Obama administration presents national plan to fight Alzheimer’s disease

Flesh-eating germ rare, especially for the healthy

A marker in the lining of the lungs could be useful diagnostic technique for lung cancer screening

Former Beverly Hospital executive pleads guilty to soliciting bribes

New criteria provide guidance about when to use cardiac catheterization to look for heart problems

MedPricer and DataPros merger provides full complement of strategic sourcing services

Obama administration presents national plan to fight Alzheimer’s disease

Health and Human Services Secretary Kathleen Sebelius has released an ambitious national plan to fight Alzheimer’s disease. The plan was called for in the National Alzheimer’s Project Act (NAPA), which President Obama signed into law in January 2011. The National Plan to Address Alzheimer’s Disease sets forth five goals, including the development of effective prevention and treatment approaches for Alzheimer’s disease and related dementias by 2025.

In February 2012, the administration announced that it would take immediate action to implement parts of the plan, including making additional funding available in fiscal year 2012 to support research, provider education and public awareness. The Secretary announced additional specific actions, including the funding of two major clinical trials, jumpstarted by the National Institutes of Health’s (NIH) infusion of additional FY 2012 funds directed at Alzheimer’s disease; the development of new high-quality, up-to-date training and information for our nation’s clinicians; and a new public education campaign and website to help families and caregivers find the services and support they need.

To help accelerate this urgent work, the President’s proposed FY 2013 budget provides a $100 million increase for efforts to combat Alzheimer’s disease. These funds will support additional research ($80 million), improve public awareness of the disease ($4.2 million), support provider education programs ($4.0 million), invest in caregiver support ($10.5 million), and improve data collection ($1.3 million).

The plan, presented at the Alzheimer’s Research Summit 2012: Path to Treatment and Prevention, was developed with input from experts in aging and Alzheimer’s disease issues and calls for a comprehensive, collaborative approach across federal, state, private and non-profit organizations. More than 3,600 people or organizations submitted comments on the draft plan.

As many as 5.1 million Americans have Alzheimer’s disease and that number is likely to double in the coming years.

The initiatives announced include:

Research – The funding of new research projects by the NIH will focus on key areas in which emerging technologies and new approaches in clinical testing now allow for a more comprehensive assessment of the disease. This research holds considerable promise for developing new and targeted approaches to prevention and treatment. Specifically, two major clinical trials are being funded. One is a $7.9 million effort to test an insulin nasal spray for treating Alzheimer’s disease. A second study, toward which NIH is contributing $16 million, is the first prevention trial in people at the highest risk for the disease.

Tools for Clinicians – The Health Resources and Services Administration has awarded $2 million in funding through its geriatric education centers to provide high-quality training for doctors, nurses, and other healthcare providers on recognizing the signs and symptoms of Alzheimer’s disease and how to manage the disease.

Easier access to information to support caregivers – HHS’ new website, www.alzheimers.gov.

Awareness campaign – The first new television advertisement this summer will encourage caregivers to seek information at the new website was debuted. To read the National Plan to Address Alzheimer’s Disease, visit here.

Flesh-eating germ rare, especially for the healthy

ATLANTA – Aimee Copeland, a Georgia grad student, is fighting for her life because of the flesh-eating bacteria that infected her after she gashed her leg in a river two weeks ago. One of her legs was amputated and her fingers will be too, her father says, because of the spreading infection. She has a rare condition, called necrotizing fasciitis, in which marauding bacteria run rampant through tissue. Affected areas sometimes have to be surgically removed to save the patient's life.

The government estimates roughly 750 flesh-eating bacteria cases occur each year, usually caused by a type of strep germ. However, Copeland's infection was caused by another type of bacteria, Aeromonas hydrophila. Those cases are even rarer. One expert knew of only a few reported over the past few decades. About 1 in 5 people with the most common kind of flesh-eating strep bacteria die. There are few statistics on Aeromonas-caused cases like Copeland's.

The germs that can cause flesh-eating disease are common in warm and brackish waters like ponds, lakes and streams. They are not a threat to most people. An infectious disease expert at Vanderbilt University, Dr. William Schaffner, said: "I could dive in that same stream, in the same place, and if I don't injure myself I'm going to be perfectly fine. It's not going to get on the surface of my skin and burrow in. It doesn't do that."

But a cut or gash — especially a deep one — opens the door for flesh-eating bacteria. Prompt and thorough medical care should stop the infection before it spreads. A wound can look clean, but if it's sutured or stapled up too soon it can create the kind of oxygen-deprived environment that helps these bacteria multiply and spread internally. Once established, these rare infections can be tricky to diagnose and treat.

Also, Aeromonas is resistant to some common antibiotics that work against strep and other infections, so it's important that doctors use the best medicines. (Associated Press) Visit USA Today for the article.

A marker in the lining of the lungs could be useful diagnostic technique for lung cancer screening

The most recent research released in June's Journal of Thoracic Oncology says molecular biomarkers in the tissue and fluid lining the lungs might be an additional predictive technique for lung cancer screening.

Since the National Lung Screening Trial found that 96.4 percent of the positive CT screening results were false positive, scientists have been looking for ways to more accurately diagnose patients. This research focused on a way to determine if the nodules detected by the CT screening, are in fact malignant or benign.

The study presented in the journal collected endobronchial epithelial-lining fluid (ELF) near a lung nodule using bronchoscopic microsampling, which is a less invasive procedure compared to surgery. After studying 142 ELF samples from 71 patients with pulmonary nodules, some cancerous, others non cancerous, the authors conclude that, "TNC (tenasin-C) gene expression and the nodule size are two independent factors that improved the prediction of lung cancer.

The authors point out that in previous research, "tumor markers like CEA and CYFRA were found to be in higher abundance in ELF close to the small peripheral lung carcinoma when compared to the contralateral site or benign cases." To learn more about IASLC please visit www.iaslc.org.

Reported increase in older adult fall deaths due to improved coding

The recent dramatic increase in the fall death rate in older Americans is likely the effect of improved reporting quality, according to a new report from the Johns Hopkins Center for Injury Research and Policy. The report finds the largest increase in the mortality rate occurred immediately following the 1999 introduction of an update to the International Classification of Diseases (ICD-10), suggesting a major change in the way deaths were classified. Several research studies, including one by the report’s authors, found that rates of fatal falls among seniors had risen as much as 42 percent between 2000 and 2006. The results are published in the May-June issue of Public Health Reports.

“We had been perplexed by the sudden increase because neither the nonfatal fall rate nor the fall-hospitalization rate increased significantly,” said Susan P. Baker, MPH, a professor with the Johns Hopkins Center for Injury Research and Policy, part of the Johns Hopkins Bloomberg School of Public Health. “By ruling out these variables, we found that a change in how the underlying cause of death gets reported explains much of the widely-reported increase.”

As it turns out, the largest increase was seen in the coding subgroup “other falls on the same level,” which refer to when an individual falls on the same surface they are standing or walking on; such falls generally do not result in injury that is immediately life-threatening.

“Death following a minor injury from a fall typically involves the elderly and usually occurs weeks or months after the fall as the result of pneumonia or other complications. Previously, many of these deaths were coded as the illness rather than the fall,” said study author Guoqing Hu, PhD, faculty with the Central South University School of Public Health in China. “However after ICD-10 went into effect in 1999, the rate of deaths from this type of fall jumped, suggesting a major change in death certification practices.”

Each year, one in three older adults in the U.S. falls, making falls the leading cause of injury deaths for older Americans. The annual direct and indirect cost of fall injuries is expected to reach $55 billion by 2020. Accurate interpretation of recent trends is critical for understanding the effect of ongoing measures designed to prevent fall injuries in the elderly.

“Falls in older adults are indeed a major public health problem, and this report should not suggest otherwise,” concluded Baker. “In fact, it’s likely that for some time we’ve been under-reporting just how many older Americans die as a result of a fall, a hypothesis supported by international comparisons. Additional research and resources are needed to address this problem.” Visit Johns Hopkins for the study.

Former Beverly Hospital executive pleads guilty to soliciting bribes

Paul Galzerano, a former associate vice president at Beverly (Mass.) Hospital, pleaded guilty to soliciting bribes and kickbacks from hospital contractors and stealing artwork from the facility while it was under renovation, according to a Salem News report. Galzerano was sentenced to serve 18 months of a two-year jail term on four larceny counts and two years of probation for two counts of commercial bribery.

The Massachusetts attorney general's office sought four to five years in state prison for Galzerano, but Judge Howard Whitehead said Galzerano was already "penniless" and had "essentially been destroyed." He has lost his home and now lives in a homeless shelter, according to the report.

The attorney general's office estimated Galzerano was responsible for nearly $400,000 in theft. Contractors allegedly worked on his home and billed the hospital for the services, such as $10,000 worth of paving work, according to the report.

Along with accepting bribes from contractors to work on the renovation project between 2003 and 2007, Galzerano also stole approximately $25,000 worth of artwork and antiques from the facility, such as a grandfather clock and paintings. Visit Becker’s Hospital Review for the article.

New criteria provide guidance about when to use cardiac catheterization to look for heart problems

Cardiac catheterization is performed thousands of times in the United States each year and, in some cases, can be the best method to diagnose heart problems. Still, the procedure is costly and may pose risks to certain patients, so determining when the benefits of performing the procedure outweigh the risks is essential. A new report issued by the American College of Cardiology Foundation (ACCF) and the Society for Cardiovascular Angiography and Interventions (SCAI) in collaboration with a dozen other professional societies provides detailed criteria to help clinicians determine when cardiac catheterization is a reasonable option for the evaluation of patients for heart disease.

The panel identified 166 possible clinical scenarios when referral for diagnostic catheterization might be considered– drawn from the medical literature and anticipated clinical applications– and then assessed the appropriateness for each indication. Altogether, the group determined cardiac catheterization to be "appropriate" in about half of the clinical situations evaluated.

Nearly 30 percent of the scenarios were rated as "uncertain," where the procedure may be considered reasonable. The authors stress an uncertain designation should not be used as grounds for denial of reimbursement. Notably, cardiac catheterization was deemed not reasonable or "inappropriate" for 25 percent of the indications rated. Dr. Patel adds these are cases for which the procedure is not needed most of the time, but it is expected that a small percentage of the cases may be justified based on extenuating clinical circumstances.

While the document primarily focuses on the standard use of catheterization to detect blockages in the arteries that are indicative of coronary artery disease, the writing group also considered its application as part of an arrhythmia work up, in pre-operative testing and to evaluate patients with possible valve disease, pulmonary hypertension or the heart muscles' squeezing capacity. Although experts want to guard against overuse of cardiac catheterization and spare patients, there is also concern about underuse of the test, especially inpatients who need more timely diagnosis and for whom a cardiac stress test, for example, might delay a correct diagnosis and add unnecessary costs.

In general, the technical panel advises that cardiac catheterization is appropriate inpatients: Without prior stress testing but who report symptoms and have a high pretest probability, or high likelihood of disease in the physician's judgment; With definite or suspected acute coronary syndrome; With typical symptoms and intermediate- or high-risk findings on prior diagnostic testing.

Flow diagrams and a referral sheet for diagnostic catheterization are included with the report. Full text of the report will be published in the May 29, 2012, issue of the Journal of the American College of Cardiology and on the ACC web site (www.cardiosource.org).

Visit Medical Express for the release.

MedPricer and DataPros merger provides full complement of strategic sourcing services

MedPricer, a cloud-based e-Sourcing service for healthcare contracting and Tampa, FL-based DataPros, involved in cleansing, preparing, and analyzing healthcare procurement data, have joined forces to offer an expanded portfolio of products and services.

DataPros products and services are enhanced through: improved category opportunity analysis for deeper interpretation of results, enhanced purchased services insight and capabilities, and the ability to execute on data-identified opportunities for a tangible return on investment. MedPricer’s offerings are heightened with improved opportunity assessment, pristine data categorization enhancing event results, and continued business intelligence both pre- and post-sourcing, delivering ongoing value. Visit here for the release.

Superbugs spread to 40 nations threatening India medical tourism

A new type of superbug, scientists warn, is spreading faster, further and in more alarming ways than any they’ve encountered. Researchers say the epicenter is India, where drugs created to fight disease have taken a perverse turn by making many ailments harder to treat.

India’s $12.4 billion pharmaceutical industry manufactures almost a third of the world’s antibiotics, and people use them so liberally that relatively benign and beneficial bacteria are becoming drug immune in a pool of resistance that thwarts even high-powered antibiotics, the so-called remedies of last resort.

Poor hygiene has spread resistant germs into India’s drains, sewers and drinking water, putting millions at risk of drug-defying infections. Antibiotic residues from drug manufacturing, livestock treatment and medical waste have entered water and sanitation systems, exacerbating the problem. As the super bacteria take up residence in hospitals, they’re compromising patient care and tarnishing India’s image as a medical tourism destination.

The germs -- and the gene that confers their heightened powers -- are jumping beyond India. More than 40 countries have discovered the genetically altered superbugs in blood, urine and other patient specimens. Canada, France, Italy, Kosovo and South Africa have found them in people with no travel links, suggesting the bugs have taken hold there.

Drug resistance of all sorts is bringing the planet closer to what the World Health Organization calls a post-antibiotic era. Already, current varieties of resistant bacteria kill more than 25,000 people in Europe annually, the WHO said in March. The toll means at least 1.5 billion euros ($2 billion) in extra medical costs and productivity losses each year.

The new superbugs are multiplying so successfully because of a gene dubbed NDM-1. That’s short for New Delhi metallo-beta-lactamase-1, a reference to the city where a Swedish man was hospitalized in 2007 with an infection that resisted standard antibiotic treatments.

The NDM-1 gene is carried on mobile loops of DNA called plasmids that transfer easily among and across many types of bacteria through a form of microbial mating. This means that unlike previous germ-altering genes, NDM-1 can infiltrate dozens of bacterial species. Intestine-dwelling E. coli, the most common bacterium that people encounter, soil-inhabiting microbes and water-loving cholera bugs can all be fortified by the gene. What’s worse, germs empowered by NDM-1 can muster as many as nine other ways to destroy the world’s most potent antibiotics.

India is susceptible because it has many sick people to begin with. The country accounts for more than a quarter of the world’s pneumonia cases. It has the most tuberculosis patients globally and Asia’s highest incidence of cholera. More than half of the nation’s 1.2 billion residents defecate in the open, and 23 percent of city dwellers have no toilets, according to a 2012 report by the WHO and Unicef.

Abdul Ghafur, an infectious diseases doctor in Chennai, southern India’s largest city, sees patients every week who suffer from multidrug-resistant infections. He and others who used to successfully combat infections with such common antibiotics as amoxicillin now must use more-expensive ones that target a broader range of germs but typically cause greater side effects. Some infections don’t respond to any treatment, evading all antibiotics, he says.

That’s bad news because the more frequently the NDM-1 gene is inserted into different bacteria, the more likely it will enter virulent forms of E. coli, sparking outbreaks that may be impossible to subdue, says David Livermore, who heads antibiotic resistance monitoring at the U.K.’s Health Protection Agency in London.

“There is a tsunami that’s going to happen in the next year or two when antibiotic resistance explodes,” says Ghafur, 40, seated at a polished wooden table in a consulting room in Chennai as patients fill 20 metal chairs in the waiting area, forcing others into the corridor. “We need wartime measures to deal with this now.”

R.K. Srivastava, India’s former director general of health services, says the government is giving top priority to antimicrobial resistance, including increasing surveillance of hospitals’ antibiotics use. At the same time, it’s trying to preserve the country’s health-tourism industry. Bristling that foreigners coined a name that singles out their capital to describe an emerging health nightmare, officials say the world is picking on India for troubles that impede all developing nations.