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 |
