There is almost a complete exchange of gases between nasal passages and sinuses while humming in one exhalation vs. 4% without humming. If you have sinus problems, you should do a lot of humming. Chanting your mantra might do the same trick.

Humming Greatly Increases Nasal Nitric Oxide

Eddie Weitzberg and Jon O. N. Lundberg

Department of Anesthesiology and Intensive Care, Karolinska Hospital, and Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden

American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 144-145, (2002)

The paranasal sinuses are major producers of nitric oxide (NO). We hypothesized that oscillating airflow produced by humming would enhance sinus ventilation and thereby increase nasal NO levels. Ten healthy subjects took part in the study. Nasal NO was measured with a chemiluminescence technique during humming and quiet single-breath exhalations at a fixed flow rate. NO increased 15-fold during humming compared with quiet exhalation. In a two-compartment model of the nose and sinus, oscillating airflow caused a dramatic increase in gas exchange between the cavities. Obstruction of the sinus ostium is a central event in the pathogenesis of sinusitis. Nasal NO measurements during humming may be a useful noninvasive test of sinus NO production and ostial patency. In addition, any therapeutic effects of the improved sinus ventilation caused by humming should be investigated.

Errors That Kill Medical Patients

Medical errors are killing tens of thousands of Americans each year and harming countless more, so it has been a salutary trend that many medical, academic and business groups have been developing ways to reduce the dangers. But now a survey of practicing physicians has revealed disheartening evidence that the doctors themselves may be the biggest obstacle to effective reform.

Three years ago the Institute of Medicine estimated that 44,000 to 98,000 patients die each year because of medical mistakes — more than are killed annually by automobile accidents. The numbers seemed so staggering that many medical practitioners thought them inflated. But the survey of physicians, published in The New England Journal of Medicine last week, has offered corroborating evidence that, whatever the number of deaths might be, there are an awful lot of medical mistakes causing an awful lot of damage.

The survey, conducted by the Harvard School of Public Health and the Henry J. Kaiser Family Foundation, examined the views of more than 800 American doctors and 1,200 other adults. Fully 35 percent of the doctors said that either they or members of their families had experienced medical errors in the course of being treated, and most said the errors had “serious health consequences,” such as death, long-term disability or severe pain. Three in ten had seen an error that caused serious harm to patients outside their families in the past year.

The critical issue, of course, is how to prevent harm, and here the survey found troubling attitudes. Although studies have demonstrated that various technological and procedural changes can cut the error rates in hospitals, the practicing physicians were lukewarm toward many reforms. Only a third of the physicians, for example, consider that reducing the work hours of young doctors in training to avoid fatigue is a “very effective” strategy to cut errors.

Less than a quarter of the doctors think it would be very effective to use computers instead of paper forms to order drugs or to include pharmacists on hospital rounds, two approaches that have been shown to reduce medication errors in hospitals. Nor were they enthusiastic about using only specially trained physicians on intensive care wards, or about limiting high-risk medical procedures to hospitals that do a lot of them, despite evidence that expertise and frequent practice are key ingredients in successful medicine.

With the evidence growing ever stronger that medical errors are a danger to many patients, it is disturbing to find such retrograde attitudes among physicians. Reform can succeed only if the medical profession gets behind changes that expert groups and plain common sense suggest could significantly reduce the harm caused by medical errors.

Views of Practicing Physicians and the Public on Medical Errors

Robert J. Blendon, Sc.D., Catherine M. DesRoches, Dr.P.H., Mollyann Brodie, Ph.D., John M. Benson, M.A., Allison B. Rosen, M.D., M.P.H., Eric Schneider, M.D., M.Sc., Drew E. Altman, Ph.D., Kinga Zapert, Ph.D., Melissa J. Herrmann, M.A., and Annie E. Steffenson, M.P.H.

Volume 347:1933-1940 December 12, 2002 Number 24

ABSTRACT

Background In response to the report by the Institute of Medicine on medical errors, national groups have recommended actions to reduce the occurrence of preventable medical errors. What is not known is the level of support for these proposed changes among practicing physicians and the public.

Methods We conducted parallel national surveys of 831 practicing physicians, who responded to mailed questionnaires, and 1207 members of the public, who were interviewed by telephone after selection with the use of random-digit dialing. Respondents were asked about the causes of and solutions to the problem of preventable medical errors and, on the basis of a clinical vignette, were asked what the consequences of an error should be.

Results Many physicians (35 percent) and members of the public (42 percent) reported errors in their own or a family member’s care, but neither group viewed medical errors as one of the most important problems in health care today. A majority of both groups believed that the number of in-hospital deaths due to preventable errors is lower than that reported by the Institute of Medicine. Physicians and the public disagreed on many of the underlying causes of errors and on effective strategies for reducing errors. Neither group believed that moving patients to high-volume centers would be a very effective strategy. The public and many physicians supported the use of sanctions against individual health professionals perceived as responsible for serious errors.

Conclusions Though substantial proportions of the public and practicing physicians report that they have had personal experience with medical errors, neither group has the sense of urgency expressed by many national organizations. To advance their agenda, national groups need to convince physicians, in particular, that the current proposals for reducing errors will be very effective.

MENLO PARK, Calif., Dec. 11 /PRNewswire/ – Some 42% of the public and more than one-third of U.S. doctors say they or their family members have experienced medical errors in the course of receiving medical care, with significant percentages reporting serious consequences, according to a new survey by the Harvard School of Public Health and the Henry J. Kaiser Family Foundation.

However, implementing the actions recommended by experts on medical errors may not be easy. Despite widespread personal experience, neither the public nor physicians name medical errors as a top problem facing health care and medicine today. Physicians and the public also disagree about many proposed solutions.

The Harvard and Kaiser researchers discuss their findings in a New England Journal of Medicine article being published on December 12, 2002. The nationwide survey examined the views of 831 physicians in April-July 2002 and 1,207 adults in April-June 2002.

“One of the striking findings of this study is that physicians disagree with national experts on the effectiveness of many of the proposed solutions to the problem of medical errors,” said Robert Blendon, Sc.D., professor of Health Policy at the Harvard School of Public Health.

“This survey provides strong documentation that medical errors represent a problem that affects a significant number of people,” said Drew Altman, Ph.D., president and CEO of the Kaiser Family Foundation. “The fact that so many physicians report personal experiences with errors corroborates what we heard from the public,” Altman added.

Experience with Medical Errors

Both physicians and the public were read a common definition of a medical error early in the survey. Subsequently, 35% of physicians and 42% of the public reported experiencing a medical error in their own care or that of a family member at some point in their life; 18% of physicians and 24% of the public said an error caused “serious health consequences” such as death (reported by 7% of physicians and 10% of the public), long-term disability (6% and 11%, respectively) or severe pain (11% and 16%, respectively).

Three in 10 (29%) of all doctors said that in their role as a physician they had seen a medical error that resulted in serious harm to a patient in the last year, and a majority of those who had seen an error said it is “very likely” (15%) or “somewhat likely” (45%) that they would see a similar one at the same institution in the next year.

Not Viewed As A Top Problem Facing Health and Medicine

Doctors and the public agree that as many as half of the deaths due to medical errors could have been prevented, but neither group listed medical errors among the top “problems facing health care and medicine in the country today.” Only 5% of physicians and 6% of the public identified medical errors as a top concern.

Instead, when asked to name in an open-ended question the top problems facing health care and medicine today physicians identified malpractice insurance costs and lawsuits (29%), health care costs (27%), and problems with insurance companies and health plans (22%). The public cited the cost of health care (38%) and cost of prescription drugs (31%) as the top problems facing health care and medicine.

Preventing Medical Errors?

Doctors and the public differ in their views of the most effective ways of reducing medical errors. Much of the public agreed that nine of the 16 offered proposals could be very effective, but a majority of practicing physicians saw just two proposals as very effective: requiring hospitals to develop systems to avoid medical errors (55%) and increasing the number of hospital nurses (51%).

Physicians and the public disagree substantially in their views on some of the key proposals:

— Seven in 10 of the public (71%) said requiring hospitals to report

errors to a state agency would be very effective, compared with 23% of

physicians.

— A majority of the public (62%) said reports of serious errors should be

released publicly; just 14% of physicians agreed, with most doctors

(86%) saying hospital reports should remain confidential.

— Half of the public (50%), but only 3% of physicians, said that

suspending the licenses of health professionals who make medical errors

would be a very effective solution for reducing errors.

— Two-thirds of the public said it would be very effective to reduce the

work hours of physicians in training (66%) compared to 33% of

physicians.

Although few physicians said that more malpractice suits could be effective in preventing individual errors, a majority believes that surgeons who make errors with serious consequences should be subject to lawsuits.

Gap Between Medical Error Experts and Views of Physicians and the Public

Physicians and the public do not necessarily agree with the views of experts regarding the effectiveness of certain approaches to reducing errors. For example, less than a majority of both physicians and the public believes that limiting certain high-risk procedures to high volume centers (40% of physicians, 45% of public), increasing use of computerized medical records (19% and 46%, respectively), or use of computers in ordering of medical tests and drugs (23% and 45%, respectively) would be very effective solutions.

Furthermore, about one-third of physicians (34%) agree that another key proposal of experts — using only physicians trained in intensive care medicine in hospital ICUs — would be very effective.

Causes of Medical Error

Physicians said the leading causes of errors are a shortage of nurses (53%) and overwork, stress or fatigue of health professionals (50%). A majority of the public identified seven causes; the top four they cited are physicians not having enough time with patients (72%); overwork, stress or fatigue of health professionals (70%), health professionals not working together or communicating as a team (67%) and a shortage of nurses (65%).

About seven in 10 physicians thought an error would be more likely at a hospital that does fewer procedures. The public was less sure, with about half saying that an error would be more likely at a low-volume center and the other half saying that errors would be more likely at a high-volume center (23%) or that volume would make no difference (26%).

Methodology

The Harvard School of Public Health and Henry J. Kaiser Family Foundation’s Medical Errors: Practicing Physician and Public Views is based on two surveys, one of physicians and one of the public, both designed and analyzed by a team of researchers from Harvard School of Public Health and the Kaiser Family Foundation.

Physician Survey

The fieldwork for the survey of physicians was conducted April 24-July 22, 2002 by mail or online with 831 physicians by Harris Interactive, Inc. The sample was drawn from the national list of physicians provided by Medical Marketing Service, Inc. This list includes both American Medical Association members and non-members and is updated weekly. The margin of sampling error was +/-3.5 percentage points.

General public sample

The survey of the public was conducted by telephone April 11- June 11, 2002 with a nationally representative sample of 1,207 adults 18 years and older. The fieldwork for the survey was conducted in Spanish and English by ICR/International Communications Research. The margin of sampling error was +/-2.6 percentage points.

Please note that for both surveys sampling error may be larger for other subgroups and that sampling error is only one of many potential sources of error in these or any other public opinion poll.

This site is based on the assumption that 50% of hospital visits can be prevented by exercise and nutrition, 35% by alternative medicine, and 10% by electronic medicine. The remaining 5% deserve careful attention because your odds of dying in a poorly rated hospital are more than twice the odds of dying in a highly rated hospital for serious conditions. See a recent article in Advances for Health Information Executives. I’m partial to this journal because they rated me one of the 15 most influential people in healthcare IT in 2000. At least someone thinks that people follow my recommendations. But I digress …

HealthGrades posts ratings for many conditions for most hospitals. Five stars is good. One star is bad. The chart above shows that survival is much higher in good hospitals vs. bad hospitals. You can drill down on the HealthGrades web site and see that a good hospital, like Massachusetts General, is highly compliant with the LeapFrog Group’s recommendations for patient safety.

The Washington Post is really focusing in on the lack of progress dealing with medical error in the U.S. Whether it is the Catholic Church or corporate America, the deeper you look, the worse it gets.

A Medical Enron

Washington Post Editorial; Monday, December 9, 2002; Page A22

“The sources of error are various. Surgeons mix up patients’ X-rays or look at them the wrong way up; as a result, they operate on the wrong patient or the wrong body part. Doctors and health workers fail to follow basic hygiene procedures such as washing hands or changing gloves; the consequent infections account for thousands of deaths a year. The largest single source of error stems from faulty drug prescriptions. One recent study found that one in five doses of medicine dispensed to patients involved an error. Either the wrong drug was given, or the wrong dose, or it was given at the wrong time.

“These various errors reflect the arrogance of the medical priesthood. Even though doctors themselves have produced studies showing how fatigue erodes worker competence, they persist in thinking that it’s normal for junior members of their profession to put in more than 100 hours of work a week. Even though every other profession has embraced computers’ ability to enhance human performance, doctors persist in scribbling prescriptions in illegible handwriting rather than punching them into a computer that might alert them if the dose is wrong. Studies of hospital infections find that junior workers are most likely to wash their hands properly. It is doctors who are most likely to forget this chore.”

One of the many newsletters I scan each month is Dr. Williams “Alternatives for the Health Conscious Individual.” In the July 2002 issue he mentions an editorial in Circulation by Dr. Leaf of Massachusetts General Hospital on the “Lyon Diet Heart Study.” Results of this study were published years ago and showed that one teaspoon of cold pressed flax seed oil per day resulted in a 70% reduction in deaths from heart disease in the study group, more than any result from any previous cholesterol study ever published.

Dietary Prevention of Coronary Heart Disease: The Lyon Diet Heart Study (Editorial)

Alexander Leaf, MD

Circulation. 1999;99:733-735

Dr. Leaf comments: “This issue of Circulation contains an article that I believe deserves special attention from cardiologists and physicians. It reports the 46-month mean follow-up findings on the original report of the study on “Mediterranean -linolenic acid–rich diet in secondary prevention of coronary heart disease,” the so-called Lyon Diet Heart Study. This study was undertaken because of the interest of the investigators in explaining the very much lower mortality from cardiovascular disease, mainly coronary heart disease, in the countries bordering the Mediterranean compared with that in northern Europe. The initial report was published in Lancet in 1994 after the study was terminated by its Scientific and Ethics Committee at 27 months mean follow-up time of what had been planned as a 5-year study, because the benefits in the experimental group at that time were so favorable. Despite the striking findings in the first report of a 70% reduction in all-cause mortality due to a reduction in coronary heart disease (CHD) mortality and comparable large reductions in nonfatal sequelae, I have encountered few cardiologists here who are aware of that study.”

There are few cardiologists at one of the world’s leading medical centers who are even familiar with the study! I don’t want to be too critical of busy physicians because Dr. Halamka, CIO of CareGroup, is also responsible for information technology for the Harvard Medical School. Every day he searches the internet and finds 40,000 new pages of information to post for medical students. This is more pages than most physicians read in a lifetime of medical practice.

What this means, is that an intelligent person must research the medical literature for pertinent information and bring this information to their physician and use the physician as a consultant. We don’t expect our lawyers to understand our business and we are at great risk if we expect our physician to fully comprehend our health status. That is just the way it is, and anyone who says otherwise is just not reading the medical literature.

To their great credit, the American Heart Association freely publishes the full text of their journal, Circulation. Check out the article on the Lyon Diet Heart Study update.

Another key point that Dr. Williams points out, is that if you are using aspirin, ibuprofen, acetaminophen, or other COX-2-inhibiting medications and getting some pain relief benefit, you are probably treating the symptom, not the disease. Since aspirin and like medications work by inhibiting the effects of eicosanoids from omega-6 fats, you need to increase you intake of omega-3 oils from flaxseed, or better yet, pharmaceutical grade fish oil. Flax seed oil or fish oil pushes the omega-3/omega-6 oil balance in your body in a positive direction. Continually treating your headache or arthritis with the drugs mentioned above could set you up for a heart attack. There a much better ways to eliminate aches and pains by curing the underlying condition.

The flu is difficult to treat with a frequency device like the FSCAN because any serious flu has multiple faces. I have seen this enough times now that the pattern is clear.

Last week a flu started in our office that has put almost every individual out of work for a least a day. I detected the frequency immediately and warned people to take oscillicosinum, since the initial frequencies in the 360KHZ range were treatable by that homeopathic remedy and most people don’t have a frequency device. The lower frequencies in the 250KHZ range which develop later are not treatable with oscillicosinum which explains why this remedy is most useful at the onset of the disease.

I went home with the virus and infected my wife. The next morning she had intestinal problems. I went home at noon and cured her. I then cleared myself of all viruses every night as soon as I came home to avoid reinfecting her. I still had the problem of sitting in meetings every day with infected people.

An allday meeting last Tuesday demonstrated clearly the clinical pathway of this flu. As soon as I had symptoms (runny nose, chest constriction, or sneezing), I left the meeting, detected the frequency, cleared it from my system and went back into the meeting. By the end of the day, I had this frequency set.

376675

367739

367655

364775

253333

276735

355644

253333

In order to clear all symptoms of this flu, you must treat all of these frequencies. My hypothesis after working with this problem during the past couple of years is that all these frequencies are one disease. The time period is too short for the virus to evolve and I have seen the same frequency pattern months later in people who were not able to eliminate the flu from their system and had a chronic chest problem.

You must be able to detect the exact frequencies to treat effectively. The frequencies above are one example and another flu will have a different frequency set. Just as flu shots are often ineffective because the strain of the virus may vary, unless you get the right frequencies, the FSCAN will be just as ineffective.

To make things more confusing, there are a number of cold viruses running around in the same frequency ranges. They are easy to eliminate in a few minutes with the FSCAN. The flu is not easy to eliminate once it gets a foothold in your physical system so you can distinguish between the cold viruses and a flu.

There are also interesting opportunistic infections that arise. For example, I had a sore throat with this flu for several nights. It took me a while to figure out the sore throat was not the flu virus, but a parasite infection that proliferated due to the assault of the flu on my immune system.

So a bad flu is a tricky disease to eliminate. The good news is that it can be done. The bad news is that it is tricky enough that you may give up and resort to Nyquil!



Finally, I have an F100 device that is very useful for treating multiple frequencies simultaneously. It is fully programmable and can be driven by a computer or a Palm Pilot. I program it as follows:

dwell 20

lable loop

376675 367739 367655 364775 253333 276735 355644 253333

goto loop

Treat until done, i.e. no more symptoms.

We are getting much better data on medication error from multiple studies published recently in leading medical journals. Here, we note that 6.3% of malpractice claims are for adverse drugs events, of which 43% are life threatening or fatal and 73% preventable.

Since there are about an equal number of inpatient and outpatient adverse events noted in malpractice claims, we can infer that the number of deaths due to medication error is at least double that estimated by the two studies noted in the recent Institute of Medicine reports, since those studies reported only inpatient errors.

Analysis of Medication-Related Malpractice Claims: Causes, Preventability, and Costs. Arch Intern Med. 2002;162:2414-2420

Jeffrey M. Rothschild, MD, MPH; Frank A. Federico, RPh; Tejal K. Gandhi, MD, MPH; Rainu Kaushal, MD, MPH; Deborah H. Williams, MHA; David W. Bates, MD, MSc

Background: Adverse drug events (ADEs) may lead to serious injury and may result in malpractice claims. While ADEs resulting in claims are not representative of all ADEs, such data provide a useful resource for studying ADEs. Therefore, we conducted a review of medication-related malpractice claims to study their frequency, nature, and costs and to assess the human factor failures associated with preventable ADEs. We also assessed the potential benefits of proved effective ADE prevention strategies on ADE claims prevention.

Methods: We conducted a retrospective analysis of a New England malpractice insurance company claims records from January 1, 1990, to December 31, 1999. Cases were electronically screened for possible ADEs and followed up by independent review of abstracts by 2 physician reviewers (T.K.G. and R.K.). Additional in-depth claims file reviews identified potential human factor failures associated with ADEs.

Results: Adverse drug events represented 6.3% (129/2040) of claims. Adverse drug events were judged preventable in 73% (n = 94) of the cases and were nearly evenly divided between outpatient and inpatient settings. The most frequently involved medication classes were antibiotics, antidepressants or antipsychotics, cardiovascular drugs, and anticoagulants. Among these ADEs, 46% were life threatening or fatal. System deficiencies and performance errors were the most frequent cause of preventable ADEs. The mean costs of defending malpractice claims due to ADEs were comparable for nonpreventable inpatient and outpatient ADEs and preventable outpatient ADEs (mean, $64 700-74 200), but costs were considerably greater for preventable inpatient ADEs (mean, $376 500).

Conclusions: Adverse drug events associated with malpractice claims were often severe, costly, and preventable, and about half occurred in outpatients. Many interventions could potentially have prevented ADEs, with error proofing and process standardization covering the greatest proportion of events.

California nurses do not go into the hospital without a buddy nurse who watches their treatment, and particularly their medications. One of my colleagues recently had a young child in for surgery who would have been overdosed on morphine if a family member was not logging every medication dose at the bedside. There have been many retrospective studies of historical data that have clearly identified the problem. Some new studies are prospective. They look at the problem as it is happening, resulting in more accurate measurement of the frequency and severity of the error.



Medication Errors Observed in 36 Health Care Facilities. Arch Intern Med. 2002;162:1897-1903

Kenneth N. Barker, PhD; Elizabeth A. Flynn, PhD; Ginette A. Pepper, PhD; David W. Bates, MD, MSc; Robert L. Mikeal, PhD

Background: Medication errors are a national concern.

Objective: To identify the prevalence of medication errors (doses administered differently than ordered).

Design: A prospective cohort study.

Setting: Hospitals accredited by the Joint Commission on Accreditation of Healthcare Organizations, nonaccredited hospitals, and skilled nursing facilities in Georgia and Colorado.

Participants: A stratified random sample of 36 institutions. Twenty-six declined, with random replacement. Medication doses given (or omitted) during at least 1 medication pass during a 1- to 4-day period by nurses on high medication–volume nursing units. The target sample was 50 day-shift doses per nursing unit or until all doses for that medication pass were administered.

Methods: Medication errors were witnessed by observation, and verified by a research pharmacist (E.A.F.). Clinical significance was judged by an expert panel of physicians.



Main Outcome Measure: Medication errors reaching patients.

Results: In the 36 institutions, 19% of the doses (605/3216) were in error. The most frequent errors by category were wrong time (43%), omission (30%), wrong dose (17%), and unauthorized drug (4%). Seven percent of the errors were judged potential adverse drug events. There was no significant difference between error rates in the 3 settings (P = .82) or by size (P = .39). Error rates were higher in Colorado than in Georgia (P = .04)

Conclusions: Medication errors were common (nearly 1 of every 5 doses in the typical hospital and skilled nursing facility). The percentage of errors rated potentially harmful was 7%, or more than 40 per day in a typical 300-patient facility. The problem of defective medication administration systems, although varied, is widespread.

In futher support of my argument that 50% of hospital days and clinic visits can be eliminated by nutrition and/or exercise, consider the considerable impact of nutrition on the immune system of older people.

“In the elderly, impaired immunity can be enhanced by modest amounts of a combination of micronutrients. These findings have considerable practical and public health significance.” Chandra, RK. Nutrition and the Immune System: An Introduction. Am J Clin Nutr 1997 Aug;66(2):460S-463S

For example, giving elderly subjects a low potency multivitamin/mineral supplement vs. a placebo for 12 months showed enhanced immune response in the supplement group. This was correlated with direct clinical benefit. The mean number of days for infectious illness was 23 days in the supplement group and 48 for the placebo group. And antibiotic use in the supplement group was an average of 18 days vs. 32 days in the placebo group. So minimal vitamin supplementation in the elderly directly enhances immune function leading to elimination of over 50% of illness and 50% of drug use. Chandra RK. Effect of vitamin and trace-element supplementation on immune responses and infection in elderly subjects. Lancet 1992 Nov 7;340(8828):1124-7

Your physician will not ensure that you take advantage of this benefit. You must take responsibility for your own health.