DAILY UPDATE

Hospitals take on post-ICU syndrome, helping patients recover

Hospitals are doing more to help the growing number of patients who receive treatment for serious illness in the intensive-care unit—only to find their release is the start of a whole new set of problems.

With medical advances, even the sickest patients now often survive potentially life-threatening conditions after a stay in intensive care. Many experience aftereffects, not only of the illness but also of the very medical care that may have saved their lives.

Doctors call it "post-intensive care syndrome" and say it is becoming more common. In the ICU, patients may be heavily sedated and hooked up to a ventilator, keeping them immobile, breathing and free of pain. But they can develop a temporary brain injury known as "ICU delirium," that is linked to later problems with memory and thinking. As many as 80% of ICU survivors have some form of cognitive or brain dysfunction, according to the Society of Critical Care Medicine, and some never recover. Many experience post-traumatic stress symptoms, depression, fatigue and prolonged muscle weakness.

More than five million patients are admitted to an intensive care unit each year for conditions such as respiratory failure and heart failure, and for monitoring after invasive surgery.

Especially at risk of developing post-ICU syndrome are patients who have sepsis.

Sepsis can rage through the body and restrict blood flow to vital organs including the brain. It kills 258,000 people a year and leaves about 1.4 million survivors at risk for long-term disability, according to the nonprofit Sepsis Alliance, an advocacy group. It was the most expensive condition treated in U.S. hospitals in 2011, costing more than $20 billion; between 2000 and 2009, the number of hospitalizations with a principal diagnosis of sepsis increased 148%, accounting for 1 out of every 23 patients, according the federal Agency for Healthcare Research and Quality.

Researchers are studying the link between delirium and sepsis as well as other causes, such as powerful sedatives. Septic patients are most likely to develop delirium, and they are at higher risk of developing post-ICU disabilities than those with other illnesses who develop delirium, research shows.

Now, many hospitals are starting to modify standard ICU practices, such as giving patients breaks from constant ventilation, avoiding over-sedation, monitoring them closely for signs of delirium and getting them out of bed to walk as soon as feasible. They are adopting protocols to treat sepsis aggressively.

Because much ICU care is necessary and many complications unavoidable, critical-care experts also are focusing on post-ICU rehabilitation, including educating patients, families and primary-care doctors about recovering from intensive care.

E. Wesley Ely, professor of medicine and critical care at Vanderbilt University, which opened an ICU Recovery Center last year, recommends "hard-core physical and mental rehabilitation" for people recovering from ICU treatment.

A group called The Sepsis Alliance, is developing handouts on post-sepsis issues for patients to provide to physicians, and it is using Facebook and other social media to help patients connect with each other.

Theodore Iwashyna, a critical-care physician and researcher at the University of Michigan Health System, is studying survivorship after critical-care illness. He says post-ICU patients need the same kinds of occupational and physical therapy as heart attack and stroke survivors.

In the past two years, a Critical Care Survivorship pilot program developed at Indiana University helped more than 100 ICU survivors and their caregivers. Malaz Boustani, chief innovation and implementation officer at Indiana University Health, says more than 88% had evidence of cognitive impairment and 40% suffered from depression. The program enhanced post-ICU care and reduced the number of emergency room visits and hospital readmissions, Dr. Boustani says.

In a Vanderbilt study, patients who survived critical illness and completed 12 weeks of in-home cognitive and physical rehabilitation scored better on tests of their ability to plan and perform tasks with multiple steps, compared with survivors who didn't undergo rehabilitation. Visit the Wall Street Journal for the article.

FDA warning: Philips HeartStart FRx, HeartStart HS1 Home, and HeartStart HS1 OnSite Automated External Defibrillators (AED)

The FDA is alerting all users of the Philips HeartStart FRx, HS1 Home and HS1 OnSite AEDs manufactured between 2005 and 2012 that these devices may fail to deliver a shock in the event of an emergency. If you have this device, please contact Philips Healthcare immediately for a replacement unit.

In September 2012, Philips Healthcare initiated a Voluntary Medical Device Recall of HeartStart Frx, HeartStart HS1 Home, and HeartStart HS1 OnSite AEDs after determining that an internal electrical component in the AED could fail, and the device could incorrectly indicate it is ready for use. This recall affects approximately 700,000 devices.

In a Medical Device Safety Notice dated Nov. 19, 2013, Philips provided customers with updated information about the failure of an electrical component that could cause the AEDs to fail to deliver appropriate shock. The notification also directed consumers to a Maintenance Advisory1 disclaimer icon.

All owners of the Philips HeartStart AEDs should contact Philips Healthcare immediately at 1-800-263-3342, and select option 5 for technical support. Live technical support is available Monday – Friday, 7:00 am – 5:00 pm Pacific Time.

Keep the recalled HeartStart AED in service until Philips Healthcare replaces the device or you can obtain another working AED. Despite current manufacturing and performance problems, the FDA considers the benefits of attempting to use an AED in a cardiac arrest emergency greater than the risk of not attempting to use the defibrillator.

Please be aware that the Philips HeartStart AEDs are designed to automatically test themselves at regular intervals to ensure they are ready for use. The HeartStart AED should emit a triple chirp sound and have a flashing “i-button” if it detects a serious problem that could prevent the HeartStart AED from delivering an electrical shock.

If your Philips HeartStart AED is emitting a series of triple chirps while in stand-by-mode, please contact Philips Healthcare immediately for a replacement unit. Keep the recalled HeartStart AED in service until Philips Healthcare replaces the device or you can obtain another working AED.

The FDA continues to closely monitor all AED manufacturers’ quality system design practices and device malfunctions that have persistently contributed to AED recall and Medical Device Reports.

In September 2012, the FDA classified Philips’ recall of HeartStart AED devices as a Class II recall after determining that the chance of serious adverse consequences or death due the device failure is remote. In this current situation, the FDA believes that because the patients who need these devices are in a life threatening situation, the chance of serious adverse consequences or death directly related to AED failure is very difficult to conclusively determine.

In March 2013, the FDA issued a Proposed Order2 requiring manufacturers of AEDS and accessories to submit premarket approval (PMA) applications. The FDA is currently reviewing and considering the comments provided by the public, and will take them into consideration when issuing a final order. Visit the FDA for more information.

Hospital employees help each other, one food item at a time

MUNCIE — The staff and volunteers of IU Health Ball Memorial Hospital and Blackford Hospital aren’t immune to the economic struggles that affect their friends and neighbors. They, too, have a hard time paying bills. They also wonder anxiously about getting laid off in the future. They’re as concerned about living paycheck to paycheck  as everyone else in East Central Indiana.

And they also go hungry.

In the last year, their peers at the hospitals have created the Employees Helping Employees Assistance Program, an opportunity for those with a few extra dollars to help  those without.

“We offer a competitive compensation package here and great benefits, but we’re a part of the community and our employees have the same struggles everyone is having,” said Emily German-Brown, the chairperson of the Employees Helping  Employees committee. “When we started to see requests for groceries and things like that, we decided to create a food pantry to help our employees and volunteers who may need that help.”

With 3,000 employees, the hospital is one of the largest employers in Delaware County. Although some outside of the hospital environment might think most hospital staffers are doctors making six-figure salaries, that’s not the case. As with any large company, the hospital employs people along a range of pay scales, including on a part-time level.

The 500 volunteers also come from diverse economic backgrounds and might need help with food from time to time, according to pantry organizers.

The pantry, which opened on Nov. 20, is located near the employee parking garage in the IU Health BMH facility, an area organizers describe as easy to get to but not heavily trafficked.

Items for the pantry will come from internal food drives and Second Harvest Food Bank  of East Central Indiana, which provided the first installment last week. The IU Health BMH Foundation has entered a partnership with the agency and will pay the customary convenience fee applicable to other local pantries.

Employees and volunteers can use the pantry anonymously and are only asked to list the number of people in their households  on the sheet provided, per Second Harvest’s request.

There are no income and time guidelines for who can use the pantry and how often. Users are simply asked to take what they need, remembering others also visit the pantry. Visit the Muncie Press for the story.

Study links high sodium 'fizzy' medicines to raised heart risks

Millions of patients worldwide taking effervescent, dispersible and soluble medicines have an increased risk of heart attacks and strokes because of the high salt content of such drugs, scientists said.

Researchers from Britain's University of Dundee and University College London found that with some "fizzy" versions of painkillers, vitamin supplements or other common medicines, taking the maximum daily dose would on its own exceed daily recommended limits for sodium, the main component of salt.

High salt intake has been linked to high blood pressure, or hypertension, which is a key risk factor for strokes, heart attacks and other cardiovascular diseases. In a study published in the British Medical Journal, they found that patients taking dispersible forms of drugs had a 16 percent increased risk of a heart attack, stroke or vascular death compared with patients taking the non-high-sodium versions of the same medications.

Jacob George, an honorary consultant in clinical pharmacology at Dundee who led the study, said patients, and consumers of over-the-counter medicines - such as soluble aspirin, effervescent vitamin C, or Bayer's Alka Seltzer for example - "should be warned about the potential dangers" of high sodium intake in medicines.

Doctors, he added, should be aware of the potential dangers and prescribe fizzy or soluble forms of drugs "with caution, only if the perceived benefits outweigh the risks".

For this latest study, George's team tracked more than 1.2 million patients, comparing those taking sodium-containing effervescent, dispersible and soluble medicines with those taking non-sodium versions of the same drugs. The study ran between 1987 and 2010 and patients were tracked for an average of just over seven years.

During this time, over 61,000 new so-called cardiovascular events - including heart attacks and strokes - occurred in the patients being studied. Beside the 16 percent higher risk of a heart problem or stroke, the team also found patients taking sodium-containing drugs were seven times more likely to develop high blood pressure, and their overall death rate was 28 percent higher. (Reuters) Visit Business World for the article.

34 Chicago-area hospitals to join health information exchange

Thirty-four Chicago-area hospitals are banding together to share secure patient data through a new health information exchange. Healthcare officials say the effort will help hospitals better care for patients and reduce unnecessary and expensive tests.

MetroChicago HIE, scheduled to launch early next year, is an online portal that will allow for patient information, such as lab tests, imaging, health conditions, medicines and treatment, to be shared in real time among hospitals, doctors and eventually patients themselves.

The initiative, led by the Metropolitan Chicago Healthcare Council, a trade group representing 170 hospitals and health care organizations, is expected to be announced Monday. The group said it will be among the country's largest health information exchanges.

Digitizing patient health information and allowing it to be shared among disparate providers can help prevent errors by ensuring that everyone involved in a patient's care, including primary care doctors, specialists and emergency departments, has access to the same information, said Guy Alton, chief financial officer at St. Bernard Hospital.

The 210-bed Englewood hospital, which treats a largely transient and poor population of patients, sees between 10,000 and 12,000 patients in its emergency room each year who have limited means to pay for services. Often, Alton said, those patients also have received treatment recently at other hospitals, where they may have had lab tests or imaging services or been given prescription medicines.

For patients, particularly those with chronic illnesses and thick medical files, the data repository can help reduce the time they must spend filling out paperwork and briefing providers on their medical history. It also can help by tracking their prescriptions, which can be difficult for some with complex medical conditions.

Hospitals, meanwhile, see the information exchange as a chance to save money, reduce medical errors and coordinate patient care, all increasingly important initiatives because of changes in the way they're paid by government and private insurers.

Sharing data metrowide is "a logical and necessary step in how health (information technology) can positively impact clinical care," said Dr. Julio Silva, the information exchange's medical director and the chief medical information officer for Rush University Medical Center. "If you think about any individual institution's ability to provide an environment that allows for great quality of care as efficiently as possible, the availability of this new data is incredibly valuable."

That's particularly true in a region as large as Chicago, where the hospital and healthcare market remains largely fragmented, despite a recent wave of consolidation. For example, a patient might seek primary care in the suburbs but have a specialist at an unaffiliated hospital downtown. A patient might visit a separate emergency department or urgent care center.

The initial group of hospitals participating includes 10 owned by Advocate Health Care, 10 by Presence Health, four by Sinai Health System, three by Rush and two each by Centegra Health System and Franciscan St. James Health. Three independent safety-net hospitals — Norwegian American, St. Bernard and Swedish Covenant — also will participate.

From 20 to 30 others in the region are expected to join by summer. Officials hope that eventually, each of the Chicago metro area's 89 hospitals will sign on. Plans to expand include other organizations, including skilled nursing centers and long-term care facilities. The council hired Ft. Worth, TX-based Sandlot Solutions Inc. to host the exchange. Terms were not disclosed.

Dan Yunker, the council's senior vice president, who is also chief executive of the startup insurer Land of Lincoln Health, said the cloud-based service is secure and adheres to privacy standards set by the Health Insurance Portability and Accountability Act.

Hospitals generally will be charged on a per-record basis. Though officials would not discuss details of the contract, St. Bernard Hospital plans for annual costs of roughly $100,000, Alton said. Visit the Chicago Tribune for the article.

RSNA Conference coverage - Radiological Society of North America (RSNA) annual meeting in Chicago, Dec. 1–6, 2013

 

Bridging the divide between radiology, interventional oncology

Deeper collaboration between radiology and radiation oncology is necessary to realize the full potential of the two specialties whose paths diverged nearly 50 years ago, said Damian E. Dupuy, M.D., who presented the Annual Oration in Diagnostic Radiology as part of the RSNA Opening Session on Sunday.

"Our patients and the medical community will reap the benefits of a stronger collaboration," Dr. Dupuy said in his presentation, "We Must Stand on the Shoulders of Giants."

Dr. Dupuy contrasted the role of the two specialties from the 1970s to today. "In the good old days, it was 'we image and diagnose' and 'you treat,'" said Dr. Dupuy, director of tumor ablation at Rhode Island Hospital and a professor of diagnostic imaging at the Warren Alpert Medical School of Brown University in Providence, R.I. "Today, we must look at our strengths and weaknesses and work together to treat patients."

In his appeal for collaboration, Dr. Dupuy invoked the words of Anthony L. Zietman, M.D., M.B.B.S., a professor of radiation oncology at Harvard Medical School and presenter of the RSNA 2012 Annual Oration in Radiation Oncology. Dr. Zietman has noted that radiation oncology is very good at irradiating the microbes of small volume disease, while most ablative technologies handle larger tumors but they don't address microscopic disease. "Imagine how powerful it could be if we put them together," Dr. Dupuy said.

There are financial benefits to collaboration, he added. In the treatment of inoperable non-small cell lung cancer (NSCLC), interventional oncology may be able to provide a more cost-effective treatment, he said. "Radiofrequency ablation (RFA) and stereotactic body radiation therapy (SBRT) have similar treatment outcomes for inoperable NSCLC, but RFA is about a third of the cost of SBRT," Dr. Dupuy said. "That's something we need to look at when the cost of lung cancer care in the U.S. is projected to be $14 billion by 2020."

In the new healthcare paradigm where evidence-based medicine is an increasingly important determinant of treatment decision-making, Dr. Dupuy said a cohesive team approach to cancer care makes the most sense. In order to change practice patterns, he said, it is also critical for novel technologies, such as image-guided tumor ablation (IGTA), to be rigorously studied in the National Cancer Institute's multicenter format, Dr. Dupuy said. IGTA and SBRT are currently the two alternative treatments for inoperable NSCLC patients.

Dr. Dupuy urged radiologists to help in the reunification process by seeking greater interdepartmental activities and sharing resources like medical physics and imaging. Visit RSNA for the report.

Toshiba’s new MR technologies make exams faster for better patient care and safer CT exams with dose reduction technology

To help healthcare providers image patients faster and more comfortably, Toshiba America Medical Systems, Inc. is introducing enhancements to its Vantage Titan MR product line. The new technologies improve workflow, image quality and patient comfort.

·         Flexible Coils: The high-density, 16ch Flex SPEEDER coils conform closer to the patient’s anatomy, improving signal-to-noise ratio for enhanced image quality. The light-weight coils are available in medium and large sizes and are ideally suited for general orthopedic and body imaging.

·         3T 32ch Head SPEEDER Coil: The 32ch Head SPEEDER coil provides superior image quality for high-end neuro applications in 3T imaging, such as fMRI and Diffusion Tensor Imaging, with high signal-to-noise ratio and high spatial and temporal resolution.

·         Rapid Transport System (RTS): The light-weight and easy-to-maneuver RTS is designed for transporting patients to the MRI suite for scanning without the need for repositioning, improving workflow and throughput. The RTS docks over the MR system’s couch, so the patient stays on one table during the entire imaging process, ensuring patient safety.

Healthcare providers can now deliver the safest CT exam possible, as Toshiba Medical Systems’ most advanced dose reduction technology, Adaptive Iterative Dose Reduction 3D (AIDR 3D), comes standard on all new Aquilion CT systems: Aquilion ONE ViSION Edition, Aquilion ONE, Aquilion Premium, Aquilion PRIME, Aquilion RXL and Aquilion LB.

AIDR 3D is Toshiba’s third-generation iterative dose reconstruction software that incorporates significant system enhancements by reducing radiation dose compared to conventional scanning. It helps Toshiba CT customers achieve the As Low As Reasonably Achievable (ALARA) principle, while still producing the image quality needed for accurate diagnoses.

Visit Toshiba’s in RSNA Booth #7330, North Hall. For more information, visit the TAMS website at www.medical.toshiba.com.

GE Healthcare's "Brilliant Machines" software transforms the patient experience by reducing wait times and helping hospital staff increase efficiency

GE Healthcare, a unit of General Electric Company (NYSE: GE), unveiled four software breakthroughs to deliver improved clinical capabilities, productivity and diagnostic confidence for clinicians.

Up-to-date, reliable and accurate software is critical to quality care for the patient and usability for the clinician. GE Healthcare recently announced a $2 billion investment in software development that is focused on maximizing asset performance, improving hospital operations management, improving clinical effectiveness and optimizing care across entire populations. And now, GE Healthcare's Xeleris 3.1, DV24.0, VolumeRAD, Enterprise Imaging Solutions and iCenter further demonstrated this commitment.

In nuclear medicine, one of the greatest challenges clinicians face is access to the advanced and unique applications required to harness the power of nuclear medicine examinations. The latest release of GE Healthcare's Xeleris software enables automation, personalization and access to these advanced applications.

Nuclear medicine clinicians will gain access to specific image results where and when they are needed. With its open interface architecture, Xeleris applications can now be launched through an integrated unified desktop from the Universal Viewer, as well as using the generic Application Programming Interface with other PACS vendors, providing radiologists and nuclear medicine physicians with tools previously only available on the Xeleris workstation, for enhanced access and productivity.

"The personalized workflow and unique new clinical applications will give clinicians the information they demand with speed, convenience and flexibility," said Nathan Hermony, general manager for GE Healthcare's nuclear medicine business.

GE Healthcare MRI's mission is to deliver the best clinical solutions with great patient experience at the right cost and quality. This year, GE Healthcare MRI is pleased to announce DV24.0, a unique software platform featuring innovative applications like Silent Scan.

Additionally, DV24.0, with FOCUS, takes Diffusion Imaging to the next level with the ability to optimize for image quality and signal to noise. FOCUS provides high-resolution, organ-specific Diffusion-Weighted Imaging (DWI) and Diffusion Tensor Imaging (DTI) for a small field of view. MAVRIC SL, a new technique designed for imaging the joints of patients with MR conditional implants, is also featured in DV24.0 and is setting new standards in musculoskeletal radiology.

GE Healthcare's VolumeRAD offers improved detection and management of patients with lung nodules compared to conventional radiography for imaging of the chest. As the first thoracic radiographic tomosynthesis product with a specific indication, this advanced application aims to improve the detection of lung nodules and the subsequent management of patients. VolumeRAD is 7.5 times more sensitive than chest X-Ray in detecting lung nodules 4mm -- 6mm in diameter, and patients benefit from low dose by receiving only 1.6 times more radiation than a 2 view (PA and LAT) chest x-ray exam.

GE Healthcare is introducing its expanded suite of Enterprise Imaging Solutions to help lower IT costs, improve clinician productivity, expand networks of care and enhance diagnostic confidence. The launch features Centricity 360 solution that connects unaffiliated clinicians and patients through a professional online collaboration tool and gives them secure on demand access to imaging applications. Centricity 360 is the newest addition to GE's PREDICTIVITY solutions, which harnesses the power of the Industrial Internet to help industrial organizations achieve zero unplanned downtime and peak productivity. GE Healthcare's Enterprise Imaging Solutions also include Centricity PACS with Universal Viewer and Centricity Clinical Archive, recently validated by IHS as the Number One global vendor neutral archive (VNA).

GE Healthcare's iCenter provides instant access to critical information such as asset status, location, maintenance history, and use and planning -- which helps enable data-driven decisions and improved operational results. Now information is easier to digest with a more dynamic, customizable and colorful user interface. Improvements mean fewer clicks, a built-in analytics engine for more visual and intuitive data depiction, user security enhancements, and integrated guided tours. iCenter is the platform for future online service applications from GE Healthcare.

Visit GE Healthcare at booth number 4033 in McCormick Place south hall. Visit here for the Digital press kit: http://invent.ge/RSNA13.