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DAILY UPDATE

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September 19, 2014   Download print version

V.A. official acknowledges link between delays and patient deaths

Medical labs make test results easier for patients to understand

A blood test for depression proves the illness is not a matter of will

GHX Compass delivers supply chain visibility to hospitals and suppliers

Vitamin E intake critical during 'the first 1,000 days'

Merck's new tool in cancer fight

Hospital stay ups risk of multidrug-resistant infection

Crosstex introduces new Sparkle Disposable Air/Water Syringe tips

 
 

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V.A. official acknowledges link between delays and patient deaths

In a contentious hearing before Congress, a senior official from the Department of Veterans Affairs’ watchdog agency acknowledged for the first time on Wednesday that delays in care had contributed to the deaths of patients at the department’s medical center in Phoenix.

The disclosure by an official from the department’s inspector general’s office, coming after more than two hours of tough, sometimes confrontational exchanges with members of the House Veterans Affairs Committee, was a significant development in what has become a heated dispute over the quality of care at the Phoenix hospital, where revelations of secret waiting lists and other schemes to disguise long delays in care turned into a national scandal.

The Veterans Affairs medical center in Phoenix, where 1,700 patients were not placed on the official waiting list for doctors’ appointments, a report by the agency’s inspector general found. Republicans characterized the acknowledgment as an about-face, and expressed frustration and some anger that a report on the Phoenix hospital issued by the inspector general last month contained language widely viewed as playing down concerns about a link between the medical-care delays and veterans’ deaths.

As the waiting-list scandal began to break in Phoenix this spring — and soon became a national controversy that led to the ouster of the department’s secretary, Eric Shinseki, and the suspension of the hospital’s director — claims were made by whistle-blowers and on Capitol Hill that the deaths of as many as 40 veterans could be attributed to delays in care.

In its report last month, however, the inspector general said that while it found that 28 veterans in Phoenix, including six who died, had experienced “clinically significant” delays in care, its investigators were unable to “conclusively assert” that any deaths had actually been caused by the waiting-list delays.

That language was added after department officials reviewed an initial draft — standard practice with such reports. Some congressional Republicans objected to the late-stage inclusion of the language, arguing that it appeared to improperly exonerate the department. They also asked whether senior department officials had pushed to include the language. But officials from the inspector general’s office said no such request had been made.

At Wednesday’s hearing, the acting Veterans Affairs inspector general, Richard J. Griffin, stood firmly by the wording of the report. But under questioning by Representative David Jolly, Republican of Florida, Dr. John D. Daigh, the assistant inspector general for healthcare inspections, conceded that medical-care delays in Phoenix had contributed to some patient deaths.

Dr. Daigh did not say how many times he believed medical-care delays had contributed to deaths in Phoenix. In addition to the six veterans who died after experiencing clinically significant delays, the inspector general’s office revealed Wednesday that 293 veterans had died out of 3,409 cases it reviewed in Phoenix.

Griffin, a former deputy director of the Secret Service, told Jolly that a careful reader of his report would have understood that delays might have contributed to deaths. Jolly asserted that Griffin was undercutting “the confidence we have in the I.G. by not being able to answer that very simple question: Did it contribute to the deaths of veterans, yes or no?”

Representative Jeff Miller, Republican of Florida, who is the chairman of the committee, said, “The confirmation from I.G. officials today that delays contributed to the deaths of Phoenix-area veterans, and I.G. officials’ admission that they couldn’t rule out the possibility that delays caused deaths, changes the entire bottom line of the I.G.’s Phoenix report.”

Miller added: “Absent these qualifying statements, the I.G.’s previous assertions that it could not ‘conclusively assert’ that delays caused deaths are completely misleading. It’s absolutely inexplicable and outrageous that the I.G.’s Phoenix report failed to clearly make these distinctions.”

Earlier in the hearing, Griffin defended the addition of the disputed sentence in the final report, saying that changes were common between drafts of inspector general reports in all departments of the federal government. He also emphasized that medical conclusions drawn by his office were overseen by board-certified physicians on his staff, and restated that he stood by the findings of last month’s report. To say definitively that some patients would have lived had they gotten care sooner “was a bridge too far for our clinicians,” he said.

Also on Wednesday, the department took a step toward remedying the main cause of long delays at many medical centers — shortages of doctors, who can make more at private hospitals — by proposing raising physician and dentist salaries by $20,000 to $35,000. Visit the New York Times for the report.

 

 

Medical labs make test results easier for patients to understand

As more patients gain direct access to lab reports and test results, healthcare providers are offering new tools to help them navigate the maze of numbers and use the data to better manage their own care.

Individual patients now can see their results on a wide variety of medical tests including complete blood counts, urinalysis and allergy tests, under a federal rule that went into effect in April and pre-empted a number of state laws prohibiting disclosure to individuals. The results must be available on request within 30 days, no physician's authorization required. Laboratories have until Oct. 6 to comply.

The 30-day window provides doctors with time to review sensitive or complicated lab findings and meet with the patient in person to discuss them. For routine tests, though, more labs and hospitals are sending results directly to the patient, in some cases on the same day that the doctor receives them.

Quest Diagnostics, which provides diagnostic information services to about 30% of U.S. adults a year, launched a new secure patient website, MyQuest by Care360, when the federal rule went into effect on April 7. Patients can view their lab results on the site at no charge within 48 to 72 hours in most states, or get them on a recently enhanced mobile app. Since the April 7 website launch, Quest says it has delivered more than 700,000 lab results to users, four times the number sent in the prior six months.

Experts say patients with direct access to lab tests can spot worrisome results that may be overlooked or delayed at doctors' offices. Research suggests it is fairly common for abnormal test results to slip through the cracks.

Rather than showing patients copies of the raw lab reports typically sent to doctors, Quest now offers graphs and other visual depictions of results for common markers like cholesterol and blood sugar, putting them in relation to reference or normal ranges and including links to more detailed information.

A study led by Dr. Brian Zikmund-Fisher and published last month in the Journal of Medical Internet Research suggested that only 38% of patients with lower health literacy and numeracy skills could correctly identify when levels of hemoglobin A1C—the common measure of blood-sugar control for diabetes—were outside the reference range. His team is now designing a Web-based application to display blood sugar test results in a format that will be easy to understand when numbers are heading into a danger zone.

Managed-care giant Kaiser Permanente, which owns its own labs and has operations in eight states and Washington, DC, has since 2008 steadily increased the types of test results directly available to members on its KP.org patient portal. In Colorado most test results are released in one or two days; in California they are released immediately. Visit the Wall Street Journal for the article.

 

 

A blood test for depression proves the illness is not a matter of will

A new test that identifies particular molecules in the blood could help doctors diagnose patients with clinical depression, according to a new study published in the journal Translational Psychiatry. The blood test can also predict which therapies would be most successful for patients, and lays the groundwork for one day identifying people who are especially vulnerable to depression -- even before they’ve gone through a depressive episode.

But perhaps just as important, said lead investigator Eva Redei, Ph.D., is the potential the test has for taking some of the stigma out of a depression diagnosis. When depression can be confirmed with a blood test like any other physical ailment, she said, there’s less stigma about having the disease and getting treatment.

The most effective way to treat depression is to treat it early, but past studies show that it takes an average of two to 40 months to diagnose depression -- if it gets diagnosed at all. Redei’s depression blood test could lead to faster and more accurate diagnoses, thereby transforming the way depression is treated.

If Redei’s findings are independently replicated and confirmed, then approved by the Food and Drug Administration, laboratories across the U.S. could incorporate the test into their battery of routine exams. This is in contrast to MDDScore, a depression blood test owned by Ridge Diagnostics that was announced in 2012. Because the test is proprietary to Ridge Diagnostics, doctors have to submit samples to the company’s lab in North Carolina, where the company analyzes the blood and sends back results. Redei's test, however, "can be done by any clinical laboratory anywhere, just like a cholesterol test,” Redei explained. “That is, assuming that we can go through the FDA approval [process] fast.”

"Being aware of people who are more susceptible to recurring depression allows us to monitor them more closely,” said David Mohr, Ph.D., co-lead author of the study in a press release. “They can consider a maintenance dose of antidepressants or continued psychotherapy to diminish the severity of a future episode or prolong the intervals between episodes.”

Redei acknowledged that the next step in research would be to run the tests on larger samples in order to validate the models and then submit them for FDA approval.

Major depressive disorder affects an estimated 6.7 percent of the U.S. population and is the leading cause of disability for Americans ages 15 to 44, according to the Anxiety and Depression Association of America. Despite the research hurdles she still needs to overcome, Redei is confident that her test can make a positive impact on the millions who struggle with depression -- not only by making treatment more precise, but by bringing psychiatry "into the 21st century,” Redei said. Visit the Huffington Post for the article.

 

 

GHX Compass delivers supply chain visibility to hospitals and suppliers

GHX announced GHX Compass, a new online tool to help North American hospitals and healthcare suppliers gain greater visibility into key performance indicators (KPIs) for greater supply chain automation, savings and efficiencies. 

At a time when the healthcare industry is facing tremendous pressure to lower costs while improving patient care, GHX Compass provides the more than 18,000 provider sites and 10,000 suppliers in the GHX Global Network of supply chain, finance and clinical professionals with on-demand access to key metrics such as volumes, contract match percentage, and exception rates for providers; and volumes, exceptions, and order conversion rates for suppliers. Visibility into these metrics enables organizations to set supply chain goals, track organizational progress, and benchmark performance against ‘best in class’ peer organizations.

With the GHX Compass dashboard, customers can track individual results with year-over-year and period-over-period trending via interactive charts and graphs. GHX Compass helps customers stay on track and exceed their performance objectives through default goals applied annually or to a customer’s fiscal year period, challenging customers to continuous improvement.  

GHX rigorously evaluated the dashboard metrics and modeled results showing that the more organizations automate business processes, the greater the savings that can be achieved. GHX Compass includes a view that shows potential savings from other GHX solutions for contract, price and item master management, as well as order cleaning and channel consolidation. Visibility into your organization’s operational and financial performance in areas such as purchase order and invoice growth, contract match, and exceptions is also included along with aggregated KPIs and contributor data on a monthly, quarterly, and yearly basis. Savings data is modeled at the highest level of the organization and then one level below to represent divisions. 

GHX Compass is multi-browser compliant, certified on IE 8-11, Safari, Chrome and Firefox with a responsive design to be viewed on tablets and smart phones and is available now for pilot customers, with general availability October 1, 2014. Visit GHX for more information.

 

 

Vitamin E intake critical during 'the first 1,000 days'

Amid conflicting reports about the need for vitamin E and how much is enough, a new analysis suggests that adequate levels of this essential micronutrient are especially critical for the very young, the elderly, and women who are or may become pregnant.

A lifelong proper intake of vitamin E is also important, researchers said, but often complicated by the fact that this nutrient is one of the most difficult to obtain through diet alone. It has been estimated that only a tiny fraction of Americans consume enough dietary vitamin E to meet the estimated average requirement.

Meanwhile, some critics have raised unnecessary alarms about excessive vitamin E intake while in fact the diet of most people is insufficient, said Maret Traber, a professor in the College of Public Health and Human Sciences at Oregon State University, principal investigator with the Linus Pauling Institute and national expert on vitamin E.

"Many people believe that vitamin E deficiency never happens," Traber said. "That isn't true. It happens with an alarming frequency both in the United States and around the world. But some of the results of inadequate intake are less obvious, such as its impact on things like nervous system and brain development, or general resistance to infection."

Some of the best dietary sources of vitamin E – nuts, seeds, spinach, wheat germ and sunflower oil - don't generally make the highlight list of an average American diet. One study found that people who are highly motivated to eat a proper diet consume almost enough vitamin E, but broader surveys show that 90 percent of men and 96 percent of women don't consume the amount currently recommended, 15 milligrams per day for adults.

In a review of multiple studies, published in Advances in Nutrition, Traber outlined some of the recent findings about vitamin E. Among the most important is the significance of vitamin E during fetal development and in the first years of life; the correlation between adequate intake and dementia later in life; and the difficulty of evaluating vitamin E adequacy through measurement of blood levels alone.

Findings include: Inadequate vitamin E is associated with increased infection, anemia, stunting of growth and poor outcomes during pregnancy for both the infant and mother; Overt deficiency, especially in children, can cause neurological disorders, muscle deterioration, and even cardiomyopathy; Studies with experimental animals indicate that vitamin E is critically important to the early development of the nervous system in embryos, in part because it protects the function of omega-3 fatty acids, especially DHA, which is important for brain health. The most sensitive organs include the head, eye and brain.

Traber said she recommends a supplement for all people with at least the estimated average requirement of vitamin E, but that it's particularly important for all children through about age two; for women who are pregnant, nursing or may become pregnant; and for the elderly.

 

 

Merck's new tool in cancer fight

Merck & Co. said on Sept. 4 that the Food and Drug Administration approved what Merck said was a groundbreaking cancer treatment that it hopes will cure many patients and generate billions of dollars in revenue. On the same day, Bristol-Myers Squibb said bunk to that, alleging patent infringement in a lawsuit in federal court in Delaware, where both global pharmaceutical giants are registered.

Bristol-Myers, whose version of that type of cancer drug was approved in Japan in July, hoped the legal move would thwart Merck in the industry race to sell expensive cancer medicine.

Merck chief executive officer Ken Frazier used his opening remarks in his Tuesday appearance at the Morgan Stanley Global Healthcare Conference to say that the first U.S. approval of this type of cancer medicine was vindication of his 2013 strategy of narrowing the company's focus. That strategy involved selling what Frazier viewed as noncore divisions, such as consumer products, and eliminating 16,000 jobs, cuts that are being implemented through 2015.

"We said that we're going to focus on those areas where we thought we could lead, and that's what we have been doing in terms of investing in our internal pipeline and programs like Keytruda," Frazier said, referring to the brand name given to the anti-PD-1 cancer drug that has the chemical name pembrolizumab.

The drug is one of the so-called immunotherapy medications that try to unlock the body's immune system to fight cancer. Merck's FDA approval was only for patients who have tried other medications to fight a type of melanoma. It's not a huge group of people. Merck says it hopes to get FDA approval for use in other cancers but won't say that it hopes doctors prescribe Keytruda for those other cancers without waiting for the FDA. Read more at the Philadelphia Inquirer.

 

 

Hospital stay ups risk of multidrug-resistant infection

Each day of hospitalization increases the likelihood of the individual acquiring a multidrug-resistant infection, says an alarming study. ‘Our findings emphasize one of the risks of being in the hospital is acquiring a multidrug-resistant infection,’ said co-author John Bosso from the Medical University of South Carolina in the US.

For the study, the researchers gathered and analyzed historical data from 949 documented cases of Gram-negative bacterial infection at their academic medical center in the US. In the first few days of hospitalization, the percentage of infections associated with Gram-negative bacteria, classified as multidrug-resistant, was about 20 percent and rose fairly steadily until four or five days, then jumped dramatically, peaking at over 35 percent at 10 days. Statistical analysis suggested an additional one percent risk per day of hospitalization.

On any given day, about 1 in 25 hospital patients has at least one healthcare associated infection and over a third of these infections are caused by Gram-negative bacteria, many of which are resistant to one or more classes of antibiotics, the study noted. Visit the Healthsite for the report.

 

 

Crosstex introduces new Sparkle Disposable Air/Water Syringe tips

Crosstex International has introduced Sparkle Disposable Air/Water Syringe tips, the latest addition to the company’s Patient’s Choice treatment accessories product line.

Sparkle tips stand out among currently available disposable air/water syringe options because they include a four-part “Quad Core” air channel that keeps water and air flow separate and distinct for specific procedures. The tips connect directly to all air/water syringe handpieces without the need for an adapter, so tips can be changed out quickly and easily. The tips feature a beveled edge on each end; on the patient facing side, the beveled edge increases comfort—without it, the blunt hard plastic tip can be uncomfortable for patients, potentially even leaving scratches in the oral cavity.

The rounded edge, on the side of the tip that gets locked into the unit, helps prevent O-ring instrument damage. Additionally, the tips’ rigid construction assists with cheek retraction.

The tips are available in a series of translucent colors and/or clear, allowing clinicians to clearly see water flow (and potential blockages) in the water chamber. And all of the plastic tips are recyclable.

Single-use tips allow staff to completely eliminate any risks associated with reprocessing reusable metal tips, which have been found to harbor deposits which can’t be seen or removed. And another important advantage of single-use tips are that since no cleaning is required, clinicians save time and increase workflow productivity. Visit Crosstex for more information.