Short hospital stay linked to increased risk of death following hip fracture

Hip fractures in the elderly are a major cause of disability and associated with an increased risk of death. The growth of the elderly population along with rising healthcare costs has placed considerable strain on hospitals. Consequently hospital bed shortages are now commonplace across Europe and length of stay in hospitals has generally decreased. Previous research has shown mixed results on patient outcomes of shorter length of hospital stay.

A team of researchers, led by Peter Nordström at Umeå University, examined the effect of the length of stay in hospital on the risk of death following a hip fracture among older persons. Results showed that average length of stay in hospital decreased from 14.2 days in 2006 to 11.6 days in 2012. Patients had an average age of 82.2 years. Patients who stayed in hospital for up to 5 days had twice the risk of death compared with patients staying 15 days or more.

High risk groups included men, patients with specific fractures along the femur connecting to the hip bone and certain conditions such as, chronic obstructive pulmonary disease, renal failure and cardiovascular disease.

The effect of hospital stays according to number of days was also analyzed. Hospital stays of less than 10 days were linked to a higher risk of death. And each one day reduction in hospital stay increased the risk of death by 8% in 2006 and this rose to 16% in 2012. This effect disappeared with hospital stays of 11 days or more. Age was found to be the strongest predictor of risk of death within one year of admission.

Shorter hospital stay may reduce proper rehabilitation that enables patients to regain mobility, for example, and limits access to medical staff, further assessment and appropriate care, explain the authors. Visit UMU for the report.

Fancy hospital flourishes often fail to impress patients

When Johns Hopkins Medicine opened gleaming new clinical buildings, it created a natural experiment to gauge patient satisfaction.

The sleek hospital tower that Johns Hopkins Medicine built in 2012 has the frills of a luxury hotel, including a meditation garden, 500 works of art, free wi-fi and a library of books, games and audio.

As Dr. Zishan Siddiqui watched patients and some fellow physicians in Baltimore move from their decades-old building into the Sheikh Zayed Tower, the internist saw a rare opportunity to test a widespread assumption in the hospital industry: that patients rate their care more highly when it is given in a nicer place.

For decades, hospital executives across the country have justified expensive renovation and expansion projects by saying they will lead to better patient reviews and recommendations. One study estimated $200 billion might have been spent over a decade on new building. Hopkins' construction of the tower and a new children's hospital cost $1.1 billion. Patient judgments have become even more important to hospitals since Medicare started publishing ratings and basing some of its pay on surveys patients fill out after they have left the hospital.

Siddiqui's study, published this month by the Journal of Hospital Medicine, contradicts the presumption that better facilities translate into better patient reviews. Siddiqui examined how patient satisfaction scores changed when doctors started practicing in the new tower, which has 355 beds and units for neurology, cardiology, radiology, labor and delivery and other specialties.

Siddiqui discovered that for the most part, patients' assessments of the quality of the clinical care they received did not improve any more than they did for patients treated in the older Hopkins building, which had remained open. Units there were constructed as early as 1913 and as late as 1980, Hopkins officials said. They functioned as the control group in the study, since a hospital's satisfaction scores often change over time even when a hospital's physical environment remains constant.

The study used the responses both to Medicare-mandated surveys and private ones from Press Ganey, a consulting company that administers surveys. In the study, Hopkins patient ratings about the cleanliness and quiet in new tower's rooms—elements Medicare uses in setting pay—soared, as did views on the pleasantness of the décor and comfort of the accommodations. But patient opinions about their actual care – such as the communication skills of doctors, nurses and staff — didn't rise any higher than they did in the older building.

The study's results were startling because previous studies have found that patients in older hospital buildings give lower scores on the quality of their care. Hospital executives have noticed it anecdotally as well. For instance, when NYU Langone Medical Center relocated its cardiology unit to a renovated floor, its patient experience scores rose.

Newer buildings allow for some medical benefits, such as better organized nursing stations and private rooms that protect against the spread of infectious bacteria and diseases. But some hospital leaders excuse low patient ratings by blaming the physical environment. The Hopkins researchers said their study showed that "hospitals should not use outdated facilities as an excuse for achievement of suboptimal satisfaction scores."

Visit NPR for the study.

Watchdog group seeks FDA ban of antifungal tablets

A consumer safety group is calling on the Food and Drug Administration to pull certain antifungal tablets off the market, saying there are safer medicines that do not carry risks of liver damage. Public Citizen filed a petition Tuesday asking the FDA to ban ketoconazole tablets, which are used against hard-to-treat fungal infections.

First approved in 1981, the drug has long carried a boxed warning about potentially fatal liver damage. In July 2013 the FDA restricted ketoconazole's use to infections that do not respond to other drugs. The agency also required that all patients filling a prescription receive a medication guide detailing the drug's risks.

But Public Citizen notes that European regulators went further, recommending that all oral versions of the drug be removed from the market. Additionally, the consumer watchdog group points to an internal FDA memo in which 14 scientists from the agency's surveillance unit conclude that ketoconazole's risks outweigh its benefits.

Those findings were delivered at an agency workshop in January 2013, six months before the FDA decided to restrict the drug's use, but keep it on the market.

Last year U.S. patients filled 462,000 prescriptions for the drug, according to data cited by Public Citizen. Ketoconazole is also available in topical formulations, though Public Citizen says those versions do not carry the risks cited in the petition. Tablets of the drug are sold by generic drugmakers Teva Pharmaceuticals and Mylan Inc. (Associated Press) Visit ABC News for the story.

Dr. Google may not be the best way to get information for picking a hospital

Searching for health information online has become almost a reflex for anyone with access to a computer. Worried about that pain in your left side? Concerned about drug interactions? Need a dentist or a dermatologist? You probably consult Dr. Google.

But JAMA Internal Medicine has a new commentary article that questions the accuracy of online information about one of the biggest decisions you might have to make: picking a hospital.

Researchers Alex John London of Carnegie Mellon University and Yael Schenker of the University of Pittsburgh took a look at a study by Mariah Kincaid and other researchers about online ads for transaortic valve replacement, or TAVR, a minimally invasive procedure for treating the narrowing of the aortic valve that is common in older adults, particularly men. The study reviewed the online advertisements of all 317 U.S. hospitals that offer TAVR and found that all of them cited the benefits of the procedure — but only one-fourth acknowledged that it had any risk. And fewer than 5 percent of the hospitals quantified the risks in a way that would be useful to consumers.

Many of the ads, the researchers noted, are very informational — with “graphs, diagrams, statistics and physician testimonials” — and therefore not identifiable to patients as promotional material. This kind of “incomplete and imbalanced information” is particularly dangerous, they note, because of its deceptively professional appearance: “Although consumers who are bombarded by television commercials may be aware that they are viewing an advertisement, hospital websites often have the appearance of an education portal.”

The authors acknowledge that many clinicians encourage patients to look for information online as a way of participating in their own healthcare. But they say the “crowded landscape of biased information” may actually mislead consumers — and they say that closer scrutiny of hospital Web sites might give reason to support stricter advertising regulations. Visit the Washington Post for the story.

FTC cracks down on marketers of “Melanoma Detection” Apps

The Federal Trade Commission has challenged marketers for deceptively claiming their mobile apps could detect symptoms of melanoma, even in its early stages. In two separate cases, marketers of MelApp and Mole Detective have agreed to settlements that bar them from continuing to make such unsupported claims. The agency is pursuing charges against two additional marketers of Mole Detective who did not agree to settle.

According to the FTC’s complaints, each of the apps instructed users to photograph a mole with a smartphone camera and input other information about the mole. The apps then purported to calculate the mole’s melanoma risk as low, medium, or high. The FTC alleged that the marketers deceptively claimed the apps accurately analyzed melanoma risk and could assess such risk in early stages. The marketers lacked adequate evidence to support such claims, the FTC charged.

MelApp Settlement. Health Discovery Corporation began marketing MelApp online in 2011 for $1.99. The proposed settlement will bar the company from claiming that any device detects or diagnoses melanoma or its risk factors, or increases users’ chances of early detection, unless the representation is not misleading and supported by competent and reliable scientific evidence in the form of human clinical testing of the device. The settlement also prohibits the company from making any other misleading or unsubstantiated claims about a device’s health benefits or efficacy. Finally, the company must disgorge $17,963. Visit FTC for the ruling.

Self-healing hydrogel offers replacement to invasive surgical implants for drug delivery

A team of chemical engineers at MIT have developed a new self-healing hydrogel that is poised to replace current surgical implants used for drug delivery.

The findings have been published in a recent issue of Nature Communications. They show the success of a two-component system for getting patients drugs designed to treat certain cancers, macular degeneration, and a range of other diseases. Researchers involved with the project say the gel is an improvement on existing drug-delivery methods, which are either quickly dispersed away from the target site or require invasive implantation.

“Now you have a gel that can change shape when you apply stress to it, and then, importantly, it can re-heal when you relax those forces,” said Mark Tibbitt, a postdoctoral researcher at MIT’s Koch Institute for Integrative Cancer Research and one of the lead authors, in a university release. “That allows you to squeeze it through a syringe or a needle and get it into the body without surgery.”  

In changing the delivery method, the team is changing the drugs’ efficacy, too. Typical drug deliveries use a liquid solution, which disperse throughout the body after injection. But since the hydrogel quickly hardens near the desired tissue, drugs stay localized. This not only reduces the necessary amount of the drug a patient needs, but allows doctors to control the timing of multiple drugs that get delivered together.

For cancer patients, the hydrogel would attack tumors that get left behind after surgery. If left unabated, residual cancer cells can multiply and reappear in the body with greater force. “Removing the tumor leaves behind a cavity that you could fill with our material, which would provide some therapeutic benefit over the long term in recruiting and killing those cells,” said Eric Appel, co-lead author on the paper. “We can tailor the materials to provide us with the drug-release profile that makes it the most effective at actually recruiting the cells.”

Visit Medical Daily for the release.

Another deadly reason why you should stop drinking soda

As a public health threat, soda is less the suspect than the messenger. Thanks to countless infographics, PSAs, and news stories revealing the astonishing number of teaspoons of sugar contained in a can of soda, it’s clear that the sweetener is the real culprit. High levels of consumption are linked not only with obesity but with the development of other chronic diseases, such as diabetes.

There’s more to worry about when it comes to soda—namely, cancer. According to a study by Consumer Reports and the Center for a Livable Future at the John Hopkins Bloomberg School of Public Health, sodas routinely have high levels of the chemical 4-methylimidazole, or 4-Mel, a common component of the caramel coloring that gives cola drinks their signature brown hue. The U.S. Food and Drug Administration does not regulate the amount of 4-Mel used in soda formulations, but in California products that contain more than 29 micrograms of the coloring agent must bear a label noting that it can cause cancer.

According to the analysis, based on current levels of consumption and the levels of 4-Mel found in retails samples, “we would expect to see between 76 and 5,000 cases of cancer in the U.S. over the next 70 years from 4-MeI exposure alone.”

The researchers looked at 110 sodas bought at retail locations in New York and California. According to the study, the highest concentration of 4-Mel was found in Malta Goya, while Coca-Cola had the lowest.

The study comes a day after Nestlé announced that it plans to drop artificial ingredients, including food dyes, from its candy products by the end of the year. In addition to switching Red 40 and Yellow 5 for plant-based coloring agents, which are used more broadly, the candy company is looking to remove caramel coloring from nine products. Similarly, brewer Newcastle recently announced that it will remove caramel coloring from its signature brown ale. Visit Yahoo for the story.

Chips under the skin: Biohacking, the connected body is 'here to stay'

If you could replace your car keys, website login data, credit cards and bus passes with a chip embedded under your skin, would you? This is a question addressed recently at the Kaspersky Labs Security Analyst Summit by biohacker Hannes Sjoblad from BioNyfiken. A pioneer in what has been deemed 'biohacking," Sjoblad is the leader of a group of biohackers in Sweden who took the first step in experimenting with embedded NFC chips -- by having them implanted into their own hands.

BioNyfiken, a grassroots open network based in Sweden, is a breeding ground for advancement in the field of biohacking. While it began with a small group of people willing to experiment with everything from "biology to cells to plants to Homo sapiens," in the last few months, over 300 people in the country have now volunteered to have NFC chips embedded in the skin between thumb and forefinger in their hands.

The first step was a successful crowdfunded Indiegogo campaign. The xNT NFC chip implant captured the attention not only of the media but the interest of the general public, and now the network is in full swing. Sjoblad himself has the implant, which he says he has developed in the last few months to replace not only his house keys, but also a bike lock, shop memberships around Sweden and his business card. However, the biohacker says chips under the skin have the potential to do much more -- and we can expect use to become commonplace in the future.

While the idea of chips embedded under the skin brings to mind the idea of cyborgs, Sjoblad was quick to point out at the conference that they are "already among us" -- thanks to pacemakers, medical implants, insulin pumps and neurally controlled prosthetics. Over time, the development and cost of materials to produce such technology becomes cheaper -- only 10 years ago mapping the human genome costed over $100,000, now it is closer to $10,000 -- and in the same way, rapid miniaturization of technology, lower production costs and demand for increased connectivity will propel under-the-skin smart technology forward.

For those concerned with privacy, the biohacker noted how wearable devices and mobile technology are already collecting and sharing our personal data. Where embedded NFC chips come in, however, is that we can achieve the same results but with "less clutter."

Sjoblad told attendees that by giving his body "the same language" as a computer system via the embedded NFC chip, life can be made more seamless and efficient. This may then open the way for a variety of uses and potentially an ecosystem around the platform -- especially as the Internet of Things (IoT) emerges.

Sjoblad also believes health monitoring will eventually move under the skin -- which will result in better data capture and intrusion, insofar that wearable devices designed for health will no longer be necessary. Visit ZD Net for the story.