Bird flu kills Indonesian teen, toll at 73 

An Indonesian teenager died of bird flu in the bustling capital of Jakarta, bringing the toll in the country hardest hit by the virus to 73, a health ministry official and doctor said Friday. The 15-year-old girl was admitted to the Sulianti Saroso Hospital for Infectious Diseases on Monday and died late Thursday, said Sandakan Giriputro, a doctor at the facility. “By the time she arrived, it was too late,” he said. “She died after experiencing multi-organ failure.” Health Ministry official Muhammad Nadirin confirmed that the girl’s lab tests showed she had contracted the H5N1 virus, apparently after coming into contact with infected pet birds at her home in central Jakarta. Bird flu has killed at least 170 people since it began ravaging Asian poultry stocks in 2003, hitting Indonesia the hardest, according to the World Health Organization. (The Associated Press)

New urgency in debating healthcare

Since Hillary Rodham Clinton’s effort to overhaul the nation’s medical system was rejected in 1994, most big employers have stayed out of the debate on healthcare reform. But with their medical costs ballooning, top executives of large companies are starting to speak up again, and many are calling for a national approach to fixing healthcare. Few advocate a wholesale shift to government-directed medicine, but most are seeking broad changes in the employer-subsidized health system, which they regard as unsustainable in its current form. Business executives are motivated in large part by health insurance premiums that are rising much faster than inflation, adding to their costs at a time when many are facing more intense competition from abroad, where companies rely on government-supported healthcare systems largely financed by taxes.

A 2006 study by the Kaiser Family Foundation and Hewitt Associates found that premiums in the United States had risen about 87 percent since 2000. “Five years from now this problem will have to be cured, or the competitiveness of the United States will be dramatically affected,” said J. Randall MacDonald, senior vice president for human resources at I.B.M. But companies are by no means speaking with one voice. Everybody’s problem, the growing cost of health coverage, can be felt differently depending on the size of a company and whether it has promised health benefits to retirees. Older companies, for example, are more likely to welcome government help on coverage for workers who leave before they are eligible for Medicare and may find they cannot afford insurance. But Silicon Valley technology companies that do not have or need retiree coverage are wary of new taxpayer-financed subsidies.

The healthcare debate is heating up as candidates polish their positions for next year’s presidential primaries, and as Democrats in Congress assert their newfound power. In general, employers “are more interested in reform today than at any time since the Clinton effort” in the early 1990s, said Robert S. Galvin, global healthcare and policy director at General Electric, which provides health benefits for 460,000 employees and dependents and 240,000 retirees and dependents. The surge of interest, Galvin said, “is driven by compounding health cost increases at three times the general inflation rate, plus the entrance of Wal-Mart and other retailers” that are beginning to feel the pain of out-of-control increases in costs. Many retailers, with large staffs of low-paid, temporary and part-time workers, would welcome a larger government role. (The New York Times) To read the full article see THIS LINK.  

Statins linked to lower risk of infection; Markedly lower frequency of sepsis in dialysis patients observed

Researchers at Johns Hopkins may have discovered an unintended benefit in the drugs millions of Americans take to lower their cholesterol: The medications, all statins, seem to lower the risk of a potentially lethal blood infection known as sepsis in patients on kidney dialysis. The study is published in the current issue of the Journal of the American Medical Association (JAMA). Sepsis is the leading cause of death in non-coronary intensive care units in the United States, according to the U.S. Centers for Disease Control. It also poses serious risk for kidney patients undergoing regular dialysis treatments. The Hopkins researchers cautioned that kidney dialysis patients should not necessarily ask their doctors to put them on statins until more studies are done to verify their findings.

Building on earlier, limited studies that suggested risk reduction in animals and some people, Professor of Medicine, Director of the Welch Center and senior author Neil R. Powe, M.D., and his Johns Hopkins team followed 1041 dialysis patients for 10 years, dividing the subjects into those taking statins and those not. “Those taking statins had a 41 in a 1,000 chance of being hospitalized for sepsis, while the other group not taking statins had a 110 out of 1,000 risk. Although the overall absolute risk is relatively small, the statin group’s risk is dramatically lower,” says Rajesh Gupta M.D., the study’s lead author, who was a senior medical resident at Hopkins when the study was conducted.

Gupta says it remains unclear why or how statins work this way, “but the consistency of the findings with laboratory studies adds a lot of credence to the idea that statins are doing something substantial to reduce risk.” “Statins are known to have an effect on the body’s immune system, but what that is exactly, and how many statin users it affects, is still not widely understood.”  Statins may regulate the immune response to infection or fight microbes directly, Powe suspects. The study’s authors also suppose that statins may work like penicillin, since the first statin was originally derived from a fungus which, it is theorized, secretes a statin as a way to starve other competing microorganisms that require cholesterol to survive. The study included patients from 81 dialysis clinics across 19 states. Only those enrollees who were admitted to the hospital with sepsis were counted, in order to rule out any subjects who became septic during an unrelated hospital stay. Only 14 percent of those initially enrolled in the study were on statins. Out of the 1,041 patients, there were a total of 303 hospitalizations for sepsis.

Touro Infirmary selects Broadlane for supply chain services

Broadlane announced that Touro Infirmary, New Orleans’ only community based, not-for-profit, faith-based hospital, has selected Broadlane to provide an array of supply chain services under an exclusive agreement. Financial terms were not announced. Under the agreement, Broadlane will provide Touro Infirmary with national and local strategic supply chain services for consumable supplies and equipment, pharmaceuticals and purchased services. Touro Infirmary will gain access to Broadlane’s existing portfolio of contracts and, in addition, Broadlane will assist Touro Infirmary in developing custom contracts and in managing various high physician preference item standardization and utilization efforts. Touro Infirmary subsidiaries include Woldenberg Village, Crescent City Physicians, Touro at Home and Metro Lab and the combined annual supply spend is in excess of $50 million. Additionally, Touro Infirmary will fully integrate into Broadlane's technology and e-commerce exchange, BroadLink. BroadLink is for Broadlane clients only and is not owned by suppliers.

Criteria for depression are too broad, researchers say

Up to 25 percent of people in whom psychiatrists would currently diagnose depression may only be reacting normally to stressful events such as a divorce or losing a job, according to a new analysis that reexamined how the standard diagnostic criteria are used. The finding could have far-reaching consequences for the diagnosis of depression, the growing use of symptom checklists to identify those who may be depressed, and the $12 billion-a-year U.S. market for antidepressant drugs. Diagnoses are currently made on the basis of a constellation of symptoms that include sadness, fatigue, insomnia and suicidal thoughts. The diagnostic manual used by doctors says that anyone who has at least five such symptoms for as little as two weeks may be clinically depressed. Only in the case of someone grieving over the death of a loved one is it normal for symptoms to last as long as two months, the manual says. The new study, however, found that extended periods of depression-like symptoms are common in people who have been through other life stresses such as a divorce or a natural disaster and that they do not necessarily constitute illness.

The study also suggested that drug treatment may often be inappropriate for people who are experiencing painful, but normal, responses to life’s stresses. Supportive therapy, on the other hand, may be useful, and may keep someone who has been through a divorce or has lost a job from going on to develop full-blown depression. The researchers, including Michael B. First of Columbia University, the editor of the authoritative diagnostic manual, based their findings on a national survey of 8,098 people. They found that those who had experienced a variety of stressful events frequently had prolonged periods in which they reported many symptoms of depression. Only a fraction, however, had severe symptoms that could be classified as clinical depression, the researchers said. An estimated one in six Americans suffer depression at some point in their lives. Under the more limited criteria the researchers urged, that number would be 25 percent lower. “The cost of not looking at context is you think anyone who comes under this diagnosis has a biological disorder, so should more or less automatically get antidepressant medication, and everything else is superfluous,” said lead author Jerome Wakefield, a New York University researcher. (Washington Post)

Total shoulder replacements as safe as swapping out hips and knees

Contrary to widespread belief, total surgical replacement of arthritic shoulder joints carries no greater risk of complications than replacement of other major joints, a Johns Hopkins study suggests. In fact, the Johns Hopkins researchers say, their study shows that patients who undergo shoulder arthroplasty to relieve chronic and significant pain can expect significantly fewer complications, much shorter hospital stays and less costs than patients undergoing hip or knee replacement.

The Hopkins research team, led by Edward McFarland, M.D., director of the Division of Adult Orthopedics at The Johns Hopkins Hospital, analyzed anonymous patient information provided by the Maryland Health Services Cost Review Commission, the state’s hospital rate-regulator. They looked at all arthroplasties performed in Maryland to alleviate osteoarthritis pain between 1994 and 2001, including details of 15, 414 hip surgeries, 34, 471 knee operations and 625 shoulder procedures. “After looking at how all these patients fared, we concluded that, comparatively, total shoulder surgery is just as safe and effective as other types of arthroplasties,” said McFarland. “Lower numbers of shoulder procedures done both regionally and nationally may indicate that many people live with shoulder pain because they fear that the corrective surgery is too risky or costs more than similar procedures. But we have found that this is just not true.” The findings appeared in an online version of the journal Clinical Orthopedics. According to nationwide 2003 Medicare figures, 6,700 people had shoulder joints replaced that year, compared to 106,887 hip replacements and 199,195 total knee replacements.

Patients in the study who had shoulder surgery had far less in-hospital post-surgical complications (7.5 percent) compared with those patients who had their hips and knees replaced (15.5 percent and 14.7 percent, respectively). McFarland's team also determined that the average time a person remained hospitalized after the surgery was lowest for those recovering from shoulder procedures (just 2.42 days for shoulder patients, versus more than four days for both the hip and knee equivalents). Shoulder arthroplasty is also less expensive, according to McFarland. A shoulder replacement's total costs, on average, are $10, 351; whereas hip replacement surgery averages $15, 442, and knee arthroplasty, $14, 674. McFarland says most patients who are candidates for total shoulder replacement surgery are “at the end of their rope” trying to manage chronic pain and disability with drugs. “Ninety-nine percent of the people who have a shoulder replacement for arthritis get pain relief and say that they wish they had done it sooner,” said McFarland. “This study indicates there may be little reason to wait.”

Research shows Masimo Acoustic Respiratory Monitoring technology provides “significantly more reliable monitoring of respiration rate”

Masimo reported that three new independent studies, including one presented the recent International Anesthesiology Research Society (IARS) Clinical & Scientific Congress in Orlando, concluded that Masimo Acoustic Respiratory Monitoring technology (ARM) is “at least as accurate as capnometry” and “significantly more reliable” for monitoring respiration in spontaneously breathing patients. Respiration is one of the five vital signs, but clinicians have long looked for a continuous and noninvasive method of monitoring respiration that is both clinically accurate, easy to use, and well tolerated by patients. Current methods of respiration monitoring, including impedance pneumography with ECG and end-tidal CO₂ with capnometry, each have limitations that make them unreliable in certain clinical situations.

In the study released at the recent IARS, conducted by M. R. Macknet, MD and a team of researchers at Loma Linda University's Department of Anesthesiology, fifteen pediatric PACU patients were monitored with Masimo's ARM technology consisting of an adhesive bioacoustic sensor applied to the patient’s neck and connected to a breathing frequency monitor prototype. In addition, a nasal cannula was placed, secured with tape, and connected to a capnometer. The study showed that “premature cannula dislodgement occurred in 14 patients” in less that 20 minutes, while “in no patient was the bioacoustic sensor dislodged before the end of the stay in the PACU.” “This data shows the relative ease and high incidence of capnometer cannula dislodgement compared to the new bioacoustic sensor,” the researchers commented. “In clinical settings where continuous and reliable monitoring of spontaneous respiration is important, the new bioacoustic sensor provides significantly greater patient connection time, which should lead to significantly more reliable monitoring of respiration rate.”

In two studies released in January at the 2007 Society for Technology in Anesthesiology annual meeting, researchers monitored ten postoperative adult ICU and six pediatric PACU patients in separate studies with Masimo’s ARM technology as well as a nasal cannula connected to a capnometer. They concluded that Masimo’s new bioacoustic respiratory sensor “demonstrates accuracy for respiratory rate monitoring as good as capnometry” and that the device “offers multiple benefits over existing devices and has a potential to improve monitoring in a general care setting.”

Masimo expects to combine its Masimo Rainbow SET Read-Through Motion and Low Perfusion pulse oximetry with Masimo ARM technology as part of a general floor monitoring solution designed to increase patient safety and heed the growing call to find ways reduce unnecessary deaths on general care floors. The combination of these two technologies will give hospitals a continuous and noninvasive way to accurately monitor a patient’s oxygenation and ventilation during patient-controlled analgesia, consistent with the new recommendations from the Anesthesia Patient Safety Foundation (APSF). In addition, the combination of Masimo Rainbow SET pulse oximetry and Masimo ARM should assist hospitals in being compliant with new American Society of Anesthesia (ASA) guidelines for management of patients at risk of obstructive sleep apnea (OSA) by providing an accurate and reliable combination of oxygen saturation and respiration rate monitoring. The technology is currently undergoing additional clinical and engineering testing and is expected to be introduced at Alpha Sites in late 2007.   

April 5, 2007

Health system to receive a license from state of Florida to operate a pharmaceutical repackaging facility
 

Study questions exam to detect breast cancer

Ibuprofen may boost chance of heart problems in high risk patients with osteoarthritis

Scientists spot mutation linked to birth defects

Effect of hormone therapy on risk of heart disease may vary by age and years since menopause

Medicare announces measure specifications for the Physician Quality Reporting Initiative

Vaccine helps prevent ear infections

Health system to receive a license from state of Florida to operate a pharmaceutical repackaging facility

Four numbers on a piece of paper may not mean much to you, but for LeeSar the Supply Chain Company for Lee Memorial Health System and Sarasota Memorial Health System (FL) it means a lot. For the past two years LeeSar has been trying to receive a license from the State of Florida Department of Public Health to operate a pharmaceutical repackaging facility. Although the health system would save money repackaging this product from direct bulk shipments, that was not the total reason this license was so important. So when LeeSar received notice that its new repackaging facility had passed inspection and then received its license with its four figured license number the excitement was that we could now free up our pharmacists to work on the patient floors with the doctors and nurses on medication management and by doing so insure the highest quality of patient care to our community. The repackaging operation is now moving into its operational phase and registering all medications it will repackage with the state. For further information you can contact; Bob Simpson, President of LeeSar @ 239-303-3402.

Study questions exam to detect breast cancer

A highly promoted and widely used computerized system for examining mammograms is leading to less accuracy, not more, a new study finds. The system, known as computer-aided detection, or CAD, did not find more breast cancer, researchers are reporting today. But it did lead to many more false alarms that resulted in additional testing and biopsies for spots on mammograms that turned out to be harmless. Such detection systems, approved by the Food and Drug Administration in 1998, are sold by several companies, including Hologic of Bedford, MA; iCAD of Nashua, NH; and Kodak. According to the National Cancer Institute, the systems are now being used in about 30 percent of mammography centers. The equipment is expensive, costing $50,000 to $175,000, but Medicare, assuming it would improve the outcome, pays an extra $20 for each mammogram read with it. That made it profitable for large centers to use it. Doctors also worried about lawsuits if they were not using it and missed a cancer. But all along, as more and more mammography centers bought the software, the assumption was that the computer would find cancers that radiologists would miss, saving women’s lives.

The new findings are likely to surprise radiologists, said Dr. Ferris M. Hall, a radiology professor at Harvard Medical School. Dr. Hall wrote an editorial accompanying the paper, which was published today in The New England Journal of Medicine. But executives at the company whose equipment was used in the study, Hologic, said they interpreted the results differently. If there is a suspicious spot on a mammogram, women will want to have a biopsy to rule out invasive cancer, said Robert A. Cascella, the company’s president and chief operating officer. And the study showed that computer-aided detection was finding proportionately more very early precancerous growths. “That’s a valuable finding,” he said. The company has improved its software since the study was conducted, Cascella added.  

The study’s lead author, Dr. Joshua J. Fenton of the University of California, Davis, emphasized that women should continue to have mammograms. But, Dr. Fenton said, they may want to ask if their mammography center uses computer-aided detection. His study, he said, “does raise concerns that technology is causing harm without clear benefit.” New technology, like computer-aided detection, digital mammography, magnetic resonance imaging and ultrasound, can be so sensitive that doctors have trouble deciding which findings are worrisome. The only screening method that has been rigorously evaluated is old-fashioned X-ray film mammograms, but it is likely to be replaced by something, or some combination of things, whose benefits and risks are largely unknown. “We are getting ourselves out on thinner and thinner ice,” said Dr. Suzanne W. Fletcher, an emerita professor of ambulatory care and prevention at Harvard Medical School. “With mammography, we have multiple studies showing what happens to mortality rates if you get this versus if you don’t,” Dr. Fletcher said. “With these newer technologies, we don’t.”  

The new study of computer-aided detection was an analysis of 429,345 mammograms obtained from 1998 to 2002 at 43 mammography centers. During that time, seven of the centers switched to computer-aided detection. That enabled the investigators to compare results with and without computer software to help radiologists find suspicious spots. Computer-aided detection, the researchers wrote, “was associated with significantly higher false positive rates, recall rates, and biopsy rates and with significantly lower overall accuracy.” With computer-aided detection, 31 percent more women were called in for additional tests and 20 percent more had biopsies. (The New York Times) To read the full article see THIS LINK.

Ibuprofen may boost chance of heart problems in high risk patients with osteoarthritis

The common painkiller, ibuprofen, may boost the likelihood of heart problems in high risk patients who have osteoarthritis, suggests research published ahead of print in the Annals of the Rheumatic Diseases. Previous studies have suggested that ibuprofen interferes with the effects of aspirin. The research team compared the cardiovascular health over one year of more than 18,000 patients aged over 50 with osteoarthritis. The patients were taking part in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET). They were taking either high dose (400 mg a day) lumiracoxib, a type of drug known as a cyclo-oxygenase (COX-2) inhibitor, or ibuprofen (800 mg three times a day), or naproxen (500 mg twice daily), both of which are traditional non-steroidal anti-inflammatory drugs (NSAIDs). One in 10 were considered to be at high risk of a heart attack or stroke, some of whom also took low dose aspirin (70 to 100 mg a day). Some 623 patients were taking ibuprofen, just over half of whom (57%) were also taking low dose aspirin.

The results showed that there was no difference in the total number of heart attacks and strokes among participants at low risk of cardiovascular disease, irrespective of their drug treatment. But this was not true of those at high risk. High risk patients taking aspirin and ibuprofen were around nine times as likely to have heart attacks and strokes over one year as those on lumiracoxib. This is the first analysis of trial data to show an increased risk for ibuprofen, say the authors.  Among high risk patients not taking aspirin, the rate of heart attacks or strokes was higher for those on the COX -2 inhibitor than it was for those on naproxen, but no higher than for those on ibuprofen. Participants taking ibuprofen also developed congestive heart failure more often than those on the COX inhibitor. Most patients given COX-2 inhibitors and NSAIDs are elderly, and evidence to date suggests that both drug types boost the chances of heart attack and stroke. But the authors say that their findings suggest that ibuprofen interferes with the blood thinning properties of aspirin in patients at high risk of cardiovascular disease.

Scientists spot mutation linked to birth defects

Canadian researchers say they have found the first genetic mutation clearly linked to neural tube birth defects such as spina bifida in humans. “We have identified the mutations in a few patients with neural tube defects,” said Philippe Gros, professor of biochemistry at McGill University in Montreal. “There are a total of 10 patients where we found the mutations. It is a very small number, but this is the first time that it has been pinned down.” The gene, designated VANGL1, codes for a protein that enables cells to orient themselves properly during development, Gros explained. A mutation causes cells to lose their orientation, so the tissue in which it is expressed fails to develop properly, causing gaps that leave nerve tissue exposed. Gros’s group first identified the mutation in mice. Now, reporting in the April 5 issue of the New England Journal of Medicine, they say they have found three VANGL1 mutations linked to neural tube defects in children treated at birth defect centers in Italy and France.

”There have been many association studies, some risk factors identified in certain genes, alterations in some genes associated with neural tube defects, but there hasn’t been any clearly causative mutation,” Gros said. “There hasn’t been any situation like this, where you knock out the gene and find a neural defect in the mouse and then find the same thing in humans.” Yet VANGL1 is just one part of a large picture of neural tube defect causation, he said. “It is clearly a multigene situation, where alterations in more than one gene are responsible for the effect,” Gros said. “This is a very important finding that associates defects in this gene with neural tube defects in these specific families,” said Marcy C. Speer, director of the Duke University Center for Human Genetics in Durham, NC.  

As far as medical practice is concerned, “for therapy, we are not sure that it will have a great impact at this time,” Gros said. Scientifically, the discovery is fascinating, because the gene is found throughout the animal world, conserved all the way from flies to humans,” he said. The next step in the McGill research will be to investigate other proteins in which VANGL1 plays a role, to further pin down its mode of action, Gros said. (HealthDay News)

Effect of hormone therapy on risk of heart disease may vary by age and years since menopause

Secondary analyses of findings from the Women’s Health Initiative (WHI) suggest that women who begin hormone therapy within 10 years of menopause may have less risk of coronary heart disease (CHD) due to hormone therapy than women farther from menopause. Overall, hormone therapy did not reduce the risk of CHD. However, the farther a woman was from the onset of menopause when she began hormone therapy, the greater her risk of CHD due to hormone therapy appeared to be. Although these findings did not meet statistical significance, they suggest that the health consequences of hormone therapy may vary by time from menopause.

These findings are consistent with the primary publications from the WHI trials of estrogen plus progestin and estrogen-alone (total of 27,347 participants) in showing no overall benefit for CHD, and in suggesting that risk due to hormones may differ depending on age or years since menopause. “Postmenopausal Hormone Therapy and Risk of Cardiovascular Disease by Age and Years Since Menopause,” will be published in the April 4 issue of the Journal of the American Medical Association. In a secondary analysis, scientists reanalyze previously collected data and findings in an effort to clarify or ask new questions. In the case of this latest WHI analysis, the authors combined the data from the two trials to explore in more detail the previously observed trends in hormone effects by distance from the menopause. Differences in hormone therapy effects were examined in three age categories (50 to 59, 60 to 69, and 70 to 79) or in years since the onset of menopause (less than 10, 10 to 19, and 20 or more). The Women’s Health Initiative and the newly published analyses are funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health.

The analyses also suggest that the increased risk in heart disease due to hormone therapy in older women is primarily in those who also have hot flashes and night sweats. Study participants who had these symptoms were more likely to have risk factors for CHD such as high blood pressure or high blood cholesterol, but it was not clear whether this explained their higher risk on hormone therapy. Other results from the analyses of the combined trials include: Confirmation that hormone therapy increases the risk of stroke and this risk does not appear to be influenced by age or time since menopause; Even in women within 10 years of menopause, there appears to be an increased risk of breast cancer in women taking estrogen with a progestin; There was a trend (not statistically significant) towards reduced risk for death associated with hormone use in younger compared to older women.

Medicare announces measure specifications for the Physician Quality Reporting Initiative  

The Centers for Medicare and Medicaid Services (CMS) announced the posting of detailed specifications for the 74 measures included in the 2007 Physician Quality Reporting Initiative (PQRI). PQRI establishes a financial incentive for physicians and other health practitioners to participate in a voluntary quality reporting program. Eligible professionals who successfully report data for a designated set of quality measures may earn a bonus payment, subject to a cap, of 1.5 percent of total allowed charges for covered Medicare physician fee schedule services provided during the reporting period of July 1, 2007 to December 31, 2007.  

The 2007 PQRI quality measures relate to important processes of care that are linked to improved healthcare quality outcomes. They are evidence- and consensus-based measures that reflect the work of national organizations involved in quality measure development, consensus endorsement, and adoption. The specifications have been posted well in advance of the statutory deadline of July 1, 2007. This is to help eligible professionals to identify measures applicable to their practices and to prepare for submission of quality data in advance of the July 1, 2007 start date of the program. CMS anticipates a small number of additional specification changes, which may expand the applicability of the measures to additional eligible professionals. The PQRI measures apply to services that eligible professionals provide to Medicare beneficiaries in their offices and other settings. CMS is implementing an extensive outreach and education plan to assist eligible professionals to understand the program and the measures and to implement processes to efficiently capture the quality data that is to be reported under the PQRI program. The measure specifications document and other programmatic information are available at THIS LINK. 

Vaccine helps prevent ear infections     

A new study found that the pneumococcal conjugate vaccine (PCV7) moderately lowered the incidence of middle ear infections and reduced the need for pressure-equalizing ear tubes, a common surgical treatment for recurrent infections. “Children prone to recurrent ear infections benefit from the vaccine,” said lead study author Katherine A. Poehling, an assistant professor of pediatrics at Monroe Carrell Jr. Children’s Hospital at Vanderbilt University in Nashville, TN. But do not expect this scourge of childhood, which affects more than 80 percent of children under age three and costs $5 billion to treat each year, to go the way of whooping cough anytime soon. The reason: PCV7 prevents only a fraction of the infections that cause it.

According to the Centers for Disease Control and Prevention (CDC), the vaccine combats the seven most common strains of pneumococcal bacteria behind otitis media (middle ear infection). But pneumococcal bacteria cause only 30 to 55 percent of such infections; other classes of bacteria cause the rest. The PCV7 vaccine has been part of the routine immunization schedule for infants in the U.S. since 2000. It was developed to prevent meningitis, invasive pneumonia and other potentially deadly diseases. It is given to infants in four doses: at two, four, six and 12 to 15 months. The findings, published in the April issue of Pediatrics are the first to document the long-term effects of the vaccine on middle ear infections. Study co-author J. Pekka Nuorti, a medical epidemiologist at the CDC’s National Center for Immunization and Respiratory Diseases, estimates that the PCV7 vaccine prevents two million cases of otitis media in children under two years of age in the U.S. annually.

”Studies show that the number of middle ear infections caused by the pneumococcus serotypes in the vaccine have declined dramatically, but others have increased by 30 percent,” Nuorti said. Bacteria on the rise may be filling the ecological void left by the decline in the vaccine’s seven pneumococcus strains. But, he adds, two vaccines in the pipeline would cover more pneumococcal strains, including those whose rates of occurrence are escalating. “Parents shouldn’t think that just because their kids are getting vaccinated that they won’t get otitis media,” said Richard Rosenfeld, director of otolaryngology at Long Island College Hospital in New York City. “Seventy percent to 80 percent of the tendency to get otitis media is genetic. Beyond that are a host of factors, including smoking in the household, attending day care and breast-feeding for the first three months of life…. The vaccine alters that equation, but the effect isn’t dramatic.” (Scientific American)  

April 4, 2007

WHO proposes global agenda on transplantation

States revising organ-donation law; critics fear measure may not go far enough to protect donors

$500 million pledged to fight childhood obesity

RFID Resource Center launched; Service provides knowledgebase for healthcare supply chain

HIBCC & Partners HealthCare collaborate on patient safety standard

Study suggests some drug resistance to influenza B medications

Amerinet announces agreement with Skytron for medical supplies

WHO proposes global agenda on transplantation

This week, at the second Global Consultation on Transplantation the World Health Organization (WHO) presented countries and other stakeholders with a blueprint for updated global guiding principles on cell, tissue and organ donation and transplantation. Those principles aim to address a number of problems: the global shortage of human materials, particularly organs, for transplantation; the growing phenomenon of ‘transplant tourism’ partly caused by that shortage; quality, safety and efficacy issues related to transplantation procedures; traceability and accountability of human materials crossing borders. Stakeholders agreed to the creation of a Global Forum on Transplantation to be spearheaded by WHO, to assist and support developing countries initiating transplantation programs and to work towards a unified global coding system for cells, tissues and organs.

A central theme of the discussions was WHO’s concern over increasing cases of commercial exploitation of human materials. “Non-existent or lax laws on organ donation and transplantation encourage commercialism and transplant tourism,” said Dr. Luc Noel, in charge of transplantation at WHO. “If all countries agree on a common approach, and stop commercial exploitation, then access will be more equitable and we will have fewer health tragedies.” Recent estimates communicated to WHO by 98 countries show that the most sought after organ is the kidney. Sixty-six thousand kidneys were transplanted in 2005 representing a mere 10% of the estimated need. In the same year, 21,000 livers and 6,000 hearts were transplanted. Both kidney and liver transplants are on the rise but demand is also increasing and remains unmatched. Reports on ‘transplant tourism’ show that it makes up an estimated 10% of global transplantation practices. The phenomenon has been increasing since the mid-1990's, coinciding with greater acceptance of the therapeutic benefits of transplantation and with progress in the efficacy of the medicines, immuno-suppressants, used to prevent the body’s rejection of a transplanted organ.

The principles put forward by WHO underscore that the person, whether recipient of an organ or a donor, must be the main concern both as patient and as human being; that commercial exploitation of organs denies equitable access and can be harmful to both donors and recipients; that organ donation from live donors poses numerous health risks which can be avoided by promoting donation from deceased donors; and that quality, safety, efficacy and transparency are essential if society is to reap the benefits transplantation can offer as a therapy. “Live donations are not without risk, whether the organ is paid for or not. The donor must receive proper medical follow-up but this is often lacking when he or she is seen as a means to making a profit,” added Dr. Noel. “Donations from deceased persons eliminate the problem of donor safety and can help reduce organ trafficking.” WHO action on transplantation will be aided by a global observatory set up in Madrid under the auspices of the Government of Spain. The observatory, which is linked to the WHO Global Knowledge Base, will provide an interface for health authorities and the general public to access data on donation and transplantation practices, legal frameworks and obstacles to equitable access.

States revising organ-donation law; critics fear measure may not go far enough to protect donors

State legislatures are rewriting legislation governing organ donations in one of the most ambitious initiatives in at least 20 years to alleviate the chronic shortage of kidneys, livers and other body parts, an effort that some doctors and ethicists fear tilts too far toward allowing organs to be taken. Virginia, Idaho, Utah and South Dakota have already adopted a model law designed to make organ donation easier by clarifying a host of sensitive questions. An especially tricky one is how to handle unconscious patients who signed donor cards but also specified that they did not want to kept alive on life-support. Another one is what doctors should do when the family of a dying person who agreed to be a donor objects to surgeons taking their loved one’s organs. 

The measure awaits the signatures of the governors of Arkansas, Indiana, Iowa and New Mexico. At least 17 other states, plus the District and the U.S. Virgin Islands, are considering the legislation. Supporters hope it is adopted nationwide. While praised by transplant advocates, the model law has stirred concern among some doctors and bioethicists. Critics say it could result in people becoming donors or kept on life support against their or their family’s wishes. And some worry that the measure could make doctors more hesitant about administering morphine and other drugs to make dying patients comfortable, for fear of rendering their organs useless for transplantation. The revised model law is the latest in a series of initiatives by transplant advocates to boost the number of organs available for the more than 95,000 Americans on waiting lists. Organ banks have also been aggressively promoting a controversial practice that allows surgeons to take organs from patients who are not brain dead, more than doubling the number of such donations in the past three years. “There are lots of efforts to bridge the growing gap between demand and supply,” said Arthur L. Caplan, a University of Pennsylvania bioethicist. “We have to be very careful that we don’t make people think that we don’t have their best interests in mind and are just going to use them to get their body parts.”  

The model law, the Revised Uniform Anatomical Gift Act, updates 1968 legislation adopted by every state to make organ donation procedures uniform nationwide. Among many changes, the measure expands the list of people who can consent to an unconscious patient becoming a donor, and makes it clear that a person’s decision to be an organ donor cannot be revoked by anyone else. The most controversial section deals with unconscious patients who have signed donor cards but also “living wills” or other documents that state that they do not want a ventilator or other medical care to keep them alive, which is sometimes necessary to maintain organ viability until a transplant can take place. Under the act, the donor card trumps the living will, which triggered objections from some bioethicists and doctors who care for critically ill patients. In response, the commission sent states substitute language that calls for family members or others to be consulted in such situations to try to determine what the donor would have wanted. Those states that have approved the law already, however, will have to wait until next year to amend it.  

The measure aims to establish more computerized registries of people who have agreed to be donors but makes no similar provision for those who do not want to be donors. It also gives organ procurement organizations the power to keep potential donors on life-support while they evaluate their organs’ suitability for transplantation. “If there’s a patient requiring palliative or comfort care, you treat them first. That’s clear. This doesn’t change that balance,” said Christina W. Strong, who represented the Association of Organ Procurement Organizations. “What it does is make sure that to free up an ICU bed a hospital doesn’t forget the patient may have wanted to be a donor or their family may want them to be a donor.” (Washington Post)

$500 million pledged to fight childhood obesity

The Robert Wood Johnson Foundation plans to spend more than $500 million over the next five years to reverse the increase in childhood obesity. It is one of the largest public health initiatives ever tried by a private philanthropy. “This is an epidemic that is going to cost the country in terms of morbidity and mortality and economically,” said Dr. Risa Lavizzo-Mourey, the foundation’s president and chief executive. “The younger generation is going to live sicker and die younger than their parents because of obesity.” The foundation estimates that roughly 25 million children 17 and under are obese or overweight, nearly a third of the 74 million in that age group, according to Census Bureau data and a 2006 study published in The Journal of the American Medical Association. Many of those children are poor and live in neighborhoods where outdoor play is unsafe and access to fresh fruits and vegetables is limited. “In many cases, the environment makes it almost impossible for them to choose healthy lifestyles,” Dr. Lavizzo-Mourey said. “We’re going to try to change that.”  

The foundation plans to invest in programs to improve access to healthy food, encourage the development of safe play spaces, increase research to enhance understanding of obesity and prod governments into adopting policies to address the problem, among other things. Experts on childhood obesity welcomed the foundation’s plans. “Government grants for biomedical research in general, including obesity research, are being funded at the lowest levels I’ve seen in my career,” said Dr. David Ludwig, director of the Optimal Weight for Life Clinic at Children’s Hospital Boston and author of a new book, “Ending the Food Fight.” “So we are especially dependent on philanthropic support.” Philanthropy has long fueled improvements in health, from John D. Rockefeller, whose money produced a yellow fever vaccine, to Bill and Melinda Gates, who are underwriting new health technologies and vaccines to address a variety of global problems.  

Robert Wood Johnson, who built Johnson & Johnson into one of the world’s largest health and medical care products companies, established his foundation at his death in 1968 with 10,204,377 shares of the company’s stock. He committed it to improving the health of Americans. Over the last few years, the foundation has pledged $80 million to childhood obesity programs, like grants to the Food Trust to persuade supermarket operators to return to poor neighborhoods. Its new effort intends to capitalize on and enhance efforts by the food industry and school districts and governments to address the problem, Dr. Lavizzo-Mourey said. Several snack food producers are making changes in their packaging and ingredients, and three soft-drink companies said they would no longer supply sweetened drinks to school cafeterias and vending machines. Several states have mandated changes in school menus, increased physical education requirements and begun reporting students’ body mass index scores to parents. (The New York Times)

RFID Resource Center launched; Service provides knowledgebase for healthcare supply chain

The Health Industry Business Communications Council (HIBCC) has announced the launch of its new RFID Resource Center. The Center provides information for the healthcare industry as it considers the emerging role of radio frequency identification technology, and is accessible to the public from the organization’s web site. Included in the RFID Resource Center: “RFID & HIBC: A Guideline to Implementation,” detailing the requirements for utilizing the HIBC Supplier Labeling Standard with RFID technology; “Understanding RFID in Healthcare: Benefits, Limitations and Recommendations”, a comprehensive and practical guide to RFID technology, its potential in healthcare and the cost implications of implementation; articles and announcements from other industries regarding trends in RFID. The RFID Resource Center can be accessed from the home page of the HIBCC Web site at THIS LINK.

HIBCC & Partners HealthCare collaborate on patient safety standard

The Health Industry Business Communications Council (HIBCC) and Partners HealthCare System have announced their joint development of a data standard to enhance providers’ patient safety systems. The standard, entitled, “Positive Identification for Patient Safety; Part 1: Medication Delivery” defines the processes and technologies involved with safe medication administration and management. The new standard is being developed from work initiated by Massachusetts General Hospital (MGH), a hospital within the Partners HealthCare System. In 2004 MGH embarked on a project to define and develop a safer system for the administration of medication to its patients. The success of their efforts led the organization to seek formal standardization of their processes, in order that they could be easily and uniformly implemented by other providers. HIBCC, an ANSI-accredited standards development organization (SDO), will administer the process to formally develop an approved data standard.

Ten persons were indicted in federal court Tuesday, accused of bilking Medicare out of more than $5 million for fraudulent claims for durable medical equipment and treatments in expensive infusion therapies intended for AIDS and HIV patients. Raul Rodriguez and Armando Arias were accused of committing fraud using Coral Way Professional Services and Sunshine Health Center of Miami, as well as R&J Medical Services and N.R. Medical Services, both located in Miami-Dade County. The infusion therapy schemes have been widespread. According to a governor’s office report, Florida has far fewer AIDS/HIV cases than California or New York, but Florida providers submitted claims for AIDS/HIV cases that were more than three times the claims from California and five times more than from New York, according to the report. The clinics and their operators have been difficult for investigators to track down because they often switch names, owners and locations, closing quickly as investigators approach.

Tuesday’s indictment showed what investigators call a typical pattern, in which Medicare patients were given kickbacks to indicate they were given treatment at the clinics. Besides Rodriguez and Arias, those indicted were Carlos Enrique Monteagudo, Alain Rhaf Vega, Marisol Gonzalez Torres, Edith Balog, Leonel Galdos Jr., William Balladares, Yulen Arderi and Jannette Morales. Balog was accused of being the owner of record of R&J from November 2002 to August 2004. Torres was office manager and patient recruiter at Coral Way from October 2004 through March 2005, when the clinic closed. The indictment charges that the accused received about $2.5 million in fraudulent durable medical equipment claims and $3.2 million for false billing of infusion therapies. Prosecutors alleged that a medical assistant was told to tamper with blood samples to justify the HIV/AIDS therapies and to inject patients with a salt solution rather than medications. Rodriguez, Arias, Monteagudo, Vega, Galdos and Balladares were also accused of money laundering in alleged attempts to hide the money from federal authorities. Rodriguez and Arias were also charged with witness tampering in alleged attempts to bribe persons to get them to lie to investigators and a grand jury. (Miami Herald)

Study suggests some drug resistance to influenza B medications

Use of certain common antiviral drugs during a recent influenza B epidemic in Japan showed the development of viruses with partial resistance to the drugs, according to a study in the April 4 issue of JAMA. Two antiviral drugs, zanamivir and oseltamivir, which are a type of drugs known as neuraminidase inhibitors, have been effective against influenza and are used extensively. There has been documented evidence of the emergence of oseltamivir-resistant type A viruses, but similar information on influenza B viruses has been limited. Influenza B viruses are associated with annual outbreaks of illness and increased death rates worldwide, according to the article.

Shuji Hatakeyama, M.D., Ph.D., of the University of Tokyo, Japan, and colleagues examined the prevalence and transmissibility of influenza B viruses with reduced sensitivity to neuraminidase inhibitors in Japan, where zanamivir and oseltamivir are now used more extensively than anywhere else in the world. In the winter of 2004-2005, an influenza B virus caused a widespread epidemic in Japan, creating an opportunity to assess the effectiveness of neuraminidase inhibitors. The researchers identified a variant with reduced drug sensitivity in one (1.4 percent) of the 74 children who had received oseltamivir, and seven (1.7 percent) of the 422 influenza B viruses isolated from untreated patients were found to have reduced sensitivity to zanamivir, oseltamivir, or both. Review of the clinical and viral genetic information available on these seven patients indicated that four were likely infected in a community setting, while the remaining three were probably infected through contact with siblings shedding the mutant viruses. “Continued surveillance for the emergence or spread of neuraminidase inhibitor–resistant influenza viruses is critically important,” the authors write. “Further evaluation of the biological properties of neuraminidase inhibitor–resistant influenza viruses is needed to fully assess their pathogenicity in humans.”

In an accompanying editorial, Anne Moscona, M.D., of Weill Medical College of Cornell University, New York, and Jennifer McKimm-Breschkin, Ph.D., of Molecular and Health Technologies, Parkville, South Victoria, Australia, comment, “The report by Hatakeyama et al raises more questions than it answers, including questions about viral evolution, biological fitness, and transmissibility. But some facts are strikingly clear. Influenza B mutants with reduced sensitivity to neuraminidase inhibitors are circulating, and these viruses can cause infections with no difference in duration of symptoms, level of viral shedding, or clinical outcome. Contrary to what had been hoped until now, some resistant variants are vigorous pathogens. Whether these viruses arise by spontaneous mutation or through drug selection, or whether they are transmitted within families or acquired from the community, the resistant variants may be here to stay. In light of the recent observation that oseltamivir may be less effective against influenza B than against influenza A, an important concern is whether suboptimal dosing for these viruses will lead to increased selection of viruses with high-level resistance.”

“Influenza viruses evolve rapidly and nimbly, which compels ongoing investigation of antiviral therapies that use alternative mechanisms of action and target different points in the viral life cycle. The emergence of drug-resistant influenza B should draw attention to the importance of continual monitoring of strains over time and to the need for frequent rethinking of policies for use of antiviral drugs. While the news about resistance is not good and certainly calls into question some of the current assumptions about drug-resistant viruses, an effective response to this news can help contend with the new challenges of influenza.”

Amerinet announces agreement with Skytron for medical supplies

Amerinet announces its agreement with Skytron, Division of the KMW Group for medical supplies. Effective through March 31, 2010, this agreement includes Skytron’s patient examination and procedure lighting. Skytron products include: portable, fixed and recessed lighting that is ideal for any size and type of health care facility. This contract was a result of a competitive bidding process. For more information see THIS LINK. 

HealthGrades patient-safety study shows hospital errors rise 3 percent

Mammograms for women in their 40s should be based on individual

AHRMM & Arizona State University Partner on Healthcare Supply Chain Benchmarking Initiative

Is it the flu? Get the fast flu test

Medicare announces competitive acquisition program for certain DME, prosthetics, orthotics, and supplies

NIAID expands capability for influenza research and surveillance

Family members most often source of whooping cough in young infants

HealthGrades patient-safety study shows hospital errors rise 3 percent

Patient safety incidents at the nation’s hospitals rose three percent over the years 2003 to 2005, but the nation’s top-performing hospitals had a 40 percent lower rate of medical errors when compared with the poorest-performing hospitals, according to the largest annual study of patient-safety issued by HealthGrades, the leading independent healthcare ratings company.
 

The HealthGrades study of 40.56 million Medicare hospitalization records over the years 2003 to 2005 found: Patient-safety incidents continue to rise in American hospitals, with 1.16 million preventable patient-safety incidents occurring over the three years studied among Medicare patients in the nation’s hospitals, an incidence rate of 2.86 percent; 247,662 deaths were potentially preventable over the three years, and Medicare patients who had one or more patient-safety incidents had a one-in-four chance of dying; The excess cost to hospitals was $8.6 billion over three years, with some of the most common incidents proving to be the most costly; Ten of the 16 patient-safety incidents tracked worsened from 2003 to 2005, by an average of almost 12 percent, while seven incidents improved, on average, by six percent. Patient-safety incidents with the greatest increase in incident rates were post operative sepsis (34.28 percent), post-operative respiratory failure (18.70 percent) and selected infections due to medical care (12.23 percent); and Patient-safety incidents with the highest incidence rates were decubitus ulcer, failure to rescue and post-operative respiratory failure.

Of the nearly 5,000 hospitals studied, the HealthGrades study identified 242 hospitals, those in the top five percent of all hospitals, to serve as a benchmark against which other hospitals can be evaluated, naming them Distinguished Hospitals for Patient Safety. On average, these hospitals had a 40 percent lower rate of patient-safety incidents when compared with the poorest-performing hospitals. If all hospitals performed at the level of the Distinguished Hospitals for Patient Safety, the study found: Approximately 206,286 patient-safety incidents and 34,393 Medicare deaths could have been avoided; and $1.74 billion could have been saved.

To be ranked in overall patient-safety performance, hospitals had to be rated in at least 19 of the 28 procedures and diagnoses rated by HealthGrades and have a current overall HealthGrades star rating of at least 2.5 out of 5.0. The final ranking set included 752 teaching hospitals and 857 non-teaching hospitals. The top 15 percent, or 242 hospitals, were identified as Distinguished Hospitals for Patient Safety, and represent less than five percent of all U.S. hospitals examined in the study. The study says, “Despite the flurry of research, publications and process improvement activity that has occurred since the IOM report there is a growing consensus that not much progress has been made leading to a visible national impact. Our findings support this consensus. However, our findings also support that progress continues to be made at the top. Distinguished Hospitals for Patient Safety continue to lead the nation in providing safer care…resulting in much lower costs to society. We believe that Distinguished Hospitals have deliberately chosen and maintained patient safety as a top priority.” For more information CLICK HERE.

Mammograms for women in their 40s should be based on individual

Should all women in their 40s be routinely screened for breast cancer? Not necessarily, according to the American College of Physicians. In a new set of guidelines for clinicians of 40-something patients, the group recommends that mammography screening decisions be made on a case-by-case basis. It advises clinicians to discuss the benefits and harms of screening with the patient, as well as each woman’s individual cancer risk and preference about screening. The organization based its recommendations, which will be published in the April 3 issue of Annals of Internal Medicine, on a rigorous review of evidence showing there is variation in the benefits and harms associated with mammography among women in their 40s. The American College of Physicians is the leading professional organization for internal medicine specialists, with a membership of 120,000.

“There are important benefits to screening mammography, but we believe the decision to be screened should be based on an informed conversation between a patient and her physician,” said health policy expert Douglas K. Owens, MD, MS, a researcher with the Veterans Affairs Palo Alto Health Care System and a professor of medicine at the Stanford University School of Medicine, who chaired the committee that developed the guidelines. “In our view, the evidence doesn’t support a blanket recommendation for women in this age group.”

Breast cancer is the second-leading cause of cancer related death among women in the United States; according to the American Cancer Society, 25 percent of all diagnosed cases are among women younger than age 50. Among these younger women, the risk of breast cancer varies greatly, from less than 1 percent for a 40-year-old woman with no risk factors to 6 percent for a 49-year-old woman with multiple risk factors, which include family history of breast cancer, older age at the birth of her first child and younger age at the onset of menstruation. While it is well-established that mammography reduces mortality from breast cancer in 50- to 70-year-old women, and that women in this age-group should be routinely screened, the evidence isn’t as clear-cut for younger women.

Because of the ongoing controversy, the American College of Physicians’ Clinical Efficacy Assessment Subcommittee decided to take its own look at the evidence related to screening in women in their 40s. After their review, the group concluded that screening mammography for women in this age group likely provides a modest reduction in breast cancer mortality, but, as with any screening intervention, it also comes with the risk of potential harms. Based on this, it recommended that clinicians: Periodically perform individualized assessment of risk for breast cancer to help guide decisions about screening mammography; Inform women ages 40 to 49 of the potential benefits and harms of screening mammography; Base screening mammography decisions on benefits and harms of screening as well as a woman's preferences and breast cancer risk profile. In the new guidelines, the organization emphasizes the importance of using a woman’s concerns about breast cancer and screening to help guide decision-making about mammography. Women’s thoughts about mammography or their risks of developing breast cancer will likely vary greatly, the group notes, but it expects the potential reduction in breast cancer mortality associated with screening to outweigh other considerations for many women. “We still think many women will choose to get mammography, and we're supportive of that,” said Owens. “The most important thing is that women be well-informed about the decision they're making.”

AHRMM & Arizona State University Partner on Healthcare Supply Chain Benchmarking Initiative

The Association for Healthcare Resource & Materials Management (AHRMM) has partnered with the W. P. Carey School of Business at Arizona State University (ASU) to establish the Healthcare Supply Chain Benchmarking and Performance Improvements Metrics, an initiative that aims to advance and improve healthcare supply chain performance analysis over the next two years. Through the partnership, AHRMM and ASU will develop an online benchmarking and performance improvement tool using well established research method techniques that have been successfully applied to improving supply chain performance in other industries. This tool will allow hospitals and providers to compare their performance with organizations of similar size and operation. The Healthcare Supply Chain Benchmarking and Performance Improvements Metrics is in the first phase of development.  

“Despite past success with benchmarking, healthcare organizations still need a consistent, actionable, and credible measure to ensure accurate comparisons and reporting of financial and other supply chain measures,” said Deborah Sprindzunas, AHRMM’s executive director. “By identifying and developing effective indicators of supply chain performance as well as metrics for evaluating partner performance, AHRMM and ASU’s new tool will lead the way toward consistent, transferable performance analysis.”  

During the first phase the research team plans to engage industry experts in the identification, evaluation, and selection of target metrics for the healthcare field. The second phase involves development of a data capture and online benchmarking tool for use by practicing supply chain managers. The third phase moves this project to initial data collection and model validation activities where a sample of targeted organizations will provide data for validating the metric definitions and testing the use of the benchmarking and analysis tool. During the final phase, full scale data collection commences.  

“The Healthcare Supply Chain Benchmarking and Performance Improvements Metrics will not only enable organizations to determine the best performer, it will also determine best known practices and capabilities that have yet to be adopted by the majority of the industry,” explained Vicki Smith-Daniels, Professor of Supply Chain Management, W.P. Carey School of Business, Arizona State University. Associations representing various healthcare professions will be invited to participate in benchmarking and performance improvement analysis on a frequent basis, allowing for longitudinal analysis of supply chain performance improvement in the field of healthcare.
For more information CLICK HERE.
 

Is it the flu? Get the fast flu test

Fast flu tests, which drastically cut the time to diagnose a patient with influenza or not, are helping doctors better treat the illness, according to a recent study and medical experts. Timing is key in treating the flu, said Dr. Greg Poland of the Mayo Clinic in Rochester, MN. If diagnosed early enough, from 24 to 48 hours after a patient first shows symptoms, a treatment of antiviral drugs can alleviate the severity of symptoms, cut down on the number of days sick and decrease potential complications, Poland said. “I think all through my career, what the medical system tried to teach people is that when you have a virus or influenza, don’t come in because there is nothing we can do,” Poland said. “Now, what we are saying is that medical science has advanced.”

The rapid diagnostic tests can take anywhere from five to 30 minutes to come up with a diagnosis. In contrast, results for a traditional viral culture test can take several days to a week. The rapid tests generally involve a nasal or throat swab and can be examined in the doctor’s office. A viral culture also usually collects a fluid sample that is sent to a laboratory. The use of these rapid tests has been growing during the past few years and more than 10 variations of the tests have been approved by the Food and Drug Administration, the CDC said. Depending on the test used and if conducted properly, they register about a 70 percent accuracy rate in diagnosing whether a patient has the flu and are about 90 percent specific in figuring out what type of flu it is, the CDC said. “Done improperly, and I think a lot get done improperly, the sensitivity falls dramatically,” Poland said. The traditional culture tests are more consistently accurate and they can distinguish between flu subtypes with more specificity. “The gold standard is still a culture, but the gold standard is not timely, hence its usefulness in diagnosis and treatment is limited,” Poland said.

Research shows the tests are having an effect on treatment. Rapid testing has led to a decreased use of antibiotics in the treatment of children with the flu, according to a recent study conducted by Rochester General Hospital and the University of Rochester School of Medicine and Dentistry. The tests also have helped lead to shorter hospital stays for kids and lessened the amount of extra laboratory testing, the study said. The diagnostic tests also could be a benefit for the public health sector because they make it easier to keep track of test results. In some cases, especially with longer laboratory testing periods, different doctors and nurses may handle the testing process and reporting the results to public health agencies gets lost in the shuffle, Poland said. However, with a rapid test, where results are in-house and the process is shorter, the reporting is more accurate. Consequently, surveillance of possible outbreaks across the country is enhanced, doctors said.

Context plays an important role in deciding when to use the test, said Dr. Henry Bernstein of the Children’s Hospital at Dartmouth in New Hampshire and also a member of the American Academy of Pediatrics’ committee on infectious diseases. For example, early in the season, the U.S. flu season can last from late December through March, the rapid tests are useful because many patients mistake symptoms of other illnesses for the flu, he said. However, in the midst of the flu season when a specific community might be overrun by the illness, the tests might be impractical or a waste of money. The reasons for being judicious in using the tests, especially if done improperly, increasing the chances of an inaccurate diagnosis, are twofold, doctors say. Antiviral doses are limited each flu season and prescribing them indiscriminately could build a resistance to the drugs in the community, doctors say. The rapid diagnostic tests have been around for several years and are widely used, with some insurance plans covering them. Yet only now are people growing more aware of them, said Poland. (CNN)
 

Medicare announces competitive acquisition program for certain DME, prosthetics, orthotics, and supplies 

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that will reduce beneficiary out-of-pocket costs, improve the accuracy of Medicare’s payments for certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), help combat supplier fraud, and ensure beneficiary access to high quality DMEPOS items and services through a new competitive bidding program. In 2008, the competitive bidding program will operate in competitive bidding areas (CBAs) within 10 of the largest Metropolitan Statistical Areas (MSAs), excluding the New York, Los Angeles, and Chicago MSAs and will apply to 10 of the top DMEPOS product categories based on criteria outlined in the final rule. The program will be expanded into 70 additional MSAs in 2009. After 2009, CMS will expand the program to additional areas and items.  

The new competitive bidding program, which is required by the Medicare Prescription Drug, Improvement & Modernization Act of 2003, will replace the current payment amounts, for the items being bid, under Medicare’s DMEPOS fee schedule with payment rates derived from the bidding process. Suppliers that wish to furnish competitively bid items in a CBA will be required to submit bids to furnish those items. Contracts will be awarded to a sufficient number of winning bidders in each CBA to ensure access and service to high quality DMEPOS items. The winning bids will be used to establish a single Medicare payment amount for each item. For beneficiaries in the selected CBAs, this program will reduce out-of-pocket expenses while ensuring that they receive high quality items and services. This is because the rule requires all contracting suppliers to be accredited by an approved accreditation organization as meeting CMS’ quality standards. CMS has designated 10 entities as qualified to accredit DME suppliers, based on quality standards that were posted on the CMS website in August 2006. 

The single payment amounts established through competitive bidding will be lower than the current fee schedule amounts for the items. In addition, contract suppliers must accept the single payment amount established through competitive bidding as payment in full. The beneficiary’s liability is limited to 20 percent of the payment amount and any unmet Part B deductible. For taxpayers, the competitive bidding program means potentially significant savings for Medicare. When fully implemented in 2010, it is projected that these savings will amount to $1 billion annually.  

CMS is creating a limited exception to the competitive bidding requirement that will allow certain treating professionals to furnish items on the competitive bidding list to their own patients without having to participate in bidding and without becoming a contract supplier. This exception would apply to certain specified items furnished by physicians, physician assistants, clinical nurse specialists, nurse practitioners, occupational therapists in private practice, and physical therapists in private practice. The item must be furnished as part of their professional services.  

CMS has included in the final rule a number of provisions that will modify the rule’s impact on small suppliers. CMS worked closely with the Small Business Administration to establish a new definition of small suppliers that is reflective of this area of the health care industry. The use of this new definition, in conjunction with policies established in the final regulation, will enhance the ability of small suppliers to participate in the competitive bidding program. The final rule will be published in the Federal Register on April 10. For more information CLICK HERE.

NIAID expands capability for influenza research and surveillance

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH), announced it is awarding $23 million per year for seven years to establish six Centers of Excellence for Influenza Research and Surveillance. Collectively, the centers will expand NIAID’s influenza surveillance program internationally and in the United States, and will bolster influenza research in key areas, including understanding how the virus causes disease and how the human immune system responds to infection with the virus. The goal of the newly created centers is to provide the federal government with important information to inform public health strategies for controlling and lessening the impact of seasonal influenza as well as an influenza pandemic.

The new awards build upon an ongoing program led by St. Jude Children’s Research Hospital in Memphis, TN, initiated by NIAID after the 1997 Hong Kong outbreak of highly pathogenic avian influenza in humans. NIAID is expanding the surveillance and research program to now include six Centers of Excellence for Influenza Research and Surveillance, residing at St. Jude Children’s Research Hospital, Memphis, University of California at Los Angeles, University of Minnesota, Minneapolis, Emory University, Atlanta, Mount Sinai School of Medicine, New York City and University of Rochester, Rochester, NY.

Their work will include determining the prevalence of avian influenza in animals that routinely come into close contact with people; understanding how flu viruses evolve, adapt and transmit infection; and identifying immunological factors that can determine whether a flu virus causes only mild illness or death. Additionally, some centers will monitor for international and domestic cases of animal and human influenza to rapidly detect and characterize viruses that may have pandemic potential and to create vaccine candidates targeted to those viruses. Ultimately, these studies will lay the groundwork for developing new and improved control measures for emerging and reemerging flu viruses. For more information CLICK HERE or CLICK HERE.

Family members most often source of whooping cough in young infants

Infants with whooping cough were most likely infected by the people they live with, according to a multi-country study led by researchers from the University of North Carolina at Chapel Hill School of Public Health. The study found that parents were the source of pertussis, commonly known as whooping cough, in 55 percent of infants. In all, household members including siblings, aunts and uncles, cousins and grandparents were responsible for 75 percent of pertussis cases among infants for whom a source could be identified. The results appear in the April 2007 issue of the Pediatric Infectious Disease Journal.

Although pertussis vaccination has reduced the number of reported cases in industrialized countries by more than 95 percent from what it was in the 1950s, the number of reported pertussis cases in the United States has tripled in the past two decades. “It is important to understand how the disease is spread, particularly to infants who are too young to be vaccinated themselves, so that steps can be taken to prevent infections in these vulnerable infants and potentially save lives,” said Dr. Annelies Van Rie, assistant professor of epidemiology in the UNC School of Public Health and the study’s senior author. “It is troubling to learn that infants are often infected with pertussis by their own family members, who are often unaware of having pertussis themselves, and in whom pertussis could have been prevented if they had received a pertussis booster vaccination,” she said.

The study, funded by grants from the Institut Pasteur Foundation, Sanofi Pasteur and Sanofi Pasteur-MSD, was conducted over a 20-month period in four countries, Canada, France, Germany and the United States. The researchers found that among infants with pertussis for whom the source case could be identified, parents were the primary source of pertussis in infants, followed by siblings (16 percent), aunts/uncles (10 percent), friends/cousins (10 percent), grandparents (6 percent) and part-time caregivers (2 percent). “Ongoing research, such as this study, demonstrates that adolescents and adults can transmit pertussis to infants,” Van Rie said. “Pertussis immunization of adolescents and adults, especially those in contact with young infants would not only protect themselves form pertussis, but would also protect young infants from pertussis and could save lives.”

Newborns who are too young to be fully vaccinated against the disease are more vulnerable to severe pertussis and face the possibility of serious complications and even death. Infants account for more than 90 percent of pertussis deaths in the U.S. The disease is spread though airborne droplets that are transmitted when an infected person coughs or sneezes. The infected person may look and feel healthy between episodes of coughing. If left untreated, people infected with pertussis can spread the disease for several weeks.

Reports of pertussis have increased most dramatically among adolescents and adults. This is partly because pertussis immunity from early childhood vaccinations wears off, leaving adults and adolescents susceptible to the disease. Most adolescents and adults are not diagnosed with pertussis because they frequently have milder cases of the disease and physicians still perceive pertussis as a childhood disease. The U.S. Centers for Disease Control and Prevention now recommends that adults and adolescents be given a tetanus-diphtheria-pertussis booster (Tdap) in place of the tetanus-diphtheria (Td) booster to reduce the burden of pertussis in the United States.

April 2, 2007

Premier acquires CareScience, strengthening ability of hospitals to improve quality while safely reducing cost

New York Times: Some hospitals call 911 to save their patients

Dengue surging in Mexico, Latin America 

Severe dengue infections may go unrecognized in international travelers

Universal red blood cells could relieve blood bank shortages

Conflict-of-interest inquiry may be reopening at NIH

Russia sees ill effects of ‘General Winter’s’ retreat

CHeS Webinar series focuses on benefits of synchronized product data across the health care industry

Amerinet signs exclusive agreement with Ohio Valley Hospital Consortium

Premier acquires CareScience, strengthening ability of hospitals to improve quality while safely reducing cost

On Friday, March 30, 2007, Quovadx, Inc. and Premier Inc. simultaneously signed a definitive agreement and closed the related transaction wherein Premier purchased all outstanding shares of CareScience stock for $34.9 million, or a multiple of approximately 2.3 times CareScience's 2006 revenue. The transaction was approved by the Boards of Directors of both Quovadx and Premier. The final purchase price is subject to certain post-closing adjustments, including the final calculation of working capital for CareScience as of March 31, 2007. The sale is not expected to result in any income taxes due from Quovadx.

"CareScience's robust clinical analytics, research capabilities and dedicated employees enhance Premier's industry-leading capabilities for improving healthcare quality while safely reducing the cost of care," said Stephanie Alexander, Premier senior vice president. "We look forward to creating new and enhanced solutions that will provide hospitals and health systems greater access to the expertise, clinical research and knowledge-sharing they need to meet the critical challenges facing healthcare today."

Together, Premier and CareScience serve more than 900 hospitals. CareScience's physician-accepted, clinical expertise complements Premier's process improvement focus and unparalleled database of hospital comparative data. Premier’s Performance Suite is a single source for integrating quality and safety, labor management, and supply chain efficiency. It provides Web-based performance measurement and benchmarking, real-time surveillance and best practices to help improve quality and reduce costs. CareScience works with hospitals to use comparative data as the basis for implementing clinical quality improvement plans that optimize patient outcomes and operational performance, increase staff efficiency and reduce costs.

“The acquisition of CareScience further demonstrates Premier’s commitment to its long-term goal of reshaping American healthcare in ways that make it the safest, most effective and efficient system in the world,” said Susan DeVore, Premier’s chief operating officer. “The greatest challenge for hospitals today is improving quality of care while safely reducing costs. Today’s agreement will help hospitals across the nation meet that challenge.”

In a second transaction Sunday, April 1, 2007, Quovadx Inc. and Battery Ventures entered into an agreement wherein Battery Ventures will acquire 100 percent of the outstanding shares of the common stock of Quovadx, Inc. for $136.7 million payable to Quovadx stockholders. Stockholders are therefore expected to receive $3.15 per share, subject to certain post-closing adjustments. The estimated per share price includes the net proceeds from the March 30, 2007 sale of the Company's CareScience division.

New York Times: Some hospitals call 911 to save their patients

Should a hospital be able to handle a medical emergency? Patients at some hospitals may find the staff resorting to what someone might do at home in a crisis: call 911 for an ambulance. That happened recently in Texas, where a 44-year-old man named Steve Spivey developed breathing problems after spine surgery. No physician was working there when the staff first recognized he was in trouble. They phoned 911, and he was taken to a nearby full-service hospital, where he was pronounced dead a short time later. The episode occurred at a small hospital that is owned and run by doctors, one of roughly 140 such hospitals around the country, with nearly two dozen more under development, that are set up to specialize in certain types of procedures like heart surgery, back operations and hip replacements. These hospitals have been assailed for cherry-picking the most profitable procedures from the nation’s 4,500 or so full-service hospitals. Critics have argued that the doctors have a financial incentive in sending patients to their own facilities, even when those patients might be better off having their surgery in regular hospitals. But the Texas case, and others like it, have invited new scrutiny from regulators and members of Congress about these hospitals’ ability to care for patients who suffer complications after their operations.

While some of these hospitals are large sophisticated operations, like those hospitals specializing in cardiac care, others are much more modest. Small surgical hospitals may not have separate emergency facilities or, as in the Texas case, a doctor on site at all times during a patient’s recovery. As the number of doctor-owned surgical hospitals grows, federal and state officials now acknowledge that the government rules may be too vague about the emergency abilities a hospital must have in place. Regulators are particularly concerned about the very small hospitals that focus on only a few kinds of surgery but perform operations that frequently require an overnight stay. While Medicare’s rules currently say a hospital must “meet the emergency needs of patients in accordance with acceptable standards of practice,” the details are left largely to the hospital’s discretion. Federal and state officials say they are now reviewing the guidelines to toughen the rules and make them more specific. Medicare recently terminated its agreement with the facility involved in the Texas case, West Texas Hospital, a 14-bed hospital in Abilene that performed procedures ranging from plastic surgery to complex spine operations. Although the chief executive of West Texas Hospital defended its practices, he said it would not appeal the government’s decision. The hospital has since closed.

The doctors who set up the specialized hospitals defend them by saying that by running the centers themselves and concentrating only on certain procedures, they can provide the best results for patients. Proponents of the specialty hospitals say the Abilene and such cases are aberrations that critics are exploiting to defend the turf of full-service hospitals. They say they are able to handle their patients’ medical emergencies, whether or not they have emergency departments. But some members of Congress are now pushing Medicare to take a closer look at how such hospitals are regulated. “The problem with physician-owned specialty hospitals is that decision-making is more likely to be driven by financial interest rather than patient interest,” said Senator Charles E. Grassley, (R-IA). “You see it in the cherry-picking of patients, and with policies that instruct hospital staff to call 911 for the local community hospital if emergency care is needed,” said Grassley, a ranking member of the Senate Committee on Finance, which oversees Medicare. Congress has asked for various reports on the issue, including a comprehensive analysis last year by the federal Department of Health and Human Services. (The New York Times) To read the full article CLICK HERE.

 

Dengue surging in Mexico, Latin America 

The deadly hemorrhagic form of dengue fever is increasing dramatically in Mexico, and experts predict a surge throughout Latin America fueled by climate change, migration and faltering mosquito eradication efforts. Overall dengue cases have increased by more than 600 percent in Mexico since 2001, and worried officials are sending special teams to tourist resorts to spray pesticides and remove garbage and standing water where mosquitoes breed ahead of the peak Easter Week vacation season. Even classic dengue, known as “bonebreak fever”, can cause severe flu-like symptoms, excruciating joint pain, high fever, nausea and rashes. More alarming is that a deadly hemorrhagic form of the disease, which adds internal and external bleeding to the symptoms, is becoming more common. It accounts for one in four cases in Mexico, compared with one in 50 seven years ago, according to Mexico’s Public Health Department.

While hemorrhagic dengue is increasing around the developing world, the problem is most dramatic in the Americas, according to the Centers for Disease Control and Prevention. Dengue is driven by longer rainy seasons some blame on climate change, as well as disposable plastic packaging and other trash that collects water. Migrants and tourists, including the many thousands of Americans expected for spring break this year, carry new strains of the virus across national borders, where mosquitoes can spread the disease. The CDC says there’s no drug to treat hemorrhagic dengue, but proper treatment, including rest, fluids and pain relief, can reduce death rates to about 1 percent. Latin America’s hospitals are ill-equipped to handle major outbreaks, and officials say the virus is likely to grow deadlier, in part because tourism and migration are circulating four different strains across the region. A person exposed to one strain may develop immunity to that strain, but subsequent exposure to another strain makes it more likely the person will develop the hemorrhagic form. This dengue spread “is one of the primordial public health problems the country faces,” said Mexico’s Public Health Department, which has sent hundreds of workers to the resorts of Puerto Vallarta, Cancun and Acapulco to try to avert outbreaks ahead of the Easter week vacation. “We are working intensively, both the federal and state governments, on (these) three sites that we want to keep under control, so that it doesn’t become a risk for tourists,” said Pablo Kuri, head of Mexico’s National Center for Epidemiology and Disease Control.  

The Canadian Embassy in Mexico City issued an alert about dengue after five Canadians were sickened in Puerto Vallarta earlier this year. Acapulco, a city of 700,000, has documented 549 cases of classic and hemorrhagic dengue in the first two months of 2007, up from just 86 for the same period last year. In January and February, Mexico’s dry season, there were 1,589 cases of both types of dengue nationwide, up 380 percent from the same period in 2006, Kuri said. And last year was also bad for dengue: Mexico documented 27,000 infections overall, including 4,477 hemorrhagic cases and 20 deaths, compared with 1,781 cases overall in 2001. Dengue has been found along the U.S.-Mexico border, where 151 classic and 46 hemorrhagic cases were recorded last year in the Gulf state of Tamaulipas, south of Texas. The Intergovernmental Panel on Climate Change, made up of the world’s leading climate scientists, predicted in March that global warming and climate change would cause an upsurge in dengue. The global solution to dengue outbreaks is mosquito control, and faltering eradication efforts, together with climate change, probably share blame for dengue’s rise in the Americas, Kuri said. (Associated Press)

 

Severe dengue infections may go unrecognized in international travelers

Severe cases of a common travelers’ infection may not be recognized if doctors rely on the World Health Organization’s (WHO) guidelines for identifying it, according to a new study published in the April 15 issue of The Journal of Infectious Diseases, now available online. Dengue is the most important emerging disease among international travelers, with a 30-fold increase in incidence over the past 50 years worldwide. Like malaria, dengue is transmitted to humans by mosquitoes.  Most cases are mild. Symptoms include fever, rash, headache, pain behind the eyes, and muscle and joint pain.

According to the WHO, dengue hemorrhagic fever (DHF) is characterized by fever, low platelet count, clinical evidence of leaking capillaries, and spontaneous bleeding or fragile blood vessels. The most serious cases can lead to shock and death. There is no cure for dengue infection, but management of the disease’s effects can prevent the worst outcomes. The study, conducted by Ole Wichmann, MD, MCTM, DTM&H, at the Robert Koch Institute in Berlin, Germany, and colleagues throughout Europe, collected data through the European Network on Surveillance of Imported Diseases at 14 sites in 8 European countries.

Out of more than 200 patients treated for dengue infection at these sites over two years, less than 1 percent fit all four criteria necessary to meet the WHO definition of DHF. However, 11 percent had at least one manifestation of severe dengue disease, and a total of 23 percent required hospitalization due to dengue-related symptoms. “Dengue exists more as a continuous spectrum,” Dr. Wichmann said. “Severe disease can be present in patients who do not fulfill all four DHF criteria.” “The term ‘dengue hemorrhagic fever’ puts undue emphasis on bleeding,” he added, noting that plasma leakage and shock can occur without it. “Clinicians who mainly focus on bleeding...may miss the most important conditions that require hospitalization and treatment.”

Their findings also showed that travelers who acquire a second dengue infection are more at risk for severe cases of dengue, although some patients had severe symptoms when infected during their first trip to a dengue-endemic country. It is becoming more and more crucial that health care providers understand the clinical spectrum of dengue and its diagnosis. “Given the increase in business travel and other travel, and the global spread of dengue fever, these findings have important implications for the future burden of severe imported dengue infections,” Wichmann said. As a next step to their study Wichmann highlighted the need for more inquiry into a clinical definition of dengue. “In order to perform more uniform surveillance and research, including vaccine trials, studies are urgently needed to establish new and more robust definitions for severe dengue.”

Universal red blood cells could relieve blood bank shortages

An international team of academic and industry scientists has come up with a feasible way of making universal red blood cells that are stripped of their blood type. The hope is that it can be developed into a viable way of relieving blood bank shortages. The study is published in the early online edition of the journal Nature Biotechnology. The idea of “universal red blood cells” has been around for some time and its feasibility has been demonstrated in clinical trials. For example, scientists in the US about 25 years ago managed to use a coffee bean glycosidase enzyme to strip the B antigen from red blood cells. But the process proved to be impractical.

In the new study, a team of scientists led by Professor Henrik Clausen from the University of Copenhagen in Denmark, found a more abundant source of glycosidase enzymes in bacteria. They found two bacterial glycosidase gene families with enzymes that efficiently remove A and B antigens from red blood cells (RBCs). Prof Clausen and colleagues conclude that “The enzymatic conversion processes we describe hold promise for achieving the goal of producing universal RBCs, which would improve the blood supply while enhancing the safety of clinical transfusions”. The university scientists worked with US industry scientists from ZymeQuest in Beverly, MA. The next step is to start clinical trials to test the method’s treatment safety and efficiency. (Medical News Today)

Conflict-of-interest inquiry may be reopening at NIH

Federal investigators are reviewing the activities of 103 scientists who may have had improper links to pharmaceutical companies while they were employed at the National Institutes of Health, apparently resurrecting a conflict-of-interest inquiry that many in the agency thought was closed. In a letter sent to several members of Congress on March 23, Daniel R. Levinson, inspector general for the Department of Health and Human Services, said his office is looking into the cases “to determine whether investigation is warranted.” Levinson also wrote that his office is reviewing whether NIH is adequately monitoring potential conflicts of interest among its thousands of grant recipients, typically university researchers. Members of Congress and watchdog groups have long called for such a review, noting that conflict-of-interest policies at universities are generally more lenient than those at NIH. The concern, critics say, is that federal grant money not go to scientists who may be predisposed to get results that favor their drug company sponsors.  

Scientific and academic organizations counter that adequate safeguards are already in place and fear that many of the nation’s best scientists would leave the federally funded research enterprise if options for outside income were lost. NIH officials had already looked into the 103 cases of possible conflict of interest in 2004, after a congressional inquiry suggested that scores of researchers may have taken drug industry money without approval. As a result of that investigation, NIH Director Elias A. Zerhouni in 2005 banned all such consulting by NIH employees. Agency investigators concluded that about half of those who were suspected of wrongdoing and who were still employed at NIH (and thus available for questioning) had indeed violated policies, including 10 who the agency concluded may have violated federal law. NIH referred only those 10 cases to the HHS Office of Inspector General (OIG), which referred two to the Justice Department for possible prosecution. One resulted in a conviction for criminal conflict of interest; the other is still pending. With new ethics policies in place and the 2008 budget fight starting, many in the agency had hoped that the worst was behind them. But the Levinson letter suggests not. 

A spokesman for Levinson said he was not at liberty to say why the OIG had renewed its interest in the cases. But the letter, made public by the House Energy and Commerce Committee, which has spearheaded inquiries into NIH for years, said the review began about six months ago. That is about when committee members complained loudly that too many of those who were found to have violated NIH rules had gotten off with only modest disciplinary action. In a joint statement released yesterday, Energy and Commerce Chairman John D. Dingell (D-MI) asserted that “NIH bungled the investigation the first time around,” and ranking Republican Joe L. Barton (TX) expressed hope that the inquiry “will finally sort things out so everyone can have confidence that the public's interest is being fully served.” NIH spokesman John Burklow said: “We welcome the additional review; however, we are confident in the rigor of our process.” (Washington Post)

Russia sees ill effects of ‘General Winter’s’ retreat

Experts have long feared that Earth’s warming climate would cause tropical diseases such as malaria to spread into more temperate zones, but a dramatic example of an apparently climate-related disease outbreak cropped up this winter in a cold place, Russia. More than 3,000 cases of infections caused by hantaviruses have been reported so far in Russian cities and towns, including many that are within a few hundred miles of Moscow, such as Voronezh and Lipetsk. The viruses can cause a serious, and sometimes deadly, disease known as hemorrhagic fever with renal syndrome, or HFRS. During Russia’s more typically frigid winters, scientists believe, HFRS-causing viruses die off in the consistently below-zero temperatures. But this winter has been anything but cold. On Dec. 7 Moscow hit a record 46 degrees Fahrenheit. HFRS was last on a rampage in Russia in 1997, coinciding with another very warm winter. By mid-spring that year, the number of cases reached more than 20,000. The viruses are transmitted to humans when infected mice set up housekeeping in the nooks and crannies of homes, barns, sheds and other buildings. If droppings left by the mice are disturbed, the viruses waft up and out of the excretions like a miasma, infecting people who breathe the air.  

Biologists estimate that the current population of rodents in Russia is 10 times as high as in previous years, and that one in three mice is infected with an HFRS-causing virus. Most researchers attribute the spike to the unusually warm weather, although some think a natural cycle in mouse populations may play a role. “Global warming has tipped a balance,” said Irina Gavrilovskaya, a scientist and physician at the State University of New York at Stony Brook who has conducted research on HFRS at the Russian Academy of Medical Sciences in Moscow. “Because of the lack of snow cover on Russian fields, the country has had an explosion in numbers of virus-carrying mice.” With the coming of spring, Lyudmial Kirillov, the regional epidemiologist in Lipetsk, is predicting a new outbreak as the little snow that fell this winter melts and hibernating, and virus-carrying, mice awaken.  

Over the past decade, unusually warm winters and large populations of mice have also been responsible for outbreaks in New Mexico and nearby states of a related illness, hantavirus pulmonary syndrome. As of last year, some 10 states had reported 30 or more cases of the syndrome since 1993, when the virus was identified. More than 20 other hantaviruses threaten people in China, Korea, Northern and Western Europe, Argentina, Chile, Brazil, Panama, and Canada. Some of those outbreaks have also been linked to climate change, higher temperatures or altered patterns of rainfall, and its effect on rodents. “Climate change is about more than a warming Earth,” said David Blockstein, senior scientist at the National Council for Science and the Environment, a scientific advocacy group in Washington. “Climate change is turning environmental issues into public health issues.” (Washington Post)
 

CHeS Webinar series focuses on benefits of synchronized product data across the health care industry

The Coalition for Healthcare eStandards (CHeS) is launching an educational Webinar series focusing on the need for supply chain data synchronization to reduce costs and increase efficiencies in the U.S. health care industry. The series brings together industry experts who are championing efforts to launch a health care product data utility (PDU), similar to systems already successfully streamlining the exchange of supply chain information in other large industries. Join CHeS and industry participants in an engaging Webinar series about how a PDU can benefit hospitals and suppliers, as well as the industry as a whole, and learn how to participate in efforts to accelerate adoption of a PDU for health care. Register online at http://chestandards.org/pduwebinars.htm.

The schedule is as follows:

Wednesday, April 4, 2 pm - 3 pm Eastern, “PDU: What's in it for Hospitals?”

Hospitals have the most to gain from an efficient supply chain, reduced rework, fewer errors, reduced costs and improved patient safety, to name a few advantages.  Find out more about the specific benefits a fully implemented PDU would bring to America's health care providers. This Webinar is lead by Robert Perry, senior consultant, MTS, Inc, 2006 President of the Association for Health care Resource & Materials Management (AHRMM), chair, CHeS Product Data Utility Provider / IDN Working Group and Frank Fernandez, assistant vice president and corporate director of materials management, Baptist Health South Florida, AHRMM member representative, CHeS Board of Directors.

Wednesday, April 11, 2pm - 3pm Eastern, “PDU: What’s in it for Suppliers?”

Suppliers have the opportunity to reduce business costs and introduce new products to hospitals, faster, with a PDU in place. Learn what one health care supplier, BD, is doing to lead efforts for the industry to adopt a PDU and how other suppliers can participate. This Webinar is led by Joe Pleasant, CIO, Premier, Inc., chair, CHeS Product Data Utility Organizing Committee and Dennis Black, director of e-Business at BD (Becton, Dickinson and Company)

Thursday, April 26, 1pm - 2pm Eastern, “PDU: How Hospitals Can Take the Lead”

Hospital materials managers and financial executives are taking ownership of their supply chain, and adopting best practices to rein in costs. Learn about efforts to control supply chain costs and processes in the industry, and how one hospital is already seeing results. This Webinar is led by Robert Perry, senior consultant, MTS, Inc., 2006 President of the Association for Health care Resource & Materials Management (AHRMM), chair, CHeS Product Data Utility Provider/IDN Working Group and Mike Brown, director of purchasing, University Health Care System. For more information call Peggy Brody of CHeS at 734-677-3300 or email Peggy@CHeStandards.org or CLICK HERE.

Amerinet signs exclusive agreement with Ohio Valley Hospital Consortium

Amerinet Inc., a national health care purchasing organization, recently renewed its agreement to serve as the sole-source purchasing agent of the Ohio Valley Hospital Consortium (OVHC), an alliance of regional health care providers in South East Ohio, following a competitive bidding process. Since the initial agreement in 2001, the consortium has achieved nearly $6 million in cost savings through Amerinet’s comprehensive portfolio of contracts and solution-based programs. Amerinet will continue to negotiate custom contracts on behalf of OVHC, and make available an array of competitively priced, quality products and services provided by industry leaders.  

This new five-year agreement creates a partnership of shared responsibility to reduce costs and discover new revenue streams. The partnership will also focus on total supply spend management, and margin improvement tools, including cost reduction, contract evaluation and implementation, and education and program coordination at all of the consortium’s facilities. The Ohio Valley Hospital Consortium is an independent organization of community healthcare providers, working collaboratively to improve the health care delivery system in their communities. The OVHC member organizations include Adena Health System, Chillicothe; Fairfield Medical Center, Lancaster; Holzer Health Systems, Gallipolis; and Marietta Memorial Hospital, Marietta.

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