Gluten in Medicine Act 2019

Link: The Gluten in Medicine Disclosure Act of 2019 Introduced in the House

An excerpt:

On April 3, 2019, Representatives Tim Ryan (D-OH) and Tom Cole (R-OK) introduced H.R. 2074, the Gluten in Medicine Disclosure Act of 2019. The bill intends to make it easier to identify gluten in prescription medications by requiring drug manufacturers to label medications with the list of ingredients, their source, and whether gluten is present.

The Celiac Disease Foundation has been working with Representative Ryan’s staff since 2012 on the need for labeling of gluten in medication and is proud to endorse this bill. The Gluten in Medicine Disclosure Act of 2019 was introduced in the House of Representatives and referred to the House Committee on Energy and Commerce. If passed by the House, the bill will move forward for review by the Senate.

Read the full text of the Gluten in Medicine Disclosure Act of 2019 here.

Take a minute to send our letter to your Members of Congress to urge them to cosponsor this bill.

Checklists for Crisis and Daily Care

Not surprisingly, a new study has shown that checklists were associated with improvement in the management of operating-room crisis (NEJM 2013;  368: 246-53).

Many people use a checklist just to go to the grocery store so they don’t forget something important.  In medicine, checklists offer the same opportunity.

In this particular study, 17 operating-room teams participated in 106 simulated surgical crisis scenarios.  When checklists were available, there was better adherence to lifesaving processes: only 6% of steps were missed with checklists compared with 23% when they were unavailable.  Every team performed better when the crisis checklists were available.  Furthermore, 97% of participants reported they would prefer to have a checklist in the event of a crisis.

There were many limitations of this study, particularly the absence of surgeons from most of the simulations (due to difficulty enlisting them as volunteers).  Nevertheless, “experts have long recognized the potential for human fallibility in complex systems…it has been nearly 100 years since the surgeon W. Wayne Babcock called for emergency protocols to be rehearsed and ‘posted on the walls of every operating room.'”

For a pediatric gastroenterologist, the implication of this study is much broader.  It is trying to develop a checklist for every patient.  For a patient with a GI bleed, that checklist may include a supply list for the endoscopy suite, having written instructions for the settings of the cautery equipment, checking the proper PPI dose, and drawing a specific set of labs.  Agreeing to a minimum and not-too-onerous checklist would be worthwhile for almost anybody.  If you have a checklist for any GI condition (or a mobile app), think about adding a comment to this posting. If something is important in day-to-day care of a specific condition, a “hardstop” can be incorporated into electronic records as a reminder.

Related blog entries (mostly guidelines –not really checklists for a few specific conditions):

A much more articulate spokesman for checklists would be Atul Gawande:

Bystander effect –Genovese syndrome

Genovese syndrome is more commonly called the “bystander effect” (NEJM 2013; 368: 8-9).

“Genovese syndrome” was coined after the brutal stabbing of Catherine Genovese in Queens, NY on March 13, 1964.  What was astonishing was that ~38 people either observed the attacks or heard the victim’s pleas for help and did nothing.  This prompted a large amount of psychological research.  The central factor identified as the reason for the bystander effect was the diffusion of responsibility.

Awareness of the bystander effect is increasingly important in medicine where large teams often are involved in the care of complex patients.  Sometimes it is difficult even to answer “Who is my doctor?”

When many doctors are involved in the care of a patient, it is easy for a passive approach to patient care to develop.  How can this be reversed?

  • Bystanders are far more likely to intervene when they are friends with one another.  Thus, encouraging collegial interactions is important.
  • Understanding that oral communication, even briefly, with the primary care team is crucial.  Written communication is useful for documentation, but important information should be relayed directly.
  • An initiative by the U.S. Agency for Healthcare Research and Quality, TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) may be helpful in improving. team-based skills (TeamSTEPPS Home)

Related Links: