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August 2006
Rising health expenses are a good value,
researchers say
FDA warns consumers about counterfeit prescription drugs from some Canadian websites
FDA forms task force on human tissue safety
DHHS announces bioshield stakeholders workshop
Nicotine levels rose 10 percent in last six years, report says
How VA hospitals became the best; No longer a nation's shame, veteran care is acing competitors
Despite dramatic increases in health expenses since 1960, the return on medical spending is high, according to a new study by researchers at Harvard University and the University of Michigan. Studying health and spending trends from 1960 to 2000, the researchers concluded that healthcare in America has been cost-effective on the whole, although ballooning costs for the elderly are a cause for concern. In an article published in the Aug. 31 New England Journal of Medicine, David M. Cutler, the Otto Eckstein Professor of Applied Economics in Harvard's Faculty of Arts and Sciences, and Allison B. Rosen and Sandeep Vijan of the University of Michigan Health System compared average per-capita spending and life expectancy of four different age groups from 1960 to 2000, analyzing increases in medical expenses versus improvements in health. “The rising cost of healthcare has been the source of a lot of saber-rattling in the media and the public square, without anyone seriously analyzing and discussing the benefits gained,” said Cutler. “But the dramatic increase in life expectancy that we've seen over the last decades shows that rising medical costs have been largely justified.” Conservatively adjusting for non-medical factors in longevity such as lower smoking prevalence and reduced death rates from accidents, suicide, and homicide, the researchers attributed 50 percent of the increase in life expectancy since 1960 to improved healthcare. Following this methodology, Cutler and colleagues estimated that from birth, the increased life expectancy since 1960, approximately seven years, from 69.90 to 76.87 years, has cost $19,900 per added year of life. Of the portion of this longevity gain attributed to improvements in healthcare, the researchers estimated that some 70 percent was due to reductions in deaths from cardiovascular disease, while reductions in infant mortality accounted for 19 percent. Comparing this $19,900 against the value of a year of life as defined by insurance companies and medical decision-makers, a figure that ranges from $50,000 to $200,000, according to different statistical estimates, Cutler and colleagues judged the increase in medical costs to be a good value. The researchers write, “The increased spending has, on average, been worth it.” By contrast, persons age 65 and older have increased their longevity by just 3.5 years since 1960, with a cost of $84,700 for each year of added life. “The foremost cause of concern posed by rising medical costs is the tremendous strain coming from increased costs for the elderly,” Cutler said. “The cost per year of life for seniors is three times higher today than it was in the 1970s.” While Cutler, Rosen, and Vijan indicate that rising costs could lead to diminishing returns as life expectancy reaches a ceiling, the researchers say greatly increased quality of life for the elderly, an important factor not considered in the current study, mitigates in favor of current levels of healthcare spending among the elderly.
DHHS announces bioshield stakeholders workshop
The US DHHS is hosting a 2-day workshop for bioshield stakeholders, in Arlington, VA, on Sept 25-26, 2006, beginning at 8 am on both days. The BioShield Stakeholders Workshop will be an open meeting for representatives from the pharmaceutical and biotech industries, professional societies, state and local public health organizations, academic R&D community, public interest groups, stakeholder federal agencies and Congress. The purpose is to accelerate the R&D, acquisition, and availability of effective medical countermeasures for chemical, biological, radiological & nuclear (CBRN) threats. Space at the Workshop is limited. There is no charge to attend. The workshop will be held on Sept. 25, from 8 am-6 pm and Sept. 26, from 8 am-5 pm at the Crystal Gateway Marriott, 1700 Jefferson Davis Hwy, Arlington, VA. Goals of the workshop include: To provide attendees with insight into the current BioShield interagency governance process; To provide individual stakeholders with an opportunity to help guide the future implementation of Project BioShield, by providing input into the draft Public Health Emergency Medical Countermeasures (PHEMC) Strategy for Chemical, Biological, Radiological, & Nuclear (CBRN) Threats. This Strategy will define the principles guiding DHHS medical countermeasure research, development and acquisition. For more information contact: Elizabeth Jarrett, DHHS Office of Public Health Emergency Medical Countermeasures at 202-260-1200. To register online CLICK HERE.
Nicotine levels rose 10 percent in last six years, report says
The level of nicotine that smokers typically consume per cigarette has risen 10 percent in the past six years, making it harder to quit and easier to be addicted, said a report that the Massachusetts Department of Health released on Tuesday. The study shows a steady increase in the amount of nicotine delivered to the smokers’ lungs regardless of brand, with overall yields increasing 10 percent. Massachusetts is one of three states to require tobacco companies to submit information on nicotine testing to its specifications and is the sole state with data as far back as 1998. The study found that the three most popular brands with young smokers, Marlboro, Newport and Camel, delivered significantly more nicotine than they did six years ago. Nicotine consumed in Kool, a popular menthol brand, rose 20 percent. The study has always measured nicotine levels based on the way smokers use cigarettes, health officials said. That includes partly covering ventilation holes while smoking and taking longer puffs. Traditional testing does not take habits into account and typically reports lower nicotine contents, researchers said. “The amount of nicotine in a cigarette has increased steadily over the past six years,” the department said, indicating in its reports that the smoking habits simulated had not changed in that period. Of the 179 brands tested in 2004, 93 percent fell into the highest range for nicotine. In 1998, 84 percent of 116 brands were in the highest range. “We want health care providers to know that smokers are getting more nicotine than in the past and may need additional help in trying to quit,” the public health commissioner, Paul Cote Jr., said. The report said that for all brands tested in 1998 and 2004 there was no significant difference in the total nicotine delivered among full flavor, medium, light or ultralight cigarettes. The finding means that agencies trying to help smokers quit may have to adjust the strength of nicotine replacement therapies like nicotine patches and gums. (The Associated Press)
How VA hospitals became the best; No longer a nation's shame, veteran care is acing competitors
Until the early 1990s, care at VA hospitals was so substandard that Congress considered shutting down the entire system and giving ex-G.I.s vouchers for treatment at private facilities. Today it's a very different story. The VA runs the largest integrated healthcare system in the country, with more than 1,400 hospitals, clinics and nursing homes employing 14,800 doctors and 61,000 nurses. And by a number of measures, this government-managed healthcare program, socialized medicine on a small scale, is beating the marketplace. For the sixth year in a row, VA hospitals last year scored higher than private facilities on the University of Michigan's American Customer Satisfaction Index, based on patient surveys on the quality of care received. The VA scored 83 out of 100; private institutions, 71. Males 65 years and older receiving VA care had about a 40% lower risk of death than those enrolled in Medicare Advantage, whose care is provided through private health plans or HMOs, according to a study published in the April edition of Medical Care. Harvard University just gave the VA its Innovations in American Government Award for the agency's work in computerizing patient records. And all that was achieved at a relatively low cost. In the past 10 years, the number of veterans receiving treatment from the VA has more than doubled, from 2.5 million to 5.3 million, but the agency has cared for them with 10,000 fewer employees. The VA’s cost per patient has remained steady during the past 10 years. The cost of private care has jumped about 40% in that same period. Vets still gripe about wading through red tape for treatment. Some 11,000 have been waiting 30 days or more for their first appointment. The Iraq and Afghanistan wars could stress the system, although for the moment VA officials say the agency can accommodate the new patients. That’s because older vets, especially those from the World War II and Korean War eras, are dying of natural causes at the rate of about 600,000 a year, whereas the Iraq and Afghanistan wars have so far created a little more than 550,000 new vets. On the other hand, because advances in body armor and field medicine have enabled soldiers to survive battlefield injuries that in earlier conflicts meant death, many of the new patients are arriving at VA hospitals with severe wounds. In response, the VA has set up four polytrauma centers around the country. The roots of the VA’s reformation go back to 1994, when Bill Clinton appointed Kenneth Kizer, a hard-charging doctor and former Navy diver, as the VA’s under secretary for health. Kizer decentralized the VA’s cumbersome health bureaucracy and held regional managers more accountable. Patient records were transferred to a system-wide computer network, which has made its way into only 3% of private hospitals. When a veteran is treated, the doctor has the vet’s complete medical history on a laptop. In the private sector, 20% of all lab tests are needlessly repeated because the doctor doesn’t have handy the results of the same test performed earlier, according to a 2004 report by the President's information technology advisory committee. Another innovation at the VA was a bar-code system for prescriptions, a system used in fewer than 5% of private hospitals. Private hospitals, which make their money treating people who come to them sick, don’t profit from heavy investments in preventive care, which keeps patients healthy. But the VA, which is funded by tax dollars, “has its patients for life,” notes Kizer, who served in his post until 1999. So to keep government spending down, “it makes economic sense to keep them healthy and out of the hospital.” Kizer eliminated more than half the system's 52,000 hospital beds and plowed the money saved into opening 300 new community clinics so vets could have easier access to family-practice-style doctors. He set strict performance standards that graded physicians on health promotion. Hundreds of thousands of veterans abandoned private physicians and enrolled in the lower-cost and higher-quality VA care. But that created a new problem. The VA’s budget from Congress (currently about $30 billion annually) couldn’t cover the influx. By January 2003, with hundreds of thousands waiting six months or more for their first appointment, the VA began limiting access to only vets with service-related injuries or illness or those with low income. Veterans’ groups understandably want the healthcare system expanded to accommodate vets with higher incomes and no service-related ailments. Tom Bock, commander of the American Legion, has another idea: allow elderly vets not in the system who are drawing Medicare payments to spend those benefits at a VA facility instead of going to a private doctor, as is now required by Medicare. “It's a win-win-win situation,” he argues. Medicare, which pays more than $6,500 per patient annually for care by private doctors, could save with the VA’s less expensive care, which costs about $5,000 per patient. The vets would receive better service at the VA’s facilities, which could treat millions more patients with Medicare’s cash infusion. But conservatives fear such an arrangement would be a Trojan horse, setting up an even larger national healthcare program and taking more business from the private sector. Congress has no plans to enlarge the scope of veterans’ healthcare, much less consider it a model for, say, a government-run system serving nonvets. But it’s becoming more and more “ideologically inconvenient for some to have such a stellar health-delivery system being run by the government,” said Margaret O'Kane, president of the National Committee for Quality Assurance, which rates health plans for businesses and individuals. If VA health care continues to be the industry leader, it may become more difficult to argue that the market can do better. (Time Inc.) To read the full article CLICK HERE.
Drug maker will pay fine for promoting off-label use
Johnson & Johnson wins antitrust suit
Transfusions of blood products might help to cut deaths in a future flu pandemic, research suggests
Hospital projects $34 million loss; However, bottom line numbers
show that it will still record
a $38 million profit
Waistlines continue to grow in U.S.
Medical errors? Patients may be the last to know
Drug maker will pay fine for promoting
off-label use
The
Schering-Plough Corporation agreed on Tuesday to
pay $435 million and plead guilty to conspiracy to settle a
federal investigation into marketing of its drugs for
unapproved uses and overcharging Medicaid for certain drugs.
Schering-Plough said it would pay $255 million to resolve
civil aspects of the previously disclosed investigation. A
subsidiary, the Schering Sales Corporation, will pay a
criminal fine of $180 million and plead guilty to one count of
conspiracy to make false statements to the government. The
agreement is subject to court approval. Schering-Plough said
the settlement resolved an investigation by the Justice
Department and the United States attorney’s office in Boston
that began before a new management team took over at the
company in April 2003. “With this agreement, we are putting
issues from the past behind us,” said Brent Saunders, senior
vice president for compliance and business practices. The
agreement comes two years after Schering-Plough agreed to pay
$346 million to settle charges that it paid a kickback to a
health insurer to protect the market for its allergy drug
Claritin. The investigation that led to Tuesday’s settlement
began in 2001. Investigators found evidence that
Schering-Plough marketed drugs for off-label uses. Off-label
uses have not been approved by government regulators, although
doctors can individually choose to prescribe drugs for those
purposes. One such drug was Temodar, which the
Food and
Drug Administration in 1999 approved to treat
anaplastic astrocytoma, a type of brain
tumor,
in patients who had not responded to other drug regimens. A
United States attorney, Michael
Sullivan, who announced Tuesday’s settlement, said Schering
promoted the drug to treat several other types of brain
cancers and
cancer
that had spread to the brain from elsewhere, uses that the FDA
had not approved. Sullivan said that Schering-Plough also
provided misleading information to the government about the
price it was charging a health maintenance organization
for Claritin RediTabs, to avoid having to pay rebates to the
Medicaid program. Medicaid is supposed to obtain the benefit
of low drug prices and drug makers are required to report
their best price on drugs supplied to commercial customers.
(The Associated Press)
Johnson & Johnson wins antitrust suit
Johnson & Johnson won an antitrust lawsuit yesterday that had accused the company of illegally using its sutures monopoly to increase sales of other surgical products. A federal jury in Santa Ana, CA, rejected claims by the Applied Medical Resources Corporation that the Ethicon unit of Johnson & Johnson had blocked competition in the market for trocars, instruments used in so-called keyhole surgery. Applied Medical, which is closely held, sued in 2003 for $54 million in damages, which could have been tripled under antitrust laws. Applied Medical, based in Rancho Santa Margarita, CA, said Ethicon had taken away its sales by offering discounts on sutures to hospitals that also bought the company’s trocars and clip appliers. Johnson & Johnson, based in New Brunswick, NJ, argued that the bundling contracts did not unfairly exclude other suppliers and were requested by hospitals that sought lower prices. The jury deliberated for 2½ days before reaching a decision. (Bloomberg News)
Transfusions of blood products might help to cut deaths in a future flu pandemic, research suggests
US researchers
examined records from the Spanish flu pandemic of 1918-1920 which killed up to
100m worldwide. They found transfusions taken from people who had recovered may
have improved the condition of others hospitalised by the virus. The study, a
joint project by various groups including the US Navy, will appear in Annals
of Internal Medicine. The latest research suggests that blood transfusions
might be an effective addition to the treatment arsenal, alongside vaccines and
anti-viral drugs. The researchers say a single recovering patient could donate
enough blood plasma to treat many others. They examined the Spanish flu outbreak
because the virus behind it is a close cousin of H5N1. However, they admit the
records on which they based their study were limited. The number of patients was
small, the work was not scientifically well controlled, and dosages were not
standardised. Disruption caused by World War 1 probably made record keeping very
difficult, and wartime censorship may have affected publication of research. The
researchers are calling for experts to examine the potential for plasma therapy,
or serotherapy, in greater detail, and to consider the benefits of drawing up
treatment guidelines. Writing in the same journal, Dr John Treanor, an expert in
infectious diseases at the University of Rochester, said a similar approach had
been used to treat other viral diseases. He said plasma therapy might pose
logistical difficulties, such as how to obtain, classify and prepare blood
materials in the midst of an outbreak. In addition, more work was needed to
refine suitable dosages. However, he added: “Although many logistical hurdles
exist, controlled clinical studies done now will probably pay a considerable
dividend when the pandemic begins. We can, should, and must explore these issues
about serotherapy now, in advance of the pandemic.” Dr John Wood, a virology
expert at the National Institute for Biological Standards and Control, said the
research was intriguing, and demanded further investigation. He said: “Our
present armoury against pandemic flu is limited. We can probably make vaccine,
but it will be five months before it is ready, and there are logistical problems
with anti-virals. It is better to have as many strings in your bow as possible.”
However, Dr Andrew Hayward, an immunologist at University College London, said
it might prove difficult to carry out research into the effectiveness of the
treatment before a pandemic strain of flu emerged. He also warned that any
treatment involving blood products carried the potential for transmission of
other infections. He said vaccines, anti-virals were likely to be the front line
defences, along with basic public health measures, such as hand washing and
wearing masks. Dr Iain Stephenson, a consultant in infectious diseases in
Leicester, said any
potential treatment for pandemic flu was worth exploring. However, he said:
“Immunotherapy is likely to work only in the very early stages of infection and
it will be difficult to identify patients that might benefit.” (BBC News)
Hospital projects $34 million loss; However, bottom line
numbers show that it will still record
a $38 million profit
How does a business lose $34 million on its day-to-day operations and still turn
a $38 million profit? Those are the bottom-line figures in Sarasota (FL)
Memorial Hospital’s proposed budget for 2007. Behind them are two trends, a
nationwide rise in bad debt, from patients who can't or don't pay their bills,
and a regional boom in property values. Hospital administrators presented the
budget last week to board members, who will conduct the first of two public
hearings on the proposal Sept. 5. The budget reflects two conflicting goals:
serving the entire community but also maintaining financial soundness. “We exist
for the public good. That's the only reason we're here,” hospital Chief
Executive Officer Gwen MacKenzie said. “We have a fiscal responsibility, too.”
The projected losses stem largely from bad debt. The hospital has seen a surge
in patients who lack insurance and insured patients who do not pay their share
of the bill. National hospital chains, including HCA and Health Management
Associates, both reported that trend in their recent financial statements.
Sarasota Memorial expects bad debt to reach $65.6 million this year, about 75
percent more than 2005's mark. It projects a smaller rise to $75.7 million next
year, still about double the 2005 total. The hospital is seeing more uninsured
patients and more patients, from many insurers, who are not paying copayments.
Bad debt is separate from charity care, which is writeoffs to patients meeting
the hospital’s poverty guidelines. That should reach $26.5 million this year and
$28.1 million next year, according to the budget. The two combine for more than
$100 million in writeoffs, about 7 percent of gross revenue. Sarasota Memorial
also is the only county hospital delivering babies, which loses money, about $4
million through nine months of fiscal 2006. The losses outpace the new
administration’s efforts to boost income and hold down salaries, benefits and
supply costs. Hospitals typically measure their performance in terms of how many
cases they handle. By that standard the hospital is holding the line. The budget
shows salary per discharge will increase less than 1 percent for the second year
in a row, after rising 6.9 percent in 2005. Fringe benefits would increase 2.6
percent in 2007, after 6 percent increases the previous two years. Supplies
would climb 4.2 percent, up from about 1 percent in 2006, but are flat as a
percentage of net revenue. The budget cites the high cost of surgical implants
as a main reason. MacKenzie said the hospital would continue the “checkbook”
approach she instituted to manage labor and supply costs. The hospital also is
holding jobs at the 2006 level and plans to recoup about $6.4 million with
better collections. To boost the revenue side, the hospital plans a 10 percent
price increase, the first in two years. The hospital also foresees the number of
outpatient cases rising 5 percent. It predicts inpatient volume will be flat.
Outpatient cases are more profitable, but generate less cash. It takes about
eight outpatient cases to make up for one inpatient case, MacKenzie said.
Meanwhile, inpatient cases are becoming harder to manage. As more surgeries
become outpatient procedures, the remaining inpatient cases tend to resemble
intensive care cases, said Michael Harrington, chief operating officer. They
tend to become more complex and require more supplies and staff time. To read
the full article,
CLICK HERE. (Sarasota Herald-Tribune)
Waistlines continue to grow in U.S.
Obesity continues to surge in the U.S., with 31 states showing an increase.
Mississippi continued to lead the way. An estimated 29.5 percent of adults there
are considered obese. That's an increase of 1.1 percentage points when compared
with last year's report, which is compiled by Trust for America's Health, an
advocacy group that promotes increased funding for public health programs.
Meanwhile, Colorado remains the leanest state. About 16.9 percent of its adults
are considered obese. That mark was also up slightly from last year's report,
but not enough to be considered statistically significant. The only state that
experienced a decrease in the percentage of obese adults last year was Nevada.
“Quick fixes and limited government programs have failed to stem the tide,” said
Dr. Jeff Levi, executive director of the trust. States have different challenges
to contend with when it comes to obesity, said Dr. Janet Collins of the Centers
for Disease Control and Prevention. “Populations are not equal in terms of
experiencing these health problems,” Collins said. “Low-income populations tend
to experience all the health problems we worry about at greater rates.” Indeed,
the five states with the highest obesity rates, Mississippi, Alabama, West
Virginia, Louisiana and Kentucky, exhibit much higher rates of poverty than the
national norm. Meanwhile, the five states with the lowest obesity have less
poverty. They are Colorado, Hawaii, Massachusetts, Rhode Island and Vermont. The
group's estimate of obesity rates is based on a three-year average, 2003-2005.
The report says health costs related to obesity are in the billions of dollars
annually. Citing a 2004 report, the advocacy group said $5.6 billion could be
saved when it comes to treating heart disease if just one-tenth of Americans
began a regular walking program. For more information
CLICK HERE. (Associated Press)
Whether or not a woman is obese will likely affect her outcome once she has been diagnosed with ovarian cancer, according to a new study from Cedars-Sinai Medical Center. The study, published online on Aug. 28 in the American Cancer Society's journal Cancer, showed that obesity affected survival rates, shortened the length of time to recurrence of the disease, and led to earlier death from the cancer than for women diagnosed at their ideal body weight. “This study is the first to identify weight as an independent factor in ovarian cancer in disease progression and overall survival, suggesting that there is an element in the fat tissue itself that influences the outcome of this disease in obese women,” said Andrew Li, M.D., the study's principal investigator at Cedars-Sinai's Women's Cancer Research Institute at the Samuel Oschin Comprehensive Cancer Institute. Ovarian cancer, one of the most lethal cancers, affects almost one in 60 women. Most will be diagnosed with advanced disease, and 70 percent will die within five years. There are several types of ovarian cancer, but tumors that begin with the surface cells of the ovary (epithelial cells) are the most common type. While previous studies have shown that obesity is a factor in the development and prognosis of cancers such as breast, uterine and colorectal, the nature of the relationship in ovarian cancers has been less well understood. In this study, Li and his colleagues examined data from 216 patients with epithelial ovarian cancer to identify relationships between obesity, ovarian cancer, tumor biology and outcome. Comparison of the obese women to ideal-weight women showed 29 percent of the obese women and 10 percent of normal-weight women had localized disease. However, obesity was shown to have a significant effect on both the recurrence and mortality of women with advanced disease. The cellular characteristics of the tumors found in the two groups also appeared to be different. “While further molecular studies are warranted, our study suggests that fat tissue excretes a hormone or protein that causes ovarian cancer cells to grow more aggressively,” said Li, who is also a physician in the Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Medical errors? Patients may be the last to know
.
A survey of more than 2,600 surgeons and medical
specialists reveals wide variations in doctors’ willingness to disclose errors
and in the ways they would present the details to patients. The authors of the
survey presented hypothetical but clinically realistic medical errors to the
doctors to determine how they would disclose the mistake, whether disclosure was
different if the error was less apparent to a patient and what factors were
associated with disclosure. The survey results were published Aug. 14 in The
Archives of Internal Medicine. The hypothetical errors were all mistakes
that would cause some degree of serious injury. Some were apparent, like leaving
a sponge in a surgical patient, and some were less so, like misreading chart
data. When the error was obvious, like an improperly written prescription that
led to an overdose, 81 percent of doctors said they would definitely disclose
the error to a patient. But when presented with an error less apparent, only 50
percent thought it was worth mentioning. One example was a blood chemistry
reading that had been overlooked. If it had been noticed, a serious complication
would have been prevented. “It isn’t that doctors routinely make a conscious
decision to conceal errors,” said Dr. Thomas H. Gallagher, the study’s lead
author and an associate professor of medicine at the
University of Washington.
But when an error is less obvious, he continued, “the doctor is thinking about
what the patient really needs to know to understand what happened.” “Doctors
worry about telling patients too much, scaring them unnecessarily,” Dr.
Gallagher said. Surgeons were more likely than other medical specialists to
believe that an error would result in a lawsuit, but they were also more likely
to report that they would definitely disclose an error. At the same time, they
would disclose less information than medical specialists, and they were less
inclined to use the word “error.” Over all, 56 percent of doctors would mention
the problem, but only 42 percent would disclose that the problem had been caused
by an error. Half of the doctors surveyed said they would disclose specific
information about what the error was, while 37 percent would offer only a
partial explanation. The remaining 13 percent would reveal no details at all
unless the patient asked. When presented with just the errors that were less
apparent, almost one-fifth would volunteer no information at all. Only 8 percent
would be silent about more obvious mistakes. Almost all doctors surveyed said
they would apologize, but only about one-third chose an explicit apology (“I am
so sorry that you were harmed by this error”) while two-thirds would offer a
general expression of regret (“I’m sorry about what happened”). According to the
authors, some
malpractice
insurers encourage doctors to apologize in the belief that this may help prevent
lawsuits or encourage smaller settlements when suits are filed. One problem
physicians face, Dr. Gallagher said, is that patients may fail to distinguish
errors from unavoidable medical problems. “I think that often patients assume
that any adverse event is due to error,” he said. “That’s not so. A vast
majority of such events are not errors and not preventable.” (The
New York Times)
Medline signs five-year, $75 million prime vendor distribution deal at Daughters of Charity Health System
Medline Industries Inc. announced that the company recently signed a $75 million Prime Vendor deal to provide medical supplies to Daughters of Charity Health System, a five-hospital system in California. The Daughters of Charity Health System (DCHS) is a regional healthcare system of five hospitals spanning the California coast from the Bay Area to Los Angeles. The sponsors are the Daughters of Charity of St. Vincent de Paul who, for more than 370 years, have been serving the sick and the poor through healing ministries around the world. “We look forward to implementing and establishing a long-term relationship with Daughters of Charity Health System. Our prime vendor program will provide high quality Medline brand products and distribution services with significant quantitative value. The program will also provide comprehensive logistical, standardization, and utilizations services through Medline Select,” said Tim Jacobson, vice president, Medline Corporate Sales. In the first year, Medline estimates it will save the system more than $900,000. Over the five-year term of the agreement, Medline estimates it will save the system nearly $5 million.
Colonel Marc Sager receives AHRMM’s 2006 Leadership Award
New test quickly pinpoints the most lethal avian flu; A 12-hour diagnosis allows for fast treatment
China: Tests find bird flu vaccine safe
Levels of serious mental illness in Katrina survivors doubled compared to earlier survey
13 plague cases reported in 4 states, highest in 12 years
At the request of the U.S. Food and Drug Administration (FDA), the U.S. District Court for the Southern District of California issued a warrant for seizure of Alaris Signature Edition Gold infusion pumps, model numbers 7130, 7131, 7230 and 7231. The pumps are manufactured by Cardinal Health Care 303, Inc. and the seizure occurred August 25. The seized infusion pumps have a design defect called “key bounce” that may cause potential over-infusion of medications. This seizure was intended to ensure that infusion pumps located at Alaris’ manufacturing facility are not distributed unless the problem is corrected. Infusion pumps are electronic devices intended for controlled delivery of intravenous solutions and medications to patients. Key bounce occurs when a number pressed on the pump registers twice although the operator only pressed the key once. If a key bounce occurs and is not detected during programming verification, it may result in an infusion rate at least 10 times the intended infusion rate. For example, if an infusion rate is intended to be entered as 4.8 milliliters per hour and the key bounce occurs when the 4 is pressed, the actual rate registered will be 44.8 milliliters per hour. If not detected during programming verification, key bounce events may result in serious patient harm or death. FDA inspections revealed that Alaris failed to follow FDA's medical device manufacturing regulations. The infusion pumps were seized by the U.S. Marshals Service at Alaris' manufacturing facility in San Diego, CA. The seized devices valued at more than an estimated 1.8 million dollars. Alaris has distributed these products nationally and internationally. No products were seized from healthcare facilities or individual users, and there are no plans to do so. Alaris was issued warning letters by FDA in August 1998 and October 1999 outlining the violations and was given opportunities to correct the violations, but failed to take appropriate actions. In an August 15 recall letter, Alaris informed customers that it will provide a warning label for the pumps and a permanent correction for the key bounce problem once it is available. In the letter, Alaris also provided recommendations to pump users on steps they can take to minimize key entry errors until the problem can be corrected. The steps are as follows: Proper Stance - When programming pumps, stand squarely in front of the keypad (ideally with the pump at eye level for best visibility) to facilitate proper depth of depressing each key. Listen - Focus on listening to the number of beeps while programming IV pumps; each beep will correspond to a single digit entry. Unexpected double tone could indicate an unintended entry. Verify Screen Display - When programming the pump or changing settings, always compare the patient's prescribed therapy or the medication administration record, original order, or bar code device to the displayed pump settings for verification before starting or re-starting the infusion. Independent Double Check - Request an independent double check of pump settings by another practitioner before starting or changing infusions with hospital-selected high alert drugs. Look - Before leaving the patient's room, observe the IV tubing drip chamber to see if the observed rate of infusion looks faster or slower than expected. Adjust accordingly. Healthcare facilities can continue to use pumps in their possession, guided by these and further instructions. For more information, CLICK HERE.
Colonel Marc Sager receives AHRMM’s 2006 Leadership Award
The
Association for Healthcare Resource & Materials Management (AHRMM) has named
United States Air Force Colonel Marc Sager as the recipient of the 2006 George
R. Gossett Leadership Award. The Association’s highest honor, presented in
memory of George R. Gossett, an early president of the Association, the
Leadership Award is given to an individual who has demonstrated an extraordinary
level of leadership and professional competence in the supply chain field,
advanced the state-of-the-art in healthcare materials management or made other
significant contributions to AHRMM. Col. Sager, administrator of the 59th
Medical Group of Wilford Medical Center in Lackland, TX, received the award in
recognition of his efforts to advance educational opportunities and experiences
for Air Force medical logisticians. He opened the door for materials and
services personnel to hold government contracting warrants and streamlined
acquisition processes for Air Force Medical Treatment Facilities. He has also
been a strong advocate for providing institutional memberships to AHRMM, and
introduced the Certified Materials & Resource Professional (CMRP) credential to
Air Force Medical Service Corps officers so they may further fulfill their
advancement criteria. With a military career that spans over 20 years, Col.
Sager has served the United States in a variety of U.S.-based healthcare
facility and staff positions, as well as in Korea and the Middle East (many of
these facilities were the Air Force’s front-line operations). Most notably, as
Chief of Air Force Medical Logistics, he was responsible for the development,
construction and deployment of mobile medical assemblages worldwide in support
of ongoing operations in Afghanistan, Iraq and other locations. “Col. Sager is
most deserving of the Association’s highest award. Not only is he a military
hero in every sense of the word, he has also proven that it is possible to
successfully transition from logistics and supply chain management into hospital
administration,” said AHRMM President Robert Perry. “He is living proof that a
logistician's knowledge and skills are ideal for senior leadership positions in
healthcare.”
New test quickly pinpoints the most lethal avian flu; A 12-hour diagnosis allows for fast treatment
In an advance that speeds up diagnosis of the most dangerous avian flu, scientists have developed a detailed influenza test that takes less than 12 hours, federal health officials said. The new technology, a microchip covered with bits of genetic material from many different flu strains, cuts the typical time needed for diagnosis of the Asian H5N1 flu to less than a day from a week or more. In addition, rather than giving just a yes-or-no result, it usually reveals which flu a human or an animal has. That means that public health officials investigating, for example, a flu outbreak in poultry or in humans in a remote Asian or African village will be able to decide quickly whether to kill thousands of birds or to treat hundreds of potentially exposed people with expensive anti-viral drugs. Right now, ascertaining whether a flu is of the lethal H5N1 strain requires that a sample be frozen and shipped to a highly secure laboratory, usually in a major city like Atlanta or Hong Kong, where the virus can be grown in eggs, isolated and genetically sequenced, a process that takes four to five days plus shipping time. The new test, called FluChip, can be performed in any laboratory that can amplify bits of genetic material; many countries have such laboratories in their national capitals. Samples need not be frozen, and because only bits of genetic material are multiplied rather than whole viruses, the work can be done in laboratories with lower biosecurity levels. Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which announced the creation of the test, called it an “encouraging advance” that could be “invaluable to international flu surveillance efforts.” A more advanced version may be ready within two years, said Kathy L. Rowlen, the University of Colorado chemistry professor who led the team that developed the test. At present, animal and human health experts trying to fight avian flu in remote areas are forced to make important decisions based largely on guesses because it is too risky to wait a week for a laboratory to confirm that a highly dangerous virus is loose. A dipstick test done on the spot, which a veterinarian working in Indonesia said was as quick and as simple as a home pregnancy test, can tell only if a flu is type A. It also has the potential to speed up mass testing because dozens of samples can be tested on dozens of chips at once. (The New York Times)
China: Tests find bird flu vaccine safe
A Chinese-developed vaccine against the H5N1 strain of bird flu in humans has
been found safe in the first round of tests, a government news agency reported.
Researchers began work on the vaccine last year, and the government said it was
ready to start mass production. But any vaccine would face more tests before it
could be approved for human use. Tests were conducted on six human volunteers at
a Beijing hospital between November and June, the official Xinhua News Agency
said. Researchers said the vaccine “proved initially safe and effective,” the
Xinhua News Agency reported. The tests were conducted by the China Center for
Disease Control and Prevent and a Chinese drug company, Beijing Sinovac Biotech
Co., according to Xinhua. Chinese authorities say the vaccine is meant for
high-risk groups such as poultry workers. The U.S. National Institute of Allergy
and Infectious Diseases is also conducting trials on an H5N1 vaccine for humans.
(The Associated Press)
Levels of serious mental illness in
Katrina survivors doubled compared to earlier survey
According to the most comprehensive survey yet completed of mental health among
Hurricane Katrina survivors from Alabama, Louisiana, and Mississippi, the
proportion of people with a serious mental illness doubled in the months after
the hurricane compared to a survey carried out several years before the
hurricane. The study also found that thoughts of suicide did not increase
despite the dramatic increase in mental illness. The authors suggest that this
low rate of suicide thoughts is due to optimistic beliefs about the success of
future recovery efforts. The research, which was published in a special online
edition of the Bulletin of the World Health Organization, was led by researchers
from Harvard Medical School (HMS). “The increase in mental illness among Katrina
survivors is not surprising, but the low suicidality is a surprise,” said Ronald
Kessler, PhD, professor of health care policy at HMS and lead author of the
study. “Our concern, though, is that this lowering of suicidal tendencies
appears to be strongly associated with expectations for recovery efforts that
might not be realistic.” This report is the first in a planned series based on
the Hurricane Katrina Community Advisory Group, a statistically representative
sample of hurricane survivors participating in ongoing tracking surveys to
monitor the pace and mental health effects of hurricane recovery efforts. The
project is funded by the National Institute of Mental Health and the Office of
the Assistant Secretary of Health and Human Services for Planning and
Evaluation. The team discovered a strong relationship between the comparatively
low rate of suicide thoughts and the existence of positive cognitions among
Katrina survivors, especially with cognitions regarding increased sense of
meaning and purpose in life and increased realization of inner strengths.
Kessler notes that although previous studies have suggested a connection between
positive cognitions and lowered suicidality, this is the first study that offers
quantitative evidence of these psychological processes in a sample of disaster
victims. Kessler and his team believe that their findings suggest a systematic
investigation of positive cognitions might be useful in guiding public health
mass media efforts in the aftermath of future disasters, given that previous
research has shown that public health messages play an important role in
psychological reactions to disasters. “The immediate take-home message for
disaster recovery and policy makers is that communications with survivors can
sometimes build on the temporary reprieve from suicidal tendencies afforded by
these protective cognitions. Efforts on the part of public officials to control
expectations as practical recovery moves forward without destroying the positive
cognitions related to these expectations could prove crucial in the process of
continued psychological recovery,” said Kessler. For more information
CLICK HERE.
13 plague cases reported in 4 states, highest in 12 years
Thirteen cases of plague including two deaths have been reported in the Western
United States this year, the highest number of cases in 12 years, health
officials say. Seven cases were reported in New Mexico, three in Colorado, two
in California and one in Texas, according to the U.S. Centers for Disease
Control and Prevention. Two New Mexicans died, a 54-year-old woman who grew ill
in May and a 43-year-old woman who became sick in July. On average, the plague
is diagnosed in about seven people a year, CDC officials said Friday. Fourteen
cases were reported in 1994. It’s treatable with antibiotics, but health
officials stress the importance of prompt diagnosis to reduce the fatality rate.
Plague is transmitted through the bites of infected fleas, but people also can
get it by direct contact with infected rodents, wildlife and pets. Most people
become ill one to six days after being infected. The increase probably stems
from human encroachment into areas where infected rodents live, said Hannah
Gould, a CDC epidemiologist who investigated some of the cases. Plague takes
three forms: bubonic, septicemic and pneumonic. A common symptom of bubonic
plague is painful swollen lymph nodes in the groin, armpit or neck. Other
symptoms include fever, chills, and sometimes headache, vomiting, and diarrhea.
Septicemic plague can involve fever, chills, nausea, vomiting, diarrhea and
abdominal pain. Eight of the cases this year were bubonic and the other five
were septicemic. Most cases usually occur in May through September, Gould said.
(The Associated Press)
Amerinet announces agreements
Amerinet announces its agreements with First Quality
Products Inc. for adult incontinence products for acute care and non-acute care
facilities. Effective through June 30, 2009 these contracts include adult and
youth incontinence products, briefs, breathable briefs, night-time briefs,
underpads, pants, protective underwear, pant liners, cotton-snap pants,
washcloths and wet wipes.
Amerinet
announces its agreement with Cincinnati Sub-Zero Products Inc. for niche cold
therapy supplies. Effective through July 31, 2009 this contract includes Electri-Cool
II localized cold therapy systems and accessories. The Electri-Cool II is
primarily used postoperatively to deliver controlled cold therapy to the patient
and operates on thermoelectric technology, eliminating the need for a
compressor.
Amerinet announces its agreement with Tyco Healthcare Group for needles and
syringes. Effective through July 31, 2009 this contract includes needles,
syringes, flush syringes, spinal needles, bone marrow and biopsy products,
allergist trays and IV access. Tyco products offer new robust print technology,
wider finger flanges, increased peel headers and many other safety conveniences
for caregivers. This contract was the result of a competitive bidding process.
AHRQ estimates on long-term uninsured, 2001–2004
MRSA linked to nearly 14,000 PA hospitalizations in 2004
Los Angeles hospital faces possible closure
Center for Hispanic medical students loses all its U.S. aid
New compound causes cancer cell suicide
PSA predicts treatment success in advanced prostate cancer
In 2004, there were 13,722 Pennsylvania hospitalizations in which patients had a Methicillin-resistant Staphylococcus aureus (MRSA)- related infection, according to a new research brief released by the Pennsylvania Health Care Cost Containment Council (PHC4). MRSA is a more serious form of the Staphylococcus aureus (often called “staph”) bacteria and is a major health concern because of its resistance to commonly used antibiotics such as methicillin. “MRSA, a virulent form of drug-resistant bacteria, can be community-acquired or hospital-acquired,” said Marc P. Volavka, Executive Director of PHC4. “Yet no matter where MRSA is contracted, it can have significant health and financial consequences, and represents a titanic public health challenge.” PHC4's latest report does not distinguish between community and/or hospital-acquired MRSA infections. Compared to patients without a MRSA infection, patients with a MRSA infection were four times as likely to die, had hospital stays more than two and a half times longer, with hospital charges three times as much for the hospitalization. Specifically, the mortality rates for patients with and without a MRSA infection in 2004 were 8.9% and 2.1%, respectively. On average, patients with a MRSA infection stayed in the hospital eight days longer than patients without a MRSA infection. Whereas the average charge of a hospitalization with a MRSA infection was $87,990, the average charge for a hospitalization without a MRSA infection was $28,711. In July of 2005, Pennsylvania (PHC4) became the first state to publicly report hospital-acquired infection numbers, and has issued two subsequent infection reports. Those reports have focused on four types of hospital-acquired infections (central line-associated bloodstream infections, ventilator-associated pneumonia, surgical site infections, and indwelling catheter-associated urinary tract infections). PHC4 is now reporting that of the 1,932 patients identified by hospitals as having hospital-acquired bloodstream infections in year 2004, 11.2% (217) had a MRSA infection. Of the 1,335 patients with hospital-acquired pneumonia, 9.2% (123) had a MRSA infection. Of the 1,317 patients with hospital-acquired surgical site infections, 6.6% (87) had a MRSA infection. Of the 6,139 patients with hospital-acquired urinary tract infections, 3.3% (200) had a MRSA infection. It is not known if MRSA was the bacteria responsible for these hospital-acquired infections. Other findings: About half (50.9%) of all hospitalizations with MRSA infections were among patients with respiratory diseases, disorders of the circulatory system, and infectious and parasitic diseases; More than half (54%) of hospitalizations with MRSA infections were for patients age 65 and older, followed by those in the 45 to 64 age category (27%) and the 25 to 44 age category (13%). The 18 to 24 age category and the 0 to 17 age category each comprised 3% of the MRSA hospitalizations; The MRSA infection rate was similar for hospitals of all sizes; Geographic differences in the rate of MRSA-related hospital discharges were found; The Southeastern Pennsylvania region had the highest MRSA infection rate; The Southcentral Pennsylvania region had the lowest MRSA infection rate. Copies of MRSA in Pennsylvania Hospitals are free and available on the Council's Web site at http://www.phc4.org.
Los Angeles hospital faces possible closure
Investigators from the Centers for Medicare and Medicaid
Services descended on the King/Drew Medical Center in South
Central Los Angeles earlier this month and will soon determine
whether the hospital meets standards of care in 23 areas. If
it doesn't, King/Drew will lose $200 million of its $380
million budget and could face closure. Should that happen,
county officials predict a health crisis across this county of
10 million people as emergency rooms from Beverly Hills to the
middle-class San Fernando Valley are flooded with patients.
“It will set off a medical meltdown in terms of emergency
service,” predicted Zev Yaroslavsky, a member of the Los
Angeles County Board of Supervisors, which oversees the
facility. King/Drew has been out of compliance with Medicare
standards since January 2004, said Medicare and Medicaid
Services spokesman Jack Cheevers. It lost its national
accreditation in early 2005. In 2004, the Los Angeles Times
produced a series of articles on the failings of the hospital
and its affiliated medical school, Charles R. Drew University.
A public outcry followed. Between 2004 and earlier this year,
more than one in five of the hospital's 2,300 staff members
were disciplined or fired, Yaroslavsky said. The trauma center
was shut in November 2004. But when the county moved to also
cut the hospital’s obstetrics, neonatal and pediatrics wards,
Rep. Maxine Waters (D-CA) and other leaders pushed back. The
county hired a new chief executive for the hospital,
Antionette Smith Epps, who has been credited with major
improvements at the facility. Still, Epps has acknowledged
that King/Drew continues to have problems recruiting permanent
staff and improving its reputation among potential patients. A
new obstetrics ward averages 60 births a month, small compared
with the 600 born at the nearby St. Francis Medical Center.
Los Angeles police officers, sheriff's deputies and
firefighters all oppose being taken to the hospital if they
are hurt in the line of duty. While the region King/Drew
serves remains poor (It's No. 1 in Los Angeles in coronary
heart disease, diabetes, homicides, poverty, uninsured
children, teen birth rate, unvaccinated elderly and total
death rate), a demographic change has swept the community.
What was once an all-black region being served by a largely
black hospital has morphed into a predominately Hispanic area
being served by an institution that is slowly changing, too.
Thirty years ago, 85 percent of King/Drew's patients were
black. Today, 70 percent are Hispanic. “This change makes the
policies of the past untenable and has emboldened those of us
who are trying to transform King/Drew,” Yaroslavsky said.
“Whether we've done enough, we'll soon find out.” A decision
on Medicare and Medicaid funding is expected in early
September. (The Washington Post) To read the full article
CLICK HERE.
As a medical student at the
Albert
Einstein College of Medicine in the Bronx,
25-year-old Noé Romo has turned again and again to the
college’s Hispanic Center of Excellence for financial support,
friendship and guidance. The center was hailed by community
leaders when it opened in 2001 as a crucial way to address
what they saw as a disturbing, little-known trend: the
underrepresentation of Hispanics in the medical field.
According to the
American
Medical Association, only 3.2 percent of physicians
in the United States are Hispanic. The Hispanic Center of
Excellence teaches medical students and doctors of various
backgrounds about Hispanic culture and conducts research on
Latino health issues. Yet its main focus is recruiting and
encouraging Hispanic students to pursue healthcare careers.
The center does this in part by providing academic counseling,
scholarships and professional networking. But budget
cuts in Washington are threatening the future of the federally
financed center. “There’s a very strong need for physicians
who not only speak the language but understand the culture,”
said Romo, who is an American citizen of Mexican descent. The
center, the first such Hispanic center in the state, recently
lost all its financial support from the federal government. In
the fiscal year that began on Aug. 1, the cut was $700,000,
about 80 percent of the center’s operating budget. Dr. A. Hal
Strelnick, the center’s director, said that as a result of the
cut, he was forced to eliminate a two-year fellowship that
helped Hispanic faculty members at Einstein sharpen their
research skills and earn a master of science degree in
clinical research methods, to supplement their other degrees.
He fears what another cut next year will mean to the center,
though he vowed to keep it open somehow, through city, state
or private support. “The metaphor that we use is a pipeline,”
Dr. Strelnick said. “If you choke off the pipeline for
producing Hispanic health professionals, you’re going to have
consequences down the line.” Yesterday at the Albert Einstein
College of Medicine, the largest private medical school in the
state, Dr. Strelnick, Romo and other Hispanic students called
on Congress and the United States
Department
of Health and Human Services to restore the money.
They were joined by Representative Joseph Crowley, a Democrat
whose district includes parts of Queens and the Bronx. The
college in the Bronx is one of 34 institutions across the
country that had received Centers of Excellence grants from
the Department of Health and Human Services. In 2005, Congress
approved $33.6 million in grants to the 34 centers. This year,
$11.8 million was approved for four centers. Crowley has urged
the leadership of the House Appropriations Committee to
include $43 million for Centers of Excellence grants next
fiscal year. David Bowman, a spokesman for the Health
Resources and Services Administration, said the president’s
proposed budget for the 2007 fiscal year included no money for
the Centers of Excellence grants. (The
New York Times)
New compound causes
cancer cell suicide
Suicide is the regular mode of cell death. When cells reach the end of their useful life, internal mechanisms kick in and the cell automatically perishes, a process known as apoptosis. But in cancer cells this mechanism has often been genetically disabled or otherwise broken, allowing tumors to proliferate. Now researchers have found a way to reactivate programmed cell death and thereby treat cancer. In preparation for apoptosis, a chain of chemical events takes place in the cell. Near the end, the chemical procaspase-3 is activated. This chemical then transforms into caspase-3, an executioner enzyme that terminates the cell. Chemist Paul Hergenrother of the University of Illinois and an international team of colleagues realized that a compound that activated procaspase-3 might be effective in killing cancer, because many tumors show elevated levels of procaspase despite their inability to complete apoptosis. After screening 20,500 related molecules for this activation ability, the researchers narrowed it down to five likely candidates. Of these, only one showed an increasingly strong effect with increased doses: newly named procaspase activating compound, or PAC-1. “We have identified a small, synthetic compound that directly activates procaspase-3 and induces apoptosis,” Hergenrother said. “By bypassing the broken pathway, we can use the cells’ own machinery to destroy them.” The researchers tested the efficacy of PAC-1 on colon cancer cells from 23 patients. The tumors had elevated levels of procaspase-3 averaging roughly eight times as much as normal colon cells and proved more sensitive to the compound. In one case, the cancerous cells were 2,000 times more sensitive to PAC-1's enforced apoptosis than were surrounding regular cells due to their increased expression of the enzyme. Further tests in mice proved effective in treating grafted human kidney- and lung-cancer cells, and those results also indicated that PAC-1's strength correlated with procaspase-3 levels in the various cancer cells. “The potential effectiveness of compounds such as PAC-1 could be predicted in advance and patients could be selected for treatment based on the amount of procaspase-3 found in their tumor cells,” Hergenrother added. Nature Chemical Biology published the paper presenting the finding online. (Scientific American)
PSA predicts treatment success in advanced prostate cancer
A test used to detect prostate cancer can also help doctors know when treatment is working. A man’s prostate specific antigen, or PSA, level after seven months of hormone therapy for advanced prostate cancer predicted how long he would survive, according to a new multicenter study conducted by the Southwest Oncology Group and led by researchers at the University of Michigan Comprehensive Cancer Center. The study evaluated 1,345 men with prostate cancer that had spread to distant parts of the body. The men were treated with seven months of androgen deprivation therapy, a treatment designed to block the effects of hormones on the cancer. PSA levels were monitored throughout the treatment. The researchers found that men whose PSA dropped below 4.0 ng/ml had a quarter the risk of dying compared to those whose PSA was more than 4.0. Results of the study appear in the Aug. 20 issue of the Journal of Clinical Oncology. “Our analysis showed that a low or undetectable PSA after seven months of androgen deprivation therapy is a powerful predictor of risk of death in patients with new metastatic prostate cancer. This could allow oncologists to identify patients who are unlikely to do well with this treatment long before they develop clinical signs of treatment resistance,” said lead study author Maha Hussain, M.D., professor of internal medicine at the U-M Medical School. The researchers found 69 percent of the men maintained a PSA level of less than 4.0 ng/ml after seven months of treatment and 43 percent had an undetectable level of PSA at that time. Patients whose PSA was higher than 4.0 at the end of seven months survived 13 months, while patients whose PSA dropped below 4.0 but above 0.2 lived 44 months and those whose PSA was undetectable, below 0.2 ng/ml, lived 75 months. “What is attractive about using PSA to predict survival in metastatic prostate cancer is that it is an easily measurable factor. These findings could help patients avoid ineffective treatment and could help researchers design further trials,” Hussain said.
Nurses strike over health plan at hospital in New Jersey
Researchers move biotechnology closer to replacing electronic pacemakers
Cooling towers may host new pathogens
Group urges disaster planning for pregnant women, babies
Business continuity planning contracts with Tenet to supplement emergency air response service
Lawson Software passes milestone in mobile supply chain offerings
2005 medical group data finds financial losses, despite increases in physician compensation for most specialties