April 2006 Daily Update Archive

Isolating sick people, rapidly treating family members with antiviral drugs, and closing schools and businesses will sharply reduce new infections in a future flu pandemic, according to a new mathematical model described in the British scientific journal Nature. An influenza pandemic in the United States would crop up first in population centers like Houston and be largely over within four months, according to the researchers who created a complex computer simulation of a flu pandemic in the U.S. and Great Britain. The strategies suggested are not new. But when plugged into the computer model and layered over travel patterns, population densities and data about flu transmission, what emerges is one of the most richly detailed glimpses to date of a much-feared pandemic, and the potential payoffs for various measures for survival. Lead author Neil Ferguson teaches in the department of infectious disease epidemiology at Imperial College London. He said his model, and another by the Los Alamos National Laboratory published earlier this month, are “unrivaled in their detail.” Ferguson and his colleagues at Johns Hopkins Bloomberg School of Public Health made their calculations using a number of assumptions. For instance, they estimated that 30 percent of transmission occurs within the household, 33 percent in the general community and 37 percent in schools and workplaces. The Los Alamos model showed how a particularly infectious pandemic strain might sicken 151 million Americans, or about half the population, if unimpeded by antivirals or vaccinations. A mortality rate similar to that of the 1918 flu, estimated at about 2.5 percent, would kill nearly 4 million in the U.S. The H5N1 strain circulating in birds and occasionally infecting people has a mortality rate of 50 percent, though most scientists believe the virus would be less virulent if it mutated into a human-to-human form. For now, the U.S. stockpile of antiviral drugs is too small to mount a successful defense, according to the model, Ferguson said. Halting the spread of the epidemic would require treatment for 150 million people. Even treatment for 75 million people could significantly reduce the impact. But the U.S. government is planning to stockpile treatment for only 51 million people by late 2008. Employing “social distancing”, keeping people away from each other, can have a dramatic impact on reducing infection rates, as it did during the 1918 flu pandemic. “But we're talking about 12 weeks to six months,” Ferguson said. “My own view is we wouldn't achieve a 50 percent reduction in contact rates” over such a prolonged period. The best hope would be blunting the pace of new infections, he said, and reducing demand for hospital services. (Houston Chronicle)

How useful would face masks actually be in the event of a flu pandemic? A 12-person panel of experts, convened by the government, answered part of that question. It said that form-fitting molded “respirators” would be better than clothlike surgical masks, and surgical masks would be better than handkerchiefs and scarves. But how much protection any would provide is largely unknown, as is the question whether they could be safely washed and reused if there were not enough new ones in a pandemic. “I would not recommend face masks alone. I would not recommend that anyone using a mask think that is adequate protection,” said John C. Bailar, a physician and epidemiologist who chaired the committee at the Institute of Medicine that examined the question. Masks are “part of a package that includes vaccination if it is available, isolation of patients and quarantining, closing of public meetings and schools, 'social distancing' and the washing of hands,” he said. The 97-page report was requested by the U.S. Department of Health and Human Services. Another member of the committee went further in warning people against relying on masks, whose effectiveness in protecting against flu is virtually unstudied. “Mask and respirator use is considered to be the very last in a series of activities that may be more effective in reducing the spread of flu,” said E. John Gallagher, chairman of emergency medicine at Albert Einstein College of Medicine in New York. What little is known about masks and respiratory infections comes from research on tuberculosis and severe acute respiratory syndrome (SARS), two infections that influenza may not mimic. Many companies are now stockpiling masks and gloves. The current growth of consumer demand is unknown, however. The Centers for Disease Control and Prevention has about 1 million masks in a national stockpile, with orders placed for 99 million more. Their delivery date, however, is also unknown. 3M and Kimberly-Clark Corp. are the two largest U.S. producers of medical masks. 3M's plants “have been working 24-7 for some time now,” said Jacqueline Berry, a company spokeswoman. Demand for masks in Asia began to rise in January 2005 and in Europe last summer. Since the start of this year, U.S. customers have been ordering more masks, Berry said. Among the many murky aspects of the subject are the names of the devices. “Surgical masks” or “medical masks” are pleated, soft, clothlike objects that cover the nose and mouth and tie behind the head. They cost about 15 cents apiece. “N95 filtering facepiece respirators” are fitted to the face by molding a cuplike mask that covers the nose and mouth. Like surgical masks, they are also made out of spun plastic fibers, but fit much more tightly. They do not work well with beards. N95 respirators, which cost $1 to $3 apiece, are designed to filter out 95 percent of particles that measure about 0.3 micrometers, or thousandths of a meter, in diameter. Influenza viruses range in size from 0.08 to 0.12 micrometers, though they are often clumped together or stuck to other airborne debris. Bulkier rubber respirators with replaceable filters, priced at $25 and up, are used in some non-healthcare settings. They were not evaluated by the committee. Masks and respirators stop particles three ways. Large particles and droplets can be stopped by the outer surface; smaller particles can be stopped by the mesh; and even smaller particles can be stuck to mask fibers by electrostatic charge. During an epidemic, surgical masks would be most useful for preventing infected people from coughing virus-laden droplets of saliva and mucus into the environment. The N95 respirators are the most useful in preventing healthy people from becoming infected by “respiratory aerosols”, microscopic clumps of material left floating in the air when the water in very small droplets evaporates. How often flu is transmitted by aerosols is unknown, but it does occur. A study found that in a commercial airplane carrying a person ill with a new strain of seasonal flu in 1979, 72 percent of passengers came down with flu. However, the circumstances were unusual; people were kept on the plane for three hours while a broken ventilation system was repaired. The Institute of Medicine committee said there were no data suggesting that surgical masks or N95 respirators could be cleaned and reused, and advised against doing so. In a shortage, however, a person could get more time out of a N95 device by wearing it covered with a surgical mask, the panel found. The surgical mask would be thrown away after a day's use, and the respirator stored in a clean bag for use later. This strategy was used in Asia during the SARS outbreak of 2003. (The Washington Post)

CDC: Milder than normal flu season ending

This year's flu season draws to a close as one of the mildest in recent years, partly because the vaccine was a good match for this winter's most common virus. Overall flu and pneumonia deaths were below those of a typical flu season, and health officials say fewer than two dozen children's deaths were reported. The one exception to the overall good news is a nasty outbreak of a different flu virus that hospitalized more than 30 children in Houston. In about half of the states, reports of flu-like illness are sporadic or virtually nonexistent now, according to the U.S. Centers for Disease Control and Prevention. “Flu season is pretty much over,” said David Engelthaler, Arizona's state epidemiologist. Flu was widespread in only five states, Connecticut, Delaware, Indiana, New York and Rhode Island, the week of April 9-15, the most recent data available. The long-lasting season started in December with a rush of cases in the Southwest that swamped hospital emergency rooms. It then rotated to other regions, with widespread activity in some areas as late as this month. But it hasn't been bad. “It has been a very mild season,” said Dr. Roland Levandowski of the National Institute of Allergy and Infectious Diseases. This season, the number of deaths are lower than normal. One possible reason: The vaccine seems to be doing the job. Last year, health officials, making essentially an educated guess, formulated the vaccine against three flu viruses. They were Type A New Caledonia, Type A California, and Type B Shanghai. Test results show 84 percent of people with confirmed flu this season had a Type A flu and the rest had a Type B. Of the patients who had Type A viruses, about 80 percent or more had viruses identical or similar to the A bugs in the vaccine. “The vaccine was a good match to the circulating viruses,” said Dr. Jeffrey Engel, North Carolina's state epidemiologist. Good, but not perfect: The B virus was not a good match. Nearly 70 percent of the people testing positive for a B virus had Type B Victoria, a version not found in the vaccine. For adults, that wasn't a big deal, because they've been exposed to both lineages of B flu through the years and could muster an immune response. But for some children never exposed to Type B Victoria, the result was more serious. Since mid-January, 31 children have been sent to Texas Children's Hospital in Houston for treatment of Type B Victoria flu. Some have suffered a rare complication called myositis, a painful inflammation of the calf muscles that hurts their ability to walk. Next year's flu vaccine will include Type B Victoria, health officials said. Some experts say there was additional bad news in the current flu season: The discovery that one Type A flu virus circulating this season is largely resistant to rimantadine and amantadine, two drugs commonly used to fight influenza. The resistance of such a common flu bug to the drugs could require significant changes in how doctors treat flu patients in the future, said Dr. Bruce Ribner, epidemiologist for Atlanta's Emory University Hospital. Some health officials also worry that the mild nature of this flu season will lull the public into forgetting the potential dangers of the common flu bug. (The Associated Press)

The American Society for Healthcare Environmental Services (ASHES) has launched an online business directory as a resource for its membership to easily find needed suppliers, products and services. The Phoenix Business Directory is an online database ASHES members can quickly browse to find suppliers, products and health care environmental services information. The directory is searchable by category or by geographical area and is available 24 hours a day, 7 days a week. Visit www.ashes.org and click on the Phoenix Business Directory logo to view the directory. With a click of the mouse, users are taken directly to the website listing. New listings will be added frequently and ASHES members are encouraged to check the directory often. Manufacturers, consultants, distributors and other health care service providers are encouraged to list their business in the Phoenix Business Directory. Interested companies may visit www.ashes.org and click on the directory's image at the bottom of the home page, or contact ASHES at 312-422-3860 to obtain an application. Applications are being accepted by mail, fax or online.

The Council of Supply Chain Executives (The Council), a division of the Institute of Healthcare Executives and Suppliers (IHES), announces the addition of Michael T. Langlois, Senior Vice President and Chief Supply Chain Officer of Ascension Health, to its roster of nationally acclaimed supply chain executives. Langlois is responsible for all aspects of Supply Chain Management including Logistics, Performance Measurement and Information Technology at Ascension Health, the largest nonprofit health system in the United States, with 67 acute care hospitals and dozens of related health facilities in 20 states and the District of Columbia. The Council is an organization that allows supply chain executives from across the country to assemble together to offer their best practices and experiences to their peers and to healthcare suppliers in focus group panels. The Council offers healthcare suppliers a collaborative forum to ask for feedback and advice from the country’s leading supply chain executives in a neutral and constructive environment. The Council of Supply Chain Executives will next convene on November 9-10, 2006 in Franklin, TN. The Council will provide their service to a limited number of healthcare suppliers. www.Councilhome.com.

Masimo Corporation announced that Dolphin Medical Inc. has agreed that it will discontinue its Dolphin ONE product line. The discontinuation is part of an agreement between Dolphin and Masimo Corporation, in which Masimo has agreed to release Dolphin and its affiliates from certain patent infringement claims.

MedAssets’ 2006 Healthcare Business Summit focuses
on innovation, transparency in healthcare

Amerinet introduces new leadership and new business model

MedAssets’ 2006 Healthcare Business Summit focuses
on innovation, transparency in healthcare

At its annual meeting in Las Vegas, April 19-20, MedAssets announced its initiative to drive innovation and support transparency in the healthcare industry by helping providers reengineer business processes and incorporate technology. In his address to the more than 2,500 healthcare professionals attending the MedAssets Healthcare Business Summit, MedAssets’ Chairman, President and CEO John Bardis emphasized the importance of transparency in sustaining our nation’s healthcare system. “We are all partners in the healthcare system, and we all have a responsibility to develop business strategies to improve the delivery and cost effectiveness of care,” Bardis said. “Normalizing the inequities between stakeholders within the healthcare environment is crucial to the future of the entire system and will ensure that America’s hospitals can continue to fulfill their mission of providing high quality patient care for years to come. There is currently a call for increased transparency in the healthcare industry that will help facilitate an improved financial balance between stakeholders, and MedAssets fully supports any effort to bring about positive change in this area.” MedAssets’ Merge Technology platform includes a suite of solutions to help providers prepare for the industry challenges such as pricing transparency and consumer-managed healthcare. During the event, MedAssets unveiled its strategy to drive process improvement in healthcare provider setting. With decision support as its core competency, MedAssets can access the financial impact of clinical outcomes to help healthcare organizations identify meaningful performance gaps. To address these opportunities, MedAssets then develops a customized program incorporating consulting and/or technology solutions, and monitors and evaluates the results. The combined capabilities of decision support, supply chain and revenue cycle solutions offers providers a single data repository and allows greater transparency for clinical, financial and operational decision-making. The general session of the MedAssets Healthcare Business Summit included the presentation of the 2006 Outstanding Humanitarian Award to Sister Alice Marie Quinn, D.C., Director of the St. Vincent Meals On Wheels program in Los Angeles in addition to other supplier and provider awards. The number of attendees increased approximately 25 percent more than last year’s meeting and was the largest in the company’s history. An addition to the meeting schedule this year was the MedAssets Revenue Cycle Forum in which chief financial officers and revenue cycle personnel learned of the latest trends in revenue cycle improvements. www.medassets.com.

The board of directors of health care group purchasing organization (GPO) Amerinet announced the appointments of a new CEO and COO. Victor E. Samolovitch was named as the new CEO replacing the retired Robert P. “Bud” Bowen. Selecting a new CEO represents the first phase of the GPO’s initiative to optimize resources and streamline operations with the implementation of a new business model. With a focus on better serving health care providers, the new model is designed to create a single national business platform among all three shareholders. Samolovitch, who is currently president of Amerinet Central, becomes CEO effective June 1, 2006. The role of CEO has been significantly redefined to expand responsibility from what was primarily St. Louis operation to all Amerinet operations, including shareholder companies. Samolovitch will oversee the implementation of a new business model, which will integrate operations nationally and unite the employees of all Amerinet companies under one strategic plan. This continues a process that began in 2003 when Amerinet united its network of companies under a new national image and strategic direction. The Amerinet board of directors also announced that Todd Ebert, who was formerly president of Amerinet, was named president and chief operating officer (COO), expanding his responsibilities to encompass all of the GPO’s customer-facing operations including contracting, sales, and marketing. The COO role is a newly created position for Amerinet. http://www.amerinet-gpo.com/

A medical group has called for sweeping changes in how the medical device industry and the government oversee implanted heart devices, and urged companies to use outside experts to help them decide when to issue alerts about potential safety problems in products. The Heart Rhythm Society believed that “single adverse events that could cause death or serious injuries in patients merit notification” if the problem was likely to recur. It also recommended ways of collecting more data about a device's performance and proposed methods to standardize how doctors and patients were made aware of problems. The organization's proposal that device producers appoint outside experts to help oversee product safety is particularly striking because it signals that doctors, who are effectively the customers of heart device makers, want independent information about product safety. The recommendation, which the group called central, may also have financial implications for makers of defibrillators because it means that units suspected of problems may be removed more quickly from hospital shelves. The high-profit devices sell for $20,000 to $35,000 each. “Manufacturers are in the best position to evaluate their own devices,” the medical group wrote in its report. “However, a concern with this system is that the evaluation of the devices and the recommendations for actions by those within the company involves an inherent conflict of interest that could affect the outcome.” The medical group's report, which is in draft form, follows a controversy last year in which the Guidant Corporation did not alert doctors to life-threatening flaws in some units and allowed more than 4,000 suspect defibrillators to be implanted in patients when safer ones were available. The recommendation that companies create outside safety panels mirrors a similar one made last month by a group of medical experts appointed by Guidant to review its handling of safety issues. Recently, device makers and the F.D.A. have adopted some of the group's recommendations. Producers have started issuing reports with far more detailed data on device performance. And earlier this month, the F.D.A. said it would appoint outside medical experts to help it review the safety of heart devices on the market. Dr. Anne B. Curtis, the president of the Heart Rhythm Society, said that manufacturers were receptive to the recommendation that individual companies, or the industry as a group, set up an independent panel of doctors and other experts to monitor product safety data and advise companies about how to respond. Boston Scientific said that it supported the creation of an industrywide, independent safety board. James R. Tobin, chief executive of Boston Scientific, based in Natick, MA, also said the company was adopting all the medical group's recommendations. The other two major heart device producers, Medtronic and St. Jude Medical, said separately that they were reviewing the safety board proposal. The group of heart specialists also recommended that added data about heart devices be collected by having physicians return more units after removal to manufacturers for review, and called on doctors to test a heart unit at the time of a patient's death to see if it played any role. The organization is also asking the F.D.A. to create specialized reporting forms to track reports of heart device problems, and urged the F.D.A. to drop use of the term “recall” when issuing an alert about a unit. Dr. Curtis, the chief of the division of cardiology at the University of South Florida, said that some experts were concerned that the term created a feeling among doctors and patients that a device had to be removed, when it might be safer to leave it in many patients. A spokeswoman for the F.D.A., said the agency was considering making such changes. (The New York Times)

California Blue Cross employee testifies company cancels policies
with inconsistencies, even inadvertent errors

A California Blue Cross employee testified in secret last year that the state's largest health-plan company routinely canceled policies of sick members after looking for inconsistencies, not fraud, in their applications. Experts say, however, that state law allows only deliberate omissions or misstatements as grounds for canceling health coverage. The testimony, given in a lawsuit against Blue Cross, also indicated that those reviews were triggered by claims for treatment of certain illnesses. The suit is one of many filed recently by a Claremont lawyer representing policyholders who say the company seized on inadvertent errors and omissions in applications to justify dumping them after receiving claims, leaving them with big medical bills and no health coverage. Two state regulatory agencies also are investigating the allegations, which involve individual policies, not those issued through employers or other groups. Blue Cross parent WellPoint Inc. of Indianapolis, the nation's largest health benefits company, denies any wrongdoing. “We do not rescind coverage based on someone having a diagnosis or receiving services,” spokesman Robert Alaniz said. “We rescind based on misrepresentations in an application that we discover. We believe that we are acting appropriately and consistent with our legal obligations to our members.” The company persuaded a Los Angeles County judge to seal several documents, including the depositions, arguing that they included proprietary information about the way it conducts business. Portions of the employees' testimony, however, are included in the public court file. Along with other documents, they offer a glimpse into the work of a four-person unit that, employees testified, reviews as many as 1,500 policies a week and cancels those whose holders misstated or omitted facts found in medical records, inadvertently or otherwise. In one exchange, plaintiffs' attorney William M. Shernoff of Claremont asked if, under Blue Cross procedures, it mattered “whether the nondisclosure was inadvertent or willful.” Cynthia Rosenfeld, identified only as the employee most knowledgeable about the cancellations, replied, “We just look at whether the condition was disclosed on the application.” A second employee, Sheila Millan, testified that the reviews were triggered by claims made for treatment for certain illnesses, such as hypertension, diabetes and cardiovascular disease. “When a claim comes in and there is a certain diagnosis that would pretty much [consign] them to be reviewed for a possible preexisting condition,” Millan testified. “There is a list.” According to portions included in the public file, the list includes diseases of the jaw, disorders of the breast, endometriosis and disorders of the female genital tract. (Los Angeles Times)

Earnings improvements reflect momentum in Cardinal Health's
core businesses during third quarter

Cardinal Health has reported that third-quarter earnings continued to strengthen sequentially as revenue reached a record level and operating margins improved in all segments from the first half of the fiscal year. During the quarter ended March 31, revenue increased 9 percent to $20.6 billion from $19 billion last year. Operating earnings of $559 million declined 5 percent from $591 million, primarily due to greater seasonality associated with its former ‘buy-and-hold’ business model during the third quarter of fiscal 2005. Today, Cardinal Health and OTN are announcing the sale of the majority of Cardinal Health's specialty distribution business to OTN, a wholly owned subsidiary of Oncology Holdings, Inc. OTN, the second largest distributor to the community oncology market, will primarily acquire Cardinal Health's oncology distribution capabilities and Cardinal Health will become a minority owner in the firm. Also, Cardinal Health sold its pharmacy staffing business during the quarter to Soliant Health, the health-care staffing unit of MPS Group. Cardinal Health also acquired Parmed Pharmaceuticals Inc. and signed a definitive agreement to acquire Denver Biomedical to extend its product and service offerings for key customers. In medical products manufacturing, sales growth was led by demand for Cardinal Health's glove and respiratory products. Revenue for the Clinical Technologies and Services segment rose 15 percent from the prior year to $603 million, led by 23 percent growth for Alaris and Pyxis products. Revenue for clinical services and consulting grew 8 percent. Operating earnings for the segment increased 73 percent from the prior year to $101 million. The sharp increase in operating earnings resulted from strong demand, combined with expense controls, manufacturing efficiency and ongoing improvements to customer service and the Pyxis installation process. Committed contracts were again strong for both Alaris and Pyxis products, with the Pyxis backlog ending the quarter at $243 million. Customers continued to transition to Cardinal Health's Pyxis MedStation 3000, which accounted for nearly 75 percent of new Pyxis orders during the quarter. In addition, approximately 40 percent of Alaris product sales during the quarter were from competitive displacements. For a copy of the complete report visit: http://www.cardinalhealth.com.

Implantable defibrillators can be erratic, studies find

Pennsylvania hospital has 'no transfusion' surgery

Implantable defibrillators can be erratic, studies find

Implantable defibrillators had a roller-coaster record of reliability, as the rate of malfunctions fell in the early years, rose in the late 1990s and recently declined again. Compared with pacemakers, implantable defibrillators are five to 20 times more likely to malfunction and need replacement. At the same time, people who learn that the device implanted in their chest may have a defect should think hard before having it replaced. Switching it out may be more risky than leaving it in. Those are among the conclusions of three studies being published in the Journal of the American Medical Association that shed light on the hazards of implantable cardioverter-defibrillators (ICDs). The number of ICDs implanted in Americans has more than tripled from about 54,000 in 1999 to 168,000 last year. Sales are increasing 15 to 18 percent a year and are expected to continue rising as the population ages and the number of medical conditions shown to benefit from ICD use grows. The devices, which are made by five highly competitive companies, cost about $20,000. The implantation procedure costs about $10,000 in physician and hospital charges. Two of the studies were headed by William H. Maisel, a cardiologist at Beth Israel Deaconess Medical Center in Boston. After a study he did suggested that malfunction rates for ICDs were rising, the Food and Drug Administration, which licenses the devices, asked him to study the issue further. Maisel and his collaborators examined device-makers’ reports of ICD and pacemaker malfunctions for the years 1990 through 2002. They calculated the number of ICDs and pacemakers that malfunctioned and were replaced per 1,000 of the devices implanted each year. (This does not represent an individual's chances of getting a defective device.) For pacemakers, the malfunction rate declined from 9 per 1,000 implantations in 1993 to 1.4 per 1,000 in 2002. For ICDs, it fell from 39 per 1,000 implantations in 1993 to 8 in 1996, but then rose to 36 per 1,000 in 2002. A study of three registries of ICD and pacemaker implantations, in North America, Denmark and Britain, found the same trend but extended it longer and found a marked decline in malfunctions from 2002 through 2004. A trade organization for device-makers, the Advanced Medical Technology Association, said its records show the malfunction rate for ICDs last year was about 1 per 1,000 implanted, and that about half the problems would simply delay a shock by several seconds. The rise in the malfunction rate in the late 1990s came as device-makers were adding new features and power to ICDs while trying to make them smaller. In the third study, Andrew D. Krahn, a cardiologist at the University of Western Ontario, examined the rate of complications in people who were told their ICD might have a chance of failing. In 17 Canadian hospitals over a one-year period, about 3,000 patients received such a notice, and 533 (18 percent) decided to get the devices replaced. Of them, 31 (6 percent) had complications and two died. During that year, only three malfunctions occurred in the devices for which “advisories” had been issued. None of those resulted in death or serious illness. Guidant Corp. of Indianapolis issued recalls last year of both pacemakers and ICDs. A leaky seal in some pacemaker models caused failure of 69 devices and one death. There were 18,000 potentially affected models in the United States and 10,000 in other countries. The company recalled three ICD models after deteriorating insulation contributed to two deaths in 42,000 devices worldwide. (The Washington Post)

Pennsylvania hospital has 'no transfusion' surgery

Pennsylvania Hospital is now able to offer so-called “bloodless surgery” to 90 percent of its patients who want it, joining a small but growing number of bloodless medicine programs around the country. Advocates put the number at about 120. Many states have bloodless surgery centers or hospitals that perform no-transfusion surgery for Jehovah's Witnesses, who believe the Bible forbids transfusions, but not for the general public. Some hospitals are now providing no-transfusion surgery to more patients because of advances in equipment and changes in protocols. Bloodless surgery techniques vary depending on the type of operation, but can include heart-lung bypass machines; using high-tech scalpels that clot the blood as they cut tissue; or freezing tissue before it’s excised. There is also pre-surgery planning. Doctors start seeing patients weeks before surgery to prepare. Among the benefits are reductions in recovery time, hospital stay, cost and complications, as well as an estimated $20,000 in savings per patient, said Dr. Charles Bridges, a Pennsylvania Hospital cardiologist. The general consensus in the medical community is that it is best to avoid donor blood transfusions whenever possible, but that transfusions remain an important lifesaving strategy. The American Medical Association endorses “autologous” blood transfusion, giving a patient his own blood, but takes no specific stance on no-transfusion surgery. Pennsylvania Hospital has for at least a decade performed all kinds of no-transfusion surgery on Jehovah's Witnesses, Bridges said. In the year that no-transfusion heart surgery has been offered to patients, Bridges estimated that he has performed between 50 and 75, up from about 10 just a few years earlier. Heart surgery, because it is associated with extensive blood loss, is more difficult to do “bloodless” than other operations. In traditional open-heart surgery, a patient may need up to six units of red blood cells, four units of plasma and 10 units of platelets, according to the American Red Cross. The best no-transfusion candidates typically are those needing only one procedure, repair of a single heart valve or a single bypass, for example. It also can be done in more complex operations, however. From pre- to post-surgery, the goal is conserving the patient's own blood, Bridges said. “There's no downside to it that we can see, and there's certainly no downside that's been documented,” Bridges said. Patients who choose the no-transfusion option eliminate the risk of blood-borne infection and complications from clerical errors. They also get out of the hospital an average of one day earlier and avoid potential transfusion-related complications including immune system suppression, inflammatory response, and renal or respiratory failure, Bridges said. (Associated Press)

FDA: Antihistamine linked to deaths of young children

Federal health officials warned parents and doctors not to give drugs that contain promethazine hydrochloride to children younger than 2, citing seven cases of death linked to use of the antihistamine. The Food and Drug Administration said in a safety alert that beyond the deaths, it also has received 22 reports of severe breathing problems associated with use of the allergy drug, all in children younger than 2. The drug, also known as promethazine HCl, is sold by Wyeth under the brand name Phenergan as well as in various generic versions. The warning covers all forms of the drug, including syrups, suppositories, tablets and injectable liquids. Parents also should use care in giving the drug to children older than 2, the FDA said. The labels on all versions of the drug have been updated to reflect the strengthened warnings, the FDA said. The drug, approved in 1951, is used to treat hay fever, stuffy or runny nose due to allergies and other minor allergies. (AP)

AANA publishes position statement on unintended
awareness under general anesthesia

Aspect Medical Systems announced that the American Association of Nurse Anesthetists (AANA) has published a position statement regarding unintended awareness under general anesthesia on the AANA Web site. Unintended awareness occurs when patients do not receive enough anesthesia to remain unconscious, leaving them at risk for becoming aware of what is happening and remembering this experience after the surgery is over. The document states that awareness occurs in one to two cases per thousand patients receiving general anesthesia. To address this clinical concern, the position statement recommends that every anesthetizing location develop a defined written policy that includes the following practices: Assessing patient risk for awareness prior to surgery and anesthesia; Ensuring proper function of anesthesia equipment; Developing an anesthesia care plan that includes appropriate pharmacologic agents, anesthesia techniques and patient monitoring techniques to reduce risk of awareness; Considering brain function monitoring in situations where awareness risk is increased; Conducting patient assessments post-surgery to identify and manage possible occurrences of awareness. The position statement notes that use of brain function monitors along with other patient monitoring modalities has been shown to reduce patient risk of awareness. Further, the document states that not all brain monitors have been studied for their effectiveness in reducing the incidence of awareness and individual health care facilities and anesthesia departments should consider clinical evidence when selecting brain monitors for use to reduce risk of awareness.

Amerinet Choice announces its agreement with Encompass Group LLC for pillows offered under the Amerinet Choice LLC label. Effective through March 31, 2009, this contract includes disposable, limited-use and reusable pillows. Disposable pillows are designed for personal single use and have a non-woven breathable cover to allow for more comfort and support. Reusable pillows are vinyl-coated for cost effectiveness and easy cleaning. This contract was the result of a competitive bidding process.

Amerinet announces its agreement with Scale-Tronix Inc. for patient weighing systems. Effective through February 28, 2009, this contract offers Amerinet members savings on pediatric scales, stand-on scales, Stow-a-Weigh scales, wheelchair scales and bed scales. This contract was the result of a competitive bidding process.

World Health Care Congress: CDHP and Pay for performance affirmed
as key to evolution of U.S. health care market

Earnings expected to decline at HCA; uninsured patients offset revenue

World Health Care Congress: CDHP and Pay for performance affirmed
as key to evolution of U.S. health care market

Goldman Sachs (GS) recently attended the annual World Health Care Congress with health care executives, key government leaders and academics in Washington, D.C. Consumer driven health plans (CDHP) and Pay-for-performance (P4P) were the focus of discussions. Key points included: 1) Treasury Secretary Snow emphasized the administration’s belief that Health Savings Accounts (HSAs) are key to controlling the unsustainable trajectory of health care costs; 2) P4P seen as key to success of CDHPs with numerous panels focused on health outcomes quality measures. While the government prefers private sector agreement on price and quality transparency, Alan Hubbard, Assistant to the President for Economic Policy, indicated it would pass legislation enforcing transparency if necessary; 3) Significant health care legislation is unlikely in the current Congressional term; 4) Abby Block of the Centers for Medicare and Medicaid Services (CMS) provided an update on Part D implementation.

Snow affirmed the Bush administration's commitment to reforming health care through HSAs linked to high deductible health plans. Hubbard addressed the perception that HSAs are favorable for richer segments of the population by indicating that of the 3 million HSA accounts, a third belong to individuals previously lacking insurance. Hubbard contended that HSAs are a viable means of health insurance particularly for individuals and small employers who would otherwise not be able to buy conventional health insurance. However, Hubbard acknowledged that HSAs are not able to address the challenge of providing care for the chronically ill. GS noted that the chronically ill account for a large majority of costs in the health care system.

A key component of consumer directed health plan initiatives is the availability of objective information on care outcomes quality that consumers can base purchasing decisions on. Numerous discussions were devoted to detailing P4P initiatives nationwide such as UnitedHealth's Premium Designation Program for physicians meeting standards of quality and efficiency of care. However, it is evident that considerable work needs to be done before payers, providers and patients can reach consensus on appropriate measures of health care quality outcomes. Hubbard made it clear that while the government prefers the private sector reach agreement on disclosure of price and quality measures, it was determined to pass legislation to enforce transparency if necessary.

In spite of widespread negative press coverage, a survey of Medicare Part D program enrollees shows that a large majority of enrollees are satisfied with the program and would recommend it to others. However, it was acknowledged that low-income seniors, potentially the biggest beneficiaries of the bill, had been enrolling at lower than expected rates. With the May 15th enrollment deadline for Part D approaching, Block emphasized that CMS does not plan to extend the enrollment deadline (although the deadline was extended for roughly 2 million low-income seniors). According to recently released figures 8.1 million seniors are enrolled in Stand-Alone Prescription Drug Plans (as of April 2006).

Hospital operator HCA Inc. said Monday that it expects first-quarter earnings to fall from the year-ago period because although revenue is rising, so is the number of uninsured patients. HCA forecast first quarter earnings per share of 89 to 93 cents, down from 95 cents per share a year ago. Nashville-based HCA also expects revenues to rise to about $6.42 billion for the first quarter, up from $6.18 billion a year ago. HCA said facility revenues increased 5 percent, and same facility revenue per equivalent admission increased 5.1 percent in the first quarter. Same-facility uninsured admissions rose by 2,438, or 13.1 percent, from a year ago. Provisions for doubtful accounts also rose to 12.8 percent of revenue, compared with 10.9 percent a year ago, when taking into account discounts for uninsured patients. (The Associated Press)

A hybrid virus may allow researchers to target tumor cells directly and to deliver genes that either treat or locate the malignancy. In principle, the hybrid virus could make it easier to image tumors, make them more accessible to treatment, and allow doctors to monitor how well anticancer agents are working, according to Wadih Arap, M.D., a professor of medicine and cancer biology at the University of Texas M. D. Anderson Cancer Center. But, Dr. Arap cautioned, the value of the hybrid virus, reported in the April 21 issue of Cell, has so far been demonstrated only in mice and will require much more research before it’s available for patients. Viruses whose natural target is animal cells have long been used to carry transgenes into tissue, but their value in targeting cancer cells is limited, because they tend to infect all mammalian cells. On the other hand, the researchers noted, viruses whose target is bacterial cells are not easily made to carry transgenes, but can be aimed directly at specific types of cells. In mice “this hybrid virus can target tumors systemically” and deliver genes that can either be used to image the tumor or perhaps to treat it, said study co-author Renata Pasqualini, Ph.D., also of M.D. Anderson. (MedPage Today)

Two Veterans hospitals select clinical decision support software
to improve patient care, infection control

VA Pittsburgh Healthcare System in Pennsylvania and VA Greater Los Angeles Healthcare System recently selected clinical decision support software (CDSS) provided by TheraDoc Inc. The software's real-time surveillance, alerting and reporting capabilities will enhance infection control and prevention initiatives at both hospitals. TheraDoc will implement its Expert System Platform (ESP), Antibiotic Assistant and Infection Control Assistant to further enhance the already high quality of patient care provided at both Veterans Hospitals. At VA Pittsburgh Healthcare System, TheraDoc will collaborate with the Pittsburgh Regional Healthcare Initiative (PRHI), a consortium that is working toward improving health care for patients and reducing healthcare costs. PRHI plays a unique role in the transfer of clinical improvement knowledge in Pittsburgh hospitals. CDSS will be integrated with the Veterans Health Information Systems and Technology Architecture (VistA) at the Pittsburgh and Los Angeles hospitals. The system automates and accelerates the surveillance of electronic medical records and the identification of infections while streamlining data collection processes for the clinicians.

Siemens Medical Solutions announced that the U.S. Food and Drug Administration (FDA) has approved a PMA supplement to allow marketing of the MAMMOMAT Novation for mobile use. Medical facilities can now “hit the road” with this full field digital mammography system, as it can be hooked up to a mobile coach, offering clinicians improved functionality and flexibility in the mobile environment. Proven in addressing the demands of the modern mammography practice, Siemens' MAMMOMAT Novation provides digital screening, diagnosis and stereotactic biopsy capabilities, all in one system. It enables clinicians to better pinpoint disease and plan treatment. With the mobile configuration, medical facilities can bring digital mammography directly to their patients and offer comprehensive women's health services on the road. Featuring a flat panel detector-based on amorphous Selenium (aSe) technology, MAMMOMAT Novation enables a direct conversion of X-ray to digital information.

FDA is criticized over drugs' safety problems

Obesity a prime agent in the diabetes epidemic

FDA is criticized over drugs' safety problems

The Food and Drug Administration is sometimes too slow in picking up safety problems once drugs are on the market and in responding to emerging danger signals, a federal study concluded in a new report. The review by the Government Accountability Office found that the FDA does not have clear policies for addressing drug safety issues and that it sometimes excludes its best safety experts from important meetings. The report also calls on Congress to consider expanding the FDA's authority to require that drug companies conduct studies of already-approved products. The agency's ability to order post-market studies is now limited, and many drug companies have been slow to conduct studies that they had agreed to undertake as a condition of gaining FDA approval. The GAO inquiry was requested by Congress in 2004 after the sudden withdrawal of the painkiller Vioxx, which was found to increase the risk of heart attacks and strokes in long-term users. The FDA was widely criticized for moving too slowly in its review of the potential health problems with Vioxx, but the GAO report took the criticism a major step forward: It concluded that the agency's entire system for reviewing the safety of drugs already on the market is too limited and broadly flawed. GAO's examiners studied the agency's handling of four controversial drugs, the cholesterol-lowering drug Baycol, the painkiller Bextra, the rheumatoid arthritis drug Arava, and the nighttime heartburn medication Propulsid, and concluded that “there is a lack of criteria for determining what safety actions to take and when to take them.” All but Arava were ultimately taken off the market because of safety concerns, but the GAO found that disputes between two arms of the FDA's Center for Drug Evaluation and Research slowed the process. Since 2000, 10 drugs have been withdrawn by their manufacturers for safety reasons. The report found that the Office of Drug Safety, which monitors reports of emerging safety risks, at times made recommendations that were ignored by the larger and more influential Office of New Drugs. The GAO also criticized the way experts in the Office of Drug Safety were kept from speaking at important advisory committee meetings on drugs they were studying. The drug safety office has seen considerable turnover, with eight directors in the past 10 years. “This report provides solid evidence that everything is not all right at the FDA and calls for long-overdue reform,” said Sen. Charles E. Grassley (R-IA), who requested the GAO report with Rep. Joe Barton (R-TX). Grassley and Sen. Christopher J. Dodd (D-CT) have introduced a bill that Grassley said would give the post-market review process “real teeth.” In its formal response, the FDA said the report was “well done” and that the “conclusions reached are reasonable and consistent with actions we already have underway or planned.” In the aftermath of the Vioxx withdrawal, the FDA created the Drug Safety Oversight Board, with expanded ability to act on emerging safety issues. The GAO report makes clear, however, that its reviewers consider FDA's actions insufficient. The new board may help provide greater oversight of high-level safety decisions, the report said, but “it does not address the lack of systematic tracking of ongoing safety issues.” To gain approval of a new drug, companies generally conduct clinical trials with hundreds or thousands of volunteers to determine whether the product is safe and effective. But some safety risks may not surface until it has been taken by millions of people. Since the Vioxx controversy, the FDA has begun posting previously withheld preliminary information about possible drug safety problems and has been quicker to highlight potential risks. But the GAO said the information available to the FDA on potential problems is still limited. Its system for collecting reports of “adverse events,” for instance, is a voluntary one that does not require doctors to report drug-related problems they encounter. Experts estimate that only about 10 percent are reported. (The Washington Post)

From 1997 to 2003, the incidence of diagnosed diabetes increased 41%, with obesity a major player, researchers at the Centers for Disease Control and Prevention (CDC) reported. During this period, the incidence of diagnosed diabetes among U.S. adults, ages 18 to 79, increased annually from 4.9 to 6.9 per 1,000 population, amounting to a 41% increase over seven years, the researchers reported in the May issue of the American Journal of Preventive Medicine. The data came from the National Health Interview Survey of the CDC's National Center for Health Statistics. All adults who were sampled (approximately 31,000 annually) were asked whether a health professional had ever told them they had diabetes other than during pregnancy. Respondents, about 2,000 annually, were then asked further questions, including age at diabetes diagnosis, health status, ethnicity, education level, and so forth. When the researchers compared the findings for 2002 to 2003 with those for 1997 and 1998, they found an increase in the prevalence of obesity among incident cases, rising to 59.7% in 2002 and 2003, compared with 51.6% in 1997 and 1998, reported Linda Geiss, M.A., Michael Engelgau, M.D., and colleagues at the CDC. Over seven years, the incidence of diabetes increased among men and women, non-Hispanic whites (once low), persons with at least a high school education, nonsmokers, active and inactive persons, and among obese persons, the researchers reported. Multivariate-adjusted incidence increased with age, rising from 2.1 to 2.5 per 1,000 persons among people 18 to 44 years old; from 8.6 to 11.2 per 1,000 among those 45 to 64; and 10.2 to 16.8 per 1,000 among those 65 to 79. Incidence decreased with higher education levels, down from 9.7 per 1,000 among people with less than a high school education to 5.6 per 1,000 for those with more education. Although age-adjusted incidence increased in all ethnic groups, the increase was significant only among non-Hispanic whites. The rates for non-Hispanic blacks were high, 8.2 per 1,000, but due to the small number of cases and limited number of years analyzed, significant differences could not be detected. The rapid increase in diabetes cases was not accompanied by improvements in the health of the incident cases, the CDC researchers wrote. The data suggest that obesity is a major factor, although not the sole factor, in the increasing incidence and that those with newly diagnosed diabetes are becoming more obese, they wrote. “Recent clinical trials have found that lifestyle changes that include moderate weight loss and exercise can prevent or delay the onset of diabetes among high-risk adults.” they concluded. “The development and delivery of lifestyle interventions to people at risk for diabetes are needed to halt the increasing incidence of diabetes.” (MedPage Today)

Thursday, Dr. David Brailer announced his resignation as the National Coordinator for Health IT. Brailer was the first person to hold this role in a presidential administration and actively used it as a bully-pulpit to tout the safety and savings benefits of electronic healthcare records and the creation of the National Health Information Network. Following is a statement from Wayne Owens, Sun's SVP & General Manager for Healthcare, regarding Dr. Brailer's departure. “In two years, Dr. Brailer has led the effort to transform Health IT from a desirable, if ethereal, goal to a necessary and critical part of the national agenda for healthcare reform. Brailer united Republicans and Democrats, insurers and technology vendors, consumer groups and health care providers and got them working together to start building a framework for a healthcare system that befits the most innovative nation on the world. Brailer coined the term RHIO. Brailer got the nation thinking and believing that the time is now, the time is right to bring clinical automation and clinical transformation to the healthcare industry. Brailer was the beacon that helped transform President Bush's call to arms for the healthcare industry to automate their old manual systems to state-of-the-art digital information systems that can be shared across the street or across the nation. We owe a large debt to Dr. Brailer, as all journeys begin with a single step, and he has put us on the right path. It will be up to the healthcare industry as a whole to make Brailer's vision a reality. Sun Microsystems thanks Dr. Brailer for his contribution and looks forward to working with his successor on improving the quality and safety of health care through effective implementation of healthcare information networks and electronic health record systems.”

Guide for blood cleaning efficiency developed
by committee on soaps and other detergents

Dried blood represents the greatest challenge to cleaning surgical instruments. To meet this challenge, ASTM International Committee D12 on Soaps and Other Detergents has developed a new standard, D 7225, Guide for Blood Cleaning Efficiency of Detergents and Washer-Disinfectors. The new guide is under the jurisdiction of Subcommittee D12.16 on Hard Surface Cleaning. Water-soluble components of blood are easily rendered insoluble when exposed to heat, chemical solutions, or time at room temperature. The water insoluble components of blood are the coagulating agents. These proteins bind quite readily to the surfaces of surgical instruments, making them difficult to remove even with the aid of chemical-cleaning agents. Instruments contaminated with blood represent a significant threat for contamination to healthcare workers and patients. Healthcare facilities typically employ the use of automated instrument washers. These devices combine mechanical action along with chemical cleaning agents in a staged cycle designed to thoroughly clean surgical instruments, including areas of instruments which are not easy observed (for example, box locks). To function properly, these machines must perform at targeted mechanical efficiency and deliver the correct chemical-cleaning agents at the correct temperature, at the correct dosage for the correct period of time. Failure to meet these parameters will lead to a less than optimal cleaning process. ASTM D 7225 suggests related methods for challenging the removal of standardized test soil as a result of mechanical or chemical action, or both, by the tested detergents or washer-disinfectors, or both. One method involves the use of a stainless steel coupon with dried blood soil held in a plastic holder. When followed, this method provides the user with a qualitative evaluation of cleaning efficiency. Another method utilizes a peroxidase reaction with hemoglobin to test for residual blood soil on presumptively cleaned surfaces. ASTM International standards are available for purchase from Customer Service (phone: 610/832-9585; service@astm.org) or at http://www.astm.org/.

Novation, the health care contracting services company of VHA Inc., and the University HealthSystem Consortium (UHC), has signed a single-source, new technology agreement with Abbott Diagnostics for the OraQuick Rapid HIV Test Kit. The agreement began on April 1, 2006 and will run through March 31, 2009. The agreement was not competitively bid, it was awarded through Novation’s new-technology evaluation process, which accelerates the review process so new and improved technologies do not have to wait for a scheduled competitive bid. The process allows VHA and UHC members speedier access to savings on the latest FDA approved medical technology. The OraQuick Rapid HIV Test is a single-use device intended to provide qualitative results for human immunodeficiency virus type 1 (HIV-1) and type 2 (HIV-2) using oral fluid, finger stick, whole blood and plasma specimens. The product is deemed a moderately complex, CLIA waived test, which means it can be used in a physician’s office setting as well as in the clinical laboratory. Other tests on the market do not have CLIA-waived status.

David J. Brailer, National Coordinator for Health IT, resigns

Case of bubonic plague confirmed in L.A.

David J. Brailer, National Coordinator for Health IT, resigns

Secretary of Health and Human Services Mike Leavitt released the following statement regarding the resignation of David J. Brailer, National Coordinator for Health IT. “It is with regret that I have accepted Dr. Brailer’s resignation as the National Coordinator for Health Information Technology. Over the past two years, David has made significant progress in advancing the President’s health IT agenda and laying the building blocks for future progress. While I will miss him here at HHS, I am pleased that David has agreed to serve as Vice-Chair of the American Health Information Community (The Community), which is charged with making recommendations to the Secretary of HHS to facilitate the development and adoption of standards-based health IT. David has helped the Community identify promising breakthroughs for near-term progress while continuing to move us closer to longer-term health IT goals. David will also continue to serve as a consultant to HHS to help lead the President’s health care transparency initiative. Until a replacement for David’s position is announced, the work of the Office of the National Coordinator will continue under the leadership of the four permanent directors of the office.”

Case of bubonic plague confirmed in L.A.

A woman is in stable condition with bubonic plague, the first confirmed human case in Los Angeles County since 1984, health officials said. The woman, who was not identified, was admitted to a hospital April 13 with a fever, swollen lymph nodes and other symptoms. A blood test confirmed the bacterial disease, and she was given antibiotics, officials said. Bubonic plague is not contagious, but if left untreated it can morph into pneumonic plague, which is. Bubonic plague is usually transmitted to humans from the bites of fleas infected by rodents. Health officials said they suspect the woman was exposed by fleas in her home and that there was no cause for alarm. An estimated 10 to 20 Americans contract plague each year, mostly in rural communities. Bubonic plague is believed to have been the “Black Death” that killed 25 million people in Europe between 1346 and 1351. (The Associated Press)

U.S. to kill flocks suspected of having bird flu

If deadly bird flu shows up in U.S. chickens or turkeys, the government will kill off any flocks suspected of having the virus even before tests are completed, officials said. At greater risk are free-ranging chickens and small, backyard flocks, as many as 60,000 in Los Angeles alone. If bird flu arrives, “quick detection will be key to quickly containing it and eradicating it,” said Ron DeHaven, head of the Agriculture Department's Animal and Plant Health Inspection Service. Most of America's chickens come from big commercial farms that keep birds indoors and are well-protected against the spread of disease. Yet there are many flocks in people's backyards, officials are unsure how many, and free-range flocks that are outdoors and could mix with wild birds or their droppings. Officials encourage those producers to bring flocks inside and watch for signs of flu, dead birds; lack of appetite; purple wattles, combs and legs; coughing or sneezing; diarrhea, and report them immediately to state or federal authorities. Owners will want to report sick birds because they will be paid fair market value for destroyed flocks, DeHaven said. Stopping the spread of bird flu has been more difficult in countries that can't afford to compensate farmers, he added. The government is testing more wild birds than usual, as many as 100,000 in Alaska and other migratory pathways. Chicken and turkey companies are testing nearly every flock for the virus. Regardless, poultry is safe to eat if people cook it to 165 degrees and follow basic kitchen safety rules, DeHaven said. If the virus turns up in commercial chickens or turkeys, the government plans to quarantine the farm, restrict bird movements within about two miles and boost testing within about six miles. If screening tests suggest a potentially virulent flu virus is present, and the birds show signs of flu, they'll be killed immediately, even before more detailed testing is finished, DeHaven said. The government has vaccines to protect poultry from the virus but is reluctant to use them because vaccinated birds can still spread the virus without appearing sick, said John Clifford, the department's chief veterinarian. Vaccines could be used in flocks surrounding the area of an outbreak, he said. (The Associated Press)

NIH researches interregional spread of influenza

Researchers at the National Institutes of Health (NIH) conclude that the regional spread of annual influenza epidemics throughout the United States is more closely connected with rates of movement of people to and from work than with geographical distance or air travels. They also found that epidemics spread faster between more populous locations. The research results, published this week in Science Express, is based on 30 years of weekly data from the National Center for Health Statistics on influenza-related mortality in different States since 1972. The investigators reached their conclusions by building a mathematical model of influenza spread in the U.S. based on the historical pattern of epidemics. The results suggest that when disease is imported into the U.S. in a well-connected state, one with many inflows and outflows of workers, for example, California, disease spreads much faster than if disease is imported in a less-connected state, for example, Wyoming. In observed epidemics, the initial focus of infection varies from year to year, but epidemics tend to emerge more often from California than other less populated states. The model can simulate influenza pandemic spread, a situation where the greatest majority of the population is susceptible to a new virus. In this case, transcontinental spread could occur more quickly. Infection could reach all states within 2-4 weeks, instead of the 5-7 weeks for annual epidemics, if seeded in a highly connected state. Past research highlighted the role of children in the local spread of influenza, in particular, in schools and households. This study, by contrast, suggests that adults are responsible for the regional spread of influenza because they travel farther and more frequently. As the speed of influenza spread between states is affected by work-related population movements and transmissibility, interventions which limit inter-regional routine travel might slow epidemic spread. Describing the mechanisms of local spread of influenza within cities or states is a key area for future work and would provide insight into which control strategies might be effective to control epidemic and pandemic influenza, in particular, social distancing measures. http://www.nih.gov.

Interdisciplinary team develops guidelines
for treating severely injured patients

If someone is injured in an automobile collision or is severely burned, emergency room physicians across the country would probably take similar steps to stabilize each condition. But subsequent treatment in the intensive care unit or operating room is less well established and may vary significantly. That is likely to change based on the work of an interdisciplinary team of dozens of scientists and physicians funded by the National Institute of General Medical Sciences (NIGMS), part of the National Institutes of Health (NIH). Drawing from the best available evidence, the team is developing a series of standard procedures for the care of severely injured patients. The guidelines will describe how to implement the most successful treatment protocols in the clinic and will include summaries of each procedure ready to print on 3-by-5 index cards for quick bedside reference. The team’s first article, on mechanical ventilation, appeared in the September 2005 issue of the Journal of Trauma: Injury, Infection, and Critical Care. Planned future topics will cover resuscitation, prevention and treatment of venous blood clots, diagnosis of ventilator-associated pneumonia, blood sugar control, nutritional support, transfusion thresholds, and sedation. The team chose to cover aspects of care for which practices vary the most and those that have the greatest potential to influence patient outcomes. The scientific team is part of a collaborative, NIGMS-supported initiative called the Inflammation and Host Response to Injury “glue grant” program. Glue grants bring together scientists with diverse expertise to address major biomedical questions that are beyond the scope of any one research group, in this case, to uncover why patients who experience comparable traumatic injuries can have dramatically different outcomes. The outcomes for trauma and burn patients often depend on the strength of their inflammatory response to their injury. Inflammation helps the healing process in many cases, but an excessive response can lead to multiple organ failure, a common cause of death following a traumatic injury. While the magnitude of the injury and the quality of care affect the inflammatory response, the patient’s genetic make-up is also thought to contribute. To pinpoint the relevant genetic factors, the researchers are looking for gene activity patterns that correlate with specific outcomes. All nine of the clinical institutions participating in the project are adopting the standard practices, which will make these genetic patterns easier to discern. “Establishing standard treatment procedures is an important first step in improving patient care,” said NIGMS Director Jeremy M. Berg, Ph.D. “But we expect the real breakthrough to come when genetic data from the project helps physicians tailor treatments for each critically injured patient.” While the inflammation glue grant focuses on the care of patients once at the hospital, a complementary NIH program, the Resuscitation Outcomes Consortium, aims to improve patient survival before an injured person reaches the emergency room. http://www.nih.gov.

Amerinet wins the Nielsen Healthcare Group Award,
makes donation to Project Perfect World

Amerinet was recognized in March as a top partner for the Nielsen Healthcare Group. Amerinet is donating the cash award to the Project Perfect World Foundation. The award recognizes Amerinet members’ high-volume use of Nielsen’s interim managers. Amerinet’s donation will help Project Perfect World achieve its mission of improving the lives of underprivileged children by providing for their health care needs.

NIH budget expected to take dive

Midwest's epidemic of mumps continues;
CDC rushes vaccine to affected states

NIH budget expected to take dive

The budget of the National Institutes for Health is expected to fall 3.8 percent next year after adjusting for inflation, a top U.S. biomedical researcher said, adding that the budget doubled each year between 1998 and 2003. This “0.1 percent decrease from last year ... will be the first true budgeted reduction in NIH support since 1970 ... this downturn is more severe than we have ever faced previously,” Dr. Joseph Loscalzo, physician-in-chief and chairman of medicine at Brigham and Women's Hospital in Boston, writes in an editorial in this week's issue of the New England Journal of Medicine. That hospital receives about $190 million a year in NIH funding, a spokesman said. “Whereas national defense spending has reached approximately $1,600 per capita, federal spending for biomedical research now amounts to about $97 per capita, a rather modest investment in ‘advancing the health, safety and well-being of our people,’” which is a mission of NIH, Dr. Loscalzo, also professor of medicine at Harvard Medical School, added. The Bush administration has proposed a $28.6 billion budget for NIH in fiscal 2007, a 0.1 percent reduction from last year. NIH is the medical research arm of the U.S. Department of Health and Human Services. “It takes many years for institutions to develop investigators skilled in modern research techniques and to build the costly, complicated infrastructure necessary for biomedical research,” Dr. Loscalzo wrote. Amanda Banks, president of the California Biomedical Research Association, said that “without NIH, no company, institution or individual has the kind of money required to get a drug or medical device from benchtop to bedside. A small decrease in the percentage of funding for NIH represents millions of dollars in grants that won't be there.” Alan Dittrich of the Massachusetts Society for Medical Research said that if Dr. Loscalzo's figures are correct, it will mean an $830 million decrease in funding. “Growth in the NIH budget is essential to keep us in the forefront of medical research,” he said. Mary Woolley of Research America, said: “With inflation factored in, an 0.1 percent budget cut would translate into a decrease of $800-plus million. Medical and health research should be a higher priority, when we are still plagued with a number of diseases and disabilities for which there will be answers in the foreseeable future,” she said. An official of the Bethesda-based Federation of American Societies of Experimental Biology said the U.S. Department of Commerce has estimated NIH's inflation rate at 3.8 percent, which makes the reduction figures provided by Woolley and Dittrich accurate, considering the Bush administration's proposed 2007 budget. (The Washington Times)

A Midwest mumps epidemic, already the largest U.S. outbreak of the viral infection in decades, shows no signs of slowing and will probably spread farther before being contained, federal health officials said. The number of cases has more than doubled in the past week, with at least 1,100 reported in Iowa and seven other states, officials said. Investigators in seven more states also are studying possible cases. “This is an unstable situation right now,” said Julie L. Gerberding, director of the federal Centers for Disease Control and Prevention in Atlanta. “We're not reliably able to predict where this will go.” The CDC has dispatched teams to Iowa and Nebraska to help local and state health workers try to contain the outbreak, mainly by urging people to watch for symptoms so they can be diagnosed and isolated quickly, and by inoculating unvaccinated adults. The epidemic has disproportionately affected young, healthy adults, including many college students. Gerberding said she expect expects the outbreak to worsen before it starts to ease. “We expect more cases, definitely,” she said, noting that the virus could spread to other parts of the country as college students who are infected but do not have symptoms leave for the summer and come into contact with other people. Intensifying the campaign to contain the outbreak, the CDC is rushing 25,000 additional doses of vaccine from its stockpile to Iowa, the epicenter of the outbreak, and another 25,000 donated by Merck & Co. to Iowa and other states, Gerberding said. Officials said they would use the vaccine to target high-risk groups, such as college students and health-care workers. But scientists are testing the virus involved in the outbreak to see whether it is unusually infectious or less susceptible to the vaccine, and whether the vaccine is less effective or wears off more quickly than had been thought. Officials suspect the outbreak erupted because the vaccine is not 100 percent effective and the virus took hold in a vulnerable population, mainly college students who did not get both of the recommended shots, triggering a “cascade of transmission that's going to take a while to curtail and stop,” the CDC director said. At least 20 people have been hospitalized, but all have recovered, officials said. The outbreak, which appears to have begun in late December, involves the same strain of the virus that has caused a massive mumps epidemic in Britain over several years. Iowa has been hit hardest, with at least 815 cases. An additional 350 have been reported in Illinois, Kansas, Minnesota, Missouri, Nebraska, Oklahoma and Wisconsin. Officials did not identify the seven other states investigating possible cases. Nationwide, about 200 to 300 mumps cases typically occur annually. (The Washington Post)

A summary released by the Centers for Disease Control and Prevention, which will be followed by a more comprehensive report to be released in May, is based on approximately 90 percent of death records reported in all 50 states for 2004, and shows an increase in life expectancy and a narrowing of the gender gap. Highlights of the report include: The life expectancy of Americans in 2004, 77.9 years, is the highest it has ever been. The life expectancy for women in the United States is 80.4 years; the life expectancy for U.S. men is 75.2 years. The life expectancy gender gap is narrowing - the 5.2 year difference in 2004 was the smallest difference since 1946. Alzheimer's disease moved into 7th place among leading killers in the United States, passing influenza and pneumonia. Age-adjusted death rates fell to a record low of 801 deaths per 100,000 population in 2004, down from almost 833 deaths per 100,000 in 2003. Total deaths (nearly 2.4 million in 2004) declined almost 50,000 between 2003 and 2004, the biggest one year drop in several decades. The report can be accessed at the CDC/NCHS web site at www.cdc.gov/nchs.

New study finds lifetime costs of injuries in billions;
costs associated with a year top $406 billion

The lifetime cost of injuries occurring in a single year in the United States totals an estimated $406 billion in medical expenses and productivity losses (including lost wages, fringe benefits, and ability to perform normal household responsibilities), according to new findings released by the Centers for Disease Control and Prevention (CDC). Nearly $80.2 billion is attributed to medical expenses, while $326 billion is estimated for lifetime productivity losses for the almost 50 million injuries that required medical treatment in 2000. These costs begin to accumulate when the injuries occur and are spread over each injured persons’ expected lifetime. “The financial and economic impact of injuries in the United States is serious,” said CDC Director Dr. Julie Gerberding. “However, by expanding our science-based injury prevention programs, we can drastically reduce these costs and even more importantly help people live longer and healthier lives.” The new data and findings were released in the book “The Incidence and Economic Burden of Injuries in the United States,” by scientists from the CDC, as wells as scientific research contractors at RTI International and the Pacific Institute for Research and Evaluation. The book, which is the most comprehensive analysis of the economic costs of injuries to date, makes use of 2000 data to update and expand a 1989 Report to Congress. Researchers noted that actual costs of injuries are likely greater than the figure reported. Police services, caregiver time, costs for pain and suffering, and other non-monetary costs are not included in this analysis. Additional findings include: Males account for approximately 70 percent ($283 billion) of the total costs of injuries, largely due to higher rates of fatal injury and the magnitude of their lost wages. Persons aged 25 to 44 years represent 30 percent of the U.S. population and 40 percent ($164 billion) of the total costs of injuries. Motor vehicle account for 22 percent ($89 billion) and fall injuries account for 20 percent ($81 billion) of the total costs of injuries. CDC supports effective interventions to save lives and reduce the cost of injuries, including increased use of child restraint systems, smoke detector programs, multifaceted interventions to prevent falls among older adults, and programs working with parents and others to prevent child maltreatment. Additional information about this book, the burden of injury in the United States and CDC’s injury prevention work can be found at CDC’s website www.cdc.gov/injury.

While health screenings proliferate, the number of people
getting the right ones isn't keeping up

Despite strong evidence that tests like a blood pressure check every two years are worthwhile, barely 50 percent of U.S. adults receive the diagnostic and preventive screenings that many medical experts recommend. Several factors explain why many Americans remain unaware that they have hypertension, colorectal cancer, high cholesterol and other lethal conditions: the proliferation of recommended tests, doubts about the value of some once-standard exams and time demands that keep many doctors from performing systematic screening. Experts say people should find a doctor who will schedule screenings as they become due, or they should take over the scheduling themselves. The merits of early detection and prevention of disease became especially clear in the 1950s and '60s, when childhood immunizations nearly eradicated a number of diseases, including measles. This success has had an ironic side effect: “As we have more entrenched screening, the risks seem less imminent, less of an immediate threat,” said Amy Compton-Phillips, Kaiser Permanente's physician director for care management in Rockville. As a result, “it's harder to convince healthy patients that a screening is important.” Today's physicians are encouraged to screen patients for literally hundreds of conditions and diseases. This advice comes from specialists, from groups such as the American Cancer Society and from standard-setters as the U.S. Preventive Services Task Force, a panel of experts that evaluates many components of primary care. The American Academy of Family Physicians endorses most of the task force's 20 or so screening recommendations, and adds about 30 more. (For details, see http://www.ahrq.gov/clinic/uspstf/uspstopics.htm and http://www.aafp.org/x24996.xml .) A further complication: The task force sometimes downplays screenings, like breast self-exams and the prostate-specific antigen (PSA) test for prostate cancer, that the medical establishment once supported enthusiastically. The annual physical has fallen from favor in an era of managed care, evidence-based medicine and too busy physicians. In a study published last year, Duke University physicians suggested why compliance with screening standards is so spotty: “Taken together, the time needed to meet preventive, chronic and acute care requirements vastly exceeds the total time physicians have available for patient care,” they said. Technology can help solve that time problem. “Compliance is close to impossible without some kind of aid, a physician prompt from something like an electronic medical record,” said Washington internist Peter Basch, who has invested in a record-keeping system that relies heavily on computerized data and minimally on paper records. These systems can automatically alert a doctor, on his hand-held computer device or on a monitor in the exam room, that the patient he's seeing right now needs a particular test. But even physicians without a high-tech office can offer timely checkups, said Thomas Weida, a doctor in Hershey, PA, who is a spokesman for the American Academy of Family Physicians. “There are lots of different systems for keeping track of necessary screenings. A simple flow sheet is very effective, and it's even more effective the closer it is to the top sheet” in the patient's chart, he said. (The Washington Post)

Cardinal Health signs preferred provider agreements with
MedAssets Supply Chain Systems for Alaris, Pyxis products

Cardinal Health Inc. signed preferred provider agreements with group purchasing organization MedAssets Supply Chain Systems for its Alaris infusion safety systems and Pyxis medication and supply automation solutions. MedAssets Supply Chain Systems has also added Alaris products to its Select Program, which offers its members market-leading pricing on the preferred contracts within each market category. The multi-year Select Program and preferred provider agreement for Alaris products includes the full range of Cardinal Health's infusion safety solutions including the Alaris System, a comprehensive IV-safety system available for all types of infusions. The multi-year renewal agreement for Pyxis products includes market-leading automation solutions such as the Pyxis Anesthesia System for secure medication and supply management; Pyxis MedStation 3000 automated medication management system; Pyxis Connect physician order management system and Pyxis SupplyStation secure inventory management system.

Alliance Medical Corp. and Vanguard Medical Concepts merger complete

Sudan reports first suspected human case of bird flu

Alliance Medical Corp. and Vanguard Medical Concepts merger complete

Alliance Medical Corp (Phoenix, AZ) and Vanguard Medical Concepts (Lakeland, FL) recently announced that they have become Ascent Healthcare Solutions Inc (Ascent), an independent third-party reprocessor of single-use medical devices (SUDs). This marks the final step in the union of the two companies following the announced merger last fall. The Ascent name and logo will immediately begin to appear on both Lakeland and Phoenix facilities as well as the Company's collection systems at customer locations. For more information, visit Ascent's new web site
www.ascenthealthcaresolutions.com.

Sudan reported its first suspected human case of bird flu on Tuesday, but confirmation was withheld until further tests by the World Health Organization (WHO). Health Minister Thabisa Shokaya said that the patient, a chicken farm owner, was in stable condition after being put into isolated and intensive care in the hospital. She stressed her ministry's readiness to cooperate with the international society in order to contain this disease around the world. Sudan has found its first cases of bird flu in poultry in the capital Khartoum and nearby Jazeera state, an official of the Ministry of Animal Resources said. “Until now the health authorities have culled more than 100,000 chickens at 15 farms in Khartoum,” Ahammed Mustafa, undersecretary of the ministry, said. Both Khartoum and Jazeera are known for large-scale agricultural and animal farm in the largest African country. (Xinhua)

Consolidation among health insurers is creating near-monopolies in virtually all reaches of the United States, according to a study released Monday. Data from the American Medical Association show that in each of 43 states, a handful of top insurers have gained such a stronghold that their markets are considered “highly concentrated” under U.S. Department of Justice guidelines, often far exceeding the thresholds that trigger antitrust concerns. The study also shows that in 166 of 294 metropolitan areas, or 56 percent, a single insurer controls more than half the business in health maintenance organization and preferred provider networks underwriting. “This problem is widespread across the country, and it needs to be looked at,” said Jim Rohack, an AMA trustee and physician in Temple, TX. The AMA study cited a Justice Department benchmark in citing antitrust concerns, the Herfindahl-Hirschman Index, or HHI. A score above 1,000 shows “moderate” concentration. Those scoring above 1,800 yield a “high” concentration. Figures show that 95 percent of the 294 HMO/PPO metropolitan markets studied were above 1,800. Raise that HHI bar even higher to 3,000, and 67 percent rise above it. The AMA study is the latest piece of evidence, and most comprehensive to date, showing the market power of a few companies, and a large number of regional nonprofit Blue Cross operations, is formidable and growing. And it comes as premiums continue to grow at near double-digit percentage rates. Critics say that carriers are not only creating monopolies and oligopolies in many regions, they also control the other side of the equation in what is known as monopsony power. That means in addition to having the most enrollees, they're also the biggest purchasers of health care and can dictate prices and coverage terms. It also makes it harder for new carriers to emerge, as pricing already has been set by the dominant carrier. That's particularly true in North Dakota, where the state's Blue Cross Blue Shield provider has, by various estimates, a roughly 90 percent share of the market, said Insurance Commissioner Jim Poolman. New carriers would have to pay more to health-care providers and charge less to policyholders to gain a foothold. The AMA says there have been more than 400 mergers among health-care insurers in the past decade. As they've consolidated and presumably eliminated duplicative functions, they're not passing the savings in personnel and administrative costs on to consumers. Rate increases, though slowing, are higher than ever and growing at a near double-digit pace. Studies by the Kaiser Family Foundation show double-digit premium hikes from 2001 to 2004, peaking with a 13.9 percent jump in 2003, soared well above inflation and wages. Those categories have risen at rates less than a half to less than one-fifth that of insurance premiums, Kaiser said. Last year, the string of double-digit jumps was broken, but was close to that level with a 9.2 percent increase, the Kaiser study said. The AMA said it has taken up this antitrust issue with the Department of Justice, but said it has run into roadblocks with regulators. (Associated Press)

The National Healthcare CFO/CIO Summit, to be held April 30 – May 2, 2006, at the PGA National Resort & Spa, Palm Beach Gardens, FL, will outfit senior Financial and Information Technology Executives with the necessary tools to combat issues relating to patient safety and the implementation of strategies and technology. The Summit will act as a forum for Healthcare Technologists and Financials to network and brainstorm on the issues at hand with a diversified Advisory Board, the speaker panel and senior executives from hospitals across the country. Attendees will also attend keynote presentations and case studies by leaders and pioneers in healthcare industries and meet one-on-one with providers from various healthcare solutions. Key topics include: “Advancing Healthcare Improvements: Utilizing Service Oriented Architectures (SOA) to Support RHIO Development”; “Educating and Involving Non-Financial Personnel in Financial Aspects of the Business”; “Consumer-Directed Care and Hospital Revenue Cycles: The Challenges and Opportunities”; “Emergency Services Process Improvements”; “Analyzing the Impact of Medicare and Managed Care Payment Systems on the Economics and Operations of Healthcare Providers”; “Optimizing Hospital Operations through Innovative Supply Chain Management Solutions”; “Implementing ITIL Service Management in a Health System”; “From Paper-Based to Artificial Intelligence at the Point of Care”; “Mapping Business Objectives to Digital Healthcare Strategies: Benchmarking and Lessons Learned”; “Overcoming Barriers to Adopting and Implementing CPOE.” For more information, visit http://www.healthcare-summit.com/.

This week at CleanMed 2006, Hospira became the first leading supplier to launch a full-service PVC-free, phthalate-free IV container, signaling an important shift in the medical device market toward safer alternatives. Hospira’s new IV container is PVC/DEHP free and weighs 40-60% less than other flexible IV containers, resulting in significant waste reduction. PVC medical devices are a health concern because they contribute to dioxin formation during manufacture and incineration; and during use, the devices can leach the phthalate DEHP, a reproductive toxicant linked to birth defects in laboratory animals. The FDA warned health care providers in 2002 that some patients may be at risk from DEHP leaching from PVC medical devices and recommended switching to alternatives. Baxter International announced a limited launch of a new specialty PVC-free IV system at CleanMed. Also at CleanMed, Arden Architectural Specialties announced it is phasing out PVC production and introducing a new line of corn-based, bio-polymer blend wall production products, including corner guards, crash rails and handrails. Also, Health Care Without Harm announced a list of more than 100 health care organizations that have undertaken efforts to reduce PVC and/or DEHP, including six of the largest Group Purchasing Organizations (GPOs) and some of the leading health care systems and largest hospitals in the country. The announcements were made at CleanMed 2006 in Seattle, where more than 500 health Also care leaders are gathered this week for the world’s largest health care conference on environmentally preferable medical products and green buildings. For more information see www.noharm.org

MedAssets Net Revenue Systems launched KnowledgeMaster Plus, a web-based tool containing comprehensive chargemaster, coding, and compliance research information, at the company’s Healthcare Business Summit in Las Vegas. Enhancements to the tool include complete integration with MediRegs’ industry leading content and research tools. MediRegs is the regulatory and content source used by more than 800 hospitals including the major healthcare agencies, regulators and several major Fiscal Intermediaries. Several features of KnowledgeMaster Plus, powered by MediRegs, include: Pricing benchmarks for 95 percent of all clinical services, including supplies and pharmaceuticals; Links between HCPCS and medical devices; Links between NDC, Charging and HCPCS; Fiscal Intermediary-specific coding recommendations; APC and DRG reimbursement information; Indexed searches of hundreds of regulatory documentations including Federal Register, Transmittals, NCDs and LCDs; Customizable content and alerts; Pharmacy multipliers; and Chargeable and non-chargeable indicators. www.medassets.com.

PricewaterhouseCoopers survey: Medical device companies
quick to adopt ethics standards to combat fraud and abuse

Goldman Sachs on Cardinal Health, CEO succession plan

PricewaterhouseCoopers survey: Medical device companies
quick to adopt ethics standards to combat fraud and abuse

Recognizing the need to bolster compliance activities in an era of increasing governmental scrutiny, the nation's largest medical device companies have proactively embraced a code of ethics with nearly universal adoption of standards to combat fraud and abuse of sales and marketing practices, according to a PricewaterhouseCoopers survey released at the Medical Device Regulatory Compliance Congress, held on the campus of Harvard University. The survey benchmarked how large medical device companies are complying with fraud and abuse laws since introduction of the Code of Ethics on Interactions with Healthcare Professionals in 2004. The voluntary code was developed by Advanced Medical Technology Association (AdvaMed), a trade group that represents more than 1100 medical technology companies. While medical device firms legitimately collaborate with healthcare professionals, such as providing expertise in how products should be designed or participating in federally required safety studies, the AdvaMed Code distinguishes legitimate interactions from potential abuses that might undermine the private healthcare system. Highlights of the survey include: There is nearly a 100 percent adoption rate of the AdvaMed Code. Approximately two-thirds of company presidents or CEOs have personally endorsed the AdvaMed Code in a written statement addressed to company employees and/or customers. Nine out of 10 companies apply the AdvaMed Code to all company professionals, regardless of title or seniority. Three quarters of companies surveyed have posted their compliance program on their company website. Virtually all respondents have linked sales force compensation to compliance with policies and procedures in some manner. Seven out of ten firms have put a process in place to track gifts, meals, travel, lodging, honoraria and other items of value that might be provided to healthcare professionals. The survey found that most large firms have instituted controls over the engagement of healthcare professionals. These controls include clear agreements that promote ethical behavior, and approaches for determining the fair market value of gifts, entertainment and other remuneration of services, and for ensuring that value is actually received for engagements of healthcare professionals. There continues to be varied practice on how broadly and deeply the medical device companies control these activities and the survey results will seek to present better practices for the consideration of the industry. Survey respondents also indicated that the control model in the medical device industry around the distribution, receipt, processing and approval of grant requests is beginning to shift toward a model whereby restrictions are placed on the involvement of the sales force related to grants. At the same time, there is growing use of grants committees for approval of educational/charitable grants and research grants. The survey was completed in March 2006 and included 20 medical device firms, including the largest medical device firms in the United States with global annual sales of greater than $1 billion.

Goldman Sachs on Cardinal Health, CEO succession plan

Cardinal Health (CAH) announced Bob Walter is immediately transitioning his CEO role to P&G Vice Chairman R. Kerry Clark. While sudden timing, the news should not come as a shock to investors, instead it appears to be an example of thoughtful succession planning without any obvious negative implications for CAH, said Goldman Sachs (GS). Key Points: 1) Walter to remain Chairman for 2 yrs, providing continuity; 2) As VC of P&G since 2002, Kerry appears to have skills useful in his new role: global, oversight of P&G's pharma & OTC products, & responsibility for P&G's shared services platform; 3) Departure of CAH President & COO George Fotiades not a major loss in the opinion of GS; & 4) While not commented on today, GS sees no reason to reduce their confidence in CAH's F'Q3 earnings to be reported April 26. Outstanding issues include: status of SEC inquiry, future board composition, and Clark's view of CAH strategies.

A boost for breast cancer prevention; osteoporosis drug
lowers risk with fewer side effects

A drug used to prevent bones from thinning also offers millions of older women a powerful way to protect themselves against breast cancer, a large government-sponsored study has found. The study of nearly 20,000 postmenopausal women found that raloxifene reduces their chance of developing breast cancer as effectively as tamoxifen, the only drug previously shown to reduce the risk, but is less likely to cause serious side effects such as uterine cancer and blood clots. The findings indicate that raloxifene, sold under the brand name Evista, is a safer alternative for the estimated 9 million postmenopausal U.S. women at increased risk for breast cancer, experts said. The National Cancer Institute sponsored the $88 million study and released the preliminary findings early because of their public health implications. Because an estimated 500,000 women use raloxifene to reduce the risk of osteoporosis, many will be more comfortable using it for breast cancer protection, several experts predicted. Several experts, however, urged caution, saying that the advantage of raloxifene remains unclear and that more research is needed to prove the drug reduced the overall risk over longer periods. Eli Lilly and Co. said it would ask the Food and Drug Administration to approve Evista for breast cancer prevention in postmenopausal women, but doctors are free to prescribe it for that purpose immediately because the drug is already marketed for osteoporosis. Breast cancer strikes more than 211,000 U.S. women each year and kills more than 40,000, making it the leading cause of cancer and second-leading cancer killer among women. Raloxifene works similarly to tamoxifen by blocking the effects of the hormone estrogen on breast tissue. Researchers gave 19,747 postmenopausal women either 60 milligrams of raloxifene or 20 milligrams of tamoxifen every day for five years. All were at increased risk of breast cancer because of their age, family history or other reasons. A preliminary analysis of the data found no difference in the number of invasive breast cancers in the two groups, indicating that raloxifene also cuts the risk by 50 percent. There were 167 invasive cancers in the raloxifene group and 163 in the tamoxifen group. About 320 women in each group would have been expected to develop breast cancer. But the women taking raloxifene experienced 36 percent fewer uterine cancers (23 vs. 36) and 29 percent fewer blood clots (100 vs. 141). They were also less likely to develop cataracts. The findings, which do not necessarily apply to premenopausal women, will be published in a peer-reviewed journal and presented at a meeting of the American Society of Clinical Oncology. Raloxifene costs about $75 for a one-month supply; tamoxifen costs about $100 for the same amount, officials said. (The Washington Post)

Families displaced by Hurricane Katrina are suffering from mental disorders and chronic conditions like asthma and from a lack of prescription medication and health insurance at rates that are much higher than average, a new study has found. The study, conducted by the Mailman School of Public Health at Columbia University and the Children's Health Fund, is the first to examine the health issues of those living in housing provided by the Federal Emergency Management Agency. Based on face-to-face interviews with more than 650 families living in trailers or hotels, it provides a grim portrait of the hurricane's effects on some of the poorest victims, showing gaps in the safety net pieced together from government and private efforts. Among the study's findings: 34 percent of displaced children suffer from conditions like asthma, anxiety and behavioral problems, compared with 25 percent of children in urban Louisiana before the storm. Fourteen percent of them went without prescribed medication at some point during the three months before the survey, which was conducted in February, compared with 2 percent before the hurricane. Nearly a quarter of school-age children were either not enrolled in school at the time of the survey or had missed at least 10 days of school in the previous month. Their families had moved an average of 3.5 times since the storm. Forty-four percent of parents and guardians said they had no health insurance, many because they lost their jobs after the storm, and nearly half were managing at least one chronic condition like diabetes, high blood pressure or cancer. Thirty-seven percent described their health as “fair” or “poor,” compared with 10 percent before the hurricane. More than half of the mothers and other female caregivers scored “very low” on a commonly used mental health screening exam, which is consistent with clinical disorders like depression or anxiety. Those women were more than twice as likely to report that at least one of their children had developed an emotional or behavioral problem since the storm. Officials at the Louisiana Department of Health and Hospitals said the study's findings were consistent with what they had seen in the field. Neither Congress nor the State of Louisiana eased eligibility requirements for Medicaid after the storm, and because each state sets its own guidelines, some families who received insurance and food stamps in other states were no longer eligible when they returned home. While state officials said $100 million in federal block grants was in the pipeline for primary care and mental health treatment, the study's authors said the need was urgent. “Children do not have the ability to absorb six or nine months of high levels of stress and undiagnosed or untreated medical problems” without long-term consequences, said Dr. Irwin Redlener, the director of the National Center for Disaster Preparedness at Mailman and co-founder of the Children's Health Fund. The survey found that of the children who had primary doctors before the storm, about half no longer did, the parents reported. Of those who said their children still had doctors, many said they had not yet tried to contact them. The study's authors recommended expanding Medicaid to provide universal disaster relief and emergency mental health services, as well as sending doctors and counselors from the federal Public Health Service to the region. Anthony Speier, the director of disaster mental health for Louisiana, said that while there were 500 crisis counselors in the field, the federal money that paid for them could not be used for treatment of mental or behavioral disorders like depression or substance abuse. Instead, he said, much of their effort goes into short one-on-one sessions and teaching self-help strategies in group settings. According to the study's authors, the post-storm environment differs significantly from other crises because of its uncertain resolution. (The New York Times)

Health officials across Arizona have been told to be alert for an outbreak of the mumps after a traveler on an airline flight originating in Tucson was diagnosed with the viral infection. Health officials said a student on vacation in Tucson and another passenger may have helped spread the disease to a large number of people. The student traveled April 2 from Tucson to Dallas on American Airlines flight 1216, then took connecting flights on to Fayetteville, AK, St. Louis and finally to Cedar Rapids, IA. The second passenger flew on several flights between Iowa, Minnesota, Detroit and Washington D.C., in late March. The unusually rapid spread of the disease, as of midweek there were 515 suspected cases in Iowa and cases were found in six neighboring states, shows how quickly modern air travel can help disease spread, the Centers for Disease Control and Prevention officials said. (The Associated Press)

Hologic Inc., a provider of diagnostic and digital imaging systems directed towards women’s health, announced it has entered into a definitive agreement to acquire Suros Surgical Systems Inc., a provider of devices used for minimally invasive biopsy and tissue excision. The transaction will be structured as a merger of a Hologic acquisition subsidiary into Suros Surgical, whereby Suros Surgical will become a wholly owned subsidiary of Hologic. The purchase price for the transaction will be $240 million (subject to adjustment), plus a two-year earn out. This transaction is expected to close by the end of the second calendar quarter and will be subject to customary closing conditions. Suros Surgical Systems Inc. is a privately held, Indiana-based manufacturer of minimally invasive surgical technologies focused on breast biopsy and tissue removal. Suros Surgical’s ATEC (Automated Tissue Excision and Collection) line of products, include percutaneous, automatic vacuum assisted breast biopsy systems, ancillary breast biopsy devices and biopsy site markers.

U.S. plan for flu pandemic revealed

Identifying a new microorganism explains the cause
of a serious lymph node infection

U.S. plan for flu pandemic revealed

President Bush is expected to approve soon a national pandemic influenza response plan that identifies more than 300 specific tasks for federal agencies, including determining which frontline workers should be the first vaccinated and expanding Internet capacity to handle what would probably be a flood of people working from their home computers. The Treasury Department is poised to sign agreements with other nations to produce currency if U.S. mints cannot operate. The Pentagon, anticipating difficulties acquiring supplies from the Far East, is considering stockpiling millions of latex gloves. And the Department of Veterans Affairs has developed a drive-through medical exam to quickly assess patients who suspect they have been infected. The document is the first attempt to spell out in some detail how the government would detect and respond to an outbreak, and continue functioning through what could be an 18-month crisis, which in a worst-case scenario could kill 1.9 million Americans. When the near-final 240-page plan is issued, officials intend to announce several vaccine manufacturing contracts to jump-start an industry that has declined in the past few decades. Administration scientists are debating how much vaccine would be needed to immunize against a new strain of avian influenza, and they are weighing data that may alter their strategy on who should have priority for antiviral drugs such as Tamiflu and Relenza. The new analysis, published in Proceedings of the National Academy of Sciences, suggests that instead of giving medicine to first responders and health-care workers, as currently planned, it might be wiser to give the drugs to every person with symptoms and others in the same household, one senior administration official said. To keep the 1.8 million federal workers healthy and productive through a pandemic, the Bush administration would tap into its secure stash of medications, cancel large gatherings, encourage schools to close and shift air traffic controllers to the busier hubs, probably where flu had not yet struck. Retired federal employees would be summoned back to work, and National Guard troops could be dispatched to cities facing possible “insurrection,” said Jeffrey W. Runge, chief medical officer at the Department of Homeland Security. The administration hopes to help contain the first cases overseas by rushing in medical teams and supplies. A central issue would be “who is ultimately in charge and how the agencies will be coordinated,” said former assistant surgeon general Susan Blumenthal. The federal government, as well as private businesses, should expect as much as 40 percent of its workforce to be out during a pandemic, said Bruce Gellin, director of the National Vaccine Program Office at HHS. The Agriculture Department, with 4 million square feet of office space in metropolitan Washington alone, has bought masks, gloves and hand sanitizers, and has hired extra nurses and compiled a list of retired employees who could be temporarily rehired. Operating the largest health-care organization in the nation, the VA has directed its 153 hospitals to stock up on other medications, equipment, food and water, said chief public health officer Lawrence Deyton. “But it's a few days' worth, not enough to last months,” he added. Anticipating that some nurses may be home caring for family members, and to reduce the number of patients descending on its hospitals, the VA intends to put nurses on its toll-free hotline to help veterans decide whether they need professional medical care. The Strategic National Stockpile has 5.1 million courses of Tamiflu on hand. The goal is to secure 21 million doses of Tamiflu and 4 million doses of Relenza by the end of this year, and a total of 51 million by late 2008. Te administration will pay one-quarter of the cost of antivirals bought by states. The administration is posting information on the Internet at http://www.pandemicflu.gov/ .
(The Washington Post)

Identifying a new microorganism explains the cause
of a serious lymph node infection

In a development unusual in an era when most disease-causing agents have already been found, government researchers have identified a new bacterium that causes a serious lymph node infection in some patients with suppressed immune systems. “The discovery of new bacteria is not uncommon, but discovering an organism that causes human illness is certainly unique,” said Dr. Elias A. Zerhouni, director of the National Institutes of Health. The bacterium has been found in three patients with chronic granulomatous disease, which affects an estimated one person in 250,000. But researchers said the source of at least half of all infections in such patients could not be identified in the past, suggesting that the bacterium could be common in this population. The immunodeficiency disease is caused by a genetic defect in an enzyme called phagocyte NADPH oxidase, which is used in immune cells to generate hydrogen peroxide that kills bacteria and fungi. In July 2003, a 39-year-old man with chronic granulomatous disease was referred to the NIH after three months of unexplainable fever, chills, fatigue and night sweats, in addition to a 10-pound weight loss. Antibiotics did no good. Two months later, he experienced painful swelling of the lymph nodes in his neck. Dr. David E. Greenberg of the National Institute of Allergy and Infectious Diseases and his colleagues biopsied the lymph nodes, which they found to be extensively infected with the new organism, they reported Thursday in the journal Public Library of Science Pathogens. Genetic analysis of the bacterium showed it to be a member of the Acetobacteraceae family, which includes several types of bacteria that are common in the environment and some that are used to make vinegar. No member of the family has previously been shown to cause human disease, however. The team named the new bacterium Granulobacter bethesdensis in honor of the location of the NIH headquarters in Bethesda, MD They have since found the bacterium in two other patients. (Los Angeles Times)

Stan, a high-tech mannequin, packed with electronics and machinery, which allow him to simulate hundreds of medical conditions, was recently showcased at the opening of Sarasota Memorial Hospital's Patient Safety Simulation Lab in Florida. Hospital officials and the donors who funded the lab crowded the small room, jostling for a view of the future of medical training. Stan’s heart monitor beeped, showing a steady 72 beats per minute. He blinked his eyes and spoke. “I'm getting that chest pain again,” he said. A team of doctors and nurses stood by, ready to treat him. Stan, short for Standard Man, is the top-of-the-line model from Sarasota-based Medical Education Technologies Inc. A $265,000 grant from Intertape Polymer Group, the Roberta Leventhal Sudakoff Foundation, the Harry Sudakoff Foundation and the Sarasota Memorial Hospital Foundation paid for Stan and the lab. METI began making the simulators in 1996 and now counts about 900 colleges, hospitals and military bases among its customers. In one published example, a Yale medical school surgeon took a group of 32 students, tested them on hand-eye coordination and other skills, then split them into two evenly matched groups. Both trained for laparoscopic gallbladder removal. One used a simulator resembling a video game. The other group went the traditional route of observing and studying. Then teams of experienced surgeons evaluated them on how well each group performed on actual patients. In short, simulators won. The traditionally trained group was five times more likely to have injured the gallbladder or surrounding tissues and six times more likely to make other errors. Stan plays out any of hundreds of medical situations programmed into his computer. (The Herald Tribune)

New guidelines for handling bodies after disasters

A new field manual for first responders offers step-by-step guidance on how to recover and identify victims killed in disasters while respecting the needs and rights of survivors. The manual was published by the Pan American Health Organization (PAHO, the World Health Organization (WHO), the International Committee of the Red Cross, and the International Federation of Red Cross and Red Crescent Societies. Management of Dead Bodies after Disasters: A Field Manual for First Responders is aimed at facilitating proper identification of victims and preventing mass burials and cremations. The book dispels the widely held misconception that dead bodies pose a serious health threat in the aftermath of disasters. “After most natural disasters, there is a fear that dead bodies will cause epidemics,” said Oliver Morgan, an honorary research fellow at the London School of Hygiene and Tropical Medicine and one of the book's three co-editors. “This belief is wrong, most infectious organisms do not survive beyond 48 hours in a dead body, and it is the surviving population that is more likely to spread disease. But authorities often feel political pressure to resort to unnecessary measures such as hasty mass burials.” Such practices can add to the mental suffering of victims' families and can lead to legal and other long-term difficulties by preventing proper identification of bodies. The job of managing dead bodies after a disaster, particularly in developing countries, usually falls to local organizations and communities rather than specialized teams of national and international experts. Among central points emphasized in the manual are: Careful and ethical management of dead bodies is a critical component of disaster recovery. Dead bodies pose a negligible threat to public health, since most victims die from injury, drowning or fire. Responders who handle dead bodies should wear gloves and practice good basic hygiene. Wearing face-masks is not necessary for infection control purposes but may help workers feel psychologically better. Bodies present virtually no risk of epidemic diseases. First responders should collect basic information about the deceased and take photographs before storing bodies for later forensic identification. Bodies should be stored at cold temperatures, either in refrigerated containers or buried temporarily in organized graves. Within 12 to 48 hours in hot climates, decomposition will be too advanced to allow facial recognition. The news media are vital channels of communication with the public, and authorities should proactively engage them. The book is available for download from the PAHO website http://www.paho.org/english
/dd/ped/DeadBodiesFieldManual.htm

Health Care Without Harm (HCWH) received the Skoll Award for Social Entrepreneurship, an honor given to leaders of organizations that use the most innovative and effective approaches to making social change. As part of the award, HCWH will receive $765,000, which will be used for a global campaign to replace mercury-containing medical devices with safe alternatives, and to expand HCWH programs in Europe, South America and Asia. HCWH is an international coalition working to reduce pollution in the health care industry, and has been instrumental in closing medical waste incinerators, reducing dioxin pollution, removing mercury products from health care, and shifting health-care purchasing dollars toward safer, less-toxic materials. The coalition, which celebrates its 10th anniversary this year, has built a growing environmental health movement in the health care industry. www.NoHarm.org

Proposed changes to the hospital inpatient payment systems

Robust health insurers suffer infirmities in 2006

Proposed changes to the hospital inpatient payment systems

The Centers for Medicare & Medicaid Services (CMS) is proposing to revise the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs. The proposed changes include the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. The proposed fiscal 2007 rate increase for acute-care hospitals averages a 3.4% update. Hospitals in rural areas would see an average increase of 6.7%.The CMS is setting forth proposed rate-of-increase limits as well as proposed policy changes for hospitals and hospital units excluded from the IPPS that are paid in full or in part on a reasonable cost basis subject to these limits. These proposed changes would be applicable to discharges occurring on or after October 1, 2006. The proposals seeks to refine the diagnosis-related group (DRG) system under the IPPS to better recognize severity of illness among patients—for FY 2007, and to use a hospital-specific relative value cost center weighting methodology, to adjust DRG relative weights and in FY 2008 to implement consolidated severity-adjusted DRGs or alternative severity adjustment methods. Among the other policy changes proposed are changes related to limited revisions of the reclassification of cases to DRGs; the long-term care (LTC)-DRGs and relative weights; the wage data, applications for new technologies and medical services add-on payments; payments to hospitals for the direct and indirect costs of graduate medical education; submission of hospital quality data; payments to sole community hospitals and Medicare-dependent, small rural hospitals. According to the CMS, the changes are designed to more accurately reflect the costs of services provided by hospitals and prevent hospitals from being rewarded for treating high numbers of low-severity patients. The reforms will significantly affect payments to specialty hospitals, the CMS said. While the new system may present disadvantages for specialty hospitals, it is expected to be a benefit rural hospitals with low-profitability services. The new program is aimed at redistributing profits from highly reimbursed procedures such as some heart surgeries, to conditions seen as underpaid, like treating pneumonia. Payment for stents fared poorly, with cuts in the double-digits. Reimbursement for implantable cardioverter defibrillators would be cut more than 20 percent under the new guidelines. The rules are subject to a public comment period and cover in-patient hospital stays in 2007 and 2008.

Robust health insurers suffer infirmities in 2006

After five years of stock market gains, shares of health insurance companies have been on a slide so far this year, down 8.6 percent since Jan. 1, as measured by a Standard & Poor's index of health insurers. Analysts blame profit-taking by big investors who have sold their insurance stocks and transferred their bets to commodities and energy. A leading insurer, UnitedHealth Group, is to report first-quarter results on Tuesday, with other major competitors issuing earnings data over the next few weeks. The sector is expected by a Citigroup analyst, Charles Boorady, to report a drop of 2 percent in earnings per share from the fourth quarter of 2005 though an 11 percent increase over last year's first quarter. United has had significant growth in the number of members in high-deductible insurance plans, which come with relatively low monthly premiums and may be offered through an employer. But the company has said it expects to report 150,000 fewer members in its large-employer commercial business for the first quarter, not counting members acquired through the acquisitions of other insurers. For one thing, it has lost some business covering state employees. Sheryl R. Skolnick, an analyst with the CRT Capital Group, said the increase in high-deductible policies meant less revenue for each member but “not necessarily that much lower profit, because it is a much skinnier benefit package.” Sometimes, people end up not using the coverage their health plans provide for catastrophic problems, she noted, so the insurer's costs may be minimal because the policies tend to cover fewer routine services. Because the companies are getting deeper into government business with the advent of the Medicare Part D prescription drug benefit, their financial results will be complicated by government spending patterns. The insurers will provide drug coverage for millions of new Medicare customers this year, but the subsidies to pay for those purchases are not likely to arrive until later in the year. Profit margins on these members are expected to be slim, though the companies see them as a chance to expand more lucrative types of Medicare-related business. (The New York Times)

Moog to continue Curlin Infusion Pump distribution
relationship with B. Braun Medical

B. Braun Medical Inc. announced that Moog Inc., worldwide designer, manufacturer, and integrator of precision control components and systems, will continue, and expects to expand, its relationship with B. Braun Medical, exclusive North American distributor of Curlin Infusion Pumps. This news follows the recent announcement by Moog that it completed the acquisition of Curlin Medical, LLC, a manufacturer of infusion pumps, and the net assets of two affiliated companies. In recent years, Moog, known for its work in high-performance systems that control military and commercial aircraft, satellites and space vehicles, launch vehicles, missiles, and automated industry machinery, has also supplied a variety of components to manufacturers of medical equipment. Sales of these medical products have grown significantly, and in the 2006 fiscal year, will approach $40 million. The purchase of Curlin Medical expands Moog’s presence in the medical market. Moog believes that its extensive background in the electronic control of fluid-flow metering devices combined with Curlin’s reputation in the medical market will facilitate the continued growth of Moog’s medical equipment sales.

Amerinet awards contract to Instrumentation Laboratory
for critical care portfolio

Instrumentation Laboratory (IL) announced that it has been awarded a three-year contract for its critical care portfolio with Amerinet Inc. This is the second contract Amerinet has awarded IL since 2001. The contract covers IL's portfolio of critical care analyzers, reagents, consumables and service, including IL's flagship product, the GEM(R) Premier(TM) 3000 analyzer for blood gas, electrolyte and metabolite testing. This analyzer features Intelligent Quality Management (iQM(TM)), a real-time, automated, continuous quality assurance system that helps ensure the quality of every test result and reduce costs and time. iQM, coupled with its cartridge-based technology and ease of use, allows the GEM Premier 3000 to be used throughout the hospital, at the point of care and in the lab. In addition to the GEM Premier 3000, IL's contract with Amerinet includes the GEM OPL, a portable CO-Oximeter; the IL682 CO-Oximeter; GEMweb, software for remote management of the GEM Premier 3000; and IMPACT(TM) for Critical Care, a data management system.

Doctors reverse girl’s heart transplant

About 10 years ago, Hannah Clark of Wales, had a heart transplant. It was an unusual operation because when doctors put the new heart in her body, they left her existing heart in place, even though the new one was doing all the work. Recently, though, Hannah's body began rejecting the donor heart. During surgery this year, doctors made an amazing discovery: Hannah's own heart looked healthy again. Apparently, all it needed was a rest. Doctors hooked the heart back up, and now Hannah is happy and healthy thanks to the heart she was born with. Doctors think it's the first case of someone getting a new heart and then switching back to their own. (The Washington Post)

Renowned pediatric cardiothoracic surgeon, Leonard L. Bailey, MD, Loma Linda University Medical Center, Loma Linda, CA, addressed the International Society for Heart and Lung Transplantation (ISHLT) 26^th Annual Meeting and Scientific Sessions in Madrid, presenting a “Pioneers in Transplantation Lecture” highlighting 20 years of historic advances in neonatal cardiac transplantation. Today, nearly 100 infants per year receive heart transplants. Dr. Bailey’s hypothesis that infants’ immature immune systems would make them more likely to accept transplanted organs than older patients is supported by years of research and studies in pediatric transplantation. The ISHLT Pediatric Registry shows that patients transplanted in early infancy have a significant advantage in long-term survival compared to pediatric patients transplanted at any later age. Researchers speculate improved infant survival is likely related to the immune advantage suggested by Dr. Bailey and that infants’ immunologic immaturity at the time of transplantation allows them to be able to receive donor organs from mismatched blood groups. In contrast to older children and adults, published studies have shown that infants under one year of age can tolerate heart transplants from donors of different blood groups, improving the chances of survival for infant candidates and substantially altering the potential donor pool for each individual.

U.S. News & World Report hosts Health Summit
on Emergency Preparedness; Leavitt, Chertoff to speak

On Tuesday, April 18, U.S. News & World Report is convening an Emergency Preparedness Health Summit, where senior health executives, experts in emergency preparedness, and CEOs of the nation’s most prestigious hospitals and medical schools will: generate a series of specific recommendations that hospital administrators, first responders, and others will be able to consult as they review and refine their own preparedness measures; discuss their frontline views of other previous calamities; and prioritize the pressing needs of the nation’s medical community as it designs preparedness plans. Keynote Speakers include Michael O. Leavitt, Secretary, U.S. Department of Health and Human Services and Michael Chertoff, Secretary, U.S. Department of Homeland Security.

Air travelers eyed in mumps outbreak

Mass. governor signs landmark health bill

Air travelers eyed in mumps outbreak

Two infected airline passengers may have helped spread Iowa's mumps epidemic to six other Midwestern states, health officials said Wednesday, the latest example of how quickly disease can spread through air travel. The mumps epidemic is the nation's first in 20 years. Health officials say 515 suspected cases have been reported in Iowa, and the disease also has been seen in six neighboring states, according to the U.S. Centers for Disease Control and Prevention. As of Monday, Nebraska has 43 reported cases; Kansas, 33; Illinois, four; Missouri, four; Wisconsin, four; and Minnesota, one. The Iowa health department identified two people who were potentially infectious when they were traveling in late March and early April. Officials in other states have not yet linked any cases to the air travelers. But because the illness's incubation is two to three weeks, cases may not begin appearing until about now, said a spokesman for the Iowa Department of Public Health. This week the CDC put out an advisory about the passengers to state health departments. The first traveler is executive director of a Waterloo, IA, downtown development organization who in late March was in a delegation that traveled to Washington, D.C. The woman had earlier visited the Dominican Republic, where she thinks she may have caught the bug. The woman, 51, left Waterloo on March 26 on a flight to Minneapolis, Minnesota, and then flew to Detroit, MI. On March 26, she flew to Washington, D.C.'s Reagan National Airport. During her visit, she shook hands with Iowa's two U.S. senators, Tom Harkin and Charles Grassley, she said. She returned to Waterloo on March 29, with a stop in Minneapolis. She said she developed a scratchy throat upon her return, and after hearing reports of a mumps outbreak, went to a doctor for testing. She got confirmatory test results six days later. During those six days, she had been to church and numerous work events, including an April 1 pub crawl that involved about 370 people. The second person was a young man returning from vacation in Arizona on April 1. He flew from Tucson, AZ, to Dallas, TX, then to Fayetteville, AK, to St. Louis, MO, and finally to Cedar Rapids, IA. No deaths have been reported from the current epidemic. A two-dose mumps vaccine is recommended for all children, and is considered highly, but not completely, effective against the illness. About a quarter of the Iowans who have suspected cases got the vaccine, said the spokesman for the Iowa Department of Health. (The Associated Press)

Mass. governor signs landmark health bill

By next summer, Massachusetts may cross a threshold that has eluded presidents, governors and other political leaders for generations by becoming the first state to require universal health care coverage. Massachusetts took a major step toward that accomplishment Wednesday when Gov. Mitt Romney signed legislation designed to guarantee coverage for virtually all residents by July 2007, including an estimated 550,000 people who are now uninsured. The law has set a standard for other states and thrust Massachusetts to the forefront of the national debate about how to dramatically expand health care coverage without creating a single government-controlled system. Still, Romney faced criticism for vetoing a key portion of the legislation: a $295 annual fee on businesses that do not provide their employees with coverage. The law also provides subsidies and sliding-scale premiums to get poor and low-income residents into health plans and require those deemed able to afford insurance to purchase a policy. ''We have found a way, collectively, to get all of our citizens insurance without some new government-mandated takeover or a huge new tax program,'' Romney said. Romney is weighing a potential run for the Republican presidential nomination in 2008 and the law could be a centerpiece of that campaign. An ABC News-Washington Post poll of more than 1,000 adults nationwide released Wednesday found 55 percent of Americans would support a health care law similar to the Massachusetts model in their own states. Forty-one percent opposed. Romney used his line-item veto power to strike eight portions of the bill, including the $295 fee. He said the fee was not needed to pay for the reform. Business and hospital leaders also criticized the veto of the fee. Massachusetts Hospital Association President Ron Hollander said it threatened the balance of the bill. “I think it is important that all the parts and all the parties stay together,” he said. “The employer assessment is critical.” Romney defended the action. “There are many businesses who have been flooding my office with calls as well as business associations, that are very concerned about it,” he said. Under the law, those who can afford insurance but still refuse to get it will face escalating tax penalties. The cost of the health care package was put at $316 million in the first year, rising to more than a $1 billion in the third year, with much of that money coming from federal reimbursements and existing state spending, officials said. (The Associated Press)

AHRQ reports on long-term uninsured in America, 2000–2003

According to a new report by the Agency for Healthcare Research and Quality, during 2002 to 2003, young adults aged 18 to 24 and 25 to 29 were the most likely to be uninsured for at least one month (54.9 and 50.7 percent, respectively). Children under age 18 were the least likely to be uninsured for the entire 2000–2003 four-year period (2.7 percent). Individuals reporting excellent or very good health status were least likely to be uninsured for at least one month during 2002 to 2003 (28.8 and 30.6 percent, respectively). Those reporting good or fair/poor health were the most likely to be uninsured for the entire 2000–2003 four-year period (8.0 and 8.5 percent, respectively). Hispanics were the most likely to be uninsured for at least one month during 2002 to 2003 (51.2 percent) and for the entire 2000–2003 four year period (15.7 percent). Hispanics or Latinos single race were disproportionately represented among the longterm uninsured. While they represented 15.0 percent of the population under age 65, they represented 37.8 percent of the long-term uninsured for the period 2000–2003. Individuals who were poor were disproportionately represented among the long-term uninsured. While they represented 12.6 percent of the population under age 65, they represented 24.2 percent of those uninsured for the entire 2000–2003 four-year period. http://www.meps.ahrq.gov/papers/st123/stat123.pdf

Inquiry yields no clues on lens cleaner linked to infections

Bausch & Lomb said that despite weeks of research neither the company nor federal regulators had figured out how its ReNu With MoistureLoc cleaner might be linked to an apparent outbreak of a severe fungal infection among American contact lens wearers. The company announced Tuesday that it had voluntarily halted shipments of the product from its Greenville, SC, factory that day, although it was not halting sales. But numerous retailers took that action on their own, taking ReNu With MoistureLoc, and in some cases other products in the ReNu line, off their shelves. The halt in MoistureLoc shipments followed an announcement Monday by the federal Centers for Disease Control that 109 infections involving a potentially blinding fungus called Fusarium keratitis had been reported in the last 10 months in the United States and that a preliminary analysis of 30 of them strongly linked the outbreak to MoistureLoc. Similar infections linked to use of MoistureLoc were reported in Singapore in February, and sales were suspended there and in Hong Kong. But no problems have been reported with MoistureLoc manufactured for sale in Europe at the company's Italian factory or in China. Although the United States statistics strongly suggest a product-related problem, the numbers are so low that no one is sure whether Fusarium infections are actually on the rise or are merely getting more attention. More cases are being reported in Northern states, where they have been rare in the past, but some researchers say that could reflect climate change rather than product defects. Ronald L. Zarella, Bausch & Lomb's chairman and chief executive said that inspectors from the Food and Drug Administration had been combing the Greenville plant for three weeks looking for ways that MoistureLoc could have been contaminated. He said that effort, fruitless so far, was expected to end this week. So far Bausch & Lomb has refused to take back shipments of the solution already delivered to customers. But Zarella said that the company would accept returns if the uncertainty was not resolved “in a reasonable period of time.” (The New York Times)

Graham-Field Health Products announces agreement
with MedAssets Supply Chain Systems

Graham-Field Health Products announces that it has signed a full-line, multi-year contract with MedAssets Supply Chain Systems. MedAssets Inc., headquartered in Atlanta, GA, is a cash flow and margin improvement company for healthcare organizations. GF Health Products Inc., headquartered in Atlanta, GA, is a major manufacturer and distributor of healthcare products for the homecare, long-term care and acute care markets. Its products include manual and power wheelchairs, homecare and long-term care beds, patient aids, diagnostics and specialty seating products. Graham-Field’s name brand products include Everest & Jennings, Basic American Medical Products, John Bunn, Grafco, Labtron and Lumex.

ZOLL Medical Corporation, a manufacturer of resuscitation devices and related software solutions, announced that it had completed the acquisition of the assets of Lifecor Inc., a privately owned medical equipment company that designs, manufactures and markets a wearable external defibrillator system. As a result of the transaction, ZOLL acquired Lifecor's assets and business, assumed Lifecor's outstanding debt of approximately $5.8 million (plus an additional $3.0 million owed to ZOLL), and also assumed certain stated liabilities of approximately $1.5 million. ZOLL will operate the Lifecor business through its ZOLL Lifecor subsidiary, based in Pittsburgh, PA.

A special invitation for Materials/Purchasing professionals

A special invitation for Materials/Purchasing professionals

The American Association of Critical-Care Nurses and Healthcare Purchasing News invite Materials/Purchasing Managers and their staffs to attend the 2006 Critical Care Exposition in Anaheim, CA, May 23-25, on a complimentary (fee-waived) admission basis.

HPN is hosting the following panel discussions on materials management:
Wed., May 24, 4:00-5:15 pm
"Critical Care Influence in Supply Purchasing"
Thurs., May 25, 7:30-8:45 am
"Critical Care Influence in Inventory Management"

You and your staff are encouraged to visit the show (free admission) and examine firsthand the critical care devices and equipment your nurses use everyday. To receive your NTI 2006 materials, send an e-mail to randy.bauler@aacn.org or call toll free at 800/394-5995, ext. 366 to request the HPN Registration Special today.

New information will help healthcare providers
adopt health IT

The Agency for Healthcare Research and Quality (AHRQ) released a report acknowledging that while health information technology has been shown to improve quality of care for patients, most healthcare providers need more information about how to implement these technologies successfully. The report, Costs and Benefits of Health Information Technology, is a synthesis of studies that have examined the quality impact of health IT as well as the costs and organizational changes needed to implement health IT systems. This report reviews scientific data about the implementation of health IT to date, as documented in studies published through 2003. It does not project future health care benefits or savings, in contrast to other reports. The authors conclude that scientific reviews have shown significant improvements in the quality of healthcare utilizing health IT systems. However, these successes have occurred primarily within large healthcare systems that created their own health IT systems and devoted substantial commitment and resources to these efforts. AHRQ's initiative is developing data needed about how to put health IT to work in more common healthcare settings such as physicians' offices and hospitals. “Widespread implementation of HIT has been limited by a lack of generalizable knowledge about what types of HIT and implementation methods will improve care and manage costs for specific health organizations,” said the report. The report points out that the smaller medical practices and hospitals that constitute the majority of the nation's healthcare providers have limited technological expertise and must depend on the purchase of commercial systems. “Healthcare providers need reliable information that tells them what they can expect when they implement health IT systems,” said AHRQ Director Carolyn M. Clancy, M.D. “Leading institutions in health IT have shown that these systems can produce improved quality and patient safety. But smaller practices and hospitals need to know how these improvements can be achieved in settings like theirs, using the kinds of commercial systems they are likely to employ.” http://www.healthit.ahrq.gov. http://www.ahrq.gov/downloads/pub/evidence/pdf/hitsyscosts/
hitsys.pdf.

Straightening out the labeling, color and designs of medical gas canisters could avoid the types of mix-ups that in the past decade have killed at least eight patients and injured 16 others, health officials said. Rules proposed by the Food and Drug Administration would establish a standard color-coding system for the canisters and require wraparound labels. The tanks would come equipped with outlet connections that could not be easily removed to discourage the improper hookup of the wrong types of gases to breathing equipment. Also, the rules would outlaw the reuse of industrial gas canisters for medical purposes, a practice that can lead to contamination by cleaning solvent residues, the FDA said. Beyond the eight deaths, the FDA also has received reports of 16 serious injuries due to gas mix-ups. Because nursing homes and hospitals are not required to report such cases to the FDA, the actual number of deaths and injuries is probably higher. The worst of the accidents involved the deaths of four patients and injury of six others in a Bellbrook, OH, nursing home in December 2000. An employee mistakenly gave the 10 patients industrial nitrogen instead of oxygen, the FDA said. The canister bore a nitrogen label but it only partially obscured a medical oxygen label. The FDA will accept public comments until July 10 on the proposed rules before they become final. The proposed FDA medical gas rules can be found at http://www.fda.gov/OHRMS/DOCKETS/98fr/06-3370.htm (The Associated Press)

Studies challenge traditional breast cancer treatments

Two important new studies challenge conventional thoughts about treating and avoiding breast cancer. One suggests that doctors may eventually be able to identify women who do not need chemotherapy. The others says that women who have had hysterectomies can take estrogen to relieve symptoms of menopause without increasing their risk of breast cancer. The first study, published in The Journal of the American Medical Association, indicates that many of the 70 percent of women whose cancers are fed by estrogen get so much benefit from estrogen-blocking hormonal therapy that chemotherapy adds little if anything. Currently, guidelines call for women to get chemotherapy if their tumors are of a certain size. The first study analyzed data from three large clinical trials that tested different chemotherapy regimens. One gave two standard drugs with or without a third drug, paclitaxel. Another compared drugs in low, moderate or high doses, and the third asked whether it was better to give the drugs more intensely, in two-week cycles, or whether three-week cycles were best. The women also had surgery and radiation as appropriate, but the studies focused on the effects of chemotherapy. The analysis, by a group of leading breast cancer researchers, led by Donald Berry, a statistician at M. D. Anderson Cancer Center, asked whether some women were more likely to benefit from chemotherapy. The conclusion was that even though the studies involved very different chemotherapy regimens, one variable always stood out: whether a woman's cancer was estrogen receptor positive, meaning it was fed by estrogen, or estrogen receptor negative, meaning it was impervious to estrogen's effects. “All the benefits were in the estrogen receptor negatives,” Dr. Berry said. He and his colleagues reported in the new paper that hormone therapies with drugs like tamoxifen that starve cancers of estrogen are so powerful, reducing the death rate by 30 percent in women with estrogen receptor positive tumors, that chemotherapy helps those women much less than it helps women with estrogen receptor negative tumors. On average, the researchers report, a women whose cancer does not respond to estrogen has a 23 percent greater chance of surviving five years, disease free, if she has chemotherapy. For a woman whose cancer is fed by estrogen, chemotherapy increases her chance of surviving that long by 7 percent. There are tests of how sensitive a tumor is to estrogen, but, Dr. Eric P. Winer, an author of the paper who is director of the Breast Oncology Center at the Dana-Farber Cancer Institute in Boston, said, they “are not as reliable as we all would like.” For now, said Dr. Clifford Hudis, a co-author of the paper and chief of the breast cancer service at Memorial Sloan-Kettering Cancer Center in New York, cancer treatment recommendations should not change. The new results, Dr. Hudis said, are “hypothesis generating” and call out for further research. The second paper, also published in The Journal of the American Medical Association, involved a federal study of more than 10,700 healthy women whose uteruses had been removed. The question was, What are the health consequences of taking estrogen for the relief of menopausal symptoms? The new report does not apply to most menopausal women, just to those who have had hysterectomies, the only women in the study. The difference is important because women who have had hysterectomies can take estrogen alone. But other women cannot because it can cause uterine cancer. For them, estrogen must be combined with another hormone, a form of progesterone, to counter the cancer-causing effect. In this case, the study, the Women's Health Initiative, found that estrogen did not increase the women's risk of breast cancer. But they did have more abnormal mammograms, usually requiring that the test be repeated, and more breast biopsies. The study ended early, at the end of February 2004, when the investigators found that estrogen increased the risk of strokes and of blood clots in the legs. (The New York Times)

Blasting of kidney stones has risks, study reports

The use of shock waves to pulverize kidney stones into sand-like material significantly increases the risk for diabetes and high blood pressure later in life, according to the longest follow-up study of the popular therapy. In the study from the Mayo Clinic, patients who underwent the pulverizing procedure, known as lithotripsy, developed diabetes at almost four times the rate of those whose kidney stones were treated by other methods. The lithotripsy group also developed high blood pressure about 50 percent more often than a group treated by other methods, the study in The Journal of Urology found. The diabetes risk was related in part to the number of shocks given, said the Mayo Clinic researchers in Rochester, MN. The risk for hypertension was related to treatment of stones in both kidneys but not to the total number of shocks, which can number in the hundreds or thousands. The Mayo Clinic issued a news release saying that its researchers are “sounding an alert about the side effects of shock wave lithotripsy” and that the findings are “completely new.” For now, the Mayo researchers hypothesize that shock wave therapy for kidney stones increases the risk for diabetes by damaging the insulin-producing cells in the pancreas, a gland through which the shock waves may pass. They also theorize that shock waves may increase the risk for hypertension by scarring the kidneys and affecting their secretion of hormones, like renin, that can influence blood pressure. The findings of the new study underscore the importance of following patients many years after they receive new therapies and how rarely studies do so because of costs and long-term research interest. Because the new findings were based on a follow-up of the first year that lithotripsy was used at the Mayo Clinic, in 1985, confirmatory studies from other medical centers are needed. Lithotripsy still has an important role in treating kidney stones despite the risks the team found, Dr. Amy Krambeck, a co-author of the study said. (The New York Times)

European regulators approve Boston Scientific-Guidant deal

Boston Scientific said Tuesday that it had won antitrust clearance from the European Commission for its $27 billion acquisition of Guidant. It must still receive approval from the United States Federal Trade Commission for the deal. Boston Scientific said it still expected the acquisition to close around the middle of this month. To satisfy concerns that the combined company could command too great a share of the market for heart stents, Boston Scientific agreed before the regulatory reviews to sell a piece of Guidant's business, including its drug-coated stents. Abbott Laboratories, based near Chicago, will pay $4.1 billion in cash, provide a $900 million loan to Boston Scientific and acquire $1.4 billion in Boston Scientific stock. In addition to approving the Boston Scientific-Guidant deal, European regulators cleared the transaction involving Abbott. (The Associated Press)

HPN creates new critical care supply management award;
deadline extended

Ask a critical care nurse about materials management's customer service to the ICU or ask a materials manager about ICU's supply demands and you'll likely elicit a lot of eye rolling and sighs. Then the complaints bubble to the surface. Materials management doesn't understand the ICU's needs; the ICU makes too many demands without any forecasting or predictive planning. Obviously, a disconnect between critical care nursing's needs and materials management's perceived customer service seems to exist, more often than not. That disconnect typically is caused by communication lacking between the two departments and by priorities being misunderstood and overlooked, if not ignored. While these failures may be all too common in today's healthcare facilities success stories do exist. Healthcare Purchasing News would like to find them and share them with you. That's why we're creating a new award that recognizes those facilities who identified problems, developed workable solutions and effectively bridged the gap between the ICU and the supply storeroom, thereby improving patient care. We'd like to honor and profile the facility that offers the optimal, if not best, solution to a lingering supply management challenge in the ICU with the “HPN Award for Critical Care Supply Innovation.”

Applying is simple: Please submit a brief nomination of no more than 750 words max that highlights and outlines what the problem was, how it was solved and who collaborated on/contributed to developing and implementing the solution. Email applications to editor@hpnonline.com or send to: HPN’s Critical Care Supply Management Award, 7650 So. Tamiami Trail, Ste 10, Sarasota, FL 34231. Extended deadline: Monday, April 17. HPN will feature the winning facility in the June 2006 edition, as well as at the 2006 National Teaching Institute and Critical Care Exposition of the American Association of Critical-Care Nurses in Anaheim, CA, May 20-25.

Employers push White House to disclose Medicare data

The White House is clashing with the nation's largest employers over their request for huge amounts of government data on the cost and quality of health care provided by doctors around the country. President Bush has repeatedly urged private insurers to disclose such data, saying it will help consumers choose doctors and hospitals. But Medicare has turned down a request for its data from the Business Roundtable, whose member companies provide coverage to more than 25 million people. Employers want to use the data to compare and rate doctors and to rein in soaring health costs, the very purpose advocated by the president. The data would show, for example, which doctors performed the most knee operations with the fewest complications. Employers said they could then compare the average cost per case for different doctors. And they could steer patients, workers, and retirees and their dependents, to doctors who achieved the best results and offered the best value. Medicare handles more than a billion claims a year. Administration officials said they shared the employers' goals, but were constrained by court rulings that limited the disclosure of data showing Medicare payments to individual doctors, identified by name. Employers disagree, saying those court rulings are no longer relevant. The Business Roundtable represents chief executives from 160 of the nation's largest companies, including Citigroup, Exxon Mobil and General Electric. (The New York Times)

Red Cross retools disaster response; Relief agency wants
new plan in place for hurricane season

The American Red Cross is embarking on a two-track effort to overhaul its entire disaster response system and the often cumbersome way it governs itself. The new hurricane season starts June 1, and the Red Cross is hurrying to get its new response plans in place before any big storms arrive. It also hopes to complete an independent audit this summer and offer governance reform proposals to Congress. The 125-year-old charity, chartered by Congress, was far the biggest player in responding to Hurricane Katrina, raising $2 billion, mobilizing 235,000 volunteers and helping hundreds of thousands of displaced people. Yet it was sharply criticized for responding too slowly in some low-income minority areas, for overreliance on inexperienced staff, and for reluctance to work closely with other nonprofits. One of the major reform proposals is to strengthen cooperation with other national charities and with grass-roots church and community groups, particularly in minority neighborhoods. The Salvation Army and the National Association for the Advancement of Colored People are among the groups that have been asked for advice. Other steps to improve disaster response will include improving communications and data-collection technology, tightening documentation of aid disbursement, and recruiting major transport and delivery companies to expedite emergency supply shipments. To better ensure that funds are well-used, the Red Cross will no longer dole out immediate aid of $1,000 or more to displaced families. Instead, $150 or $200 might be provided up front, with larger sums handed out only after validation of a family's need. Coinciding with the disaster-response overhaul is an intensive effort to improve how the Red Cross governs itself: It now has a 50-member board. Outside experts want to reduce the size of the board so decision-making is easier, weeding out board members, including presidential appointees, who often miss meetings. They're also concerned about local Red Cross chapters, who now hold a majority of board seats, dominating national policy-making. (The Associated Press)

ASLMS: Gold nanoparticle, laser treatment holds promise

Exposing clusters of gold nanoparticles to low-pulse laser energy holds promise as both a diagnostic and therapeutic technique for treatment of cancer, drug-resistant bacteria, and viruses, reported researchers. Gold nanoparticles delivered topically in a cream vehicle, injected subcutaneously, or delivered systemically by a monoclonal antibody or viral vector selectively seek out target tissue and cause a potent but highly localized thermal reaction when they are exposed to pulsed laser light, the investigators said. “Our approach uses relatively small and simple gold nanoparticles to offer more effective delivery to the target,” said Vladimir P. Zharov, Ph.D., director of laser research and the Phillips Classic Laser Laboratory of the University of Arkansas in Little Rock. Gold nanoparticles have about a 600-fold greater affinity for malignant cells than for normal cells, and gold is capable of absorbing approximately one million times more laser energy than natural tissues, Dr. Zharov said at the American Society for Laser Medicine and Surgery meeting. “If we use pulsed laser, we can also produce bubble nanoparticles that mechanically kill cancer cells,” Dr. Zharov said. The use of nanosecond-long laser pulses keeps the energy confined to the target and prevents the spread of thermal damage to surrounding healthy tissue, he added. Dr. Zharov and colleagues are developing several different methods for targeting cancer cell and other pathogens. One approach they're using is to conjugate nanoparticles of gold to monoclonal antibodies that have been raised against tumor-specific surface antigens. At the tumor site the gold particles self-assemble into nanoclusters that can then be targeted with pulsed laser to heat the tissue to several thousand degrees Celsius, resulting in a destructive thermal effect coupled with acoustic effects and mechanical stress to kill tumor cells. Working with both in vitro and animal models, the investigators have also engineered adenoviral vectors to carry the gold particles into target cells. The virus itself is only the carrier, and does not have an effect on the target tissue, he said. They are also exploring the potential for gold nanoparticles in the treatment of bacterial infections such E. coli and methicillin-resistant Staphylococcus aureus, and viral infections such as HIV, he said. Dr. Zharov said that the gold nanoparticles are expected to be safe for use in humans, because gold in various forms has been used in medicine for decades with an excellent safety record, he noted. (MedPage Today)

FDA investigating serious eye infections associated with
soft contact lens use and contact lens solution

The U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) are alerting health care professionals and their patients who wear soft contact lenses to an increasing number of reports in the United States of rare but serious fungal infections in the eye that can cause permanent loss of sight. Some patients have reported a significant loss of vision, resulting in the need for a corneal transplant. A fungus called Fusarium has been identified as the cause of the reported infections. As of April 9, 2006, 109 cases of suspected Fusarium keratitis are under investigation by CDC and public health authorities in 17 states of the U.S. Clinicians who evaluate patients with microbial keratitis should consider that a fungal infection may be involved and refer the patient to an ophthalmologist, if appropriate to obtain a specimen for laboratory analysis. In addition, the FDA and CDC are urgently advising consumers to take precautions to prevent contamination of the soft lenses and the products used to maintain them including: Wash hands with soap and water, and dry (lint-free method) before handling lenses. Wear and replace lenses according to the schedule prescribed by the doctor. Follow the specific lens cleaning and storage guidelines from the doctor and the solution manufacturer. Keep the contact lens case clean and replace every 3-6 months. Remove the lenses and consult your doctor immediately if you experience symptoms such as redness, pain, tearing, increased light sensitivity, blurry vision, discharge or swelling. Regardless of which cleaning/disinfecting solution used, wearers may want to consider performing a “rub and rinse” lens cleaning method, rather than a no rub method, in order to minimize the number of germs and reduce the chances of infection. Of the 30 patient cases fully investigated so far, 28 wore soft contact lenses and two reported no contact lens use. Twenty-six of the soft contact lens users who remembered which solution they used during the month prior to the infection onset reported using a Bausch & Lomb ReNu brand contact lens solution or a generic brand manufactured by the same company. Five case-patients reported using other solutions in addition to the ReNu brand, and 9 patients reported wearing contact lenses overnight, a known risk factor for microbial keratitis. www.fda.gov/cdrh/safety/041006-keratitis.html

Amerinet launches Amerinet Decision Rx to help members
manage pharmacy purchasing activity across supply chain

Health care group purchasing organization Amerinet launched Amerinet Decision Rx, a program that provides members with valuable tools to help them make educated pharmacy supply chain decisions. The three components of the program, Amerinet Pharmacy Price Management, Amerinet Pharmacy Price Auditing, and Amerinet Pharmacy Optimization, were designed to help members utilize contracts and resources more effectively and better manage purchases across the entire pharmacy supply chain from manufacturer to end user. The three components of the program were developed to manage purchases, audit and correct pricing, and optimize margins. Amerinet Pharmacy Price Management was designed to help health care providers better time their pharmacy purchases and verify historical pricing. The tool is available to Amerinet members as part of the online member resources and can be accessed via ValuSource. Valuable data is available in the form of historical pricing reports, current pricing reports, future pricing reports, and price change reports. Amerinet Pharmacy Price Auditing is a daily price-auditing tool that is powered by AccuPrice. Offered through Amerinet’s subsidiary Diagnostix, AccuPrice is a proprietary software tool that quickly identifies and resolves pricing errors. This tool reviews purchases each day to ensure that members are receiving accurate pricing from the supplier. The program returns a report via email to the participating facility outlining the number of invoices, the number of lines, unfavorable variances, favorable variances, and items not on file. Amerinet Pharmacy Optimization provides tools to identify lost contract pricing opportunities, manage and track rebates, maximize market share and tier pricing, and measure product, manufacturer, and wholesaler order fill rates.

Britain confirms case of bird flu in dead swan

Britain confirms case of bird flu in dead swan

A swan found dead in eastern Scotland has tested positive for the deadly strain of bird flu, government officials said, making it the first recorded case of the disease in a wild bird in Britain. The bird, believed to be a native mute swan, was discovered eight days ago in the harbor at Cellardyke, a small coastal town in Fife, northeast of Edinburgh. Officials have established a 1.8-mile protection zone around the spot where it was found to prevent the movement of poultry in and out of the area. Officials hastened to emphasize that although the swan had died from the virulent A (H5N1) strain of flu, there was no immediate danger to humans and no danger, at least yet, to the poultry supply. Cobra, the government's emergency planning group, met Thursday morning in London with officials from the environment and health departments, the Scottish executive and the prime minister's office to map out government contingency plans. With tests now being conducted on an additional two swans found dead in Glasgow, “further cases of avian influenza in wild swans in Scotland cannot be ruled out,” the union said.

A third person died Friday from a viral outbreak at a retirement center in Vancouver, WA, that has sickened more than 55 residents and workers, authorities said. Forty residents and 19 staff members of the Cascade Inn were affected by the norovirus. Nine people have been hospitalized, Clark County health officials said. All three deaths involved elderly residents with other underlying medical conditions, health officials said. Health officials have asked the 180 residents to stay in their rooms and urged friends and family not to visit until the outbreak runs its course. (The Associated Press)

WHO: Health workforce crisis is having a deadly impact on many countries’
ability to fight disease and improve health

A serious shortage of health workers in 57 countries is impairing provision of essential, life-saving interventions such as childhood immunization, safe pregnancy and delivery services for mothers, and access to treatment for HIV/AIDS, malaria and tuberculosis. This shortage, combined with a lack of training and knowledge, is also a major obstacle for health systems as they attempt to respond effectively to chronic diseases, avian influenza and other health challenges, according to The World Health Report 2006 - Working together for health, published by the World Health Organization (WHO). More than four million additional doctors, nurses, midwives, managers and public health workers are urgently needed to fill the gap in these 57 countries, 36 of which are in sub-Saharan Africa, says the Report, which is highlighted by events in many cities around the world to mark World Health Day. Every country needs to improve the way it plans for, educates and employs the doctors, nurses and support staff who make up the health workforce and provide them with better working conditions, it concludes. The World Health Report sets out a 10-year plan to address the crisis. It calls for national leadership to urgently formulate and implement country strategies for the health workforce. These need to be backed by international donor assistance. Infectious diseases and complications of pregnancy and delivery cause at least 10 million deaths each year. Better access to health workers could prevent many of those deaths. There is clear evidence that as the ratio of health workers to population increases, so in turn does infant, child and maternal survival. To tackle this crisis, more direct investment in the training and support of health workers is needed now. Initial costs will be for the training of more health workers. As they graduate and enter the workforce, funds will be needed to pay their salaries. Health budgets will have to increase by at least US$10 per person per year in the 57 countries with severe shortages to educate and pay the salaries of the four million health workers needed to fill the gap. To meet that target within 20 years is an ambitious but reasonable goal, the Report concludes. Financing this gap will require significant, dedicated and predictable funding from national sources, as well as from international development partners. The Report recommends that of all new donor funds for health, 50% should be dedicated to strengthening health systems, of which 50% should be dedicated specifically to training, retaining and sustaining the health workforce.

AHRQ: Reasons for being admitted to the hospital through
the emergency department, 2003

The Agency for Healthcare Research and Quality reports that in 2003, 55 percent of 29.3 million hospitalizations (excluding pregnancy and childbirth) began in the emergency department (ED). Government payers, Medicare and Medicaid, bear the greatest burden of hospital admissions through the ED, covering 66 percent of all admissions through the ED. The mean cost for hospitalizations that began in the ED was $7,400. While 12.4 percent of the U.S. population was covered by Medicaid in 2003, 20.3 percent of hospital admissions through the ED were billed to Medicaid. Similarly, 13.7 percent of the population was covered by Medicare, but 45.4 percent of hospital admissions through the ED were billed to Medicare. Uninsured hospital stays or those covered by commercial insurance showed the opposite pattern: 68.6 percent of patients had some commercial insurance coverage, but private insurance was billed for only 25.2 percent of hospital admissions through the ED. While 15.6 percent of the U.S. population was uninsured in 2003, only 6.2 percent of admissions through the ED were uninsured. Circulatory disorders (diseases of the heart and blood vessels) were the most frequent reason for admission to the hospital through the ED, accounting for 26.3 percent of all such admissions; injuries accounted for 11.4 percent. The top 20 specific conditions accounted for more than half of all hospital admissions through the ED, with pneumonia as the single most common specific condition at nearly one million (5.7 percent) of all such admissions. Complications of procedures, devices, implants, and grafts ranked as the ninth most common reason for admission through the ED and included postoperative infections, malfunction of orthopedic devices, and infection of arteriovenous fistulas used for dialysis. The top 20 specific conditions admitted through the ED included several chronic conditions: chronic obstructive lung disease, asthma, diabetes, and mood disorders. Also included were fluid and electrolyte disorders; urinary, skin, and blood infections; gall bladder disease, gastrointestinal bleeding, and appendicitis; and hip fracture. While up to 82 percent of the most frequent acute conditions were admitted through the ED, a large percentage of chronic conditions were also admitted through the ED; for example, 72 percent of cases with congestive heart failure, chronic obstructive lung disease, and asthma were such admissions. For more, go to http://www.hcup-us.ahrq.gov/reports/statbriefs.jsp

Everyday too many healthcare workers unintentionally cause illness and sometimes fatal harm to patients under their care. Hospital-acquired infections, or infections that are obtained through contact with healthcare professionals or treatment, are a leading and persistent cause of unnecessary patient harm and death. These infections can lead to the spread of drug-resistant strains of bacteria, such as MRSA, an often deadly infection. Unbelievably, most of these infections are transmitted on the hands of healthcare workers who have failed to properly wash their hands. Despite numerous regulations and tomes of data that show a simple hand washing can prevent the spread of infection, compliance of healthcare providers remains unacceptably low – generally below 50%. Because the problem stubbornly persists, The Institute for Healthcare Improvement (IHI) in collaboration with the Division of Healthcare Quality Promotion of CDC, Association for Professionals in Infection Control and Epidemiology (APIC) and the Society of Healthcare Epidemiology of America (SHEA) have developed a practical tool kit for hospitals and health care workers. The kit is available as free content on ihi.org at: http://www.ihi.org/IHI/Topics/Critical
Care/IntensiveCare/Tools/HowtoGuideImprovingHandHygiene.htm. Links are also available on APIC, CDC and SHEA’s websites as well. The guide, entitled “Getting Started: Improving Hand Hygiene,” is written in accessible language and is very user-friendly. It describes well-tested improvement approaches and stresses the importance of 100% compliance because patients can die from ‘partial’ compliance.

Lawson introduces first Landmark-developed application
designed for SOA to help improve supplier relationships

Lawson Software announced its first Landmark-developed application, Lawson Strategic Sourcing, to help customers improve the way they develop and manage supplier relationships. Landmark applications are specifically designed to deploy in a service-oriented architecture (SOA) and to help Lawson and its customers to more quickly and easily modify business processes to better adapt to rapidly changing business or technology needs. Landmark is Lawson's next-generation business application platform based on a SOA, which was designed to bring simplicity, adaptability and manageability to enterprise applications. Government customer Buncombe County, NC, has been a beta user of Strategic Sourcing. The organization was able to incorporate new requirements delivered as part of the beta software instead of waiting until Lawson's next product release, illustrating how Landmark delivers high-quality applications faster than traditional development approaches. Strategic Sourcing is designed to support the acquisition of goods and services with an optimal balance of cost, quality and service while promoting adherence to internal controls and external regulatory compliance requirements. Strategic Sourcing can be set up to significantly reduce the time and costs associated with sourcing events through the utilization of more efficient electronic processes. Functionality encompasses automation of key sourcing events such as request for proposal (RFP), bid analysis and bid award, and for the public sector, a bid tracking system to support compliance with federal, state or locally mandated requirements. The application also includes setup of predefined information for rapid event creation, including standard terms and conditions, questions and templates, as well as integrated creation of purchase orders and vendor agreements from awarded events. And event analysis allows for comparisons of responses and multiple ways to award the events, driving efficient management of the entire source-to-settle business process.

F.D.A. plans to intensify oversight of heart devices

UM Miller School researchers identify how CoQ10 fights cancer,
present findings AACR

F.D.A. plans to intensify oversight of heart devices

The Food and Drug Administration plans to strengthen how it monitors critical heart devices like defibrillators by appointing outside medical experts to help it review the safety of units already on the market, a top agency official said. The move would be the first time the F.D.A. would have outside experts regularly advising it about the safety of medical devices being sold, said Dr. Daniel G. Schultz, director of the agency's Center for Devices and Radiological Health. Traditionally, the F.D.A. has used its advisory panels to help it decide whether to permit the sale of a new device. The agency's decision comes as a medical group that represents doctors who implant devices prepares to release a report recommending changes in how data about heart units is collected and disclosed. Among other proposals, the group, the Heart Rhythm Society, may urge manufacturers to establish an outside panel to review product safety and help companies decide when to issue alerts, people involved in the group said. Dr. Schultz said that the F.D.A. plans to expand an existing advisory panel that reviews and approves new heart devices for sale, adding members who will help the agency oversee the safety of marketed products. Those experts will be asked to help the F.D.A. interpret data from device manufacturers and will also be available to advise the F.D.A. on how best to respond to immediate problems like recalls, he said. Dr. Schultz said the agency planned to start appointing new experts to the panel within the next few months and expected the process to be completed by October. He said that one problem the agency faced was finding experts who did not have financial ties to heart device manufacturers. (The New York Times)

UM Miller School researchers identify how CoQ10 fights cancer,
present findings AACR

Researchers from the Department of Dermatology and Cutaneous Surgery at the University of Miami Leonard M. Miller School of Medicine have identified how Coenzyme Q10 inhibits a protein that plays a vital role in cancer. The researchers, Niven R. Narain and Indushekhar Persaud, presented findings at last year’s meeting of the American Association for Cancer Research (AACR) on the ability of CoQ10, a powerful antioxidant, to inhibit melanoma in the lab. They are now reporting their new findings showing how CoQ10 works and expanding its use at this year’s AACR meeting, held this week in Washington, D.C. Bcl-2 is a protein that tells cells when to shut themselves off, a normal process called apoptosis. But in malignant cells this programmed cell death is switched off, allowing cancer to proliferate and spread. Bcl-2 and CoQ10 are present in both normal and malignant human cells but the ratio changes in malignant cells. Cancer cells have more Bcl-2 and less CoQ10 than normal cells. Narain and Persaud examined that relationship and found that when they administered more CoQ10 to melanoma and prostate tumors in the lab the level of Bcl-2 dropped, and the tumors got smaller. This is the first time researchers have established a correlation between the Bcl-2 protein family and Coenzyme Q10. The Bcl-2 protein shows such promise as a therapeutic target that it is a major research theme at this year’s AACR, which is considered by oncologists to be one of the most important cancer research meetings in the world. The AACR put out a call for investigators to pursue data on the genetic and chemical workings of this protein family. “Last year we found that CoQ10 was inducing apoptosis,” said Narain, Director of Transdermal Delivery/Cutaneous Cancer Research in the Department of Dermatology and Cutaneous Surgery and a member of HPN’s editorial advisory board. “What we’ve found now is that a protein family called Bcl-2 is responsible for conferring resistance to many chemotherapeutic drugs and to radiation. Bcl-2 is a soldier on behalf of cancer.” Bcl-2 takes away the ability of a cell to kill itself and it is over-expressed in many cancers, making the tumor cells resistant to treatment and more likely to grow and spread. In laboratory testing, CoQ10 reverses that, restoring the cancer’s susceptibility to chemo and radiation, and fighting the tumor cells by itself. Since CoQ10 occurs naturally in the cell, it promises to have few side effects. “We’re using something that is already nestled in the mitochondrial membrane, alongside Bcl-2 in the cell.” The UM group developed a novel way to combine CoQ10 with phospholipids, which are prolific in the skin, effectively creating a way to deliver CoQ10 through the skin with a cream. There is tremendous interest among researchers and biotechnology companies to develop this promising knowledge into human therapies. “We are looking forward to further investigating Coenzyme Q10's mechanism of action with the UM Miller School of Medicine,” said Lan Strickland, General Manager, Dermal Technology Business Unit at Pathfinder Management Inc., in Nashville, TN. Pathfinder Management has licensed the technology. “We see great opportunities for this technology while improving overall quality of life in the management of cancer.”

In an ambitious effort to identify some of the thousands of South Floridians who have HIV but don't know it, patients who walk into the emergency room at Jackson Memorial Hospital will soon be offered a routine test for the virus that causes AIDS. Officials hope the program, set to begin later this month, will not only get more people into treatment but also slow the person-to-person spread of the virus. In South Florida, where the rate of HIV infection is among the highest in the nation, more than 30,000 people are HIV positive. One in four don't know they're infected, the Centers for Disease Control and Prevention estimates. Many states, including Florida, have strict rules governing HIV testing procedures. The rules were designed to protect patients' rights, but they have had the unintended consequence of separating HIV screening from routine medical care. The CDC has called for expanded testing nationwide, and a set of guidelines likely to be adopted later this year recommend that everyone between 13 and 64 be tested at least once. In recent years, the virus has moved into heterosexual communities in poor South Florida neighborhoods, where many lack access to routine medical care and use Jackson's emergency room as their medical provider. The Jackson program will be staffed by full-time HIV counselors who circulate in the emergency room offering testing. The Florida Department of Health is paying for the testing kits; a $100,000 grant from Gilead Sciences, which makes HIV medications, is paying staff salaries for the first year. The tests will be free but available only to those admitted to Jackson's emergency room with a medical problem. Patients who decide to be tested will be given a private pre-test counseling session and a rapid test, with results coming in about 20 minutes. Those who test positive on the rapid test and a second, confirmatory, test will be referred into HIV care. (The Miami Herald)

GlaxoSmithKline Plc's experimental vaccine against a virus that causes cervical cancer protected women for as many as four and a half years, according to a company-sponsored study published in the Lancet. The Cervarix vaccine produced and maintained high levels of antibodies against HPV-16 and HPV-18, the most common types of the virus associated with cervical cancer, according to a study of 776 women by Dr. Diane Harper of the Dartmouth Medical School in New Hampshire. London-based Glaxo, Europe's biggest drugmaker, is conducting studies to win regulatory approval for a vaccine that fights the sexually transmitted human papillomavirus, or HPV. HPV has been shown to be the cause of cervical cancer, the second- most common cancer in the world and the most common cause of cancer death in the developing world. “The high level of efficacy seen here against persistent infection might ultimately lead to the long-term prevention of HPV-16 and HPV-18 associated precancerous and cancerous lesions,'' Harper said in her study. “These findings set the stage for the wide-scale adoption of HPV vaccination for prevention of cervical cancer.” Glaxo in March asked European regulators to clear Cervarix, which it bought from biotechnology company MedImmune Inc. of the U.S. in 1997. The product would compete with Gardasil, a product U.S. rival Merck & Co. may start selling as early as June. (Bloomberg)

The Institute for Healthcare Improvement is hosting its 2^nd Annual International Summit on Redesigning Hospital Care, JKune 12-14, 2006 in Atlanta. Celebrate the successes of the 100,000 Lives Campaign. Not only will this mark the culmination of the Campaign, but it will also provide an opportunity for you to interact with other health care leaders and discuss shared accomplishments, learn how best to sustain our progress, and discover what comes next. Plenary Sessions speakers include: Donald M. Berwick, MD, MPP, FRCP, President and CEO, Institute for Healthcare Improvement; Carolyn M. Clancy, MD, Director, Agency for Healthcare Research and Quality (AHRQ); Shirley Franklin, Mayor, City of Atlanta; and Tamra Merryman, RN, MSN, FACHE, Vice President, Center for Quality Improvement and Innovation, UPMC Health System. If you can't be there in person, IHI will bring the Hospital Summit to you via live satellite. Visit: http://www.ihi.org/IHI/Programs/ConferencesAndTraining/Satellite2ndAnnualInternationalSummitOn
RedesigningHospitalCareJune2006.htm You'll find all the details at www.ihi.org, including information on continuing education credits.

Privately held PEPID LLC, a developer of mobile clinical information and decision-support software for doctors and nurses, announces the signing of an agreement with Research In Motion (RIM) of Ontario, Canada, makers of BlackBerry wireless devices and enterprise platform solutions. Under the terms of the agreement, the firms will share development, engineering, marketing and sales expertise to deliver vital medical and drug information to healthcare professionals. The agreement will facilitate the wireless delivery of PEPID clinical content as a knowledge-based solution for enterprise-wide information systems, as well as to individual subscribers.

JCAHO raises violation threshold, permits
more lapses before taking action

Deadly H5N1 bird flu found in dead UK swan

JCAHO raises violation threshold, permits more lapses before taking action

The Joint Commission on Accreditation of Healthcare Organizations last month raised the number of deficiencies a hospital may accumulate during an inspection before being punished. Critics say that the new rules are a step back for the influential group and that it may be more eager to please hospitals than protect patients. If the new rules had been in place in 2004, for example, Martin Luther King Jr./Drew Medical Center in Los Angeles County would have kept its accreditation after myriad problems with care that led to some patients' deaths. Commission officials defended their decision this week, saying the group would prefer to identify more problems and have hospitals fix them than strip more facilities of accreditation. Two major factors cited in the decision were a rise in the number of deficiencies found by better-trained inspectors and a switch this year to surprise reviews. “We shouldn't deny accreditation to 10 or 15 or 20% of all the hospitals in the United States,” said Joseph L. Cappiello, vice president of accreditation field operations. Patients are better served when the group's findings are not a punishment but a "catalyst for improvement,” he said. Dr. Dennis S. O'Leary, the commission's president, predicted that the number of hospitals sanctioned this year would actually increase from years past. O'Leary said the commission made the changes not because of outside pressure but because it found that too many decent hospitals were being referred for punishment this year. Sanctions against hospitals inspected earlier this year were put on hold while the new rules were discussed. Commission officials declined to say how many hospitals would have been punished this year had the rules not changed. Sen. Charles E. Grassley (R-IA) said in a statement Wednesday that he found the changes “puzzling.” “Government investigators already have documented that the Joint Commission misses too many serious problems and rarely drops any hospital's accreditation,” said Grassley, who heads the Senate Finance Committee. “This move to weaken standards seems to be going in the opposite direction of what makes sense for quality of care.” Under the commission's new rules, a large hospital is not downgraded to conditional accreditation unless it has violated 14 standards, up from 10. It can't be recommended to lose its accreditation unless it has violated 20, up from 15. A small hospital must violate 11 instead of 10 standards for probation and 16 instead of 15 standards to lose accreditation. The threshold for large hospitals is higher because more inspectors are sent to review them, the commission said. Discipline is not automatic; it must be approved by an accreditation committee. The commission sanctioned more hospitals last year than in years past. In 2005, 14 hospitals were recommended to lose accreditation, compared with nine in 2004 and one in 2003. Also last year, 52 hospitals were placed on conditional accreditation, up from 41 in 2004 and 17 in 2003. The organization's inspectors now pull active medical charts of patients and backtrack to see whether medications were given and whether lab work was done promptly, among other things. Alta Bates Summit Medical Center in Berkeley, CA, initially was recommended to lose its accreditation after a November 2004 survey, but it was placed on conditional accreditation after an appeal. Hospital officials estimate they have had the equivalent of 10 full-time employees working for 19 months to address issues raised by the commission. Newton noted that the hospital would not have been sanctioned under the new rules. (Los Angeles Times)

Deadly H5N1 bird flu found in dead UK swan

The lethal H5N1 strain of bird flu has been found in a Mute swan found dead in a small Scottish coastal town last week, Britain's Sky television reported on Thursday. Officials from the Scottish Department of Environment said they had not yet received the test results. The discovery in the wild bird of the virulent strain that has been blamed for 108 human deaths elsewhere since 2003 would make Britain the 14th country in the European Union to find the disease on its territory. (Reuters)

Tipping point in obesity epidemic? Women's obesity
rate levels but men, kids getting fatter

According to the government's most accurate recent check of the nation's girth, U.S. men and children are increasingly getting heavier, but the obesity rate among women, who at 33 percent are heavier as a group, held steady. The study didn't examine why men and children are getting fatter and women aren't. But some experts think the leveling off in women could signal a turning point in the nation's obesity epidemic. “Women have always been more responsible about health than the general population,” said Dr. William Dietz, of the U.S. Centers for Disease Control and Prevention, which reported the new data. “I'd like to think this shows women are leading the way in recognizing obesity as a health threat,” said Dietz, director of the CDC's Division of Nutrition and Physical Activity. Another piece of research also suggests a turn. The NPD Group, a New York-based market research firm, found the percentage of overweight adults has held steady from 2002 to 2005. “I would say it has leveled off. The bad news is we haven't found a way to lose weight,” said Harry Balzer, vice president of NPD, which each year tracks what thousands of people eat and their self-reported height and weight. The CDC report is being published in this week's Journal of the American Medical Association. The findings come from the CDC's National Health and Nutrition Examination Survey, which collects data on a sample of about 5,000 people each year. The researchers clustered years together, presenting calculations for 1999-2000, 2001-2002 and 2003-2004. The survey is considered the gold standard for obesity data; it's done through in-person examinations that include actual height and weight measurements. The study found the percentage of men who are overweight rose to 71 percent in 2003-2004, from 67 percent in 1999-2000. The obese percentage rose to 31 percent, from 27.5 percent. For women, both the overweight and obese percentages held steady, at about 62 percent and 33 percent, respectively. For children, the percentage of boys, ages 2 to 19, who were seriously overweight, or obese, rose to more than 18 percent in 2003-2004, from 14 percent four years earlier. For girls, the percentage rose to 16 percent, from about 14 percent. The CDC study also offered data on the percentage of kids who were heavier than 85 percent of children the same age and sex, as recorded in an earlier growth chart benchmark. The percentage of kids in that category shot up to almost 34 percent in 2003-2004, compared to 28 percent in 1999-2000. (The Associated Press)

The Joint Commission on Accreditation of Healthcare Organizations issued a Sentinel Event Alert that urges health care organizations to pay special attention to how tubes and catheters are connected to patients and challenges the manufacturers of these devices to redesign them in ways that will make dangerous misconnections much less possible. Reports to the Joint Commission, ECRI, the Food and Drug Administration (FDA), the Institute for Safe Medication Practices, and United States Pharmacopeia show that tubing and catheter misconnection errors occur frequently and lead to deadly consequences in many instances. This reality prompted the Joint Commission to issue a Sentinel Event Alert to more than 12,000 health care organizations nationwide, including hospitals, ambulatory care centers, home care agencies, nursing homes and behavioral health care facilities, to create new awareness of the problem and offer practical solutions to avoiding these occurrences. Important warning signs of a possible misconnection, according to the Alert, include having to force-fit tubes together or having to use an adaptor. Using a tube or catheter for something other than its intended purpose also may signal, or cause, a misconnection. To reduce the risk of errors related to tubing misconnections, the Joint Commission’s Sentinel Event Alert newsletter recommends that health care organizations take the following specific steps: Avoid purchasing non-intravenous equipment with tubing connectors that permit connection with intravenous (IV) connectors; Conduct tests on and assess risks of new tubing and catheter purchases to identify the potential for misconnections, and take appropriate preventive measures before using; Always trace a tube or catheter from the patient to the point of origin before connecting any new device or infusion; Route tubes and catheters having different purposes in different, standardized directions, e.g., IV lines are routed toward the head; enteric lines are routed toward the feet; Recheck connections and trace all patient tubes and catheters to their sources as a standard of care when a patient arrives in a new care setting; Emphasize the risk of tubing misconnections in clinician orientation and training programs; Inform patients and their families of the importance of getting help from nurses or doctors whenever there is a real or perceived need to connect or disconnect devices or infusions.

Government officials in Germany have reported what appears to be the first health-related recall of a nanotechnology product, raising a potential public perception problem for the rapidly growing but still poorly understood field of science. At least 77 people reported severe respiratory problems over a one-week period at the end of March, including six who were hospitalized with pulmonary edema, or fluid in the lungs, after using a “Magic Nano” bathroom cleansing product, according to the Federal Institute for Risk Assessment in Berlin. Symptoms generally cleared up within 18 hours, though some had persistent breathing problems for days. The spray is meant to be used on glass and ceramic surfaces to make them dirt- and water-repellant. “The distributors have launched a recall and advised against using the sprays,” according to a statement from the institute, which is conducting tests on the product. Nanotechnology is an emerging field of materials science involving substances smaller than one-ten-thousandth the width of a human hair. The tiny specks have chemical properties that make them potentially useful in engineering and medicine. But some can clog airways or trigger immune responses. Studies of health effects have just begun in several countries, and regulatory agencies are still formulating their stances, but hundreds of nano products are already for sale. It was unclear yesterday what kind of nanomaterial is in the spray, or even whether the particles were to blame. Every case has involved the aerosol spray-can form (the product was previously available in a pump bottle, without complications). And the propellant used in the aerosol has long been used uneventfully in hair sprays and other products. David Rejeski, director of the Project on Emerging Nanotechnologies at the Woodrow Wilson International Center for Scholars in Washington, said he has not seen the German product on the U.S. market. But a recently released survey of nano consumer products, compiled by his organization, lists other aerosolized nano products, including a foot spray. (The Washington Post)

Sunnybrook and Women’s College Health Sciences Centre purchase
Avega’s Alliance Decision Support, other tools

Avega Health Systems, a subsidiary of MedAssets Inc., announces that Sunnybrook and Women's College Health Sciences Centre, located in Toronto, Ontario, Canada has recently purchased the Alliance Decision Support system, Alliance Financial Management, and myAlliance Portal from Avega. The Alliance Suite integrates financial, clinical, and administrative information to support decision-making across the healthcare enterprise.

Massachusetts sets health plan for nearly all

2nd Tenet trial ends in a hung jury

Massachusetts sets health plan for nearly all

Massachusetts is poised to become the first state to provide nearly universal health care coverage with a bill passed overwhelmingly by the legislature Tuesday that Gov. Mitt Romney says he will sign. The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance. It accomplishes that in a way that experts say combines methods and proposals from across the political spectrum, apportioning the cost among businesses, individuals and the government. “This is probably about as close as you can get to universal,” said Paul B. Ginsburg, president of the nonpartisan Center for Studying Health System Change in Washington. The bill requires all Massachusetts residents to obtain health coverage by July 1, 2007. Individuals who can afford private insurance will be penalized on their state income taxes if they do not purchase it. Government subsidies to private insurance plans will allow more of the working poor to buy insurance and will expand the number of children who are eligible for free coverage. Businesses with more than 10 workers that do not provide insurance will be assessed up to $295 per employee per year. All told, the plan is expected to cover 515,000 uninsured people within three years, about 95 percent of the state's uninsured population, legislators said, leaving less than 1 percent of the population unprotected. Hawaii passed a universal access law in 1974 requiring employers to offer health care coverage for employees working 20 hours or more a week, but nearly 10 percent of people remain uncovered. Efforts to cover all citizens in Minnesota and Vermont in 1992 and in Massachusetts in 1988 fell flat in the mid-1990s when the language in the bills concerning universal coverage was repealed. In 2003, Maine enacted a law that significantly broadened insurance coverage and combined employer payments with expanded government programs. That year, California enacted a law that required employer contributions, but it was repealed in a referendum in 2004. Massachusetts would be the first state to require its citizens to have health insurance. The Massachusetts bill creates a sliding scale of affordability ranging from people who can afford insurance outright to those who cannot afford it at all. About 215,000 people will be covered by allowing individuals and businesses with 50 or fewer employees to buy insurance with pretax dollars, and by giving insurance companies incentives to offer stripped-down plans at lower cost. Lower-cost basic plans will be available to people ages 19 to 26. Subsidies for other private plans will be available for people with incomes at or below 300 percent of the poverty level. Children in those families will be eligible for free coverage through Medicaid, an expansion of the current system. (The New York Times)

2nd Tenet trial ends in a hung jury

For the second time, the prosecution of Tenet Healthcare Corp. and a former executive, accused of bribing physicians to refer patients to the company's San Diego hospital, ended in a hung jury. U.S. District Judge M. James Lorenz declared a mistrial Tuesday after jurors notified him that they were hopelessly deadlocked after 4 1/2 months of deliberation. A unit of Dallas-based Tenet, its 311-bed Alvarado Hospital Medical Center and former CEO Barry Weinbaum were charged with violating criminal anti-kickback laws by funneling more than $10 million to physicians to boost admissions. U.S. Atty. Carol C. Lam, who personally participated in the second trial, gave no hint that she was ready to drop the charges. “The government continues to believe that it is important to address violations of the Medicare anti-kickback statute,” Lam's office said in a statement. Judge Lorenz scheduled a status hearing for April 17. For the hospital industry, Tuesday's ruling served up another round of confusion. The industry had been focused on the retrial because it involved the use of physician relocation agreements. Federal law allows hospitals to pay certain relocation expenses to recruit physicians with needed specialties but forbids hospitals to pay physicians to refer patients. Tenet and its lawyers maintain that Alvarado's relocation payments complied with the laws and were similar to those used by many hospitals. But the government argued that the scope and intent of Alvarado's relocation deals were anything but ordinary and legal. Alvarado, prosecutors charged, used more than 100 agreements over a decade to pass more than $10 million in bribes to physician groups already in the community to entice them to admit patients to the hospital. (Los Angeles Times)

New company forms to provide hospitals with data
to drive savings in materials management operations

Benchmarking Excellence LLC has been formed to provide hospitals with a blend of data, research, content and supply chain expertise to assist them in reducing the cost of their in-house materials management operations. Hospitals need to find new ways to save money and the materials management function is a significant area of opportunity that is often overlooked. It has been estimated that nearly 40 percent of supply related costs in health care are spent moving supplies. If true, a hospital with an annual supply budget of $50 million would have a real total materials management operational cost of as much as $20 million dollars per year. The company’s benchmarking program allows hospitals to compare their total supply management cost per average occupied bed against other similar sized hospitals. Their web site is expected to become a repository of performance improvement content, including data from other industries, designed to enhance customers’ operational savings. Customers will also benefit from training and guidance in implementing Activity Based Management. The company’s benchmarking program will be supported with content and Founder and General Manager Lynn Everard’s supply chain operations expertise. According to Everard, “While some suppliers and consulting firms do touch on this area it is often not their core expertise. Benchmarking Excellence is neither a supplier nor a consulting firm and is therefore able to deliver its array of services free from the pressure to sell supplies or consulting services.” To learn more visit the company’s web site at www.benchmarkingexcellence.com or call 954-647-3554 or send an email to info@benchmarkingexcellence.com.

CleanMed conference to be held in Seattle, April 18-20

CleanMed 2006, the world’s largest conference on environmentally preferable medical products and green health care buildings, will be held in Seattle, April 18-20. Leaders from the entire health care supply chain, including major hospital systems, top group purchasing organizations, health care providers, product manufacturers, architects and designers, will attend CleanMed to learn about the latest trends in safe products, green buildings, waste prevention, healthy food service and other health-care industry efforts to protect health. CleanMed 2006 is sponsored by Health Care Without Harm, Hospitals for a Healthy Environment, Catholic Health Initiatives, Kaiser Permanente, MedAssets, The Consorta Group and Premier, Inc. Keynote speakers are best-selling author Paul Hawken, whose books include “Natural Capitalism: Creating the Next Industrial Revolution”; and Tyrone Hayes, PhD, professor of Developmental Endocrinology at UC Berkeley, who is renowned for his groundbreaking work on the herbicide atrazine. The theme of CleanMed 2006 is “Celebrating Success.” For more information visit, http://www.noharm.org/details.cfm
?ID=1275&type=document

SAP will hold its annual customer event, SAPPHIRE 06 Orlando, May 16th-18th at the Orange County Convention Center. Event activities will run from approximately 7:30 am to 6:00 pm. each day. SAPPHIRE 06 is your opportunity to talk with SAP customers, hear about the latest news and product enhancements firsthand, and see how SAP continues to advance the industry toward realizing the vision of the Business Process Platform via its proven enterprise services architecture, which is already delivering measurable business value to customers in every sector worldwide. You'll have the opportunity to engage in a dialogue with SAP's senior-level executives in important solution areas at keynotes, demonstrations and one-on-one meetings. For more information about the event at this time, please visit the official SAPPHIRE 06 website at http://www2.sapsapphire.com
/usa2006/index.epx.

Cardinal Health signs agreement with the University Of Texas
M.D. Anderson Cancer Center for its Alaris system

Cardinal Health Inc. has signed an agreement with The University of Texas M. D. Anderson Cancer Center for its Alaris System. The Alaris System with Guardrails Suite MX software is a comprehensive safety system available for all types of infusions and the only system with the ability to enable pre-configured limits around both total dose and duration of intermittent drug infusions including chemotherapy. The Alaris System has demonstrated measurable improvements in patient safety and clinical performance in managing IV medications at the point of care. It is the only system available to offer a modular platform that includes infusion therapy and patient monitoring.

Iowa mumps outbreak spreads quickly to other states

Patterns: Finding clues to flu's spread on the way to work

The mumps outbreak that started in Iowa has spread to Illinois, Minnesota, Nebraska, South Dakota, and Wisconsin, an epidemiologist with the Iowa Department of Public Health said today. Meghan Harris, M.P.H., said all states bordering Iowa, with the exception of Missouri, have reported cases of mumps. Moreover, said Harris, the end is no where in site. “You can expect the numbers that we report tomorrow to be up [from cases reported March 30] and the numbers that will be reported Thursday are likely to be higher again,” she said. The Iowa Department of Public Health will update mumps information tomorrow and again on Thursday. The 245 confirmed, probable, or suspected cases of mumps reported to the Iowa Department of Public Health already represent the nation's largest mumps outbreak in 17 years. Early on most of the Iowa cases were reported in college-age students. Follow-up reports have been completed on 136 cases of which 66% were in patients who had received two doses of the measles/mumps/rubella vaccine, which is considered sufficient to guarantee full immunity. Blaise Congeni, M.D., director of infectious diseases at Akron Children's Hospital in Ohio, said that with any vaccine there is always a chance of primary vaccine failure, “meaning that the vaccine never achieved conversion, or the possibility of secondary vaccine failure, meaning that immunity wanes over time.” The current recommendation is that a first dose of measles-mumps-rubella (MMR) vaccine be administered at 12 to 15 months with a second dose at four to six years, but Dr. Congeni said that “if the second dose is missed it can also be administered during adolescence.” Based on published reports, Congeni speculated that secondary vaccine failure may be a factor in the mumps outbreak, but Harris said that theory failed to pan out after investigation. “There is no correlation between time since immunization and outbreak,” she said. “There are cases among people who were immunized two years ago and other who were immunized 23 years ago. There is also no correlation with lot number of the vaccine, manufacturer, or physician who gave the immunization.” Congeni also speculated that it may be difficult to identify an index case because the primary symptom of mumps, parotitis, is often not fully evaluated by clinicians. “If the patient's record indicates that he or she has received two MMR doses, the assumption would be that this is caused by another virus,” he said. Harris agreed that Congeni's theory best explains what has happened in Iowa, especially since the mumps strain is the same one that caused outbreaks in England over the past few years. That suggests that mumps arrived with a recent visitor from Britain. Congeni said, however, that a mumps outbreak does not carry the potential for public health disaster that would be associated with a measles or rubella outbreak. “There is a small risk that some kids will develop viral meningitis and orchitis is a concern, but we know that orchitis doesn't cause sterility,” Congeni said. As of March 30, 5% of cases included orchitis among symptoms and one case of encephalitis was being investigated. (MedPage Today)

Patterns: Finding clues to flu's spread on the way to work

Researchers who pored over three decades of flu data from the United States are rethinking their understanding of how it spreads from region to region. The researchers, led by Cécile Viboud of the National Institutes of Health, looked at flu season data from 1972 to 2002, in an effort to understand how the disease spreads over long distance and how to help control it. Writing in the online version of Science, at sciencexpress.org, the researchers said that on average, it took about five weeks for the flu to spread throughout the lower United States. They also said that California often plays a central role in the disease's spread. “There is a tendency for the influenza season to start in California more often than any other state (with an average lead of one week for California),” the researchers wrote. Since California is the most populous state, this might be only to be expected. But population alone cannot explain it, they said, and understanding what is going on might help explain the broader influenza picture. The key, the study said, may lie with adults and, more specifically, their workplace commutes. When the researchers looked at information from the Census Bureau and the federal Department of Transportation, they found that the regional spread of the flu correlated closely with commuting patterns. Recent research has suggested that children, especially 3- and 4-year-olds, are the driving force behind epidemics. The new findings, the researchers said, are “not necessarily contrary” to that. Children, they said, may drive the spread of the disease locally, while adults are responsible for its spread from city to city and state to state. Quantifying long-range dissemination of infectious diseasesis a key issue in their dynamics and control. Outbreaksshow hierarchical spatial spread evidenced by higher pairwisesynchrony between more populous states. Seasons with higherinfluenza mortality are associated with higher disease transmissionand more rapid spread than mild ones. The regional spread of infection correlates more closely with rates of movement ofpeople to and from their workplaces (workflows) than with geographical distance. Workflows are described in turn by a gravity model,with a rapid decay of commuting up to around 100 kilometersand a long tail of rare longer range flow. A simple epidemiologicalmodel, based on the gravity formulation, captures the observedincrease of influenza spatial synchrony with transmissibility;high transmission allows influenza to spread rapidly beyondlocal spatial constraints. (The New York Times)

First bladders grown in lab transplanted in patients successfully

Researchers said Monday that they have grown complete urinary bladders in a laboratory and transplanted them into patients, improving their health and achieving the first cultivation of working replacements for failing solid organs in people. The “neo-bladders,” each one grown in a small laboratory container from a pinch of a patient's own cells, have been working in seven young patients for an average of almost four years, according to a report by the British journal the Lancet. The organs have remained free of the many complications that bedevil the conventional practice of surgically constructing bladders from other tissues. If ongoing studies continue apace, the researchers said, they hope someday to offer patients more than a dozen other homegrown organs, including blood-vessel complexes, partial kidneys and perhaps hearts. Anthony Atala of Wake Forest University School of Medicine in Winston-Salem, NC, led the work with Alan Retik at Children's Hospital and Harvard Medical School in Boston. Because the replacement bladders were made from patients’ own cells, they did not stimulate an immune-system reaction. The new study involved seven children and young adults, age 4 to 19, with spina bifida. (The Washington Post)

Celebrex cuts pre-cancerous colon growths in study

High doses of Pfizer Inc.'s arthritis pill Celebrex reduced the number of pre-cancerous growths in the colon in two large studies but ongoing concerns about heart risks make it too soon to recommend that use, researchers said on Monday. More study is needed to determine if taking Celebrex daily for years makes sense for some patients who face a high risk of developing colon cancer, the scientists said. Celebrex, known generically as celecoxib, is in the same family of drugs as Merck & Co. Inc.'s Vioxx, which was pulled from the market in 2004 because of a link to heart attacks and strokes. Both drugs inhibit the COX-2 enzyme involved in inflammation. Shortly after the Vioxx withdrawal, Pfizer said preliminary analyses of a cancer-prevention study showed Celebrex more than doubled heart attack risk. At the time, the company said another trial to reduce colon polyps did not show an increase in heart problems. Additional details, including the effectiveness results, from those studies were released on Monday at a meeting of the American Association for Cancer Research. A new, broader analysis “found more cardiovascular events with Celebrex compared to placebo” in both trials, Pfizer said in a statement. More research may yield clues as to who is most likely to suffer heart problems while taking Celebrex and who might benefit most from a cancer-prevention use. Pfizer is funding a separate study designed to determine the heart risks of Celebrex compared to other pain relievers. (Reuters)

Sisters of Mercy Health System chooses MedAssets Net Revenue Systems

MedAssets Net Revenue Systems has entered into a multi-year agreement to implement tools for chargemaster monitoring and maintenance and workflow management in 15 Sisters of Mercy Health System (Mercy) facilities. Implementation of these revenue cycle tools is expected to enhance chargemaster compliance, assist in standardization efforts, and improve efficiencies in operations for management of the Mercy Revenue Management consolidated chargemaster function, which will be rolled out to facilities this year. Mercy, based in Chesterfield, MO, consists of 18 acute care hospitals, a heart hospital, outpatient care facilities, physician practices, skilled nursing and long-term residential care facilities, clinics, a managed care organization and other health-related services. Mercy operates facilities and services in a seven-state area encompassing Arkansas, Kansas, Louisiana, Mississippi, Missouri, Oklahoma and Texas. “We decided to move forward with MedAssets’ tool, BPI.Net, in order to maintain the accuracy of our hospitals’ chargemasters and develop consistency in charging throughout our facilities” said Russ Reiter, director of revenue management for Mercy. “In addition, MedAssets’ work flow management tool, TaskMaster, will automate and track the distribution and completion of tasks associated with changes to the chargemaster.” MedAssets’ suite of tools, including BPI.Net, CCA.Net, CRM.Net, DPM and KnowledgeMaster, have all earned Peer Reviewed status from the Healthcare Financial Management Association (HFMA). www.medassets.com.

Amerinet announces its agreement with MSO Medical Inc. for bariatric surgery services and weight loss initiatives including Web-based resources, telephonic weight-loss advising, physician visits and medical supervision for surgery candidates.

Mumps Strikes 245 in Iowa

Health officials are trying to find the cause of a skyrocketing number of mumps cases in Iowa, the nation's largest outbreak of the infection in 17 years. At least 245 cases have been reported in Iowa in the past three months. The state previously averaged five per year. The number is approaching the average annual number reported nationwide. "When you expect five and you get 245, this is pretty serious," said Patricia Quinlisk, state epidemiologist at the Iowa department of public health. "We're trying to get ahead of it and get it stopped." The most recent epidemic of mumps occurred in Douglas County, Kan., with 269 cases from 1988 to 1989, said Lola Russell, a spokeswoman for the federal Centers for Disease Control and Prevention. College students in Iowa account for about 23 percent of the reported cases of the infection, commonly transmitted by coughing or sneezing. About half of the cases are people ages 17 to 25. Close quarters in dormitories, classrooms and cafeterias and perhaps a lower vaccination rate on college campuses might have made the student population more vulnerable, Ms. Quinlisk said. "It could be that on some of these college campuses, they were not as well vaccinated as we'd like them to be," she said. But she added, "Our law does not allow us to identify entities associated with outbreaks." At least 66 percent of the infected people in Iowa had previously received the recommended two doses of the vaccine for measles, mumps and rubella. At least 14 people with symptoms were being examined in three neighboring states this week.The state is recommending that patients be isolated for five days. (NY Times)

Rubbermaid and Signalife enter into marketing partnership
Rubbermaid Medical Solutions and Signalife Inc. announce that the firms have jointly entered into a multi-year, exclusive marketing and sales agreement involving the nationwide rollout of Signalife's Fidelity 100 ECG heart monitor and other Signalife products. Under the pact, Rubbermaid shall be responsible for all marketing and sales efforts to market the Signalife devices nationwide. Signalife shall maintain responsibility for sales support, technical support, manufacturing and quality control and product fulfillment. The parties plan to market the Signalife products together with Rubbermaid's mobile computing stations whose easily adjusted ergonomic features make them perfectly suitable for charting, clinical documentation, respiratory and cardiovascular therapy and operative room use. Signalife Inc., also announced that the company was awarded the Frost & Sullivan 2006 Technology Innovation Award in the field of ECG Monitoring. Originally developed to read brain waves of US Air Force F-16 pilots to objectively determine their performance, Signalife's technology is focused on signal fidelity.

Fewer than half of the people in a new study who felt the symptoms of a "mini-stroke" sought medical attention quickly, and just one in 10 went to an emergency room. "These figures are a cause for concern," said lead researcher Dr. Matthew F. Giles, a research fellow in clinical neurology at the University of Oxford, England. According to Giles, these transient ischemic attacks (TIAs) put individuals at high risk of having a major stroke soon afterward. Reporting in the March 31 issue of Stroke, Giles and his colleagues interviewed 241 people who had a TIA, asking them about what they thought was causing their symptoms. Symptoms typically include a sudden numbness or weakness of part of the body, sudden confusion, visual problems, dizziness or a sudden severe headache. Just 107 recognized the onset of symptoms as an emergency. Only 27 sought non-emergency treatment the same day; 43 waited until the next day to seek treatment, and 64 delayed two days or more. People who had TIA symptoms on a Friday or Saturday were especially unlikely to seek medical attention the same day. "That is an example of people not paying heed to these symptoms," Giles said. "If you have a TIA on the weekend, you'll say, 'I'll get in touch with the family doctor on Monday.' But by Monday everything is settled down, and you don't do it." The nature of the symptoms had a strong influence on an individual's response. People who experienced major motor problems such as weakness in the face, arm or leg were more likely to recognize these symptoms as an emergency. The same was true for those whose symptoms persisted for more than an hour. The average age of the people in the study was 71. Prompt treatment of the immediate event and follow-up therapy -- such as lowering cholesterol levels and blood pressure -- can reduce the long-term risk of a major stroke, Giles said. What was true in the British study holds for the United States, noted Dr. Claudette Brooks, an assistant professor of neurology at West Virginia University and a spokeswoman for the American Heart Association. Anyone feeling the symptoms of a TIA should go directly to an emergency room, she advised. "If you call your family doctor, you're wasting time," she said. "If you call your primary-care physician you'll be told to go to an emergency room anyway." Immediate action is necessary, Brooks said, because after a TIA, "you are at increased risk especially over the next 90 days, but also of having a major stroke in the next 48 hours to seven days." (HealthDay News)

GAO report: New Orleans healthcare severely damaged
Since Hurricane Katrina hit New Orleans, the health care infrastructure was severely damaged and the availability of health services declined significantly. The area’s only Level I trauma unit was closed, and the number of staffed hospital beds in the City of New Orleans was estimated to be about 80 percent less in February 2006 than before Hurricane Katrina, according to figures reported by hospitals. Efforts to rebuild the health care system were being affected by several factors, including uncertainty about how quickly the population would return and how a future health care system should be configured, particularly since some experts noted that New Orleans had an oversupply of hospital beds before Hurricane Katrina. Uncertainty about how quickly the population would return to New Orleans, as well as who would return, was making it difficult for local officials to plan the restoration of health services. The health care infrastructure in the New Orleans area, including emergency, hospital, and clinic facilities, was severely damaged by Hurricane Katrina. Level I trauma services are available in the state in Shreveport, Louisiana. Other health services in New Orleans were also severely damaged, including hospitals, emergency services, and safety net clinics.
• Of the 9 acute care hospitals in the city prior to Katrina, only 3 had re-opened at a capacity of approximately 456 staffed beds as of February 22, 2006 Emergency Care: Increased demand has been reported at the open emergency departments and has led to slow unloading of patients from ambulances and to patients being housed in the emergency department because hospital beds were not available. For example, according to data reported by hospitals on February 22, 2006, wait times for emergency medical services (EMS) vehicles to offload stable patients into emergency departments varied from no wait at some hospitals to as long as 2 hours reported by 2 hospitals, and hospitals reported that 38 patients had been admitted and were being housed in the emergency department.
• Safety Net Clinics: More than three-fourths of the safety net clinics in the New Orleans area were closed, and many of those that were open had limited capacity, according to data gathered by officials at the DHH. For example, prior to Katrina, 90 clinics were in operation, including 70 clinics run by MCLNO, with the remainder being federally qualified health centers, mental health or addictive disorder clinics, or other specialty clinics. Post-hurricane, 19 clinics were open according to DHH figures, generally operating at less than 50 percent of pre-Katrina capacity. or a copy of the complete report visit - http://www.gao.gov/new.items/d06576r.pdf

GlaxoSmithKline starts RFID anti-counterfeit tests
In the USA, GlaxoSmithKline (GSK) has begun distributing a medicine tagged with RFID technology as part of an initial pilot project to help protect patient safety. The trial is likely to be followed by other similar programmes if it is considered successful. The tags are to be placed on all bottles of Trizivir (an HIV medicine) distributed in the United States. When scanned at close range, the tags will help verify that the medicine bottle contains authentic Trizivir. This specific medicine was selected for the project because it has been listed by the National Association of Boards of Pharmacy as one of 32 drugs most susceptible to counterfeiting and diversion. The US Food and Drug Administration (FDA) has asked the pharmaceutical industry to develop standards and pilot processes for RFID that may lead in the next few years to broad adoption and use of the technology. The RFID chip stores a unique code that reflects information about the drug's manufacturing and shipping history. A product's code can be read by pharmaceutical wholesalers and pharmacists using a hand-held or stationary RFID reader that is placed within 2 to 18 inches of the tag. The tag can be read by wholesalers when it is received from the manufacturer and when it is shipped to pharmacies, who would then record when they have received the medicine. This allows manufacturers to more precisely account for medicine as it moves through the distribution chain and to authenticate medicine at the point of dispensing. The technology does not collect any patient information. The RFID tag contains information about the product only, not the patient. GlaxoSmithKline stresses that it will not collect any personally identifiable information about patients using the technology. A variety of other measures (including packaging design) have also been taken by GSK and other manufacturers to discourage counterfeit medicines. RFID-tagged bottles of Trizivir will begin appearing on pharmacists' shelves in mid-April 2006. GSK says it is working closely with the FDA to assess the technology and its prospects for reducing counterfeiting. The project is reported to have cost several million dollars to-date, and the testing of RFID with additional products will be evaluated by GSK with guidance from the FDA as this initial pilot progresses. GSK worked with IBM to design and build the technology in the pilot programme, which allows GSK to tag each bottle with a unique product code. The tags themselves are not easily copied.
For more info:http://www.gsk.com

China bans human organs sales
China's Health Ministry has explicitly banned sales of human organs in an apparent attempt to clean up the country's lucrative but laxly regulated transplant business. New regulations viewed on the Health Ministry's Web site Tuesday forbid the buying and selling of organs and require that donors give written permission for their organs to be transplanted. While China has long defended its transplant business as legal, little information about it is publicly available. Critics contend it is profit-driven with little regard for medical ethics. Chinese legislators have been pushing for years for a law to regulate and promote voluntary organ donations. However, the Health Ministry regulation — to take effect on July 1 — was officially titled a "temporary regulation," suggesting that further legislation could follow. The Health Ministry had no comment. Foreign Ministry spokesman Qin Gang told reporters a more permanent regulation on organ transplants was being drafted. The true number of transplants carried out annually isn't known, although a professional group, the Chinese Society of Transplantation, says about 5,000 kidney transplants and 1,500 liver transplants were carried out in 2003. Human rights groups say many organs — including those transplanted into wealthy foreigners — come from executed prisoners who may not have given their permission, claims China routinely denies. Voluntary donations remain far below demand, partly because of cultural biases against organ removal. Safety concerns about the transplant industry also have surfaced. Last month, Japan announced it was examining cases involving at least eight Japanese patients who received organ transplants in China and later fell seriously ill or died from infections and other problems after returning home. The Foreign Ministry spokesman repeated China's insistence that all organ transplants were conducted with the permission of the donor. "It is a complete fabrication, a lie or slander to say that China forcibly takes organs from the people convicted of the death penalty for the purpose of transplanting them," Qin said. The new Chinese rules limit transplant surgery to top-ranked institutions that must verify the organs are from legal sources and that the procedure is safe and justified. Transplant hospitals must keep specialists on staff and have all the required medical equipment, according to the rules. Hospital transplant ethics committees must approve all such surgeries in advance, and institutions where patients die shortly after having transplants will be banned from conducting such surgeries. "The rule explicitly states that human organs cannot be bought or sold; medical institutions must obtain written permission from donors for any transplant of organs for clinical purposes; donors have the right to refuse to donate organs prior to the organ transplant," the ministry said in an introduction to the rules. The rules "aim to organize and strengthen management of human organ transplant technology for clinical use, assure the quality and safety of treatment and protect patient health," it said. (The Associated Press)

Computer simulation shows pandemic would start in big cities, end in four months

MedAssets’ 2006 Healthcare Business Summit focuses on innovation, transparency in healthcare

Implantable defibrillators can be erratic, studies find

Pennsylvania hospital has 'no transfusion' surgery

FDA: Antihistamine linked to deaths of young children

World Health Care Congress: CDHP and Pay for performance affirmed as key to evolution of U.S. health care market

David J. Brailer, National Coordinator for Health IT, resigns

Case of bubonic plague confirmed in L.A.

U.S. to kill flocks suspected of having bird flu

NIH budget expected to take dive

New study finds lifetime costs of injuries in billions; costs associated with a year top $406 billion

PricewaterhouseCoopers survey: Medical device companies quick to adopt ethics standards to combat fraud and abuse

Goldman Sachs on Cardinal Health, CEO succession plan

U.S. plan for flu pandemic revealed

New guidelines for handling bodies after disasters

Proposed changes to the hospital inpatient payment systems

Robust health insurers suffer infirmities in 2006

Air travelers eyed in mumps outbreak

Mass. governor signs landmark health bill

Inquiry yields no clues on lens cleaner linked to infections

New information will help healthcare providers adopt health IT

Blasting of kidney stones has risks, study reports

European regulators approve Boston Scientific-Guidant deal

HPN creates new critical care supply management award; deadline extended

Employers push White House to disclose Medicare data

F.D.A. plans to intensify oversight of heart devices

JCAHO raises violation threshold, permits more lapses before taking action

Massachusetts sets health plan for nearly all

2nd Tenet trial ends in a hung jury

Patterns: Finding clues to flu's spread on the way to work

Computer simulation shows pandemic would
start in big cities, end in four months

MedAssets’ 2006 Healthcare Business Summit focuses
on innovation, transparency in healthcare

World Health Care Congress: CDHP and Pay for performance affirmed
as key to evolution of U.S. health care market

New study finds lifetime costs of injuries in billions;
costs associated with a year top $406 billion

PricewaterhouseCoopers survey: Medical device companies
quick to adopt ethics standards to combat fraud and abuse

New information will help healthcare providers
adopt health IT

HPN creates new critical care supply management award;
deadline extended