February 2008
February
15, 2008 Download print version
WHO advises total makeover for 2008-09 flu vaccine
California hospitals now must report
serious staph cases to officials
Bill targets health insurance cancellations
CDC study warns of deaths due to the “choking game”;
most fatalities in 11-to-16 year old boys
PTSD a medical warning sign for long-term health problems
Probiotics may be fatal in acute pancreatitis: study
WHO advises total makeover for 2008-09 flu vaccine
The World Health Organization
(WHO) today reported evidence of a less-than-satisfactory
match between all three components of this season's influenza
vaccine and the flu strains currently making people sick. Last
week US health officials reported mismatches between the
influenza A/H3N2 and influenza B components of this year's
vaccine and the circulating H3N2 and B strains. Today the WHO
reported that the majority of recent H1N1 virus isolates
globally have not matched well with the H1N1 component of the
vaccine. As a result, the WHO recommended replacing all three
components in next year's flu vaccine for the northern
hemisphere.
H1N1 is the flu subtype that has begun to show resistance to
the antiviral drug oseltamivir (Tamiflu), one of the two
neuraminidase inhibitors recommended for flu patients. In a
separate update today, the WHO said H1N1 viruses with a
resistance mutation have been found in 18 of 37 countries
where the viruses have been analyzed. The mutation was
observed in 14% of the isolates studied, including 8% of those
in the United States. Each February the WHO assesses the flu
virus strains in circulation before picking the strains for
the next northern hemisphere flu season. It takes about 6
months for vaccine manufacturers to grow the viruses in
chicken eggs and formulate them into trivalent (three-strain)
vaccines. Changing one or two strains is not unusual, but
replacing all three is less common.
The WHO recommended the following for next season's vaccine:
-
For the
H1N1 component, a strain similar to A/Brisbane/59/2007,
replacing A/Solomon Islands/3/2006
-
For the
H3N2 component, a strain similar to A/Brisbane/10/2007,
replacing A/Wisconsin/67/2005
-
For the B
component, a strain similar to B/Florida/4/2006, replacing
B/Malaysia 2506/2004
The Brisbane strains of H1N1 and H3N2 will be used in this
year's vaccine for the southern hemisphere, where the flu
season runs from May through October, according to the WHO.
The agency said H1N1 viruses were the predominant flu subtype
in most parts of the northern hemisphere from September
through January, though flu activity in that period was
generally low in comparison with the same interval in recent
years. While some H1N1 viruses analyzed this season were
similar to the Solomon Islands strain used in the vaccine,
"the majority of recent isolates were distinguishable from the
vaccine virus and antigenically similar to
A/Brisbane/59/2007," the WHO report states.
The report says that in lab tests, serum samples from people
immunized with this year's vaccine generated a lower antibody
response to recent H1N1 isolates than to the Solomon Islands
H1N1 strain used in the vaccine. The US Centers for Disease
Control and Prevention (CDC) reported last week that 46 of 53
H3N2 viruses it had tested through Jan 26 were similar to
A/Brisbane/10/2007, which evolved from the Wisconsin strain
used in the vaccine. The CDC also said 40 of 43 influenza B
viruses tested belonged to the Yamagata lineage, not the
Victoria lineage represented by the Malaysia strain used in
the vaccine. In today's update on the oseltamivir resistance
problem, the WHO said 237 (14%) of 1,703 H1N1 viruses tested
so far had the mutation conferring resistance. Resistance
rates are highest in Norway (66% of isolates), France (40%),
and Luxembourg (25%). (CIDRAP News) See
THIS LINK. 
California hospitals now must report
serious staph cases to officials
California for the first time is requiring that hospitals
report to local health authorities certain kinds of staph
infections that result in death or a stay in the
intensive-care unit. The order issued Thursday by Dr. Mark
Horton, state public health director, is an initial step by
state officials to gain insight into an alarming increase in
drug-resistant staph infections. Until now, there has been no
state requirement for reporting staph infections. As a result,
disease trackers have had a hard time calculating the severity
of the problem. The new reporting requirement, however, is
limited to cases that start outside hospitals or nursing homes
in otherwise healthy people, leaving out about 85 percent of
life-threatening encounters with the most feared bug,
methicillin-resistant Staphylococcus aureus, or MRSA. State
Epidemiologist Dr. Gilberto Chavez said the new rules will
help. "We are concerned about recent reports of severe MRSA
infections in previously healthy individuals," he told
reporters. "We believe we will have a better picture of the
incidence of staph infections in California."
Staph infections have been a problem in hospitals for decades,
but since the 1990s various strains of drug-resistant staph
have been turning up outside the medical setting, afflicting a
broad spectrum of society, from jail inmates and injection
drug users to athletes, mothers and schoolchildren. A
particularly virulent strain of MRSA, dubbed USA 300, appears
to be driving a marked increase in these so-called
community-acquired staph infections. First isolated by San
Francisco researchers in 2001, the bug is now believed to be
responsible for a majority of skin and soft-tissue infections
treated in emergency rooms in the United States.
Employing authority granted by lawmakers in 2004, state health
officials have been preparing for several weeks a plan to
require some MRSA reporting. As of today, life-threatening,
community-acquired staph infections are added to the list of
diseases - such as measles, meningitis and syphilis - that
hospitals are required to report to county health departments.
The counties then forward the information to the state. "It
will tell us where in the state this is occurring, and who in
the state is at risk for infection," Chavez said. In addition
to names, Chavez said the confidential information gathered
will include gender, race and ethnicity. Sexual behavior, he
said, "may well be something we include" in the data gathering
effort. San Francisco Supervisor Tom Ammiano said that sort of
reporting is potentially troubling. "I think we should be
very, very cautious about this. There are privacy concerns,"
he said. "We need to know what the goals are, and what the
benefits would be."
Lisa McGiffert, a campaign manager for Consumer Union's
StopHospitalInfections.org, said private information in the
hands of public health departments is "strongly protected"
from any public access. "I don't have privacy concerns here,"
she said. However, she said the degree of MRSA reporting now
required in California falls well short of what is needed to
get a handle on the spread of the disease. "They are focusing
on the smallest part of the problem," she said. "They want to
focus on community infections, which they are not responsible
for." ( San Francisco Chronicle)
See
THIS LINK.
Insurer urges computerized prescriptions at hospitals
Massachusetts’ largest medical insurer said yesterday that it
will require all the state's hospitals to fully install a
computerized medication ordering system within four years or
face a loss of lucrative payouts from an incentive program
promoting good-quality care. The announcement by Blue Cross
and Blue Shield of Massachusetts was released at the public
unveiling of a report that found that one of every 10 patients
admitted to six Massachusetts community hospitals suffered
serious and avoidable medication mistakes, including severe
allergic reactions or dangerous drug interactions.
The study, by Dr. David Bates of Brigham and Women's
Hospital, recommended that every hospital in the state use a
computerized prescription system. Researchers said the
system's high up-front costs, roughly $2.5 million, would be
recouped within two years by eliminating unnecessary medical
care resulting from errors, as well as by reducing the use of
expensive brand-name and intravenous drugs when cheaper
alternatives are available. Currently, 10 hospitals in the
state, mostly Boston's large academic hospitals, have fully
adopted the computerized system that requires doctors to type
in medical orders, including prescriptions, diagnostic tests,
and blood work. The remaining 63 hospitals, mostly community
hospitals, have been slower to embrace the new technology
because of the expense associated with starting it up, said
Donald Thieme, head of the Masssachusetts Council of Community
Hospitals. Thieme said the council has requested $30 million from the
state to help subsidize community hospitals that install the
new systems.
Chris Murphy, spokesman for Blue Cross, said the results of
the study, sponsored by the Massachusetts Technology
Collaborative and the New England Healthcare Institute,
demonstrated the urgent need for hospitals to embrace an
error-reducing prescription system. He said Massachusetts
hospitals will be barred from participating in the insurers'
$104 million incentive program if they do not adopt the
computerized system by 2012. "The report made it clear that
it's something we should do," he said.
Tufts Health Plan also has offered financial incentives for
hospitals to adopt this new computerized system, though it has
not imposed a deadline for full implementation, said its
spokeswoman, Pam Giannatsis. Dr. Judyann Bigby, the state
secretary of health and human services, is looking for ways to
help defray the cost of introducing the system in hospitals.
She is exploring the possibility that the state's Essential
Community Provider Trust Fund, which typically has about $40
million a year, can be used for this purpose, her spokeswoman
said.
Money is not the only obstacle to the introduction of the
new system in community hospitals, say researchers. Many
physicians, particularly older ones, struggle to adjust to a
system that requires them to type every medical order, even
dietary restrictions for hospitalized patients. Initially, all
medical staff members report some disruption to their
established routines, researchers say. Dr. Sam Bagchi is
director of hospital medicine at Emerson Hospital in Concord,
where the system is in place in many units. There is always an
initial learning curve with this new technology, he said, but
all physicians ultimately see the benefits in reducing errors.
State Senator Richard Moore, chairman of the Joint Committee
on Healthcare Financing, said he wants the state Board of
Registration in Medicine to mandate that all doctors seeking
new licenses or renewals show a proficiency in using the
system. Thieme said he was startled to learn that the six
community hospitals studied had a 10 percent rate of
preventable medication errors, but he said he has no reason to
dispute the finding. (Boston Globe)
Bill targets health insurance cancellations
Spurred by complaints that Blue Cross of California and other
health insurers cancel patients' policies after they get sick,
a Southland lawmaker has introduced legislation that would
require state regulators to sign off before carriers drop
policyholders for allegedly failing to disclose preexisting
medical conditions. Assemblyman Hector De La Torre (D-South
Gate) said his bill was prompted by recent letters from Blue
Cross to physicians asking them about new patients' health
issues that could be used as a reason for canceling coverage.
De La Torre said his bill was needed because insurance
companies "were not intending to abide by the spirit" of a law
he wrote last year prohibiting carriers from refusing to pay
medical bills for previously authorized services. "We all
agree that if someone is lying and doing willful
misrepresentation, then they should not be insured," the
assemblyman said. "But the insurance companies should not be
taking premium dollars from someone and dumping them."
Health insurance companies contend that weeding out people who
may not have been forthright when they applied for coverage is
an essential part of keeping treatment costs under control.
"We need to make sure that the process for application,
rescission and cancellation is fair," said Christopher Ohman,
chief executive of the California Assn. of Health Plans. "But
we also want to make sure that the millions of people who do
the right thing aren't left paying for the relatively few who
don't." Ohman's association represents 40 health maintenance
organizations and preferred provider organizations covering 21
million enrollees in California. Ohman said his group's
members were "analyzing the implications" of De La Torre's
bill.
The assemblyman's bill is the latest in a series of
legislative, regulatory and legal actions in California in
response to aggressive efforts by insurers and health
maintenance organizations to drop patients who hold individual
policies after they've filed claims. The practice, known in
the health insurance industry as rescission, has been the
target of growing criticism from patients, physicians and
healthcare reform advocates. In recent weeks, the state
Department of Insurance and Department of Managed Health Care
levied $1.3 billion in penalties on Cypress-based PacifiCare
for alleged improper claims handling and other violations.
(Los Angeles Times)
CDC study warns of deaths due to the “choking game”;
most fatalities in 11-to-16 year old boys
At least 82 youths have died as a result of
playing what has been called “the choking game,” according to
a study released by the Centers for Disease Control and
Prevention in today′s Morbidity and Mortality Weekly Report.
The choking game involves intentionally trying to choke
oneself or another in an effort to obtain a brief euphoric
state or “high.” Death or serious injury can result if
strangulation is prolonged.
Eighty–seven percent of these deaths were among males, and
most fatalities occurred among those 11 years to 16 years old;
the average age was 13, the report said. Choking game deaths
were identified in 31 states, it said. CDC found that most of
the deaths occurred when a child engaged in the choking game
alone, and that most parents were unaware of the choking game
prior to their child′s death.
“Because most parents in the study had not heard of the
choking game, we hope to raise awareness of the choking game
among parents, healthcare providers, and educators, so they
can recognize warning signs of the activity,” said Robin L.
Toblin, Ph.D., M.P.H., the study′s lead author. “This is
especially important because children themselves may not
appreciate the dangers of this activity.” Three or fewer
choking game–related deaths per year were reported in the news
media from 1995 to 2004, the report said. However, 22 deaths
occurred in 2005, and 35 in 2006. Nine deaths occurred in the
first 10 months of 2007; the explanation for this decrease is
unclear. The researchers said the study probably
underestimates the number of deaths.
Signs that a child may be engaging in the choking game
include: discussion of the game, including other terms used
for it, such as “pass–out game” or “space monkey”;
bloodshot eyes; marks on the neck; severe headaches;
disorientation after spending time alone; ropes, scarves, and
belts tied to bedroom furniture or doorknobs or found knotted
on the floor; unexplained presence of things like dog leashes,
choke collars and bungee cords. If parents believe their child
is playing the choking game, they should speak to them about
the life–threatening dangers associated with the game and seek
additional help if necessary. For more information about CDC′s
work in injury and violence prevention, please see
THIS
LINK.
PTSD a medical warning sign for long-term health problems
Geisinger
research finds that veterans suffering from posttraumatic
stress disorder (PTSD) are as likely to have long-term health
problems as people with chronic disease risk factors such as
an elevated white blood cell counts and biological signs and
symptoms. However, few healthcare providers screen for PTSD in
the same way as they screen for other chronic disease risk
factors. “Exposure to trauma has not only psychological
effects, but can take a serious toll on a person’s health
status and biological functions as well,” Geisinger Senior
Investigator Joseph Boscarino, PhD, MPH says. “PTSD is a risk
factor for disease that doctors should put on their radar
screens.”
For this
study, Dr. Boscarino examined the health status of 4,462 male
Vietnam-era veterans 30 years after their military service.
Results are being published in the current edition of the
Journal of Nervous and Mental Disease. The study finds
that having PTSD was just as good an indicator of a person’s
long-term health status as having an elevated white blood cell
count. An elevated white blood cell count can indicate a major
infection or a serious blood disorder such as leukemia. The
study also found that veterans with high erythrocyte
sedimentation rate (ESR), which indicates inflammation, were
also at risk. There was a similar finding for a possible
indicator of serious neuroendocrine problems. While these
disease markers are measured with a blood test, PTSD is
commonly measured with a psychological test or a mental health
examination. This research comes as Geisinger is organizing a
national conference on May 13 to address PTSD in combat
veterans from rural parts of the country.
Boscarino
says that almost anyone who experiences a traumatic event can
experience PTSD, meaning accident and disaster victims are
also predisposed to the biological risk factors associated
with PTSD. Although therapy doesn't necessarily have to be
extensive, Boscarino says it should occur shortly after a
person has experienced a traumatic event. Early treatment may
be critical to avoiding depression, PTSD and substance
abuse-related problems following trauma. “As the conflicts in
the Middle East continue, we’re seeing a new wave of our
service members who have posttraumatic stress,” said Boscarino,
a Vietnam veteran. “If we don’t get these personnel help
earlier, our research shows that they may experience more
serious health problems down the road.”
Probiotics may be fatal in acute pancreatitis: study
"Good"
bacteria commonly found in probiotic yogurts and drinks may be
fatal for people with severe cases of pancreatitis, Dutch
researchers said on Thursday. More than twice as many patients
with severe forms of the disease given probiotic supplements
to prevent infections died compared to those who received
placebos, the researchers reported in a study in the Lancet
medical journal. "The adverse effects of probiotics noted here
were unexpected," Hein Gooszen and colleagues at the
University Medical Centre Utrecht in the Netherlands wrote.
"Several studies have associated probiotics with a reduction
in infectious pancreatitis." Gooszen was careful not to link
probiotics to any other specific condition but said they
should not be given to severely ill patients with organ
failure and on a feeding tube.
Probiotics contain live microorganisms, usually so-called good
bacteria that colonize in the intestine. They are sold as
supplements but also found naturally in many fermented food
including yogurt and certain juices. Humans normally carry
several pounds of bacteria in their intestines, and they are
key to digestion, immune system function and possibly play
other beneficial roles. They can also out-compete "bad"
bacteria that may cause disease. They have been used as a
treatment for pancreatitis, an inflammation of the pancreas
that can precede pancreatic cancer. The condition usually
develops and subsides quickly but can destroy the function of
the vital organ when untreated. Complications are common and
about a fifth of people with pancreatitis develop a severe
form of the disease that raises the risk of death, mainly due
to infections.
In the
study of 296 people with similarly acute forms of pancreatitis,
one group received a placebo and the other a mixture of
probiotic supplements, some commonly available. The number of
people who developed infections was similar but 24 volunteers
died in the probiotic group compared to nine in the placebo
group, the researchers said. The team said it did not know
exactly why probiotics may be harmful but speculated the
supplements may somehow boost demand for oxygen and worsen
already reduced blood flow. Other experts said that while
probiotics are safe, they should not be given to patients with
severe acute pancreatitis, an ailment largely due to
gallstones or heavy alcohol use that has no satisfactory,
specific treatment. "Probiotics are safe and may be beneficial
in many people who are not critically ill," Robert Sutton, a
researcher at Royal Liverpool University Hospital, who was not
involved in the study, said in a statement. (Reuters) See
THIS
LINK.
February
14, 2008 Download print version
Chinese factory linked to drug under inquiry in u.s.
Loma Linda University
Medical Center signs agreement with Amerinet
A kiss, it turns out, is definitely not
always just a kiss
Chinese factory linked to drug under
inquiry in u.s.
A Chinese factory that has not been inspected by the Food and Drug
Administration is the source for the active ingredient of a critical
blood-thinning drug whose production was suspended this week after 350
patients reported ill effects from it. At least four people died after being
given the drug, heparin.
An F.D.A. spokeswoman, Heidi Robello, said Wednesday that the agency was
making plans to inspect the Chinese factory as well as a finishing plant in
New Jersey “as soon as possible.” She said that “it was yet to be
determined” if the Chinese plant was the source of the problem that led to
the spike in reports of problems with the drug’s use. Heparin is made from
pig intestines. Ms. Robello said that she did not know whether the pigs used
to produce the suspended product, made by Baxter International, came from
China.
Heparin is used widely in dialysis, heart surgery and chronic care
hospitals. Baxter manufactures half of the nation’s supply of the drug, and
the company’s suspension of its production of multiuse heparin vials is
expected to lead to shortages.
A Baxter spokeswoman, Erin Gardiner, said her company bought the active
ingredient for the drug from another concern, which she would not identify.
She said that company had plants in the United States and China. Public
health officials noticed a problem with heparin supplies late last year when
children undergoing dialysis at a Missouri hospital had severe allergic
reactions. As officials investigated, they discovered hundreds of similar
cases. Baxter initially recalled some of the product, but the problems
persisted.
The F.D.A. decided to allow Baxter to deliver heparin that it was in the
midst of shipping for fear that a total recall would lead to an immediate
and severe shortage of the drug. The F.D.A. cautioned doctors to use as
little of the Baxter drug as possible and to infuse it into patients very
slowly. The agency also suggested that doctors consider giving steroids or
antihistamines along with the Baxter heparin to help prevent possible severe
allergic reactions.
See
THIS LINK.
1 in 10 patients gets drug error
One in every 10 patients admitted to six Massachusetts community hospitals
suffered serious and avoidable medication mistakes, according to a report
being released today by two nonprofit groups that are urging all hospitals
in the state to install a computerized prescription ordering system. The
report is the first large-scale study of preventable prescription errors in
community hospitals, and its author, Dr. David Bates of Brigham and Women's
Hospital in Boston, said he was surprised that these mistakes were so
frequent in these community hospitals. Previous studies in large academic
hospitals that also lacked computerized systems found such medication errors
occurred less than half as often, he said.
Researchers declined to release the names of the six Massachusetts
hospitals, which participated in the $5 million study voluntarily on
condition that they would remain unnamed. Of 73 hospitals in the state, only
10, almost all of them large teaching hospitals in Boston, have adopted the
computerized physician order entry system, which requires doctors to type
into a central database every medical order, including prescriptions,
diagnostic tests, and blood work. The doctors' orders are matched against
the patient's medical history, triggering red flags to prevent problems
related to drug allergies, overdoses, and dangerous interactions with other
drugs.
Bates said that after this system was put in place at Brigham and Women's
Hospital in 1995, preventable medication errors declined by 55 percent over
the next two years. The researchers could not explain the higher rate of
preventable errors in the community hospitals but cautioned against patients
assuming that these hospitals overall are less safe than academic teaching
hospitals. They said this is one of only a small number of studies
nationwide that have analyzed prescription error rates at hospitals, and
comparisons are difficult because each study varied slightly in its scope
and definitions.
Donald Thieme, head of the Massachusetts Council of Community Hospitals,
said studies show that many community hospitals offer the same, if not
better, care for patients with some serious illnesses. He said community
hospitals struggle to adopt the computerized prescription systems because of
cost, but they are committed to improvements because they want "errors down
to zero." Thieme said he could not comment on the specifics of today's study
because he had not seen it.
Community hospitals in Massachusetts may not have a choice but to implement
such computerized systems, based on increasing pressure from insurers who
see the systems enhancing patient safety and saving money. Gerald Greeley,
director of information services at Winchester Hospital, said Blue Cross
Blue Shield of Massachusetts and Harvard Pilgrim Health Care, over the last
year, have demanded the gradual introduction of the computerized physician
order entry system as a condition of reimbursement contracts with Winchester
Hospital.
The report argued, based on a financial analysis by PricewaterhouseCoopers,
that it makes financial sense for all hospitals to install a computerized
ordering system, despite the $2.1 million up-front costs and more than
$400,000 annual operating costs. The study estimated that the average victim
of a medication error stays in the hospital at least four extra days. The
researchers also looked at how often doctors at the six community hospitals
ordered more expensive drugs when a cheaper, generic drug would do, or when
they ordered an intravenous delivery of a medication when a less expensive
oral pill would have been just as effective. Redundant lab tests were also
documented.
The study concluded that by eliminating these extra expenses, a computerized
system could save each of the community hospitals an average of $2.7 million
a year, said Mitchell Adams, executive director of the Massachusetts
Technology Collaborative, a nonprofit organization focused on the state's
high-tech economy and the other group involved in the study. Adams said any
hospital putting the system in place would recoup its cost in about two
years. The two nonprofits called on hospitals to install the computerized
systems within three years.
Adams said he hopes the study's results will spur more medical insurers,
government officials, and healthcare providers to pressure the state's
hospitals to adopt the computerized system. "We must speed up the adoption
of this technology in every hospital in Massachusetts," he said. (Boston
Globe)
First evidence-based genetic test evaluation service for insurers, hospitals
and policy makers
Hayes, Inc. has launched a Genetic Test Evaluation (GTE), a
subscription-based, online service that provides insurers, hospitals and
policy makers objective insight into the clinical utility of genetic tests.
Hayes GTE is a powerful tool designed to sort through the entanglement of
information and clinical trial data surrounding the more than 1,200 genetic
tests that are currently available to doctors and patients.
The clinical, ethical, and financial implications of these tests are broad
and pressing. Hayes GTE is the first evidence-based service to address these
issues through application of the Hayes Rating, a proprietary system that is
a standard in the industry. The evidence behind each test is critically
appraised to evaluate the analytical validity, clinical validity, and
clinical utility. Ratings range from "A, Established Benefit," meaning that
there is good evidence that the test has validity and utility, to "D, No
Proven Benefit," which means that the test lacks validity or utility, or
that there is insufficient evidence to evaluate the test.
In fact, the Hayes international team of medical analysts found inadequate
evidence for some of the most widely used genetic tests for breast cancer,
including Mammostrat, MammaPrint, Oncotype DX, and Rotterdam Signature,
which all received Hayes Ratings of C or lower.
Hayes GTE addresses these issues by providing independent, evidence-based
assessments of genetic tests. These unbiased evaluations provide important
information for insurers, hospitals, and policy makers to consider when
making decisions regarding the use of these genetic tests in the clinical
setting.
Seavey Healthcare Consulting, Inc. offers new service
Seavey Healthcare Consulting, Inc. has launched a new consulting service.
They provide sterile processing and surgical services consulting to
hospitals, surgical centers, vendors, physicians, dentists, and architects
on a full-time basis.
Seavey Healthcare Consulting President and CEO, Rose Seavey RN, BS, MBA,
CNOR, ACSP, is the former Director of Sterile Processing at The Children’s
Hospital in Denver. Rose Seavey has over 30 years experience working in
surgery, managing large sterile processing departments, working on industry
standards groups, lecturing around the world, providing educational classes,
and writing articles for trade journals. Rose Seavey is considered an
industry leader in her field and has been in business since 2003 on a
part-time basis. She has also recently joined the Healthcare Purchasing
News editorial advisory board.
The firm will offer expert advice on personnel, education and training,
certifications, standards and procedures, equipment, architectural design,
and expert witness using evidence based practices to ensure compliance with
industry standards (AAMI, AORN, IAHCSMM, FDA, CDC, OSHA, and Joint
Commission). For further information, contact James Seavey at 303-467-0868.
Visit their website:
www.seaveyhealthcareconsulting.com
Loma Linda University Medical Center signs agreement with
Amerinet
Loma
Linda University Medical Center (LLUMC) has signed a new affiliate agreement
to strategically partner with Amerinet Inc., a national health care group
purchasing organization (GPO). As an affiliate partner, LLUMC, (Loma Linda,
Calif.) has agreed to utilize exclusively Amerinet’s national portfolio of
product and service contracts and Total Spend Management business
intelligence solutions to assist in managing the facility’s combined annual
spend of $150 million. Additionally, Amerinet will jointly fund a full-time
facility contract manager to ensure optimization of contracting services on
the $1.5 billion in new construction and renovations LLUMC has planned for
the next 10 years.
The new partnership will focus on total spend management solutions that
provide savings opportunities on consumable supplies and purchased services.
The agreement will also result in the implementation of cost reduction
initiatives through contract evaluation and utilization.
Cigarette after Valentine snuggle deadlier for some
The proverbial cigarette after a Valentine’s Day snuggle can prematurely end
a love affair, as new evidence emerges that a common defect in a gene
significantly increases a smoker’s risk of an early heart attack.
Researchers say that as much as 60 to 70 percent of the population has a
gene defect that delivers a one-two punch to smokers. In a recent published
study, heavy smokers with this common gene variant experienced a heart
attack around the age of 52.
“We’ve all heard the stories: Someone’s great-uncle has smoked three packs
of cigarettes since he was 14, and now, at the age of 88, he’s living a
fine, healthy life,” said Arthur Moss, M.D., director of the Heart Research
Follow-up Program at the University of Rochester Medical Center. “Contrast
that with the 52-year old neighbor, who also was a heavy smoker, and just
last week, dropped dead from a heart attack. Why is it that some smokers
seem unaffected by their habit and even outlive the healthiest individuals,
while many other smokers suffer significant cardiac events at a relatively
young age? We think we now know why.”
According to Moss, the answer lies is a common deviation of the gene CETP
(cholesteryl ester transfer protein), a protein found in all people that
controls cholesterol metabolism. Smokers with a common form of this gene are
likely to suffer a heart attack 12 years earlier than a non-smoker, while
smokers who do not carry this variant appear to be “protected” and have the
same risk of heart attack as non-smokers.
While genes have long been linked to diseases, it’s only been recently that
researchers have been able to begin unraveling the intricate interplay
between genes and the environment. By understanding how certain
environmental factors such as diet, chemicals and even smoking can influence
how well – or not – a particular gene works, scientists hope to provide new
approaches to help decrease a person’s risk of disease.
In this case, researchers zeroed in on CETP, which manages a person’s level
of high-density lipoproteins (HDL), the “good cholesterol.” Unlike
low-density lipoproteins (LDL), which build up plaque on artery walls and
predispose a person to heart attacks or strokes, HDL helps filter LDL out of
the blood and chips away at the plaque lining artery walls.
When CETP has a common defect, it makes the protein controlling HDL work on
overdrive. This overactive protein more furiously “attacks” HDL, breaking it
into smaller particles that are more easily cleared from the blood, leading
to decreased HDL levels – and less good cholesterol.
“It’s this efficient removal of HDL caused by the CETP gene defect that puts
people at higher risk of an early onset of heart disease,” said Moss. “The
problem only gets worse for smokers who have this form of CETP, because
smoking is known to also lower HDL levels. The cumulative effect is a
dramatic drop in the age such smokers are likely to experience a heart
attack – about a dozen years earlier than someone who also has the variant
but does not smoke.”
Moss added that the research also helps explain why some heavy smokers
appear to beat the odds when it comes to heart disease.
Moss’ conclusions are based on patients enrolled in the THROMBO Study, a
multi-center trial that collected blood samples and medical histories from
patients who had suffered their first heart attack in the 1990s. Researchers
were able to retrieve frozen blood samples from 814 study participants to
determine if they had the CETP gene deviation. Other interesting findings
concerning smokers include:
How much you smoke impacts your risk: Researchers found that heavy smokers –
those who smoke more than one pack a day – are likely to suffer heart
attacks about 12 years earlier than nonsmokers; for those who smoke less
than one pack a day, the age difference is only six years.
Smokers can recover lost ground within one year of quitting. Those who had
smoked more than one pack a day gained about four years within one year of
quitting, while those who had smoked less than one pack a day gained about
six years.
Moss believes his work touches on a theme that is becoming more prevalent in
all fields of medicine.
A kiss, it turns out, is definitely not always just a
kiss
As
Valentine's Day arrives, research has begun shedding light on that most
basic of all human expressions of love -- the smooch -- which has received
surprisingly little scientific scrutiny.
"You'd think there would be a lot of research on kissing behavior. It's so
common," said Susan M. Hughes, an assistant professor of psychology at
Albright College in Pennsylvania, whose recent study is one of the first on
kissing.
In
fact, much about love and attraction remains mysterious. In people, kissing
to express affection is almost universal. About 90 percent of human cultures
do it. One traditional view is that kissing, known scientifically as
osculation, evolved from women chewing food for their children and giving it
to them mouth-to-mouth, says Helen Fisher, a Rutgers University
anthropologist who studies love. "I've never believed that," adding that
similar behavior is found in many species. Birds tap beaks. Elephants shove
their trunks in each other's mouths. Primates called bonobos practice their
own version of French kissing. Fisher believes kissing is all about choosing
the right mate.
"There's so much information exchanged when you kiss someone that I just
thought it must play a vital role in mate choice, and this paper is
elegantly showing that," Fisher said. A disproportionate amount of the
brain, she noted, is geared toward interpreting signals from the mouth.
"When you look at the brain regions associated with picking up data from the
body, a huge amount of the brain is devoted to picking up information from
the lips and tongue," she said. "Very little of the brain is built to pick
up what happens to, say, your back. There have been case reports of people
being stabbed in the back without even knowing it. But even the lightest
brush of a feather on your lips and you feel it intensely."
"This was a fishing expedition," Hughes admitted. "We didn't know what to
expect."
But
Hughes and her colleagues had three hypotheses: "People may use kissing as a
sort of mate assessment," she said. "You can tell a lot of information about
a person by being in close proximity -- from their breath, the taste of
their saliva, things like that."
Their second hypothesis was that kissing promotes bonding. "If you are
accepting a kiss you are putting yourself at risk of contracting an illness.
And we suspect it raises levels of a hormone called oxytocin, which is
related to interpersonal bonding," Hughes said.
The
third hypothesis was that kissing is simply a way of inducing sexual
arousal, increasing the chance of having sex. "Men might use this more to
seduce their partners more than women do," she said.
The
researchers found support for all three theories, Hughes and her colleagues
reported in the October issue of the journal Evolutionary Psychology,
as well as provocative differences between men and women. Women place more
emphasis on the taste and smell of the person they kiss than men do, the
researchers found.
Women were also more likely to refuse to have sex with a partner unless they
kissed first. More than half of the men said they would have sex without
kissing first, but fewer than 15 percent of the women said the same.
Moreover, kissing is clearly a much bigger potential deal-breaker for women
than for men. Women were much more likely to say they would refuse to have
sex with a bad kisser.
"Women are definitely using kissing to make an assessment about the male. If
he's a bad kisser, then she's not going to want to have sex with him. She's
getting a lot of information from that kiss," she said. Men were also more
likely to expect kissing to lead to sex. Men assumed that would be the case
about half the time; women only about one-third of the time. And it made no
difference to men if they were in a short- or long-term relationship.
"Men
tend to think kissing should lead to sex no matter what," Hughes said. Men
were also much more likely to want to exchange more saliva during a kiss.
"Males like the very moist, wet open-mouth kisses," Hughes said. "We didn't
expect that." Men tend to have less acute senses of taste and smell than
women, which could explain that finding, she said. The study did find that
kissing lowered levels of the stress hormone cortisol in both sexes.
See
THIS LINK.
February
13, 2008 Download print version
CMS releases list of worst nursing homes
Expenditures rising for back and neck
problems, but health outcomes do not appear to be improving
Boston Scientific loses patent trial, $431
million awarded in damages
Doctors discredit
Lipitor's link to memory loss
J&J is recalling a pain patch
Researchers find disability does not
necessarily follow disease in living to old age
Blue Cross halts letters amid furor
Researchers can now determine when a human
was born by looking into the eyes of the dead
CMS releases list of worst nursing homes
The
Centers for Medicare & Medicaid Services (CMS) offers a list of nursing
homes that (a) have had a history of serious quality issues and (b) are
included in a special program to stimulate improvements in their quality of
care. The CMS and States visit nursing homes on a regular basis to determine
if the nursing homes are providing the quality of care that Medicare and
Medicaid requires. These “survey” or “inspection” teams will identify
deficiencies in the quality of care that is provided. They also identify any
deficiencies in meeting CMS safety requirements. When deficiencies are
identified, we require that the problems be corrected. If serious problems
are not corrected, they may terminate the nursing home’s participation in
Medicare and Medicaid.
Most
nursing homes have some deficiencies, with the average being 6-7
deficiencies per survey. Most nursing homes correct their problems within a
reasonable period of time. However, CMS has found that a minority of nursing
homes have:
•
More problems than other nursing homes (about twice the average number of
deficiencies),
•
More serious problems than most other nursing homes (including harm or
injury experienced by residents), and
• A
pattern of serious problems that has persisted over a long period of time.
Although such nursing homes would periodically institute enough improvements
in the presenting problems that they would be in substantial compliance on
one survey, significant problems would often re-surface by the time of the
next survey. Such facilities with a “yo-yo” or “in and out” compliance
history rarely addressed underlying systemic problems that were giving rise
to repeated cycles of serious deficiencies. To address this problem CMS
created the “Special Focus Facility” (SFF) initiative.
The list of homes is available here
http://www.cms.hhs.gov/CertificationandComplianc/Downloads/SFFList.pdf
Expenditures rising for back and neck problems, but
health outcomes do not appear to be improving
Although expenses related to back and neck problems have increased
substantially in the last decade, outcomes such as functional disability and
work limitations do not appear to be improving, according to a study in the
February 13 issue of JAMA.
Back
and neck problems are among the symptoms most commonly encountered in
clinical practice. In a 2002 survey of U.S. adults, 26 percent reported low
back pain and 14 percent reported neck pain in the previous three months,
according to background information in the article. Rates of imaging and
therapy for back and neck (spine) problems have increased substantially in
the last decade, but it is not clear how this has effected expenditures or
health outcomes for individuals with these problems.
Brook I. Martin, M.P.H., of the University of Washington, Seattle, and
colleagues conducted a study to examine changes in expenditures and health
status related to spine problems. The researchers analyzed 1997 – 2005 data
from the nationally representative Medical Expenditure Panel Survey (MEPS).
The
researchers found that expenditures were higher in each year for those with
spine problems than for those without. In 1997, the average age- and
sex-adjusted medical costs for respondents with spine problems was $4,695,
compared with $2,731 among those without spine problems (inflation adjusted
to 2005 dollars). In 2005, the average age- and sex-adjusted medical
expenditures among respondents with spine problems was $6,096, compared with
$3,516 among those without spine problems. From 1997 to 2005, these trends
resulted in an estimated 65 percent inflation-adjusted increase in the total
national expenditure of adults with spine problems, a more rapid increase
than overall health expenditures.
Most
of the difference observed in inflation-adjusted expenditures between those
with and without spine problems in 2005 was accounted for by outpatient
services (36 percent) and inpatient services (28 percent). Smaller
proportions were accounted for by prescription medications (23 percent);
emergency department visits (3 percent); and home health, dental and other
expenses (10 percent).
The
estimated proportion of persons with back or neck problems who self-reported
physical functioning limitations increased from 20.7 percent to 24.7 percent
from 1997 to 2005. Adjusted self-reported measures of mental health,
physical functioning, work or school limitations, and social limitations
among adults with spine problems were worse in 2005 than in 1997.
Boston Scientific loses patent trial, $431 million
awarded in damages
A
jury in Texas has ruled that Boston Scientific’s drug-coated stents infringe
a 1997 patent issued to a radiologist in Princeton, N.J., and has awarded
the inventor $431 million in damages, Boston Scientific said Tuesday. The
suit by the patent holder, Dr. Bruce N. Saffran, did not seek to halt sales
of the stents. Boston Scientific said that it would first try to overturn
the decision in post-trial motions in the federal court in Marshall, Tex.,
where the case was heard and the jury reached its verdict late Monday. If
that effort fails, the company said, it expects to be able to appeal the
outcome successfully in the United States Court of Appeals for the Federal
Circuit, in Washington. The company said that because it was confident it
would win on appeal, it did not plan to set aside money to pay the damages
award.
Dr.
Saffran’s patent primarily described how fractures could be healed more
quickly if a thin, flexible sheet of material with tiny pores is used to
control the flow of large molecules into and out of the wounded bone. But it
also described how the invention could apply to stents, which are used to
prop open arteries after blockages have been cleared. The patent said that
Dr. Saffran’s porous “sheet,” when wrapped around a bare metal stent, could
control delivery of drugs to a blood vessel wall. Boston Scientific’s
drug-coated stents — the Taxus Express, introduced in 2004, and the
yet-to-be-released Liberté — accomplish the same thing with drug-infused
layers of polymer on top of a metal stent. Dr. Saffran filed his
infringement lawsuit against Boston Scientific in 2005.(NY Times)
See
http://www.nytimes.com/2008/02/13/business/13stent.html?ref=health
Doctors discredit Lipitor's link to memory loss
Doctors have largely discredited an anecdotal link between the popular
cholesterol drug Lipitor and memory loss. The possibility of such a link
involving the widely used statin drug surfaced Tuesday in an article
published in The Wall Street Journal.
Perhaps the most controversial statement was attributed to Dr. Orli Etingin,
vice chairman of medicine at New York Presbyterian Hospital, who noted,
"This drug makes women stupid."
Dr.
Antonio Gotto, dean of the Weill-Cornell Medical School in New York, noted
that the quote was likely taken out of context when Etingin spoke at a
recent luncheon on women and the brain. But Etingin also mentioned that two
dozen of his patients who take Lipitor have reported fuzzy thinking and
memory loss. Despite these reports, ABC News medical editor Dr. Timothy
Johnson said he believes a rational response is due.
"You
can never make policy based on one case, and when you look at the overall
evidence, it does not appear that problems with cognition are a common or
serious side effect," Johnson said. "In general people should not worry, but
if they're having a problem, they should talk to their doctors about
switching the drug they are on."
Currently, about 18 million people take Lipitor, which is made by Pfizer.
Memory loss is not listed as a side effect on the drug's patient information
sheet. When asked about the possibility of memory loss, Pfizer responded
with a statement that claimed less than 2 percent of Lipitor users which
would account for about 360,000 people reported such a side effect. The
company noted that its research has shown no cause-and-effect link between
the statin drug and memory problems.
"[Etingin's
statements] are unnecessarily inflammatory," said Dr. James Stein, of the
division of cardiovascular medicine at University of Wisconsin in Madison.
Stein says the reports could be the result of a "nocebo" effect, where the
patient attributes unrelated health problems to a drug-not-producing side
effect in many ways the opposite of a placebo effect, in which patients
attribute improved health to a sugar pill or other sham treatment.
Still, the article noted that Dr. Gayatri Devi, an associate professor of
neurology and psychiatry at New York University School of Medicine, had seen
at least six patients who have had memory loss associated to statins. "The
changes started to occur within six weeks of starting the statin, and the
cognitive abilities returned very quickly when they went off," Devi told the
Wall Street Journal. "It's just a handful of patients, but for them, it made
a huge difference."
Even
if the side effect is real, many doctors stress that the connection should
be proven by careful scientific research, not by anecdote. In fact, a recent
scientific study, published in the January issue of the journal Neurology,
looked at 929 elderly women and found that statins were not tied to mental
confusion or Alzheimer's disease. In an even larger study, carried out by
Pfizer in August 2006 on nearly 5,000 stroke patients, the company showed
that patients taking Lipitor did not report memory loss as a significant
problem. (ABC News)
See THIS
LINK.
J&J is recalling a pain patch
Johnson & Johnson is voluntarily recalling a version of its pain patch
Duragesic because of manufacturing issues that could lead to accidental
overdoses. Duragesic, for patients experiencing moderate to severe chronic
pain, contains fentanyl, an opioid that could lead to problems such as
respiratory depression and fatal overdose.
The
recall includes all 25-microgram-per-hour patches that are sold in the U.S.
by J&J's PriCara unit and Sandoz; they are made by another J&J unit, Alza
Corp.
In
all, about 32 million patches will be recalled. PriCara estimates that two
per million -- 64 total -- have the defect.
The
Food and Drug Administration issued an alert about fentanyl patches in July
2005. The issue involves a sliced edge in the pouch that contains the
fentanyl gel, which could result in the gel leaking. That could result in an
overdose, or leave insufficient medicine. A handful of product returns
alerted PriCara to a possible problem in January, and the company "acted
immediately," says PriCara spokesman Greg Panico. No fatalities were
reported, the company said. An FDA spokeswoman says, "The FDA continues to
engage with the company in its voluntary recall, and is investigating the
situation."
Recalls in 2004 were limited to some batches of the 75-microgram patch. The
more-widely used 25-microgram patch is prescribed mainly for lower-weight
patients, children and patients just starting on the medicine. Duragesic
lost U.S. patent protection in 2005. Nonetheless, the patch still brought in
$1.16 billion in 2007, largely because international sales remain strong.
J&J's follow-up pain medicine, called Ionsys, has been delayed coming to
market in the U.S. because of manufacturing difficulties.
In
its most recent public filing with the Securities and Exchange Commission,
J&J said 72 people have sued the company alleging injury from Duragesic. A
case this past summer yielded a $5.5 million verdict. The recall may boost
the hopes of plaintiffs' attorneys who are claiming that the product is
responsible for dozens of deaths.
Researchers find disability does not necessarily follow
disease in living to old age
Researchers from Boston Medical Center’s (BMC) New England Centenarian Study
report that for a substantial proportion of their centenarian subjects,
avoiding age-related diseases (i.e. stroke, cardiovascular disease,
diabetes) may not be the key to their longevity; rather, the avoidance of
disability may be a key feature in their exceptional survival. These
findings appear in the February 11th issue of Archives of Internal
Medicine.
The
researchers examined the health histories of 739 centenarians and found
about one third of the subjects had age-related diseases for 15 or more
years (age of onset prior to the age of 85). “We expected to find that
nearly all centenarians have to compress the time they are sick towards the
very end of their lives, otherwise how could they get to such old age"”
asked senior author, Thomas Perls, MD, MPH, director, of BMC’s New England
Centenarian Study and associate professor of medicine at Boston University
School of Medicine. “One factor enabling the survival of these sick
centenarians-to-be appears to be a delay or compression of their
disability,” he added.
Seventy two percent of the male centenarians and 34 percent of the female
centenarians in this “survivors-of-disease” group (centenarians who
developed age-related diseases prior to age 85) scored in the independent
range on the Barthel Activities of Daily Living Index at the age of 97 or
older. According to the researchers, for a significant proportion of people
surviving to extreme old age, compression of disability, rather than
morbidity is a key feature of their ability to live such long lives.
“The
ramifications of our findings are that among older people, morbidity and
disability do not always go hand in hand,” said lead author Dellara Terry,
MD, MPH, co-director of the New England Centenarian Study and assistant
professor of medicine at Boston University School of Medicine. “Eventually
being able to understand the underlying mechanisms for delaying disability
in the presence of important age related diseases could lead to better
prognostication and perhaps even therapies,” she added.
The
researchers also found that though far fewer in number, male centenarians
tend to have significantly better cognition and physical function than their
female counterparts. One possible explanation for this may be that women are
more resilient compared to men when it comes to aging. Thus, for a man to
live to 100 or older, he must be in truly fantastic shape as close to the
end of his life, whereas, the women can better handle living with
age-related illnesses.
Blue Cross halts letters amid furor
Facing a torrent of criticism Tuesday, Blue Cross of California abruptly
halted its practice of asking physicians in a letter to look for medical
conditions that could be used to cancel patients' insurance coverage. In a
statement issued about 6 p.m., the state's largest for-profit insurer said,
"Today we reached out to our provider partners and California regulators and
determined this letter is no longer necessary and, in fact, was creating a
misimpression and causing some members and providers undue concern.
The
announcement came after blistering rebukes Tuesday by physicians, patients,
privacy experts and officials including Gov. Arnold Schwarzenegger and Sen.
Hillary Clinton (D-N.Y.) after The LA Times disclosed the practice.
The letter had been sharply criticized Monday by the California Medical
Assn., and Tuesday night its president, Richard Frankenstein, said: "This
letter was part of Blue Cross' pattern of unfairly canceling policies when
people need coverage most. We're relieved that Blue Cross is ending this
particular tactic but continue to have serious concerns about this company's
practices looking forward."
Earlier in the day, Shannon Troughton, a spokeswoman for Blue Cross parent
WellPoint Inc., said the company had been sending as many as 1,000 letters a
month for years and had received no complaints. Blue Cross sent physicians
copies of insurance applications filled out by new patients, along with the
letter advising them the company had a right to drop members who failed to
disclose "material medical history." That could include "preexisting
pregnancies." The letter asked physicians to "immediately" report any
discrepancies between their patients' medical condition and the information
in the applications. Other major insurers in California said Tuesday that
they had not asked physicians to do anything like what Blue Cross was
seeking.
Schwarzenegger sharply criticized the practice, which he described as akin
to telling physicians to "rat out the patients and to give the patients'
medical history to the insurance company so they have a reason to cancel the
policy." The governor said the practice should be banned. "That is
outrageous," he said, and "one more reason why it is so important to have
comprehensive healthcare reform."
California insurers, including Blue Cross, are under fire for issuing
individual policies without checking applications and then canceling them
after patients get sick. The practice, known in the industry as rescission,
is under scrutiny by state regulators, lawmakers and the courts. In scores
of lawsuits, patients contend that the insurers dropped them over honest
mistakes and minor inconsistencies on applications that they allege are
purposely confusing. People ailing with cancer or other diseases often are
unable to get new coverage once their insurance has been rescinded, and they
may go without treatment. Swamped with medical debt, people have lost homes
and businesses.
Insurers say the cancellations are an important weapon against fraud and
occur rarely. Several physicians and medical groups said they were troubled
by the letters. Robert Margolis, a physician and the chief executive of one
of the state's largest medical groups, described the letters as "an
obnoxious intrusion" on the relationship between physicians and patients.
"They don't have a right to contact someone that you hired and you employed
to take care of your health and to release data about you without your
permission," said Deborah Peel, a Texas physician who founded Patient
Privacy Rights, a nonprofit advocacy organization. "What's the point of
paying for insurance if they are going to look for every reason to deny what
you think you paid for, which is access to services to help you?" (LA
Times)
See THIS LINK.
Researchers can now determine when a human was born by
looking into the eyes of the dead
Using the radiocarbon dating method and special proteins in the lens of the
eye, researchers at the University of Copenhagen and University of Aarhus
can now establish, with relatively high precision, when a person was born.
This provides a useful tool for forensic scientists who can use it to
establish the date of birth of an unidentified body and could also have
further consequences for health science research.
The
lens of the eye is made up of transparent proteins called crystallins. These
are packed so tightly together and in such a particular way, that they
behave like crystals, allowing light to pass through the lens of the eye so
that we can see. From conception and up until a human being is 1-2 years of
age, the cells in the lens build these crystalline proteins. Once this
organic construction work is done, however, the lens crystallins remain
essentially unchanged for the rest of our lives. This is a fact that
researchers can now put to good use.
A
minute quantity of Carbon (C-12) in the carbon-dioxide content of the
atmosphere contains two extra neutrons and is therefore called Carbon-14
(C-14). This isotope is radioactive, but decays so slowly and harmlessly
into nitrogen, that this small carbon element, which occurs quite naturally
in nature, is in no way harmful to humans, plants or animals. At the same
time, carbon is one of the principal organic elements, and constantly moves
in and out of the food chain. The same is true for the tiny quantity of C-14
in the atmosphere. As long as an organism is part of the food chain, the
amount of C-14 in its cells will remain constant and stay at the same level
as the C-14 atmospheric content. When the organism dies, however, the
quantity of C-14 will slowly but surely drop over the course of thousands of
years, while it transforms into nitrogen. This is the key to the Carbon 14
method known as radiocarbon dating, which scientists use to date up to
60,000 year old biological, archaeological finds.
From
the end of World War II and up until about 1960, the superpowers of the Cold
War era, conducted nuclear tests, detonating bombs into the atmosphere.
These detonations have affected the content of radioactive trace materials
in the air and created what scientists refer to as the C-14 bomb pulse. From
the first nuclear detonation and, until the ban on nuclear testing was
evoked, the quantity of C-14 in the atmosphere doubled. Since 1960, it has
only slowly decreased to natural levels.
This has left an
impression in the lens crystallins of the eyes, which have absorbed the
increased carbon content through food stuffs. Since the crystallins remain
unchanged once they have been created, they reflect the content of C-14
present in the atmosphere at the time of their creation. Using a large
nuclear accelerator, physicists at Aarhus University can now determine the
amount of C-14 in as little as one milligram of lens tissue and thereby
calculate the year of birth.
See
THIS LINK.
February
12, 2008 Download print version
Autopsy findings suggest end of decline in
coronary disease rates
Problems in blood drug lead to halt by factory
Autopsy findings suggest end of decline in
coronary disease rates
Autopsies of individuals in one Minnesota County suggest that
the decades-long decline in the rate of coronary artery
disease may have ended and possibly reversed after 2000,
according to a report in the February 11 issue of Archives
of Internal Medicine, one of the JAMA/Archives journals.
“Over the past century, the rate of death due to heart disease
in the United States rose until the mid 1960s when it began a
steady decline, which continues today,” the authors write as
background information in the article. These declines appear
to be accompanied by reductions in the incidence and death
rates of coronary artery disease, the most common form of
heart disease, characterized by blockages in the vessels that
supply blood to the heart. The gold standard for detecting
trends in the prevalence of coronary artery disease among the
general population has been gathering information from
autopsies. However, autopsy rates must be high to ensure that
findings accurately reflect the general population. The
national autopsy rate has never been high and continues to
decline, with a national average of only 8.3 percent in 2003.
Olmsted County, Minnesota, has traditionally had high autopsy
rates across all age groups. Rates are especially high for
non-elderly individuals who died of unnatural causes (such as
accidents, homicides or suicides). A total of 3,237 Olmsted
County residents in this age group died in those years, 515 of
unnatural causes. Among those 515, 96 percent were autopsied
and 82 percent (425) had grades assigned based on the amount
of blockage in several coronary arteries, with grades ranging
from zero (no blockage) to five (100 percent blocked).
“Over the full period (1981 to 2004), 8.2 percent of the 425
individuals had high-grade disease, and 83 percent had
evidence of any disease,” the authors write. High-grade
disease was defined as a grade of three or higher in the left
main artery or a grade four or higher in any other single
artery. Analyses adjusted to consider the individuals’ age and
sex revealed declines over the entire period for high-grade
disease, any disease and the average grade of disease.
However, “declines in the grade of coronary disease ended
after 1995 and possibly reversed after 2000.”
“Our finding that temporal declines in the grade of coronary
artery disease at autopsy have ended, together with suggestive
evidence that declines have recently reversed, provides some
of the first data to support increasing concerns that declines
in heart disease mortality may not continue,” the authors
conclude. “The extent to which recent trends are attributable
to the epidemics of obesity and diabetes mellitus awaits
further investigation.”
Owensboro Medical Health System selects
MedAssets
for supply chain solutions
MedAssets Inc. announced monday that Owensboro Medical Health
System (OMHS), based in Owensboro, Kentucky signed an
agreement for supply chain management. The solutions include
group purchasing, supply chain analytics and technology tools
from MedAssets’ spend management segment. The agreement was
effective November 1, 2007. OMHS is implementing MedAssets’
group purchasing contract portfolio, supply chain technology,
and analytical services. A customized contract catalog is in
development and will include all local, regional and national
agreements to ensure the lowest cost for all items purchased
by the system. Strategic Information and Strategic Information
for Pharmacy will be used to gain an in-depth look at supply
cost and pharmacy purchasing data to identify opportunities
for additional savings and will help to significantly drive
down supply and pharmacy costs through contract compliance and
rebate management as well as pharmacy market share monitoring
and identification of cost saving alternatives.
New finding may help explain development of
preeclampsia
In a study of pregnant women, those with pregnancy-induced
high blood pressure were found to have higher levels of a
peptide that raises blood pressure in the pieces of tissue
linking mother and fetus, according to researchers at Wake
Forest University Baptist Medical Center. The finding,
reported online in the journal Hypertension, may help
explain how the disorder develops. Preeclampsia, or high blood
pressure induced by pregnancy, affects 7 to 10 percent of
pregnancies in the United States and is the second-leading
cause of maternal mortality. It is the leading cause of
pre-term delivery and contributes significantly to stillbirths
and death in newborns.
The researchers found that in women with preeclampsia, levels
of angiotensin II (Ang II), a hormone that constricts blood
vessels and causes blood pressure to rise, was doubled in the
chorionic villi, part of the placenta that links mother and
fetus and supplies food and oxygen.
“This finding may be part of the preeclampsia puzzle,” said
Lauren Anton, a graduate student who is first author on the
research. “Anything that gets us closer to understanding this
disease is important because there is no treatment and no cure
and women are still delivering babies too early.”
The researchers theorize that Ang II may restrict the fetal
vessels that lie within the chorionic villi, which not only
raises blood pressure, but also lowers oxygen and nutrient
flow to the baby and may result in lower birth weight and
other complications of preeclampsia. Ang II is part of the
renin angiotensin system (RAS) that regulates blood pressure.
The system has been shown to play an important role in
preeclampsia. However, changes in the system also occur in
women who don’t develop the condition. In normal pregnancies,
estrogen causes increased levels of several hormones,
including Ang II, in the blood. Despite the increase of Ang II
in the blood during pregnancy, most women do not develop
preeclampsia.
“This implies that local tissues are contributing to the
problem,” said K. Bridget Brosnihan, Ph.D., senior researcher,
who has been studying preeclampsia for 12 years. “The hormone
is remarkably elevated in this relatively small tissue, which
implies that it has an important role in the development of
preeclampsia.”
The researchers hope that the findings may one day lead to
treatment for preeclampsia. ACE inhibitor drugs are currently
used to lower Ang II in non-pregnant women with hypertension,
but these drugs cannot be given to pregnant women. The study
authors suggest that other therapies aimed at regulating blood
pressure might be beneficial if they target the chorionic
villi rather than the system as a whole. They are currently
working to determine if growth factors that cause the
placenta’s blood supply to develop may also be regulated by
the increase in Ang II.
Problems in blood drug lead to halt by
factory
A major maker of heparin, a blood thinner used widely in
surgery and dialysis, has stopped making it after hundreds of
patients reported severe allergic reactions to the drug, which
is made from pig intestines. Shortages of the drug are all but
certain, federal regulators said. Although alternatives exist,
doctors warned of serious consequences if heparin became truly
scarce.
“Inadequate heparin would cause a health care crisis in this
country,” said Dr. Daniel Coyne, a professor of medicine at
Washington University in St. Louis.
Public health officials first noticed a problem late last year
in four children undergoing dialysis at a hospital in
Missouri. Within minutes of being injected with heparin, the
children experienced serious allergic reactions. As officials
investigated, they found a total of 350 reports of patients’
experiencing problems after being injected with large doses of
heparin made by Baxter Healthcare. Baxter supplies about half
the nation’s heparin. Most of the cases were reported in late
December or January; 40 percent were deemed serious. The
reactions included difficulty breathing, nausea, vomiting,
excessive sweating and rapidly falling blood pressure that in
some cases led to life-threatening shock.
A spokeswoman for Baxter, Erin M. Gardiner, said the company
had not changed its heparin manufacturing for several years.
The company initially recalled nine lots of the drug, but
problems continued. Baxter suspended manufacturing multidose
vials that have been associated with most of the problems.
Baxter continues to make single-dose vials.
Dr. John Jenkins, director of the Food and Drug
Administration’s office of new drugs, said the agency decided
to allow the company to continue distributing the multidose
vials that it had made because a full recall “would result in
an immediate and severe shortage of this medically necessary
drug.”
APP Pharmaceuticals in Schaumburg, IL, manufactures much of
the rest of the heparin supply. Its president, Tom Silberg,
said APP was rapidly increasing production. Dr. Jenkins said
doctors who had to continue to use Baxter heparin should use
the lowest possible dose, infuse it slowly, monitor patients
closely and consider administering steroids or antihistamines
before heparin. Doctors said they would face difficult choices
if heparin supplies ran low.
“There is going to be a shortage problem in the immediate and
long-term future with the suspension of Baxter’s
manufacturing,” Dr. Jenkins said. “Facilities and physicians
will have to decide immediately what they do with the heparin
on hand, and they’ll have to start looking for heparin for the
long term.”
Heparin is also used to prevent clotting in catheters, which
25 percent of dialysis patients have to use for treatment. The
drug is commonly used in heart-bypass surgery and for the
bedridden. Other drugs thin blood, but their effects are
rarely as rapid or as easily reversed. Heparin has been
manufactured since 1930. (New York Times)
Click here
Online Registration Open for AHRMM08 Annual Conference & Exhibition
Registration is now available for the
AHRMMM08
Annual Conference & Exhibition in
San Antonio, TX on
July 20-23, 2008. The event, held at the
Henry B. Gonzalez Convention Center, offers three full days of
valuable education and networking programs for professionals
at every level within the healthcare supply chain field.
AHRMM08 attendees will be updated on current industry news,
trends, and best practices; learn from national experts in the
materials management field; network with colleagues and
industry leaders from around the world; and view the latest
marketplace business solutions.
View the complete
detailed
program and
register
online now. Attendees who register before the Early
Bird deadline on
May 9, 2008 can save up to $150 off the Full-Conference
Registration rates. See
THIS LINK www.ahrmm.org
Team treatment for depression cuts
medical costs
A team approach to treating depression in older adults, already
shown to improve health, can also cut total health-care costs,
according to a new study led by the
University
of Washington. The study appears in the February issue of the
American Journal of Managed Care. Clinical depression
affects about 3 million older adults in the
United States
and is associated with 50 to 70 percent higher health-care
expenses, mostly due to an increased use of medical, not
mental health, services.
In this study, researchers found that adults over 60 who received a
year of team care for depression had lower average costs for
all of their health care over a four-year period, about $3,300
less than patients receiving traditional care, even when the
cost of the team care treatment is included. Over the past
several years, a multi-center research team has been studying
a team care approach called IMPACT (Improving Mood – Promoting
Access to Collaborative Treatment for Late Life Depression).
The treatment model features a nurse, social worker or
psychologist serving as a depression-care manager. This
depression-care manager works with the primary care physician
and a consulting psychiatrist to care for depressed patients
in their primary care clinic. Previous studies have shown that
the IMPACT program provides powerful health benefits,
including significantly decreased depression and chronic
physical pain, improved physical functioning and better
overall quality of life.
In this cost evaluation study, 551 IMPACT participants from two
large health-care organizations, Group Health Cooperative of
Puget Sound and Kaiser Permanente of
Southern California,
were followed for four years to examine long-term effects of
team care on medical costs. “Study participants assigned to
the IMPACT program saw significantly lower total health care
costs over four years than patients receiving standard care,
and our research shows that this difference was almost
certainly due to the IMPACT team-care model,” said Dr. Jurgen
Unutzer, professor and vice-chair of psychiatry and director
of the IMPACT Implementation Center at the UW.
“This research, combined with our other work showing how team care
for depression has significant health benefits for older
adults, illustrates how important it is for health
organizations to consider implementing evidence-based
collaborative models of depression care, such as IMPACT.” The
cost of using the IMPACT model of depression care treatment is
only about $500 per year for each patient – a modest
investment compared to the total medical costs of about $8,000
per year for an older adult with depression. When spread out
over an entire population of older adults, the cost of
offering IMPACT as a health care benefit amounts to about $1
per person per month.
Based on its high effectiveness and cost-effectiveness, several
major health organizations have already implemented the IMPACT
model for depression care, including Kaiser Permanente of
Southern California, which serves more than 3 million people
in its 12 regional medical centers. In the Seattle area,
Virginia Mason Medical Center will begin rolling out IMPACT to
patients in their primary care clinics over the next few
months. The John A. Hartford Foundation is supporting the
efforts of Unutzer and his colleagues to help these and other
health-care systems around the country adapt and implement
IMPACT.
A cheaper, more effective method of treating clinical depression in
older adults has become more important in recent years, as
physicians have learned that the condition affects not only
the mental health but also the physical health of millions of
patients and helps drive up health-care costs. Studies
estimate that 5 to 10 percent of older adults seen in primary
care suffer from clinical depression. The condition is
associated with a bevy of other medical problems, including
more suffering and physical pain, decreases in physical
ability and self-care of chronic illnesses, and a high
potential for suicide. It also can significantly increase
medical costs. The
IMPACT Implementation Center, where physicians and health care
professionals can learn more about implementing the IMPACT
model in their organizations , can be found at:
http://www.impact-uw.org
Blacks twice as susceptible and more likely
to die of severe sepsis than whites
Blacks have almost double the rate of severe sepsis—an overwhelming
infection of the bloodstream accompanied by acute organ
dysfunction—as whites, according to recent research. “The
difference in incidence was evident by age 20 and continued
throughout the adult lifespan. After accounting for
differences in poverty and geography, black race remained
independently associated with higher severe sepsis incidence,”
wrote lead authors Amber E. Barnato, M.D., M.P.H., M.S., of
the Center for Research on Health Care at the
University of Pittsburgh, and Sherri L. Alexander, Ph.D., of
Genentech. Hispanics, on the other hand, have a lower
incidence of severe sepsis than whites. What is more, blacks
die more frequently of severe sepsis that either whites or
Hispanics.
The findings appear in the first issue for February of the
American Journal of Respiratory and Critical Care Medicine,
published by the American Thoracic Society.
Dr. Barnato and colleagues conducted a retrospective
population-based analysis of race-specific incidence and ICU
case fatality rates for hospital-based infection and severe
sepsis in
Florida, Massachusetts, New Jersey, New York, Virginia and
Texas. They obtained demographic and socioeconomic data from
the 2000 U.S. census and clinical data for hospitalized severe
sepsis cases from the hospitals’ discharge data. They compared
incidence of severe sepsis, ICU admission and ICU case
fatality among races, controlling for age and gender. The
total analysis included more than 71 million people.
One factor that clearly differed among groups was the type of
hospital facilities in which patients received care. Blacks
were more likely to be treated at hospitals with poorer
outcomes for severe sepsis than whites. “If a black and white
patient with the same clinical characteristics were treated at
the same hospital, they would have identical case survival
rates,” said Dr. Barnato. “Therefore,” she continued, “it may
be that the hospitals that treat most black patients see black
and white patients who are sicker than we can measure using
these data sources, and/or that these hospitals are providing
lower quality care.”
Blue-eyed humans have a single, common
ancestor
New research shows that people with blue eyes have a single,
common ancestor. A team at the University of Copenhagen have
tracked down a genetic mutation which took place 6-10,000
years ago and is the cause of the eye color of all blue-eyed
humans alive on the planet today.
“Originally, we all had brown eyes”, said Professor Hans Eiberg from the
Department of Cellular and Molecular Biology. “But a genetic mutation
affecting the OCA2 gene in our chromosomes resulted in the creation of a
“switch”, which literally “turned off” the ability to produce brown eyes”.
The OCA2 gene codes for the so-called P protein, which is involved in the
production of melanin, the pigment that gives color to our hair, eyes and
skin. The “switch”, which is located in the gene adjacent to
OCA2
does not, however, turn off the gene entirely, but rather limits its action
to reducing the production of melanin in the iris – effectively “diluting”
brown eyes to blue. The switch’s effect on
OCA2
is very specific. If the
OCA2 gene had been completely destroyed or turned
off, human beings would be without melanin in their hair, eyes or skin color
– a condition known as albinism.
Variation
in the color of the eyes from brown to green can all be explained by the
amount of melanin in the iris, but blue-eyed individuals only have a small
degree of variation in the amount of melanin in their eyes. “From this we
can conclude that all blue-eyed individuals are linked to the same
ancestor,” says Professor Eiberg. “They have all inherited the same switch
at exactly the same spot in their
DNA.” Brown-eyed individuals, by contrast, have
considerable individual variation in the area of their
DNA that
controls melanin production.
The
mutation of brown eyes to blue represents neither a positive nor a negative
mutation. It is one of several mutations such as hair color, baldness,
freckles and beauty spots, which neither increases nor reduces a human’s
chance of survival. As Professor Eiberg says, “it simply shows that nature
is constantly shuffling the human genome, creating a genetic cocktail of
human chromosomes and trying out different changes as it does so.” For the
complete article,
click here
February
11, 2008 Download print version
This season's flu strains are not a good match
for vaccine
U.S. puts Botox under review
Mock CPR "Codes" expose weaknesses in hospital
emergency response for children
Scientists find new receptor for H.I.V.
Depression in young doctors tied to medication
errors
Artificial sweeteners linked to weight gain
ASHES appoints new board members
This season's flu strains are not a good
match for vaccine
Seasonal
influenza is spreading widely throughout the United States, with nearly half
the cases caused by strains of the virus that are not directly covered by
this year's flu vaccine. Whether the winter will end up being worse than
usual remains to be seen. Flu mortality in adults has been higher than in
the past two years, but deaths in children, an important marker of severity,
have been rare. Nevertheless, this winter is likely to be one of the few
times that public health experts lose the bet they make each year when they
devise the formula for the flu vaccine, eight months before the virus starts
circulating in the fall. Experts must decide on the formulation then because
of the time it takes to produce mass quantities of the vaccine. "Most years,
the prediction is very good," said Joseph S. Bresee, an influenza
epidemiologist at the
Centers for Disease
Control and Prevention. "In 16 of the last 19 years, we have had
a well-matched vaccine." But probably not this time.
Each year, the vaccine contains representatives of the three huge families
of flu virus that are currently circulating. They are two main types of
influenza A, H1N1 and H3N2, and influenza B. The viruses in the vaccine are
either dead or, in the case of the nasal-spray flu vaccine developed four
years ago, crippled so they cannot cause illness. What they can do is
stimulate the body's immune system to mount a defense, sometimes a
lifesaving one, should the virus be encountered. The viruses in each of
these lineages are constantly changing through mutation. Inevitably, one
appears that is different enough from its ancestors that a person protected
against them, through either previous infection or vaccination, is not
protected against the new variant. Such an emergent virus easily finds
victims because almost nobody has immunity against it.
A version of this scenario, muddied, of course, by real life,
apparently happened twice this year. A new strain of H3N2 virus was
identified in
Brisbane,
Australia, last
February, a few weeks after the components of this winter's vaccine were
chosen. (Later studies showed it had been around at least since January
2007.) But it was too late to substitute "Brisbane/10", the short version of
its name, for the H3N2 strain that had been in the vaccine since the
2006-2007 season, called "Wisconsin." Even if there had been time, it was
not certain the Brisbane strain would take off and spread. It has. From the
start of flu season until the beginning of February, 34 percent of flu
viruses taken from patients around the country were Brisbane strains. At the
same time, a strain of influenza B called "Yamagata," which is significantly
different from the "Victoria" B strain in the vaccine, was taking off. About
16 percent of all flu samples this winter are influenza B, and of them 93
percent are Yamagata. Together, the Brisbane and Yamagata strains are
accounting for 44 percent of all flu samples this winter, and neither is in
the vaccine.
That does not mean the vaccine is of no benefit. The immunity conferred by
the
Wisconsin
strain may protect somewhat against its Brisbane descendant. A vaccinated
person may have milder symptoms. But the vaccine is unlikely to prevent
infection altogether in lots of people. A study done by the
Defense Department
last year after Brisbane emerged found that it was 52 percent effective in
preventing infection. That is much lower than the 70 to 90 percent
protection provided by a well-matched vaccine given to healthy young adults.
The agency is doing three studies to determine with precision how much
protection the vaccine is providing against the Brisbane strain this winter.
Results of the first may be available in a few weeks. The vaccine's
protection against the Yamagata strain is probably also poor. The best
evidence that Yamagata is not well covered by the vaccine is that it is just
about the only strain of influenza B around. Influenza virologists from
around the world will gather in
Geneva this
week to decide the formula for next year's vaccine. (Washington Post) See
THIS LINK
U.S. puts Botox under review
The safety of the anti-wrinkle wonder injection Botox is being called into
question, with U.S. drug safety regulators on Friday putting the product
under review after reports of death or serious reactions, the most severe in
children taking the product for spasms related to cerebral palsy. The FDA
said there is no need for health professionals to discontinue prescribing
Botox or a similar treatment known as Myobloc. Some doctors say the dosages
used to treat such spasms are far higher than those used for cosmetic
reasons, suggesting less reason to worry about the product as a treatment
for wrinkles and facial lines. The agency did not focus attention on the
risk to cosmetic users but said the investigation is in its early stages.
The most severe reactions were found in unapproved uses for "children
treated for spasticity in their limbs associated with cerebral palsy." The
products have been linked in "some cases" to adverse reactions, including
respiratory failure and death. The FDA said doctors and their patients
should be on the lookout for signs of difficulty in swallowing, weakness and
breathing problems. "This is another serious reminder for people that you
need to have a serious conversation with your doctor because there are risks
and benefits to every procedure," said Dr. Michael J. Lee, an assistant
professor of plastic surgery at Northwestern Memorial Hospital. "It reminds
patients and consumers that you need to talk to your doctor to see if there
are potential risks to using Botox. There are obviously benefits."
Botox and Myobloc, derived from botulinum toxins, block the impulses to
muscles and therefore cause them to relax. The toxins can spread beyond the
injection site to other parts of the body, which doctors and the FDA say can
weaken muscles used for breathing and swallowing and potentially be harmful.
Eventually the toxins become metabolized and are broken down, doctors say,
but the toxins' potential spread to other parts of the body can be
worrisome. "Every doctor who injects botulinum toxin needs to know about the
dangers of the toxin spreading to other parts of the body," said Dr. Sidney
Wolfe, head of Public Citizen's health research group. "The only way this is
going to happen is by requiring the makers of the drug to send warning
letters to all doctors who use Botox and Myobloc."
Botox is best known for its cosmetic purpose in reducing the appearance of
wrinkles by paralyzing muscles in the face. But the drugs are also used for
a variety of muscle spasm conditions in the neck, vocal cords and in legs,
such as is the case with children who have cerebral palsy. The FDA said the
most severe adverse effects, including at least one death, involve children
being treated for "spasticity in their limbs." The FDA has never formally
approved that use for the drugs. Because of the large doses given to treat
spasticity the adverse events could be related to overdosing, the FDA said.
A common dosage for a wrinkle reduction treatment in the face can be 20 to
25 units, a fraction of the 300-unit to 600-unit dosage that can be used to
treat a leg spasm, doctors say. The FDA said it is looking into a variety of
dosages and into both approved and unapproved uses of the products. So far,
the FDA said, the number of adverse events is a "relatively small number,"
said Dr. Russell Katz, the FDA director in the agency's division of
neurology products. (Chicago
Tribune)
Mock CPR "Codes" expose weaknesses in hospital emergency
response for children
Staging
mock cardiac and respiratory arrests, “code” situations in hospital
parlance, easily expose common failures in rapid response with CPR and
other life-saving care for children and also set up powerful incentives to
sharpen emergency skills and move fast to use them, suggests a study from
the Johns Hopkins Children’s Center. Results of the study, conducted in part
at Hopkins Children’s, and published in the January issue of Pediatrics,
found sometimes alarming delays and lapses in emergency care among
first-responders during the critical five minutes after a child’s heart or
breathing stops.
Although
cardiopulmonary arrest deaths or permanent brain damage are relatively rare
among hospitalized children, the mock drills, the researchers say, could
help hospitals nationwide improve such dismal outcomes by focusing
attention on fast action and the highly detectable events that lead up to
such failures before they occur in real patients. Past research estimates
that only 14 percent to 36 percent of children who suffer an arrest in the
hospital survive, although the absolute number of deaths is quite small. “An
honest look at what goes wrong is uncomfortable but worth it if it means
preventing harm to patients,” said lead investigator Elizabeth Hunt, M.D.,
M.P.H., a critical-care specialist at Hopkins Children’s. “Our hope is that
other hospitals will use our model to test their own performance.”
Using a
child-size dummy, researchers staged a series of pretend codes between 2000
and 2003 at Hopkins Children’s and another local hospital, simulating
cardiac or pulmonary distress. In 75 percent of the 34 mock codes, nurses
and residents failed to immediately check the ABCs (airway, breathing,
circulation) and perform basic cardiopulmonary resuscitation (CPR) maneuvers
such as opening the airway, checking the pulse and starting chest
compressions. Virtually all mock codes revealed at least one resuscitation
error, and there was miscommunication among caregivers in all drills. While
the codes were staged in general pediatric wards rather than the intensive
care unit or the emergency room, where children are most likely to arrest
and receive aggressive treatment from special code teams, arrests also
happen on general wards, and delays in stabilizing children can have
disastrous consequences.
Nurses,
who are typically the first-responders on general wards, seemed to focus
first on preparing the room for the arrival of the critical-care team rather
than responding directly with ABCs and CPR, investigators observed. “We see
a lot of people who’ve lost their first-responder instincts because we’re
asking them to do too much,” says Hunt. “The drills have a way of getting
them back to the basics—open the airway, assess breathing and restore
circulation. It’s really as simple as that.”
Since
2003, when the study ended, Hopkins Children’s now: Clearly states in nurse
job descriptions that they are required to act as first responders; Stages
monthly mock codes for pediatric residents at all locations within Hopkins
Children’s; Holds monthly classes on pediatric resuscitation and advanced
life support. Hopkins Children’s also uses special rapid-response teams that
can be called to a general ward anytime a nurse or a resident notices subtle
changes in a child’s status that might signal an impending crisis, such as
heavy breathing, fast heart rate and irritability, an often-ignored red flag
that might mean the brain isn’t getting enough oxygen. “Our mantra to the
nurses has been ‘call early even if it means a false alarm,’” Hunt said.
Scientists find new receptor for H.I.V.
Government scientists have discovered a new way that
H.I.V. attacks human cells, an advance that could provide
fresh avenues for the development of additional therapies to stop AIDS, they
reported on Sunday. The discovery is the identification of a new human
receptor for H.I.V. The receptor helps guide the virus to the gut after it
gains entry to the body, where it begins its relentless attack on the immune
system. The findings were reported online Sunday in the journal Nature
Immunology by a team headed by Dr.
Anthony S. Fauci, the director of the National Institute
of Allergy and Infectious Diseases.
For
years, scientists have known that H.I.V. rapidly invades the lymph nodes and
lymph tissues that are abundant throughout the gut, or intestines. The gut
becomes the prime site for replication of H.I.V., and the virus then goes on
to deplete the lymph tissue of the key CD4 H.I.V.-fighting immune cells.
That situation occurs in all H.I.V.-infected individuals, whether they
acquired the virus through sexual intercourse, blood transfusions, blood
contamination of needles and syringes, or in passage through the birth canal
or drinking
breast milk. The findings appear to provide some, if not
the main, answers to how and why that situation occurs.
Dr. Warner C. Greene, an AIDS expert and the director of the
Gladstone Institute of Virology and Immunology here who was not involved in
the research, said the findings were “an important advance in the field.”
“They begin to shed light on the mysterious process on why the virus
preferentially grows in the gut,” Dr. Greene said. Dr. Fauci, James Arthos,
Claudia Cicala, Elena Martinelli and their colleagues showed that a
molecule, integrin alpha-4 beta-7, which naturally directs immune cells to
the gut, is also a receptor for H.I.V. A protein on the virus’s envelope, or
outer shell, sticks to a molecule in the receptor that is linked
specifically to the way CD4 cells home in on the gut, the researchers said.
Binding of the virus to the integrin alpha-4 beta 7 molecule
stimulates activation of another molecule, LFA-1, which plays a crucial role
in the spread of the virus from one cell to another. The actions ultimately
lead to destruction of lymph tissue, particularly in the gut. Several other
receptor sites for H.I.V. are known. The most important is the CD4 molecule
on certain immune cells; the molecule’s role as an H.I.V. receptor was
identified in 1984. Two other important receptors, known as CCR5 and CXCR4,
were identified in 1996. CCR5 is a normal component of human cells and acts
as a doorway for the entry of H.I.V. People who lack it because of a genetic
mutation rarely become infected even if they have been exposed to H.I.V.
repeatedly. “The work we did took nearly two years, and there’s little doubt
that what we have found is a new receptor,” Dr. Fauci said, adding that “we
certainly have to learn a lot more about it.” Scientists have sought to
identify receptors because they offer targets for the development of new
classes of drugs.
Dr. Fauci said he hoped his team’s findings would encourage other
scientists from different disciplines to explore new ways to attack H.I.V. A
number of experimental drugs that block the integrin alpha-4 beta-7 receptor
are being tested for the treatment of
autoimmune disorders. Dr. Fauci said such drugs should
also be studied for their potential benefit in AIDS treatment. Organization
of new trials in the next year or so could test such drugs in animals and
humans to determine their safety and effectiveness against H.I.V., Dr. Fauci
said. One candidate is a drug,
Tysabri or natalizumab, that is marketed for treatment of
multiple sclerosis, Dr. Fauci said. Biogen/Elan makes
Tysabri. If trials for H.I.V. are successful, Dr. Fauci said, the drugs
could be added to existing treatment regimens. (The New York Times) See
THIS LINK
Depression in young doctors tied to medication errors
Medical
residents who are depressed are about six times more likely to make
medication errors than those who aren't depressed, says a study that looked
a 123 pediatric residents at three children's hospitals in the United
States. Researchers found that 20 percent of the residents were depressed,
and 74 percent were burned out. During the study period, the residents made
a total of 45 medications errors, and those who were depressed made 6.2
times more medication errors than those who weren't depressed. There didn't
appear to be any link between higher medication error rates and burnout. The
study was published online Feb. 7 in the British Medical Journal.
These findings suggest that doctors' mental health may play a more
significant role in patient safety than previously suspected, the study
authors said. In addition, the high burnout rate among residents in this
study, consistent with other studies, indicates that methods of training
doctors may cause stress that harms residents' health.
The
researchers did note that their data was collected before work hour limits
were implemented for medical residents in the United States. More needs to
be done to study and improve the mental health and working conditions of
doctors, the study authors concluded. Each year in the United States, as
many as 98,000 patients die due to medication errors, and the stress of
resident training, including lack of sleep and leisure time, are among the
most commonly cited reasons for such errors, according to background
information in the study. While it may seem logical to link medication
errors to depression and burnout among doctors, these study findings are not
conclusive, researchers from Scotland's University of Aberdeen noted in an
accompanying editorial. Large, prospective trials need to be conducted to
pinpoint the factors that cause medication errors, they wrote. (HealthDay
News)
Artificial sweeteners linked to weight gain
Researchers have laboratory evidence that the widespread use of no-calorie
sweeteners may actually make it harder for people to control their intake
and body weight. The findings appear in the February issue of Behavioral
Neuroscience, which is published by the American Psychological
Association (APA). Psychologists at Purdue University’s Ingestive Behavior
Research Center reported that relative to rats that ate yogurt sweetened
with glucose (a simple sugar with 15 calories/teaspoon, the same as table
sugar), rats given yogurt sweetened with zero-calorie saccharin later
consumed more calories, gained more weight, put on more body fat, and didn’t
make up for it by cutting back later, all at levels of statistical
significance.
Authors Susan Swithers, PhD, and Terry Davidson, PhD, surmised that by
breaking the connection between a sweet sensation and high-calorie food, the
use of saccharin changes the body’s ability to regulate intake. That change
depends on experience. Problems with self-regulation might explain in part
why obesity has risen in parallel with the use of artificial sweeteners. It
also might explain why, says Swithers, scientific consensus on human use of
artificial sweeteners is inconclusive, with various studies finding evidence
of weight loss, weight gain or little effect. Because people may have
different experiences with artificial and natural sweeteners, human studies
that don’t take into account prior consumption may produce a variety of
outcomes.
Three different experiments explored whether saccharin changed lab
animals’ ability to regulate their intake, using different assessments –the
most obvious being caloric intake, weight gain, and compensating by cutting
back. The experimenters also measured changes in core body temperature, a
physiological assessment. Normally when we prepare to eat, the metabolic
engine revs up. However, rats that had been trained to respond using
saccharin (which broke the link between sweetness and calories), relative to
rats trained on glucose, showed a smaller rise in core body temperate after
eating a novel, sweet-tasting, high-calorie meal. The authors think this
blunted response both led to overeating and made it harder to burn off
sweet-tasting calories.
“The data clearly indicate that consuming a food sweetened with
no-calorie saccharin can lead to greater body-weight gain and adiposity than
would consuming the same food sweetened with a higher-calorie sugar,” the
authors wrote. The authors acknowledge that this outcome may seem
counterintuitive and might not come as welcome news to human clinical
researchers and healthcare practitioners, who have long recommended low- or
no-calorie sweeteners. What’s more, the data come from rats, not humans.
However, they noted that their findings match emerging evidence that people
who drink more diet drinks are at higher risk for obesity and metabolic
syndrome, a collection of medical problems such as abdominal fat, high blood
pressure and insulin resistance that put people at risk for heart disease
and diabetes.
Swithers and Davidson wrote that sweet foods provide a “salient orosensory
stimulus” that strongly predicts someone is about to take in a lot of
calories. Ingestive and digestive reflexes gear up for that intake but when
false sweetness isn’t followed by lots of calories, the system gets
confused. Thus, people may eat more or expend less energy than they
otherwise would. The good news, Swithers says, is that people can still
count calories to regulate intake and body weight. However, she sympathizes
with the dieter’s lament that counting calories requires more conscious
effort than consuming low-calorie foods. Swithers adds that based on the
lab’s hypothesis, other artificial sweeteners such as aspartame, sucralose
and acesulfame K, which also taste sweet but do not predict the delivery of
calories, could have similar effects. Finally, although the results are
consistent with the idea that humans would show similar effects, human study
is required for further demonstration.
ASHES appoints new board members
The
American Society of Healthcare Environmental Services (ASHES) announced the
appointment of Brett Higgins, CHESP, director of environmental services at
Genesis Health System in Davenport, IA, and Bill Slezak, healthcare segment
manager for Rubbermaid Commercial Products in Winchester, VA, to the ASHES
board of directors. Higgins’ and Slezak’s appointments are effective
immediately. They will serve a one-year term that will run through 2008.
Higgins was appointed vice president of the ASHES board of directors and
will also serve on the executive committee. Higgins has over 20 years in
healthcare environmental services. An ASHES member since 1998, Higgins has
served two terms on the board, most recently as president and past
president. His term as vice-president will be his last with the board.
Slezak will also be serving on the executive committee and as ASHES Industry
Liaison. Slezak’s appointment will fill a previous vacancy on the executive
committee and will bring service experience and a passion for healthcare and
environmental services to the board providing increased depth to the group.
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