 2:54 Reserve University centers, $4ClevelandJewishNews.HA.4.75x5.25.012916.pdf billion in revenue, it’s sort
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School of Medicine. “It brings together the power of healing and teaching and discovery, and he recognized that the future of great medicine lay in the academic medical center model,” Rothstein said. “He was a great visionary, no doubt about it.” Mather’s vision led to a host of discoveries, Simon said. He cited Dr. Oscar D. Ratnoff, a CWRU and UH hematologist who died in 2008, and his research into blood clotting. He praised Claude Beck, who pioneered heart surgery, including operations to improve circulation in damaged heart muscles, as well as ways to revive heart attack victims that included the defibrillator and CPR. University Hospitals also played a critical role in the response to the AIDS crisis, with Ratnoff and Dr. Michael Lederman describing the occurrence of AIDS-related immune deficiency in otherwise healthy men with hemophilia in 1983, authoring hundreds of pieces on how HIV induces immune deficiency and establishing the Special Immunology Unit at UH in 1985, Northeast Ohio’s first dedicated HIV clinic. “We’re an academic medical center and it’s very important to understand what an academic medical center is,” Simon said. “It’s not a community hospital. It’s very interested in a healthy community, it’s very interested in delivering care, but its mission is much greater than care delivery.” If the system’s research is long established, its expansion is new and exciting. “The real growth and the consolidation of the market really began in the early- to mid-90s and that’s when all of the acquisitions really started to happen and we’ve grown tremendously ever since that time,” Rothstein said. The Seidman Cancer Center, opened in 2011, was one example, a personal one, for Bob Gries, hospital trustee for 39 years, given that his parents had been treated for cancer at UH. “When they built it, they were very careful to really consider what was important for patients,” Gries said. “They really took treating cancer to another
Dr. Herman Hellerstein, pictured in the 1970s, was a famed University Hospitals cardiologist whose 1950s research helped in the rehabilitation of heart attack patients who might have previously been forced into premature retirement. | Photo / University Hospitals
level.” Despite all the growth, Rothstein said the system has never lost track of its mission. “We have been a community asset for 150 years and we’ve continued to be there 24/7, 365 days a year independent of people’s ability to pay,” Rothstein said. “For me, that’s really one of the bellwethers of why I stayed at UH – because of the great things that we do for the community that we have the privilege to serve.” Indeed, that’s what drew Barbara Robinson, currently on the Seidman Leadership Council. “I was really impressed and kept hearing that one of the main focuses of the hospital was care and patient care and caring and I had experienced that and I realized that it wasn’t just something that people said, that it actually was in practice there,” Robinson said.
HEALTH
MAY 13, 2016
Messinger-Rapport to become Hospice chief medical officer
Dr. Barbara Messinger-Rapport will succeed Dr. Charles V. Wellman as chief medical officer of the Hospice of the Western Reserve when Wellman retires later this year after 17 years of medical leadership, according to a news release from the hospice. Messinger-Rapport, who lives in Highland Heights, joined the hospice in November from Cleveland Clinic, where she was director for the Center for Geriatric Medicine. “Her skills in clinical care, leadership, program development, regulatory environment, post-acute care, quality measures and Messinger-Rapport improvement, and research and grant experience make her the optimal person to lead the agency’s medical care,” said Bill Finn, hospice president and CEO, according to the release.
Heart issues to be discussed June 9
The Menorah Park Aging Resources Center will present “Age-Related Heart Problems: Myth & Reality” with Dr. Guilherme Oliveira at 6:30 p.m. June 9. Oliveira is the Lorraine and Bill Dodero master clinician in heart failure and transplant and chief of heart failure at University Hospitals. He has practiced at several institutions, including Cleveland Clinic, Mayo Clinic and Baylor. Oliveira will identify major cardiac concerns that arise with age, address myths related to heart disease and explain ways to maximize cardiac health. The conversation will be preceded by a dinner at 5:30. The program and dinner are free and will take place at Menorah Park, 27100 Cedar Road in Beachwood. RSVP is requested by May 16 to Beth Silver at 216-839-6678 or bsilver@menorahpark.org.
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The 38th Annual
Workmen’s Circle Yiddish Concert in the Park _DSC3388.NEF
featuring
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Sunday, June 26, 2016 • 7:00 p.m. _DSC3390.NEF
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44 | CLEVELAND JEWISH NEWS | CJN.ORG
HEALTH
MAY 13, 2016
Solon teen leading fight against juvenile arthritis JONAH L. ROSENBLUM | STAFF REPORTER jrosenblum@cjn.org
E
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than Berkovitz has led an active, fulfilling life despite having juvenile idiopathic arthritis. Now, the 14-year-old eighth-grader at Solon Middle School wants to help other children with juvenile arthritis do the same. Ethan will be the youth honoree at the Arthritis Foundation’s Photo / Jonathan Gibson 2016 Walk to Cure Arthritis – Cleveland May Berkovitz 21 at the Cleveland Metroparks Zoo. Given his role, he is expected to be a leading fundraiser for the event. He is the top individual fundraiser for the Cleveland walk and “Team Ethan” ranks third, with $3,292 toward its goal of $4,000. “It’d be great to just get other people from the community to come out and learn about the fact that kids have arthritis,” Ethan’s mother, Joanne Berkovitz said. “A lot of people don’t think about children getting arthritis.” Berkovitz said she “didn’t know children could get arthritis” until her son’s diagnosis in 2009, when he started experiencing pain walking down the stairs and to the bus stop. After a short period of over-the-counter treatment, Ethan began taking medication that has essentially allowed him to lead a normal life. Today, he plays club soccer, competing in Toledo one weekend and Indiana the next. “He responded wonderfully to the medication and is able to have a fantastic quality of life,” Berkovitz said. “He does everything that he wants. Nothing gets in his way.” “I’ve been lucky that the medication has worked for me very well, but there are
WHAT: 2016 Walk to Cure Arthritis – Cleveland WHERE: Cleveland Metroparks Zoo, 3900 Wildlife Way, Cleveland WHEN: 9 a.m., May 21 INFO: Join Team Ethan at bit.ly/1TiN4gZ. some days that I’m not feeling as good or I’m tired or my hands hurt a little bit, but overall I’m doing pretty well right now,” Ethan said. Not everyone is so lucky. Not everyone with juvenile arthritis responds so well to medication. Adding to the uncertainty is the fact that for some children, juvenile arthritis goes away as they age – and for some, it does not. Shortly after Ethan received his diagnosis, he connected with a student with juvenile arthritis playing football for Ohio Wesleyan University in Delaware. That gave him an idea of what he could achieve, despite his diagnosis. “When I was younger, I didn’t really know at the time what to do and how to overcome it, but he helped me realize that I could still be active and play sports and do all the things that I love to do,” Ethan said. As the Northeast Ohio youth honoree, he hopes to do the same for others with juvenile arthritis. “It makes us proud and it has to feel very good for him to know (that for) all this pain and suffering and what he’s gone through that he can be a role model to other kids who maybe are struggling and offer them hope as well,” Berkovitz said. For the Berkovitz family, it has been a team effort, with Berkovitz’s parents in Aurora, Vera and Ron Dombcik, turning to their friends for money, and with Joanne and her husband, David, doing the same. Ethan, meanwhile, has distributed fliers around their neighborhood in Solon.
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HEALTH
MAY 13, 2016
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Five ways to observe Healthy Vision Month this May. Eyes are windows into your body. By looking into your eyes, ophthalmologists can see evidence of diabetes, high blood pressure and other conditions you may not know you have. That’s why comprehensive eye exams are so important – for your vision and your whole body. Eye exams include checking the optic nerve and retina at the back of Philip Goldberg, MD your eye (which requires using drops to dilate your pupils) and measuring your eye pressure. “It requires more than reading an eye chart,” says Philip Goldberg, MD, an ophthalmologist with Cleveland Clinic Cole Eye Institute. “We will check peripheral vision and motion of the eye as well. Everyone should have their first comprehensive eye exam by age 40 – earlier if there are vision problems or if eye disease runs in the family.” If it’s time for your comprehensive eye exam, schedule one this May, during Healthy Vision Month. In addition, Dr. Goldberg recommends these five tips for healthy vision: 1. Eat plenty of leafy greens. Foods rich in vitamins C and E, zinc, lutein, zeaxanthin and omega-3 fatty acids are good for eye health. Diet won’t help you get rid of glasses, but it may help prevent eye disease. 2. Don’t rub your eyes. That’s how germs can enter an eye and cause infection. 3. Wear eye protection when doing yard work or working under your car. Regular eyeglasses or sunglasses sometimes aren’t enough to keep debris out of your eyes. Use goggles with side protection. 4. Practice good contact lens hygiene. Most serious eye infections are caused by poor use of contact lenses. Never sleep in contacts, don’t wear them for longer than directed, and clean them daily. Otherwise, bacteria can build up and put you at risk for long-term eye problems. 5. Don’t ignore eye problems. Delaying treatment only makes things worse. See a board-certified ophthalmologist to get the most thorough care. Dr. Goldberg sees patients at Cleveland Clinic Cole Eye Institute in Beachwood and the Twinsburg Family Health and Surgery Center. For an appointment, call 216.444.2020. Cleveland Clinic offers same-day appointments.
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Every year in May, Cleveland Clinic celebrates their nurses. As serving leaders, nurses recognize that the essence of caring and care delivery is human connection. Human connection is created through a healing environment with the patient and the family at the center – and includes relationships with colleagues, community and self. This therapeutic relationship is dynamic and fluid as nurses respond to changes with patients, families and the environment. Our nurses continually assess, plan, implement and evaluate care based on evidence, sound clinical judgment and critical thinking skills to provide safe, quality, expert, compassionate care. For everything nurses do, celebrate them this month! If you would like to thank a Cleveland Clinic nurse, visit clevelandclinic.org/thankanurse.
5/3/16 9:16 AM
46 | CLEVELAND JEWISH NEWS | CJN.ORG
MAY 13, 2016
HEALTH
Avoid sugar, boost intelligence MICHAEL F. ROIZEN
A
YouDocs@gmail.com
60-year-old Beachwood woman whose parents lost their memories at about age 70 wrote for advice, worried she might lose her memory, too. There are ways to minimize that possibility, even though one in five will experience some form of brain drain, ranging from fuzzy thinking to Alzheimer’s disease.
“They encouraged me, but weren't too pushy. They would knock on the door every day and gently persuade me to go to rehab. Without a doubt, I will be back at the center after my knee replacement.”
While some causes of memory loss are genetic, you can build a bigger brain and postpone memory loss. One study found that there are nine risk factors for Alzheimer’s, ranging from obesity to
inflammation to plaque in the arteries, and most of them are modifiable. Because your brain is plastic (a good word in brain talk), it is flexible enough to grow and strengthen if you
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empower it to do so. Some specific tactics for creating a brain built for a centenarian follow: • Avoid foods with sugar. Sugar for the slightly and very diseased brain is like cocaine; short-term increases in sugar improve function, but chronic, slightly raised sugar levels, even if you don’t have diabetes or pre-diabetes, will affect your memory. That excess blood glucose in that sugar doughnut (made worse by its saturated fat) and from the sugar in your coffee cause inflammation, which damages brain cells. Higher blood sugar is linked to a smaller hippocampus, which means poorer ability to form and store new memories. The same thing (or at least its rat equivalent) occurs when mice were fed the equivalent of a liter of sugared soda a day. • Manage stress or eradicate your stressor. Stress is the greatest cause of memory loss linked to a shrinking hippocampus. It seems that the inflammation caused by stress prunes old and makes new connections for establishing memories more difficult. You can use meditation and behavioral modification to control your reaction to stressful events, or learn to deal with the stress and eradicate its cause or causes. • Do physical activity. Any physical activity for 45 minutes three times a week, even walking, expands your hippocampal region. New data would indicate that maybe intense exercise for 20 seconds three times in a 10-minute period three times a week may be even better, but check with your doctor before increasing the intensity of
your exercise program. • Learn something new. Try a new skill, hobby or game, or even try to find new directions – without GPS – to a place you visit regularly. These will create more connections that also help enlarge your hippocampus, lowering your risk of memory loss. • Take in enough magnesium, foliate, B12, B6, and Vitamin D3. Magnesium ensures strong links between your brain cells, so you have a big network ready to solve problems. You need 420 milligrams daily, but most of us fall short. Turn to brown rice, almonds, hazelnuts, spinach, shredded wheat, lima beans, and bananas to top off your tank, or just get ½ a multimineral and vitamin supplement twice a day. The B vitamins are key for brain functioning, too. Vitamin D3, like DHA Omega-3, protects your DNA and seems to prevent damage from free radicals (rogue oxygen molecules that attack DNA). Aim for 1,000IU daily from a D3 supplement. Get it measured; you want to aim for a level over 35. • Don’t short-change sleep. When you’re busy, it’s easy to say the thing you want to sacrifice is sleep. But you need sleep for lots of reasons, and one of the biggies is that it acts as a brain scrub and gets your brain in condition for optimal learning, problem-solving and memory.
Dr. Michael Roizen writes about wellness for the Cleveland Jewish News. He is chief wellness officer and chair of the Wellness Institute at Cleveland Clinic. Follow him on Twitter at @ YoungDrMike.
HEALTH
CJN.ORG | CLEVELAND JEWISH NEWS | 47
MAY 13, 2016
Kids need books of different colors DR. ROBERT NEEDLMAN rneedlman@metrohealth.org
R
ace is like sex – all around us, but unmentionable. As a pediatrician, though, I bring up both often. Most children know it’s wrong to treat people badly because of the color of their skin. But some adults seem to think it’s wrong even to notice how people look, let alone mention it. Young children on the other hand notice pretty much everything, and tend to talk about what they see.
In the office, I welcome children’s awareness of differences. Given crayons and paper, many children choose to draw their doctor. In my case, these pictures often feature round glasses, a big nose and a fringe of curly hair. “Yep, that’s what I look like,” I comment, “and don’t forget the bow tie!” Then we talk about when it’s polite to comment on someone’s appearance and when it’s good manners to
keep quiet. But noticing is natural, and the office is a place to share observations, thoughts and feelings freely. This goes for the parents, as well. One of the best compliments I’ve gotten came from a father (African-American) who asked me blankly, “You’re Jewish, doc, right?” The question told me that he felt safe venturing into territory that is usually off limits. After that, we
Faiman selected woman of year by leukemia group
Beth Faiman, a nurse practitioner at Cleveland Clinic, was honored as the Leukemia and Lymphoma Society’s woman of the year at the annual gala at the Renaissance Hotel May 6. She and her husband, Dr. Matthew Faiman, live in Highland Heights.
Faiman
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talked about how our backgrounds affect who we are and how we see things. Anxiety about race and ethnicity can block honest discussion (and when you’re talking about children, that’s the only kind of discussion worth having). It’s important to be able to talk about these topics in a way that feels comfortable. I may start the conversation by asking AfricanAmerican parents if they own any children’s books (or even know of any) that have black children in them. Many do not. They are surprised to learn about “The Snowy Day” and “Whistle for Willie” by Ezra Jack Keats, “Cherries and Cherry Pits” by Vera B. Williams and “Mu-
faro’s Beautiful Daughters” by John Steptoe. But once they think about it, they quickly understand that children need to see themselves in the books they read (especially when “reading” is listening and looking together with a parent), in order to feel connected to and welcomed by the world of literature. But white kids need books with black characters, too. Why? Because for children, the fictional characters they meet in books become as real in their imaginations as any they might encounter on the playground. Kids who grow up in our indelibly color-conscious society cannot help but imagine that people with differ-
ent skin color are also somehow fundamentally different inside. When black characters like Peter, or Bidemmi or Nyasha (from the books I’ve just mentioned) take up residence in a child’s imagination, they become friends, paving the way for friendships of the 3-D variety. This summer, Reach Out and Read Greater Cleveland is raising funds to buy enough copies of two classic Afrocentric books, “I Love My Hair” and “Bippity Bop Barbershop,” both by Natasha Anastasia Tarpley, so that doctors can give a copy to every preschooler who comes for a well-child visit. Later, we plan to make a similar purchase
of books that celebrate Latino culture. And I hope we don’t stop there. There are many wonderful picture books about Jewish children and Muslim children and children from many other cultures, religions, regions and ethnicities. How would the world be if all of our children grew up with all of those children, fictional but in their own way very real, as friends?
Dr. Robert Needlman writes about pediatrics for the Cleveland Jewish News. He is a pediatrician and child development specialist at The MetroHealth System.
Menorah Park’s Marcus Rehabilitation Center. We’ll get you back to your game. With a National 5-Star rating and outstanding state inspections...
We focus on more than just getting you back home after an illness or surgery. We aim to get you back to golf, tennis and what you love to do. That’s the goal of our compassionate care specialists, who use the latest techniques and a team approach. We provide a seamless transition to home health services and outpatient therapy. We Offer: A personalized plan of care Full-time in-house physicians Aquatic, physical, occupational and speech therapies A transitional living suite where you can practice skills safely in a home setting Support to identify challenges and address them before returning home Reservations accepted for post-op stays after hip, knee, back or other surgeries
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48 | CLEVELAND JEWISH NEWS | CJN.ORG
MAY 13, 2016
HEALTH
Of lies, damned lies and statistics DR. DANIEL FLEKSHER
A
Daniel.Fleksher@uhhospitals.org
s a physician, I am inundated with studies, statistics, graphs and charts. However, it is not the hours of reading medical journals that is in of itself difficult. On the contrary, it is one of my true pleasures and possibly the only thing I do that is both relaxing and productive (when I can find some quiet time to read, that is). What is challenging, is analyzing the information from the dozen or so journals I subscribe to and deciding if and how it is clinically relevant to my practice and my patients.
One thing that I enjoy, but takes up much of my time, is answering questions patients may have regarding some medical information they may have read, heard or seen on television. Most commonly, this is gleaned from headlines in the popular media. I often find myself on the defensive explaining why I am not recommending diet “X” or therapy “Y” or how I can continue prescribing a “dangerous” medication that is “known” to cause such and such side effects. I am blessed to have patients who are so educated and actively participate in their care, and I strongly believe that patients should question and engage their physicians regularly regarding medical decision making. However, I thought it would be beneficial to explain, in general, how some of this discrepancy arises and how I deal with it.
As Mark Twain (from whom I borrowed the title of this article) noted, statistics and numbers have extraordinary power of persuasion and, when misused, can bolster otherwise weak arguments. In this and, hopefully, future articles I would like to examine some of the many different ways statistics and scientific studies are created, misquoted and misused. One of the most important factors to consider when assessing the practical clinical value of a statistic is whether or not the study that generated it is generalizable to the general population and to what extent. This is why the type of study and the selection of participants is so important at the outset. In statistics, when failure to achieve proper randomization occurs, this is called a “selection bias” and can drastically distort the validity of a statistical analysis. To be sure, even in
the most well-designed trials, randomizedcontrolled trials being the gold standard, the very act of volunteering for a trial is a type of selection bias that limits, usually to a minimal extent, the generalizability of the trial. However, when selection is done improperly, the entire result can be skewed. For example, many “positive” trials of diets and dietary supplements are observational studies. That is, instead of choosing a large pool of matched people and randomizing them into different treatment/study arms, the studies follow people who are already using the intervention in question and comparing them to a cohort that is not. What’s wrong with this approach you ask? Indeed, there is good reason to perform studies this way. RCTs are both costly and time consuming. In the case of diet and exercise it is challenging to verify the intervention is being performed. However, following cohorts is very tricky and prone to many confounding factors. In the examples above, the people in the cohort involved in diet “A” or taking supplement “B” have self-selected themselves as people who, arguably, care more about health and are making a host
of healthy lifestyle choices that the cohort not using intervention “A” or “B” is making. Therefore a positive result for “A” or “B” may be true, but may also be reflecting something altogether unrelated. It could be the same group would actually be better off WITHOUT “A” or “B.” In truth, this small aspect of clinical trials would require an entire semester to cover properly and I am significantly more limited (and under-qualified) than that. I hope, though, to have exposed at least a small crack in the armor of the heretofore infallible “statistic” and that armed with this knowledge you will be more skeptical and discerning with what you read and hear. In future articles, I hope to address other aspects, including the difference between association and causality and the frequent misrepresentation of science in the media.
highly explosive agents from the dawn of the surgical era. In the current area, physicians are generally not found to be smoking pipes in a close proximity to patients, nor are most hospitals heated by coal burning stoves. This has certainly made the hospital a safer place, but perhaps the rarity of fires may have lowered our vigilance for these once-common problems. Second, the rarity of serious safety events makes it difficult to quantify how well we are controlling them. By analogy, a major league baseball player may have 500 chances per season to demonstrate how well he can make contact with the ball, draw walks or avoid striking out. Deficiencies in routine regular-season hitting are quickly spotted by his coaches and can be remedied by tweaking training routines or game-time strategies. But try to systemically coach a player on how to deal with one particular right-handed pitcher with a troublesome slider when he may only face that pitcher-pitch combination three times
per season. Similarly, institutions and individual provider may keep prodigious statistics concerning procedural success rate or length of times spent recovering in the hospital, but these mundane figures are easy to track. The real outlier safety events are too rare to measure. Proactive risk reduction, ongoing training and good intentions can prevent most problems, but in an environment as complex and fluid as a hospital, there will always be new and completely unexpected threats. The final piece of the puzzle is the cultivation and support for sound judgment by members of a health care team. As long as there is heat and oxygen tanks there is risk, but a team that is appropriately sensitized to safety and communicates well can generally prevent problems or at least contain them before they cause real harm.
Dr. Daniel Fleksher is an internist with University Hospitals’ Beachwood Internal Medicine Associates.
Playing it safe DR. IRA TAUB itaub@chmca.org
“This is ridiculous,” I muttered, as I rubbed my eyes and pushed back from my desk. This was several years ago, and I was preparing for my fellowship training by going through the requisite online orientation materials. These ranged from standard human resources protocols to the rudiments of the electronic medical record system. So far so good. But the last training video that I had to review left me dumbfounded; it was an instructional video on “Preventing Operating Room Fires.” I was going to learn how to avoid setting patients on fire. Despite my incredulity, I learned that operating room fires are far from unheard of in the United States. Published estimates suggest that they still occur hundreds of times per year. Nor are they confined to the dysfunctional fringes of the health care system. In fact, just this past week, a New York City tabloid announced one such incident at NYU’s Langone Medical Center, a perennial on the Best Hospitals List. Incidents like operating room fires could be considered predictable sequelae
to obvious risk factors: volatile gases under pressure; powerful high-energy equipment like lasers and electronic equipment and a confined space. No one would be shocked at a fire in a chemical factory or electronics fabricator; it is a wonder that they don’t occur more often in hospitals. Of course, hospitals are supposed to handle more important tasks than putting together circuit boards and should consequentially be held to a higher standard. Yet, despite commitment of prodigious clinical and administrative resources to the problem of patient safety events, the incidence of such events remains stubbornly above zero percent. Why? First, much of the proverbially lowhanging safety fruit has been picked. Medications used to put patients to sleep have evolved, with injectable drugs and relatively inert gasses replacing the
Dr. Ira Taub is a pediatric cardiologist for Akron Children’s Hospital Heart Center who sees patients in multiple locations throughout Northeast Ohio.