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October 2, 2015   Download print version

There are now officially 70,000 ways to get sick or die

CDC reports injuries cost the US $671 billion in 2013

New test detects all the viruses that infect people, animals

Every 9 minutes, someone in the world dies of rabies

HHS enhances preparedness with new products to treat severe burns

HHS sponsors development of drug for hospitalized influenza patients

Doctors advised to wait longer before diagnosing miscarriages

New virus found in blood supply — but don't freak out just yet


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Self Study Series:
October 2015

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There are now officially 70,000 ways to get sick or die

There are 70,000 ways to get sick, hurt or mortally injured, and the U.S. is making them official.

On Thursday, U.S. hospitals, doctors and other care providers had to start using internationally developed standards called ICD-10 codes to bill government programs and private insurers in the nation’s $2.9 trillion-a-year healthcare system. The codes cover everything from parrot bites to getting sucked into a jet engine.

Doctors have already begun mocking the diagnostic list, picking out the most absurd and arcane, such as Z63.1, “Problems in relationship with in-laws,” or V91.07XA, “Burn due to water skis on fire.” Yet for healthcare providers who have payments at stake, the complex change is no joke.

Health insurers and government programs stopped accepting the old set of ICD-9 codes in the early morning hours Thursday, completing the switch.

In a study released last month, the Government Accountability Office, said “little is known” about how much it will cost the healthcare system to make the transition. HCA Holdings Inc., the Nashville, TN-based hospital chain, said 2015 costs for the transition to the new codes will be about $30 million.

Insurers began preparing for ICD-10 in 2010 and have been ready since the government first delayed implementation in 2012, said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, a Washington-based industry group.

Concerns about the changeover grew as the possibility loomed that Congress might not pass a spending bill and cause a shutdown of the federal government. The administration, which mandated adoption of the new codes, has said it’s ready, despite any political or technical challenges.

Administration officials, who have already delayed the codes’ debut twice, say the system will help identify efficient ways to manage all kinds of conditions, from heart disease to roller-skating injuries. 

Some hospitals and physician groups are putting aside reserves in case of interruptions in reimbursement, said Lana Cabral, senior director of case management services for Conifer Health Solutions, a unit of the hospital company Tenet Healthcare Corp. Conifer, which processes bills for doctors and hospitals, has set up a “command center” to manage the transition, she said.

And if, even after all the efforts to get the transition right, doctors and hospitals are still dealing with problems, there’s an ICD-10 code for that -- F43.22: “Adjustment disorder with anxiety.”

Visit Bloomberg for the story.

CDC reports injuries cost the US $671 billion in 2013

The total cost of injuries and violence in the United States was $671 billion in 2013, according to two Morbidity and Mortality Weekly Reports (MMWR) released by the Centers for Disease Control and Prevention (CDC).

The cost associated with fatal injuries was $214 billion; nonfatal injuries was $457 billion. Each year, more than three million people are hospitalized, 27 million people are treated in emergency departments and released, and more than 192,000 die as a result of unintentional and violence related injuries.

The two studies include lifetime medical and work loss costs for injury-related deaths and injuries treated in hospitals and emergency departments and break down costs by age, gender, and injury intent. Other key findings include:

·         Males accounted for a majority (78 percent) of costs for injury deaths ($166.7 billion) and nonfatal injury costs (63 percent; $287.5 billion); 

·         More than half of the total medical and work-loss costs of injury deaths were from unintentional injuries ($129.7 billion), followed by suicide ($50.8 billion) and homicide ($26.4 billion);

·         Drug poisonings, which includes prescription drug overdoses, accounted for the largest share of fatal injury costs (27 percent), followed by transportation-related deaths (23 percent) and firearm-related deaths (22 percent);

·         The cost for hospitalized injuries was $289.7 billion in 2013; the cost for injuries treated and released in hospitals and emergency departments was $167.1 billion; and

·         Falls (37 percent) and transportation-related injuries (21 percent) accounted for a majority of the costs associated with emergency department treated non-fatal injuries.

To review the full report and the study details, visit the CDC.

New test detects all the viruses that infect people, animals

Unlike standard tests, the ViroCap tests for the viruses and all of their variations at the same time, making it faster and far less expensive.

Researchers have developed a new test that can detect nearly any virus known to infect humans and animals, offering the potential to help doctors diagnose infections even without a clue of what they are looking for.

The test, called ViroCap, is likely years from being used regularly with patients because its accuracy needs to be verified in extensive clinical trials. The technology is being made publicly available, however, to scientists and doctors as it continues to be developed.

"With this test, you don't have to know what you're looking for," said Dr. Gregory Storch, a professor of pediatrics at Washington University in St. Louis, in a press release. "It casts a broad net and can efficiently detect viruses that are present at very low levels. We think the test will be especially useful in situations where a diagnosis remains elusive after standard testing or in situations in which the cause of a disease outbreak is unknown."

The researchers created a panel with sequences and tests DNA and RNA from viruses in 34 organism families, and was found to be just as sensitive as polymerase chain reaction, or PCR, assays but can test for all the viruses at once, which traditional tests can't do. It can also test for variations on more common viruses, offering the potential to catch infections that doctors may never even consider.

In two sets of samples, from blood, stool and nasal secretions, researchers compared the results of standard PCR tests against the ViroCap. The PCR caught viruses in 10 of 14 patients, however the ViroCap detected viruses in the other 4 patients. The viruses missed were relatively common: influenza B, a cause of seasonal flu; parechovirus, a mild gastrointestinal and respiratory virus; herpes virus 1, responsible for cold sores in the mouth; and varicella-zoster virus, which causes chickenpox.

Overall, the researchers reported that ViroCap had a 52 percent improvement over PCR tests for viruses, jumping from 21 to 32 being detected.

The study is published in Genome Research. Visit UPI for the story.

Every 9 minutes, someone in the world dies of rabies

A human death from rabies is a tragic but rare thing in the United States and most developed nations. It's just as tragic but sadly common in parts of the world where some 3 billion people are at risk of being bitten by a rabid dog. More than 59,000 people die of rabies each year because they cannot get the care they need. That's about 1 person dying of rabies every 9 minutes.

Most of these deaths are in Africa and Asia, and nearly half of the victims are children under the age of 15. Many of these lives can be saved if bite victims and healthcare providers know what to do and have what they need - rabies vaccine and immunoglobulin.

The fact that so few people in the United States and other developed nations get rabies shows that the disease can be controlled. Canine rabies has been eliminated in the United States, thanks to routine dog vaccinations and licensing and better control of stray dogs. Since the control of canine rabies in the United States, it has now been recognized that numerous wild animals can be infected with this disease. For that reason, people still must remain aware of the risk of rabies and seek medical care when exposed to wildlife and unusually acting animals.

To combat rabies, CDC works with many partners, including the Global Alliance for Rabies Control (GARC), World Health Organization, Humane Society International, National Association of Public Health Veterinarians, and American Veterinary Medical Association. Together, these partners have made great strides toward eliminating rabies in countries hard hit by rabies.

For example, in Ethiopia, which has reported some of the highest rates of human and animal rabies deaths in the world, a project is under way to control canine rabies through activities such as education, mass dog vaccination clinics, spay-neuter campaigns, establishment of new laboratories to diagnose rabies in dogs, and training to show veterinarians how to safely capture and humanely euthanize dogs suspected of having rabies. CDC and partners are working together to establish the first rabies-free zone in Ethiopia and ultimately end canine rabies in this country.

Visit PR Newswire for the release.

HHS enhances preparedness with new products to treat severe burns

Four novel products to treat severe thermal burns will be developed and acquired under contracts with the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR). The products are intended to enhance the available treatment options for disaster response and are being designed to find uses in routine clinical burn care.

ASPR’s Biomedical Advanced Research and Development Authority (BARDA) will leverage authority granted under the Project BioShield Act of 2004 to purchase one of the products currently available commercially and fund late-stage development and procurement of the other three. These products will be added to the Strategic National Stockpile (SNS) or managed by vendors to help protect people from burn injuries resulting from radiological and nuclear threats.

The detonation of an improvised nuclear device would produce intense heat, resulting in many patients with severe burns. The treatments for such burns require complex procedures including surgical skin grafting that is resource-intensive and technically demanding. With only 127 burn centers nationwide, a mass casualty incident of this scale could easily overwhelm the nation’s burn care infrastructure.

The first product, Silverlon, could improve care for burn patients before they reach the hospital and can receive a surgical treatment for their burn injuries. Silverlon, manufactured by Argentum of Geneva, IL, is a long-acting silver-impregnated nylon bandage available commercially and used widely to cover acute wounds and first- and second-degree thermal burns. The silver helps control bacterial growth within the dressing.

The other three products are being developed to address challenges in burn care treatment. BARDA will fund pivotal clinical studies necessary for the companies to submit applications for approval from the U.S. Food and Drug Administration. While this late-stage product development takes place, BARDA will begin procuring the products for the SNS. Wide-scale use of the products could be permitted by FDA in a disaster response under an Emergency Use Authorization. 

Under a five-year, $40.4 million contract, MediWound of Israel will develop NexoBrid, a topical gel made of pineapple-based enzymes and designed to dissolve the damaged or dead skin tissue to create a clean wound-bed for skin grafting.

Stratatech Corporation of Madison, WI will advance its development of a novel cell-based skin substitute made from living human cells called StrataGraft. In addition, Avita Medical Americas, LLC of Northridge, CA will advance the development of a device called ReCell, which produces a topical spray derived from a small sample of the patient’s own skin

With the agreements, using Project BioShield authorities, BARDA has supported the development and procurement of 16 medical countermeasures – vaccines, drugs, and other medical products needed for emergencies – since 2004, including products needed to treat some of the health impacts of ionizing radiation, as well as drugs or products to treat illness from anthrax, smallpox, and botulism.

To learn more about ASPR and preparedness, response and recovery from the health impacts of disasters, visit the HHS public health and medical emergency website,

Visit HHS for the release.

HHS sponsors development of drug for hospitalized influenza patients

Development of an experimental influenza antiviral drug that may be more potent and could have a longer treatment window than existing drugs will receive support from the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR). The drug is being developed for use in treating patients hospitalized with influenza.

If development is successful and the drug receives U.S. Food and Drug Administration (FDA) approval, the drug could become the first specifically for this use and potentially the first in a new class of influenza antivirals.

The ASPR Biomedical Advanced Research and Development Authority (BARDA) will provide technical assistance and funding to Janssen Pharmaceuticals Inc., one of the pharmaceutical companies of Johnson & Johnson, in Raritan, NJ, for advanced development of the drug, JNJ-872 (also known as VX787). The contract will provide up to approximately $103.5 million over the next four years and three months. The contract includes options for additional work up to a total of approximately $131 million.

While other FDA-approved influenza antiviral medications are usually more effective if given within 48 hours of symptom onset, studies of JNJ-872 to date suggest that the experimental drug may provide clinical benefits when administered much later than 48 hours after symptoms begin.

JNJ872 may represent an entirely new class of influenza antiviral drugs that has a unique mechanism of action, meaning that the drug works through different mechanisms than currently available antiviral drugs. Having unique mechanisms of action may be important as influenza viruses emerge that are resistant to current antivirals drugs, particularly influenza viruses with potential to become pandemics.

BARDA’s goal in supporting JNJ872 is development of a product that can be used not only to treat hospitalized influenza patients but also to treat patients for whom influenza poses high risks, such as the elderly, pediatrics, and those with chronic conditions such as COPD and heart disease, and for use specifically in treating patients who have been hospitalized with influenza.

The new antiviral drug development project is part of BARDA’s comprehensive integrated portfolio approach for advanced research and development, innovation, acquisition, and manufacturing of vaccines, drugs, diagnostic tools, and non-pharmaceutical products for public health emergency threats. In addition to pandemic influenza, these threats include chemical, biological, radiological, and nuclear agents, emerging infectious diseases, and antimicrobial resistance. Visit HHS for the report.

Doctors advised to wait longer before diagnosing miscarriages

Doctors are being advised to wait longer before they diagnose a miscarriage in order to avoid the risk of ending a pregnancy that might have been viable.

Experts who have carried out a large study say the guidelines for hospitals on diagnosing a miscarriage need to be updated, so that women always get a second ultrasound scan two weeks after the first if the gestational sac seen in the scan is small. It is not always possible to be sure that a very small embryo with no detectable heartbeat is going to miscarry, they say.

A large study published in the BMJ Open journal looked at the outcomes for 2,845 women who arrived at NHS hospitals with bleeding or pain and had a scan that doctors felt showed the continuation of the pregnancy was uncertain. The researchers found that 19 pregnancies out of 549 would have wrongly been thought to have miscarried if the current guidelines had been followed and they had not been scanned two weeks later.

The guidelines from the National Institute for Health and Care Excellence say that a second scan should be offered if the gestational sac is over 25mm in diameter. Many doctors will offer a second scan even for a smaller pregnancy. But the guidelines need to state that this must happen, said Tom Bourne, consultant gynecologist at Queen Charlotte’s and Chelsea hospital, professor at Imperial College, and the lead author of the study. “When they are dealing with something as important as miscarriage, it has to be black and white,” he said.

The early weeks of pregnancy are an anxious time for women. About one in five pregnancies ends in miscarriage, most within the first three months. But establishing whether a miscarriage has taken place in the early weeks is difficult. It rests on the size of any embryo, if it can be seen, the size of the gestational sac and whether it appears empty, and whether a heartbeat can be detected during an ultrasound scan.

In 2011, as a result of work by the same team of experts, it was recognized that the guidelines that had existed were unsafe and that there was a risk that some viable pregnancies might have been ended. That led to the 2011 update. Broadly, the guidelines were now right, the team said, but they are not specific enough about the size of the embryo related to gestational age and should specify the 14-day wait between scans in most cases.

“Women should be able to rely on a diagnosis of miscarriage. It’s an area of medicine where the highest levels of caution are warranted,” said Bourne. “Just one misdiagnosis of miscarriage is too many. We have shown that perhaps people are being brought back too early. Most guidelines say if you’re uncertain, then come back in seven days, repeat the scan, and at that time you should expect to see a heartbeat or, perhaps if you have an empty sac, you should expect to see an embryo. (The Guardian) Visit EIN News for the story.

New virus found in blood supply — but don't freak out just yet

Scientists have found a new virus that can be transmitted by blood transfusions and other blood-based products. It looks a little like the hepatitis C virus, which can cause permanent liver damage, and a little like the human pegivirus, which appears to be harmless, the team reports in the journal mBio.

They've named it human hepegivirus-1 (HHpgV-1).

"We have been able to find a new virus. It's clearly transmitted as a result of human (blood) transfusion," said infectious disease expert Dr. Ian Lipkin, who oversaw the study team at Columbia University. "It is the first transfusion-associated virus that's been described in a long time. We don't know if it is going to be a significant cause of human hepatitis," Lipkin told NBC News.

But probably not, the researchers said.

To find it, the team sampled blood banked at the National Institutes of Health from 46 volunteers between 1974 and 1980. They found it in two samples. Both patients appear to have "cleared" the virus and there is no evidence it caused any disease. All the volunteers got blood products to treat hemophilia. The virus only showed up after they got transfusions.

Then they looked at samples from 106 people in another study, and found the virus in two more people. One appears to have been infected for as long as five years but both cleared the virus, too.

"We just don't know how many viruses are transmitted through the blood supply. There are so many viruses out there, and they need to be characterized in order to ensure that transfusions are safe," said Amit Kapoor, an assistant professor at Columbia University who led the study.

Hemophilia was once only treated with blood products taken from people. Now it's often treated with genetically engineered products, which do not carry infectious agents.

Now that the genetic sequence of this new virus is published, Lipkin said, other scientists can start looking for it.

"More than 30 million blood components are transfused annually in the United States alone. Surveillance for infectious agents in the blood supply is key to ensuring the safety of this critical resource for medicine and public health," the researchers wrote. Visit NBC News for the article.