March 5, 2010   Download print version

Bill eyes hospital charges, rates would be set by commission

21 hospital workers fired for being blizzard no-shows

Radiation risks prompt push to curb CT scans

Salmonella scare leads to FDA recall of processed foods

Could anti-inflammatory drugs break link between fat, diseases?

Complex communication inhibits the delivery of safe healthcare

If you take simvastatin to control cholesterol, watch out for infection says new report

Kaiser Permanente completes electronic health record implementation

Bill eyes hospital charges, rates would be set by commission

New Hampshire - The state's hospitals are worried about a proposal in the Legislature that would establish a government commission to set hospital rates. Supporters of the bill say it would cut healthcare costs, while opponents say it amounts to a government takeover of healthcare and will not accomplish its goals.

State Sen. Maggie Hassan (Dem.), sponsored the bill that would create a "cost review commission." She says the commission would improve competition among insurers, stop hospitals from charging higher rates for uninsured patients and spread the burden of paying for uncompensated care more evenly. "The notion is somewhat similar to what the Public Utilities Commission does with energy costs," she said. "The real goal here is to have small businesses and consumers afford health care."

But hospitals say the measure will create an expensive bureaucracy without addressing the core reasons why healthcare costs are so high. "The overhead associated with the cost of a commission of this nature is staggering," said Concord Hospital CEO Mike Green. "The fact that it only applies to hospitals means I don't know how it can succeed."

State Republicans have dubbed the plan "Maggiecare," a takeoff on the national healthcare plan opponents refer to as "Obamacare." The 4,700-word bill would create a three-person commission, appointed by the governor, to set rates for procedures in every New Hampshire hospital. The rates would be different for each hospital, but hospitals would need to charge the same amount to all their patients, regardless of whether they had insurance. The rates would take into account factors such as the number of Medicaid patients a hospital serves and the amount of charitable care it provides. The commission could set methods for payment that reward efficiency and coordination of care.

The commission's cost would be divided among the state's hospitals, based on their operating revenue. The commission would be created in September 2010 and could begin setting rates by late 2011, Hassan said. Beginning in 2012, the hospitals would have to pay $3.5 million a year.

The commission would be tasked with ensuring that rates are "related reasonably" to the cost of providing the service and to the hospital's total costs, that all payers are treated equally, that hospitals are compensated for charity care, and that they are paid based on quality and efficiency. Hospitals would need permission from the commission to change their rates.

Hassan said the price of services can now vary by up to 70 percent among hospitals. "This would begin to put a referee in the playing field," Hassan said. "We have a disorganized system in which everyone is trying very hard to protect their companies or their hospitals, but we have nobody who's really speaking for the consumer." Hassan said the commission would also bring transparency to the process by allowing a detailed public examination of what drives up healthcare costs.

Hospitals are vehemently opposed to the bill. Green said that in addition to paying the fee for the commission, hospitals will have to add administrative staff and pay for lawyers and accountants. At the same time, Green said, it is not clear from the bill whether hospitals would be allowed to make enough of a profit to invest money into buying new technology or replacing facilities.

Green disputed the idea that the bill would result in cheaper care. The commission would not set rates for surgery centers, laboratories or doctors in private practice, nor would it regulate insurance company profits. The bill also would not address the major reason why insurance premiums are so expensive, he said - the state does not pay hospitals enough money to cover services for Medicaid patients, so hospitals have to find money elsewhere.

The New Hampshire Hospital Association and the New Hampshire Medical Society, which represents doctors, are also opposed to the bill. It would be "one more infringement by government into the practice of medicine," said Palmer Jones, executive vice president of the Medical Society.

Only one state, Maryland, has a similar system. Since 1971, Maryland's Health Services Cost Review Commission has set rates for all the state's hospitals. Unlike the plan envisioned in New Hampshire, Maryland gets a federal waiver that allows the commission to set rates not only for private payers but also for patients on Medicare and Medicaid. The Maryland commission has a staff of about 30, with a budget of about $5 million a year, paid for by the hospitals through a fee incorporated in their rates.

Ed Beranek, director of regulatory compliance for the Johns Hopkins health system in Maryland, said the system has helped patients by keeping costs down. On the positive side, Beranek said, the costs of uncompensated care are spread more widely, patients do not have to worry about "irrational discounting" to insurance companies, and the commission adjusts rates annually so hospitals can increase theirs as costs rise. On the other hand, Beranek said, doctors are paid less than they are elsewhere, and hospital profits tend to be lower than the national average. Visit the Concord Monitor for the article.

21 hospital workers fired for being blizzard no-shows

Washington Hospital Center fired eight more employees this week after they failed to show up for work during last month's crippling snowstorms. The hospital announced that it has also rehired three of the 16 workers it had terminated. Hospital President Harrison J. Rider III announced in a letter to staff members Wednesday, just days after he acknowledged the first round of firings, that after a review of employees who did not make it in during the record-breaking snowstorms that hit the region between Feb. 5 and Feb. 11, it was concluded that 15 nurses and six members of the support staff should be terminated.

"While I am very pleased that we found merit in some of the cases we reviewed, we have not found any redeeming circumstances in the behavior of the others, so we are proceeding with the dismissals of 21 total associates," Rider wrote.

Representatives of the nurses' union, Nurses United of the National Capital Region, said they remain "mystified" over the firings. At least two of the terminated nurses had more than 30 years experience at the hospital. The union filed a class-action grievance with the hospital last week.

"We remain bewildered that the employer would depart from practices that go back over 30 years in how snow emergencies are handled," said the union's chief shop steward, Stephen Frum. Cheryl Peterson, director of nursing practices and policy for the American Nurses Association, said she has not heard of any other hospital in the nation taking similar action. Rider, who stayed at the hospital through both blizzards, said the number of inpatients at the facility grew from 675 to 740 during the weather emergency, when 90 babies were delivered. Hospital officials would not say how many employees faced other disciplinary actions, such as suspensions.

Daniel Fields Jr., president of SEIU 722, which represents the hospital's non-professional employees, including janitorial and clerical staff, said many members were suspended without pay for the amount of time they missed, including a legally blind man who could not get to the operating room where he works because Metro's bus service for the disabled was not running. That man, whom Fields said he could not identify because he feared for the man's job, also could not walk to work because he's had both hips replaced. A hospital spokesman said she could not comment on individual cases. Visit the Washington Post for the article.

Radiation risks prompt push to curb CT scans

For millions of patients, a CT scan can mean the difference between life and death, detecting a brain tumor, blood clot or burst appendix in seconds. But federal regulators, radiology groups and hospitals are launching efforts to scale back use of the scans, also called CAT scans, amid growing evidence that they are exposing millions of patients to radiation that may elevate the risk of cancer in the future. A third or more of scans may be unnecessary or repetitive, studies show, and in scans that are medically appropriate, radiation doses could be dramatically reduced without hurting the quality of images.

New clinical decision support tools help doctors decide whether or not a CT scan is necessary based on medical evidence. Nuance Health Care, for example, licensed a program developed by Massachusetts General Hospital to create RadPort, which contains more than 15,000 continuously updated rules based on guidelines from the American College of Radiology and others. Appropriateness is ranked on a scale of one to nine, giving doctors green, yellow and red lights accordingly as well as alternate procedures to consider.

Combining special X-ray equipment with sophisticated computers, CT—for computed tomography—produces vivid cross-sectional pictures of organs, bone, soft tissue and blood vessels with far greater clarity and detail than regular X-ray exams—but at 50 to 500 times the radiation dose. The number of CT scans in the U.S. has skyrocketed to about 70 million a year from just three million annually in 1980. A study in the Archives of Internal Medicine estimated that 29,000 future cancers could be related to CT scans performed in the U.S. in 2007 alone.

The Food and Drug Administration (FDA) recently announced a broad initiative to reduce unnecessary radiation exposure from all medical imaging, and is developing new safety requirements for manufacturers of CT devices. It also said it will support "informed clinical decision making" programs that prompt doctors to think twice before ordering a scan whose risk may outweigh its benefit.

"If a CT scan is medically warranted, the benefit is going to completely outweigh the risk," says David Brenner, director of Columbia University's Center for Radiological Research in New York. Too often scans are ordered because they are quick and easy, because a doctor fears a lawsuit from a missed diagnosis, or owns a scanner and directly benefits from its use, he says. Moreover, "patients may put the pressure on to get a CT scan," Dr. Brenner says. Dr. Brenner co-authored a study in the New England Journal of Medicine in 2007 estimating that 20 million adults and one million children are being irradiated unnecessarily and up to 2% of all cancers in the U.S. at present may be caused by radiation from CT scans, based on data extrapolated from atomic bomb survivors in Japan. The American College of Radiology says equating the CT scans and atomic exposure is faulty, and that there is still no direct evidence linking CT scan radiation to cancer.

"Someone who comes in with a stroke could die today, but if they are worried about a cancer 30 years from now they may refuse a life-saving scan," says James Thrall, chairman of the American College of Radiology's Board of Chancellors and chief radiologist at Massachusetts General Hospital in Boston. That said, Dr. Thrall says patients should ask doctors whether a scan is necessary, what the risks and benefits are, and whether there is an alternative test that doesn't use radiation such as ultrasound, which relies on sound waves, or magnetic resonance imaging, which uses powerful magnets and radio-frequency waves. The College is working on a national registry to the track the radiation dose that patients receive from CT scans nationwide, which will allow facilities to compare their rates to others. Visit the Wall Street Journal for the article.

Salmonella scare leads to FDA recall of processed foods

Numerous food products are being recalled due to possible salmonella contamination in a widely used flavor enhancer, hydrolyzed vegetable protein (HVP), the FDA has announced. HVP, a relative of MSG, enhances savory flavors in processed foods such as soups, hot dogs, chili, stews, dips, salad dressings and other snack foods.

"We don't know precisely how large this recall will get, but we expect this to get larger over the next several days to several weeks," Jeff Farrar, FDA associate commissioner for food protection said at a Thursday press conference.

The contamination was detected several weeks ago in HVP produced by Basic Food Flavors Inc. of Las Vegas, NV, and made known to the FDA through the newly-instituted Reportable Food Registry. Since then, the FDA has confirmed salmonella contamination at Basic Food Flavors' plant, and all HVP produced by the facility since Sept. 17, 2009, is subject to recall. As of Thursday afternoon, nearly 30 products had been recalled. For a full list of recalled items, see the FDA's site www.foodsafety.gov.

Because the FDA requires that the flavoring be declared on the packaging, consumers will be able to tell which products contain HVP, it will be noted on the ingredients list. However, the FDA said in a press release Thursday that consumers will be unable to tell which HVP-containing foods might be dangerous just by reading food labels. The labels do not say which items have HVP manufactured by Basic Food Flavors, Inc. Visit ABC News for the article.

Could anti-inflammatory drugs break link between fat, diseases?

What if you could be fat but avoid heart disease or diabetes? Scientists trying to break the fat-and-disease link increasingly say inflammation is the key. In the quest to prove it, a major study is underway testing whether an anti-inflammatory drug — an old, cheap cousin of aspirin — can fight the Type 2 diabetes spurred by obesity. And intriguing new research illustrates how those yellow globs of fat lurking under the skin are more than a storage site for extra calories. They're a toxic neighborhood where inflammation appears to be born.

Diabetes and heart disease usually tag along with extra pounds, a huge risk for the two-thirds of Americans who are overweight or obese. What isn't clear is what sets off the cascade of damage that ends in those illnesses. After all, there are examples of obese people who somehow stay metabolically fit — no high blood pressure or high blood sugar or high cholesterol.

"If fat cells functioned perfectly, you could be as obese as you want and not have heart disease," says Dr. Carey Lumeng of the University of Michigan. "It's something we don't understand, why some people are more susceptible and others are not so susceptible."

Solving that mystery could point to more targeted treatments for obesity's threats than today's effective but hard-to-follow advice to lose weight. The chief suspect: Inflammation that the immune system normally uses to fight infection runs amok with weight gain — simmering inside fat tissue before spreading to harm blood vessels and spur insulin resistance.

Dr. Steven Shoelson at the Harvard-affiliated Joslin Diabetes Center noted reports from 150 years ago that one of the oldest anti-inflammatories around — salsalate, from the aspirin family — could lower blood sugar. Less harsh on the stomach than aspirin, generic salsalate is used today for arthritis, and Shoelson discovered that it inhibits what he calls a master switch in inflammation regulation.

Pilot trials found short-term use of salsalate, added to regular diabetes medication, helped poorly controlled Type 2 diabetics lower their blood sugar substantially. Fasting glucose levels dropped from about an average of 150 down to 110, Schoelson says. Now an NIH-funded study is recruiting several hundred Type 2 diabetics at 21 medical centers around the country to take the drug or a dummy pill for a year, to track long-term effects.

But what sparks that inflammation in the first place? Other researchers are hot on the trail of immune cells called macrophages that cluster inside fat tissue. The more pounds you put on, the bigger fat cells called adipocytes become until they release fatty acids and eventually die. The theory is that macrophages come in to clean up the dead cells but are hijacked to produce inflammation-causing chemicals — signals that also spur further adipocyte dysfunction.

"Four to five years ago, no one thought fat tissue matters for this stuff," adds Michigan's Lumeng, who studies the macrophage link. "There clearly are going to be anti-inflammatory therapies for diabetes coming out of the pipeline. Visit USA Today for the article.

Complex communication inhibits the delivery of safe healthcare 

According to the Joint Commission, communication is cited as a root cause in nearly 70% of reported sentinel events, surpassing other commonly identified issues such as staff orientation and training, patient assessment, and staffing. The increasingly complex healthcare environment can complicate the communication process and hinder the information exchanges necessary for optimum care.

In honor of National Patient Safety Awareness Week, March 7-13, 2010, ECRI Institute, an independent, nonprofit organization that researches the best approaches to improving patient care, is providing free access to web-based resources to help healthcare professionals face communication issues in their organization. This free Risk Analysis, a publication of ECRI Institute’s Healthcare Risk Control System, provides examples of communication breakdowns that can affect patient outcomes and patient safety and result in liability claims and other potential losses for healthcare organizations. It reviews strategies for improving communication and teamwork, suggests ways to comply with the Joint Commission’s National Patient Safety Goals related to communication, and provides action recommendations to improve communication and teamwork among healthcare providers and other staff. In addition, information on resources and toolkits is provided to assist risk managers in enhancing communications, improving patient safety, and reducing risk in their organizations.

The Communication Risk Analysis is available for free download from March 7-13, 2010, from ECRI's Patient Safety Center Web site. The Patient Safety Center also contains free resources that patient safety professionals can access throughout the year, including reports on the Centers for Medicare & Medicaid Services final rule on hospital-acquired conditions, medical technology issues, surgical fire prevention, and more. Healthcare professionals can download the full Risk Analysis, “Communication,” from ECRI Institute’s Patient Safety Center Web site at www.ecri.org/patientsafety.

If you take simvastatin to control cholesterol, watch out for infection says new report

New research published in the Journal of Leukocyte Biology suggests that simvastatin negatively impacts the immune system's ability to clear infection and control inflammation in the presence of bacteria. Simvastatin might help us control our cholesterol, but when it comes to infection, it's an entirely different story says the study. In the research report, scientists from Italy show that simvastatin delivers a one-two punch to the immune system. First it impairs the ability of specialized immune cells, called macrophages, to kill pathogens. Then, it enhances production of molecules, called cytokines, which trigger and sustain inflammation.

"Statins are key drugs in the primary and secondary prevention of cardiovascular disease," said Cosima T. Baldari, Ph.D., a scientist from the Department of Evolutionary Biology at the University of Siena in Siena, Italy, who was involved in the research. "Our understanding of how these drugs affect the immune system should help maximize the benefits of these excellent drugs."

To make this discovery, the researchers conducted experiments using human cells and then followed up by conducting additional experiments in mice. They used human macrophages derived from blood samples of healthy donors and murine (mouse) macrophages. The macrophages were incubated with Staphlococcus aureus, a pathogen commonly found on the skin and in the upper airways. Once the infection manifested, researchers analyzed the bactericidal response of macrophages treated with simvastatin. Results showed that the treated macrophages were significantly impaired in both the removal of the pathogen and related cell debris and the killing of ingested bacteria compared to untreated cells. Additionally, the treated cells produced higher amounts of cytokines, which are responsible for triggering and sustaining inflammation. The same experiment was conducted in vivo, using mouse models, with similar results.

"Statins are lifesavers, but there might be room for improvement," said John Wherry, Ph.D., Deputy Editor of the Journal of Leukocyte Biology. "Studies like this help pave the way for researchers to develop newer versions of drugs like statins that are more specific for their intended effect increasing the benefits of these pharmaceuticals." Visit PhysOrg.com for the article.

Kaiser Permanente completes electronic health record implementation

Kaiser Permanente announced that every medical facility within the health system is now equipped with Kaiser Permanente HealthConnect, the largest private sector electronic health record in the world. Kaiser Permanente hospitals in Oakland, Richmond and Vallejo in Northern California are the most recent facilities to complete the final phase of electronic health record implementation, which includes bedside documentation, clinical decision support and bar-coding for medication administration. 

KP HealthConnect provides care teams with access to patient information and the latest best practices all in one place to further enhance patient safety and quality care while increasing convenience and coordination. The comprehensive health information system securely connects more than 8.6 million people to their physicians, nurses, and pharmacists, personal information, and the latest medical knowledge. Combined with Kaiser Permanente’s integrated approach to health care, KP HealthConnect helps facilitate collaboration among both primary and specialty care teams. 

In addition to increasing communication and data sharing among care teams, KP HealthConnect also empowers patients to manage their own health. My Health Manager on kp.org provides secure access to a personal health record that includes shared access to the KP HealthConnect clinical record and tools designed to help members connect to the people and services they need to stay healthy. Through My Health Manager, Kaiser Permanente members have timely access to their lab test results, medication information and refill capabilities, summaries of their health conditions, and other important health information at just the click of a mouse. The technology also allows members to securely e-mail their doctor, often saving them the inconvenience of having to go to a physician’s office, or wait on hold to speak with a doctor on the phone. More than 3 million Kaiser Permanente members are using My Health Manager, with more than 27 million logins to the system documented in 2009 alone.

Earlier this week, the Health Information Management System Society honored Kaiser Permanente for their hospital-based implementation. HIMSS Analytics created the EMR Adoption Model to measure health IT adoption across all 2400 hospitals in the US. By the end of 2009, 39 hospitals were recognized for achieving the highest state of implementation; 24 of those are Kaiser Permanente hospitals. With the final implementation of KP HealthConnect, it is expected that many, if not all, of the remaining Kaiser Permanente hospitals will be recognized as Stage 7 hospitals in 2010.

Kaiser Permanente is also working with other healthcare organizations, such as the U.S. Department of Veteran’s Affairs, to determine ways to securely share patient information from KP HealthConnect through the National Health Information Network when patients are under the care of multiple health systems, and provide permission for record sharing. This data sharing helps reduce redundancies and ensures that each care team treating the patient has the complete, up-to-date clinical information necessary to provide quality care.  Visit here for more information.

March 4, 2010   Download print version

Obama steps up healthcare pressure

Early test for a killer of the sickest

Concerns over ‘metal on metal’ hip implants

Total fat, trans fat linked to higher incidence of ischemic stroke

FDA classifies Baxter's HomeChoice Peritoneal Dialysis Cycler corrective action as a Class I Recall

Ex-hospital official fined in conflict of interest case

FDA warns consumers in Puerto Rico of harmful bacteria in hand sanitizers

Analgesics contribute to hearing loss, study finds

Staffing woes hinder healthcare job-boosting program

Obama steps up healthcare pressure

President Obama increased the pressure on Congress yesterday to take an up-or-down vote on his healthcare package, calling on Senate Democrats to bypass a Senate filibuster and revive the stalled legislation over the objections of Republicans. Despite polls that signal that strategy holds dangers for Democrats, the president is gambling that the voters who sent him to office want action on healthcare and share his impatience with inaction in Washington.

The president did not utter the words “budget reconciliation,’’ shorthand for the parliamentary tactic used to attach legislation to a budget bill that can pass by a simple majority of 51 votes, rather than the 60 needed to overcome an expected GOP filibuster. But his demand for the controversial option was clear, and many Democrats consider it their only hope to pass a sweeping healthcare overhaul. Obama ticked off a variety of other initiatives that previously have been passed by majority parties using budget reconciliation in the Senate, including welfare reform and tax cuts.

The House majority leader, Maryland Democrat Steny Hoyer, acknowledged that it would take a leap of faith for House Democrats to vote in favor of the previously approved Senate bill, based on a promise of a successful simple-majority budget vote in the Senate. Further aggravating the negotiations is a growing resentment of the Senate by House members, who feel they passed controversial pieces of legislation last year - a climate bill, a Wall Street regulatory overhaul, and healthcare - only to have them languish in the Senate.

Obama yesterday enumerated what he sees as the benefits of reform - new curbs on the insurance industry, broader coverage, reducing premiums - a list apparently meant to provide Congress with a moral foundation for speedy action, and a rationale for the bill to an American public that has witnessed a yearlong contentious debate. The president emphasized the need to change many rules at once because of the interlocking nature of proposed insurance reforms, and to require that people purchase insurance, which is expected to expand coverage to 31 million people who lack it now. Republican proposals would result in 3 million newly insured people, he said. Obama also said he had adopted some ideas to reduce medical fraud and waste, proposals put forth by Republicans at an extraordinary summit meeting between Obama and leaders from both parties last week. Visit the Boston Globe for the article.

Early test for a killer of the sickest

An early test for fungal infections that measures how a patient's genes are responding could save the lives of some very sick patients. Researchers at Duke University's Institute for Genome Sciences & Policy have devised an early gene-expression test for the fungal pathogen Candida that worked in mice. It is an entirely new and more rapid way to reveal an infection which occurs in very sick or immunocompromised patients, particularly critical care patients. Candidemia can kill 10-15 percent of critically ill patients within the first 24 hours of infection. If the disease goes undetected for up to three days, the mortality rate rises to 30 percent. Now that the gene-based test has worked well in mice, the Duke scientists are gathering human specimens to devise a similar test to be used in people.

"This study provides the basis for development a blood-gene expression test in humans to detect a life-threatening infection earlier than can be done using currently available methods," said Geoffrey Ginsburg, M.D., Ph.D., director of Duke University's Center for Genomic Medicine in the Institute for Genome Sciences & Policy, professor of medicine, and the senior author of the study. "Earlier detection will lead to earlier treatment and save lives. This work is also part of a portfolio of blood gene-expression-based tests we are developing to detect viral, bacterial and now fungal infections that will lead to more precise diagnosis and more appropriate therapies for infectious disease. This is personalized medicine."

The findings, which appear in the journal Science Translational Medicine, mark the beginning of an entirely new way of diagnosing infectious disease, said co-lead author Aimee Zaas, M.D., assistant professor of medicine in the Duke Division of Infectious Diseases and International Health, and the Duke Institute for Genome Sciences & Policy. "We are redefining the way that physicians identify infectious disease using a combination of host-based blood RNA tests with traditional microbiology methods."

One of the challenges in diagnosing candidemia is that it often appears to be similar in symptoms to other serious bloodstream infections. To discriminate whether a patient has a bloodstream fungal infection versus a bacterial infection often can take 48 to 72 hours until blood culture tests are completed and even then the results may only be positive 50 percent of the time. People most at risk for candidemia include patients hospitalized in intensive care units, those who've had abdominal surgery, those receiving antibacterial therapies, those with central line catheters, and those who are immunosuppressed.

The team of scientists sees the findings as a jumping off point for producing gene-expression signatures to detect a number of infections. They pursued the candidemia test first because of the high mortality rate in hospitalized patients with that hard-to-treat infection. Visit Science Daily for the article.

Concerns over ‘metal on metal’ hip implants

Some of the nation’s leading orthopedic surgeons have reduced or stopped use of a popular category of artificial hips amid concerns that the devices are causing severe tissue and bone damage in some patients, often requiring replacement surgery within a year or two. In recent years, such devices, known as “metal on metal” implants, have been used in about one-third of the approximately 250,000 hip replacements performed annually in this country. They are used in conventional hip replacements and in a popular alternative procedure known as resurfacing. The devices, whose ball-and-socket joints are made from metals like cobalt and chromium, became widely used in the belief that they would be more durable than previous types of implants.

The cause and the scope of the problem are not clear. But studies in recent years indicate that in some cases the devices can quickly begin to wear, generating high volumes of metallic debris that is absorbed into a patient’s body. That situation can touch off inflammatory reactions that cause pain in the groin, death of tissue in the hip joint and loss of surrounding bone.

Doctors at leading orthopedic centers like Rush University Medical Center in Chicago and the Mayo Clinic in Minneapolis say they have treated a number of patients over the last year with problems related to the metal debris. Artificial hips, intended to last 15 years or more, need early replacement far more frequently for reasons like dislocation than because of problems caused by metallic debris. But surgeons say that when metal particles are the culprit, the procedures to replace the devices can be far more complex and can leave some patients with lasting complications.

All the major orthopedics makers sell these devices. Several companies said in statements that the implants did not pose a significant risk and that the incidence of metal debris problems was extremely low. For example, Zimmer Holdings, one of this country’s biggest producers of artificial joints, said in a statement that published data “suggests that ion release levels from Zimmer’s metal-on-metal hip systems are commensurate with other metal-on-metal systems in the industry, and are not associated with significant risk to patients.”

But some surgeons are concerned that they may only now be seeing the leading edge of a mounting problem. The current generation of metal-on-metal devices is still relatively new, having been used increasingly over the last decade.

Surgeons at Rush University Medical Center have performed about two dozen replacement procedures because of metal debris over the last year, said Dr. Joshua J. Jacobs, the head the orthopedic surgery department there. A similar number of patients have had metal-on-metal hips removed at the Mayo Clinic, according to Dr. Daniel J. Berry, Mayo’s head of orthopedic surgery.

Dr. Berry added that surgeons at the Mayo Clinic had reduced by 80 percent their use of metal-on-metal implants over the last year in favor of those made from other materials, like combinations of metal and plastic. Other doctors said that to be cautious they were also scaling back their use of the all-metal implants until the scientific evidence became clearer.

It is not clear whether some makers’ devices are more prone to the debris problem than others. But some experts argue that some manufacturers, in a rush to meet the demand for metal-on-metal devices, marketed some poorly designed implants and that some doctors fail to properly implant even well-designed ones.

“It is a sad travesty,” said Dr. Harlan C. Amstutz, an orthopedic surgeon in Los Angeles who helped pioneer hip resurfacing. “It is design-related and it is technique-related.” Dr. Amstutz, who developed a hip-resurfacing system sold by the Wright Medical Group, said he believed that resurfacing, which typically uses all-metal components, was safe. The procedure, which preserves more thigh bone than in a conventional hip replacement, is aimed at younger, more active patients who may need several hip replacements in their lifetimes.

Several orthopedic surgeons agreed that the procedure was generally safe. But those doctors said they were limiting resurfacing procedures to men under 55 with strong bones because other patients, including women, did not have good outcomes.

One hip device company, Smith & Nephew, which markets an implant called the Birmingham hip resurfacing system, said that data from an implant registry in Australia showed that fewer than 1 percent of patients using that product had reactions to metal. Another major producer, the DePuy Orthopaedics division of Johnson & Johnson, said that, “as with other materials, metal-on-metal wear debris may cause soft tissue reaction in the area of a hip implant in a small percentage of cases.” Visit the New York Times for the article.  

Total fat, trans fat linked to higher incidence of ischemic stroke

Post-menopausal women who reported consuming the most daily dietary fat had a 40 percent higher incidence of clot-caused strokes compared to women who ate the least amount, according to research presented at the American Stroke Association's International Stroke Conference 2010. The incidence of ischemic stroke also increased by 30 percent in the quartile of women consuming the highest daily amount of trans fat (average intake 7 grams per day) compared to those who consumed the least (average 1 gram/day). Two common sources of trans fat are processed foods and fried foods. Ischemic strokes are caused by blockages in blood vessels in or leading to the brain.

The study is the first to examine the associations of different fats and different subtypes of ischemic stroke in post-menopausal women, who face a higher stroke risk than men of a similar age. Evidence from other studies shows that different types of fat have different effects on the incidence of coronary heart disease (CHD), with trans fat implicated in the development of CHD. However, studies of ischemic stroke and fat have been inconclusive, possibly because earlier studies had small numbers of ischemic stroke cases. Researchers looked for links between dietary fat intake and four ischemic stroke subtypes, which were characterized by their size or point of origin. Researchers divided the women into quartiles based on the amount of total dietary fat and types of fat (saturated fat, monounsaturated fat, polyunsaturated fat and trans fat) they reported consuming per day. Women in the top quartile for total fat intake had an average intake of 86 grams of total fat per day. Those in the lowest quartile consumed an average of 26 grams a day. Visit the American Heart Association for the article.

FDA classifies Baxter's HomeChoice Peritoneal Dialysis Cycler corrective action as a Class I Recall

Baxter Healthcare Corporation announced that the FDA has classified Baxter’s recent Urgent Product Recall regarding Increased Intraperitoneal Volume (IIPV), or overfill of the abdominal cavity, associated with HomeChoice and HomeChoice Pro peritoneal dialysis cyclers as a Class I recall. This action has been classified as a Class I recall because of the risk of serious injury or patient death that could be associated with the use of this device. Over the last two years, Baxter has received serious injury reports and at least one patient death report associated with this issue.

IIPV may result in serious injury or death from conditions such as: abdominal wall and/or diaphragmatic hernias, hydrothorax, heart failure, acute hypertension, pulmonary edema, decreased pulmonary function and pericardial effusion. Children and non-verbal patients may be at increased risk because of their smaller size and/or inability to communicate. Increased monitoring of these patients is recommended. Other vulnerable populations include critically ill patients and patients with pulmonary and hemodynamic instability.

Patients and caregivers should watch for the potential signs of IIPV. These include: difficulty breathing; vomiting or spitting up; a child complaining of a “funny feeling” in the abdomen; a child crying during therapy without other apparent reasons; difficulties feeding; feeling full, bloated, or overfilled after treatment; abdominal pain or discomfort; expanded or tense abdomen; localized swelling around the genital area (labia, scrotum) or groin region, belly button, the tunnel tract of the peritoneal dialysis catheter or the PD catheter exit site; leakage of fluid from the PD catheter exit site; and unexpected increase in blood pressure.

If patients or caregivers notice any of these symptoms, they should stop the device, initiate manual drain, and contact their healthcare provider immediately. Additional information that will be relevant in assessing patients for IIPV includes: careful monitoring of pre- and post-treatment weight; evaluating vital signs including heart rate and blood pressure; review of the recorded ultrafiltration from the device; and development of symptoms of respiratory distress or increased effort in breathing. For patients in a clinic, hospital, or critical care setting, clinicians should consider increased monitoring. This would include evaluating oxygen saturation and evidence of abdominal tenseness.

Baxter is continuing to investigate the causes, fixes, and mitigations associated with IIPV and use of the HomeChoice device. HomeChoice systems are intended for automatic control of dialysis solutions exchange in the treatment of adult and pediatric renal failure patients undergoing peritoneal dialysis. Visit Baxter for more information.

Ex-hospital official fined in conflict of interest case

A former board member of New York City’s public hospital system has been fined $13,500 for his role in soliciting coveted training spots in city hospitals for students from a Caribbean medical school, the city’s Conflicts of Interest Board said Tuesday. The former board member, Dr. Daniel D. Ricciardi, agreed to the fine in a settlement in which he admitted that he had held high-ranking paid positions at St. George’s University School of Medicine on the island of Grenada while soliciting clinical clerkships — a critical part of medical education — from personnel in the city hospital system that he also helped to lead.

Dr. Ricciardi, a rheumatologist and 1981 graduate of St. George’s, acknowledged that between January 2000, when he was appointed to the board of the Health and Hospitals Corporation, and August 2008, when he resigned after The New York Times disclosed the potential conflict, he had served in positions at St. George’s including dean of clinical studies, chair of medicine and director of medical education.

During the same period, he said, he had contacted personnel at Kings County Hospital Center, Metropolitan Hospital Center, Woodhull Medical and Mental Health Center, Lincoln Medical and Mental Health Center, and Elmhurst Hospital Center to try to get them to increase the number of placements available to St. George’s students, a violation of prohibitions against representing a private interest before his public agency.

The $13,500 fine, which includes multiple violations, being paid by Dr. Ricciardi is relatively high for the conflicts board. Its highest settlement was $20,000, and five-figure fines are rare, an official said. He said in the settlement that he was aware that St. George’s, a profit-making school, had contracted since 1977 with several city public hospitals to train its third- and fourth-year medical students through so-called clinical clerkships. In 2007, St. George’s entered into a 10-year, $100 million contract intended to provide training for hundreds of its students across the city hospital system. The contract also banned city hospitals from providing clerkships to competing Caribbean medical schools.

The Health and Hospitals Corporation said at the time that it had agreed to the contract because it needed the money. But New York-based medical schools complained that traditionally they had been charged at most a nominal amount for clerkships and that St. George’s was turning an academic relationship into a financial one. Visit the New York Times city blog for more information.

FDA warns consumers in Puerto Rico of harmful bacteria in hand sanitizers

The U.S. Food and Drug Administration is warning consumers in Puerto Rico that two hand sanitizers – "Bee-Shield Hand Sanitizer” with Aloe Vera (10 fl. oz. or 1 gallon bottles) and “MD Quality Hand Sanitizer” with Aloe Vera (10 fl oz. bottles) – contain high levels of a bacteria, Burkholderia cepacia, that can cause serious infections in humans. The products are manufactured by Puerto Rico Beverage Inc. of Maunabo, and distributed by Lord Pharmaceuticals LLC, Bee International Distributors, and Morales Distributors Inc. The hand sanitizers are distributed only in Puerto Rico.

Burkholderia can cause harm when hand sanitizers are used on skin with cuts or abrasions. Infections caused by the microbe that begin in the skin may progress farther into the body and require medical or surgical attention. A recent FDA inspection of the Puerto Rico Beverage facility found serious problems in meeting the FDA’s current Good Manufacturing Practice requirements. Visit the FDA for more information.

Analgesics contribute to hearing loss, study finds

Perhaps it wasn't those years of listening to rock 'n' roll that damaged my hearing after all. New research suggests that regular use of aspirin, acetaminophen and other analgesics can substantially increase the risk of hearing loss, especially in men younger than 50. Researchers report in the American Journal of Medicine that use of acetaminophen more than twice a week by such men doubles the risk of hearing loss, use of ibuprofen and related non-steroidal anti-inflammatory drugs (NSAIDs) increases the risk by nearly two-thirds, and regular use of aspirin increases it by about a third.

Hearing loss is the most common sensory disorder in the United States, afflicting more than 36 million people. It is prevalent in the elderly, but about a third of those ages 40 to 49 already suffer some hearing loss. Common risk factors include loud noises, alcohol, hypertension, diabetes and the use of the diuretic furosemide. Studies in animals and anecdotal reports in humans indicate high doses of the analgesics can interfere with hearing, but there have been few studies looking at regular use and none studying acetaminophen (one brand name is Tylenol), according to the authors.

Dr. Sharon G. Curhan of Brigham and Women's Hospital in Boston and her colleagues studied 26,917 men enrolled in the Health Professionals Follow-up Study. Their ages ranged from 40 to 75 at enrollment in 1986. Controlling for a variety of other risk factors, the researchers found that among all men who used aspirin at least twice a week, there was a 12% increased risk of hearing loss. Among those who used ibuprofen and related analgesics, there was a 21% increase; for those who used acetaminophen, a 22% risk. But the risk was much higher when they considered only men younger than 50. In that group, there was a 33% increased risk for aspirin use, a 61% increase for ibuprofen and related NSAIDs, and a 99% increase for acetaminophen. Visit the Los Angeles Times for the article.

Staffing woes hinder healthcare job-boosting program

As Washington debates new job-creation initiatives, one federal program already in place is hitting obstacles to boosting employment—in part because the program itself could use some more staffers. A Federal Housing Administration program intended to help healthcare providers build facilities has been swamped by applications in recent months, slowing approval of more than $2 billion in construction projects that await loan financing. The projects would create a number of construction, healthcare and support jobs.

Through the FHA's Section 242 Hospital Mortgage Insurance construction loan program, started in 1968, the government backstops hospital construction projects by insuring the underlying mortgages, which are then funded through bond issues. Hospitals that usually benefit are smaller, rural ones whose creditworthiness is enhanced by the government backing.

The FHA says each construction dollar spent on the projects from 2007-09 generated $2.84 in overall economic activity. The program became increasingly important amid the credit crisis as many hospitals found it harder to secure financing. As a result, the Department of Housing and Urban Development's Office of Insured Health Care Facilities, which administers the program, has seen a surge in demand. The program typically insures about 10 projects a year. This year the office expects to insure 23, plus an additional seven for a new, related program. Currently, 21 applications worth $2.3 billion are under review.

The application holdup comes amid unprecedented government stimulus spending aimed at creating jobs, which over time has become a core purpose of the FHA program, but hinges in part on the FHA's inability to hire more people to keep pace. The program wants to hire more staff but is short of cash. According to the FHA, average processing times rose to 76 days in 2009 from 51 days in 2007. People familiar with the program place that figure near 120 days now.

Typically, a hospital reaches out to the FHA, which provides a list of banks that are active lenders in the program. After the hospital chooses a partner bank, the bank submits an application to the FHA. For approval, hospitals must fit certain criteria, such as having at least 20% of the mortgage going toward construction, and 10% of equity to contribute. After the application is reviewed, the hospital is notified by the FHA of eligibility.

The program is one of the few HUD insurance enterprises to turn a profit. Several people familiar with the program praised the FHA's lending standards, but some say the program could include more hospitals. The FHA notes that it was never intended to be the sole financing option for hospitals, and says loosening standards could create more of a backlog. Visit the Wall Street Journal for the article.

March 3, 2010   Download print version

Kimberly-Clark Health Care receives FDA clearance for KimGuard Onestep Sterilization Wrap usage with STERIS’s Amsco V-Pro Sterilization systems

Warning over wave of child eye injuries from liquid detergent capsules

Kidney injury linked to greater risk of death among pneumonia patients

Food-borne illnesses in U.S. cost $152B annually

The truth behind fish oil concerns

Parity law requires mental health benefits comparable to physical care benefits

HPN special HIMSS10 product coverage

Kimberly-Clark Health Care receives FDA clearance for KimGuard Onestep Sterilization Wrap usage with STERIS’s Amsco V-Pro Sterilization systems

Kimberly-Clark Health Care announced today that it has received 510(k) clearance from the Food and Drug Administration (FDA) to market the use of its KimGuard One-Step (KC 100-600) Sterilization Wrap in conjunction with the Amsco V-PRO 1 and Amsco V-PRO 1 Plus Low Temperature Sterilization Systems from STERIS Corporation.

The KimGuard One-Step (KC 100-600) Sterilization Wrap is made of strong Spunbond Meltblown Spunbond (SMS) nonwoven fabric, which features two layers of wrap that are ultrasonically seamed along two sides. By providing the protection of double-wrapping in a single step, the time to open or wrap sequential wrapping is cut in half, saving both time and money. Each grade of wrap features Kimberly-Clark Health Care’s exclusive Daisy bond pattern, providing easy identification from one wrap to another.

The STERIS V-PRO 1 and V-PRO 1 Plus Low Temperature Sterilization Systems can quickly process high volumes of heat and moisture-sensitive devices using vaporized hydrogen peroxide, an environmentally friendly sterilant. In addition to the single 55-minute automated cycle of the V-PRO 1 system, the new V-PRO 1 Plus sterilizer includes a second 28-minute cycle specifically for sterilizing non-lumened devices. This allows operators to enhance productivity by choosing the cycle that best matches the devices being sterilized. Both systems have a one-touch control that requires minimal training, and both are equipped with remote monitoring capabilities for increased uptime. For more information, please visit www.kchealthcare.com and www.steris.com.

Warning over wave of child eye injuries from liquid detergent capsules

In this week's BMJ, senior eye doctors are warning people to keep liquid capsules for fabric detergents out of the reach of children after a wave of eye injuries in young children at their hospital. Rashmi Mathew and Melanie Corbett from The Western Eye Hospital, Imperial College Healthcare NHS Trust in London report that last year chemical injuries associated with these capsules accounted for 40% of ocular chemical injuries in children under the age of five at their hospital. They also report that Guy's and St Thomas' Poisons Unit received 192 enquires related to the capsules during 2007-8 and 225 calls during 2006-7, a fifth of which related to ocular exposure.

The capsule in most liquid detergent capsules is a water soluble polyvinyl alcohol membrane, explains co-author Katherine Kennedy, senior chemist at Guy's Toxicology Unit in London. The liquid detergent is a mixture of three active agents - an anionic detergent, a non-ionic detergent, and a cationic surfactant - dissolved in water to give an alkaline solution, making the capsule more dangerous than initially perceived.

The authors warn that alkali injuries are the most severe form of chemical eye injury which can cause irreversible damage and have lifelong ramifications, such as constant discomfort, scarring and even amblyopia (lazy eye). They conclude: "After recent discussions with Guy's Poisons Unit, some manufacturers have made hazard labels more prominent. But greater consumer awareness is required to reduce injury. Such concentrated cleaning products must be kept out of the reach of children, and immediate irrigation is crucial to reduce the risk of clinically significant injury." Visit PhysOrg.com for the article.

Kidney injury linked to greater risk of death among pneumonia patients

Patients hospitalized with even mild to moderate community-acquired pneumonia who develop acute kidney injury (AKI) are more likely to die after discharge than pneumonia patients whose kidneys remain healthy, according to a University of Pittsburgh School of Medicine study in the February issue of Kidney International. The study also found a strong relationship between AKI and levels of inflammatory biomarkers.

Doctors have long known that sepsis, can trigger abnormalities in kidney function that contribute to higher mortality rates, but the impact of AKI in people with milder infections has not been well characterized, said lead author Raghavan Murugan, M.D., assistant professor in the Department of Critical Care Medicine at the University of Pittsburgh School of Medicine.

"Our study found that kidney injury was quite common among pneumonia patients whose illness course was otherwise uncomplicated," he said. "They also had a higher risk of dying that persisted even 50 to 100 days after admission, which is surprising because most appeared stable and ready for discharge after eight days in the hospital."

The data were gathered from more than 1,800 participants with community-acquired pneumonia in the multicenter Genetic and Inflammatory Markers of Sepsis (GenIMS) study. A third of all patients were diagnosed with AKI, identified by abnormal creatinine levels or urine output, either on the first day of admission or sometime during their hospital stays, as were a quarter of those with mild or moderate pneumonia. Also, a third of all the pneumonia patients progressed to severe sepsis, and of that group more than half developed AKI. Compared to those without kidney injury, AKI patients had longer hospital stays and a higher risk of dying at hospital discharge (11 vs. 1.3 percent), 90 days later (24 vs. 9.8 percent), and one year (36.3 vs. 20.1 percent) later.

Another key study finding is that pneumonia patients who also developed AKI had higher concentrations of biomarkers of inflammatory and blood coagulation pathways than those who did not have a kidney injury. "This suggests that the immune response in pneumonia is different in patients with AKI," Dr. Murugan said. "It may be a bidirectional relationship. A stronger immune response might have caused AKI or the response was a consequence of AKI, or it worked both ways." Visit e-Science News for the article.

Food-borne illnesses in U.S. cost $152B annually

Food-borne illnesses cost the United States an estimated $152 billion each year in health-related expenses, much more than previously thought, a new report contends. "These costs are significantly more than previous official estimates, and it demonstrates the serious burden that food-borne illness places on society," Sandra Eskin, director of the Food Safety Campaign at the Pew Charitable Trusts in Washington, DC, said during a Tuesday press conference. These health-related costs include physician services, hospital services, medicines and also quality-of-life losses, such as deaths, pain, suffering and disability.

Every year, an estimated 76 million Americans are sickened by contaminated food and 5,000 of these people die, according to federal statistics. Although most of these of costs are due to unidentified germs, infections from well-known pathogens play a large role. For example, costs related to campylobacter exceed $18.8 billion annually; costs linked to salmonella are estimated at $14.6 billion; and costs related to listeria are $8.8 billion, according to the report.

The majority of food-borne illnesses are caused by produce, which are regulated by the U.S. Food and Drug Administration. Thirty-nine percent of E. coli outbreaks were due to produce regulated by the FDA, the report said. According to the report, California, Texas, New York, Florida and Pennsylvania have the highest costs related to food-borne illness, ranging from $6.7 billion to $18.6 billion each year.

Eskin hopes the report will spur Congress to pass a food-safety bill that with strengthen the FDA's food-safety efforts by giving the agency more authority over the foods it regulates and more money to devote to making the food supply safer. The new report was sponsored by a variety of groups, including the Center for Foodborne Illness Research & Prevention, the Center for Science in the Public Interest, Consumers Union, the Pew Charitable Trusts, and Trust for America's Health. It was conducted by the Produce Safety Project at Georgetown University. Visit Healthday for the article.

The truth behind fish oil concerns

Fish oil supplements are constantly touted for their seemingly miraculous health benefits because they contain omega-3 fatty acids. But a new lawsuit contended that they may contain something else, too: PCBs, industrial chemicals that were banned in the 1970s because they caused cancer and birth defects. Environmental activists who tested 10 different fish oil supplements say each contained PCBs.

While people should always be concerned with exposure to toxins, the charges still need to be verified, ABC News' senior health and medical editor Dr. Richard Besser said. He explained that only one sample of each product was tested and more testing is needed to truly determine potential exposure. It should also be noted that requirement for product labeling in California is very conservative and the World Health Organization considers these levels of exposure to be safe, Besser said.

Consumers should not necessarily avoid the fish oil supplements because of PCB concerns, Besser said. But weighing the risk really comes down to how beneficial fish oil supplements are to the consumer, he said. For people with heart disease, omega-3 acids can greatly reduce the risk of heart attack or dying from heart failure, Besser said, adding that he would not advise heart patients to stop taking fish oil supplements based on the known information. But if someone has a low risk of heart disease and is concerned, then he or she could stop taking the supplements until further testing is done, Besser said. Instead, he suggested, follow the guidelines from the American Heart Association to find other sources of omega-3 acids such as fatty fish. Visit ABC News for the article.

Parity law requires mental health benefits comparable to physical care benefits

Denise Camp was resigned to the double standard that had long applied to her medical bills, forcing her to skimp on other expenses so she could pay for mental health treatment. While visits to her internist for physical problems required a $20 co-pay, her weekly therapy sessions with a social worker cost $50 and trips to the psychiatrist who prescribed her medication were $75. A similar disparity applied to medicines: Drugs to treat the crippling depression that ended her engineering career cost her twice what she paid for an antibiotic.

Camp is among an estimated 140 million Americans, most of them covered by group insurance plans provided by employers, who are the beneficiaries of a sweeping new federal law designed to guarantee parity in insurance coverage. The law, which took effect for most plans Jan. 1, applies to groups of more than 50 employees and is designed to end what Health and Human Services Secretary Kathleen Sebelius called "needless and arbitrary limits on care." Higher deductibles, steeper co-pays and other restrictions are no longer allowed for mental health and substance abuse treatment. The law does not apply to individual insurance policies, nor does it require group plans to provide mental health and substance abuse treatment, although most do.

Several weeks ago the Obama administration issued 154 pages of regulations governing implementation of the law, which was sponsored by the late Sen. Paul Wellstone (D-MN) and former Sen. Pete V. Domenici (R-NM). Passed with broad bipartisan support and signed into law by President George W. Bush in 2008, the measure is widely regarded as the last major piece of health legislation passed by Congress. The rules, which are subject to a comment period, are scheduled to take effect July 1.

Officials of key business and insurance industry groups said they were displeased that the regulations were "more expansive" than they believe lawmakers intended. Mental health advocates applauded the rules, which they said would help ensure that Americans battling schizophrenia, for example, receive the same level of care provided to those facing leukemia.

Federal officials estimate that complying with the law will increase premiums nationwide by four-tenths of 1 percent, or about $25.6 billion over 10 years. Employers are free to drop mental health and substance abuse coverage and are allowed to manage claims to determine if treatment is medically necessary, just as they do now for physical ailments, but the standards can no longer be more stringent. Plans are also allowed to exclude treatment for certain illnesses, such as eating disorders, as long as state law does not mandate coverage. There is also an escape hatch: Plans that can prove that their costs increased by more than 2 percent in the first year can file for an exemption.

The regulations also require insurers to explain the criteria used to evaluate or deny a claim, which HHS said "must be based on the same level of scientific evidence used by the insurer for medical and surgical benefits." Although it is not widespread, advocates say they have received scattered reports from around the country of employers dropping coverage rather than making changes to comply with the law.

This story was produced through a collaboration between The Post and Kaiser Health News. KHN is a service of the Kaiser Family Foundation, a nonpartisan healthcare-policy research organization unaffiliated with Kaiser Permanente. Visit the Washington Post for the article.

March 2, 2010   Download print version

The cost of doing nothing on healthcare

Key FDA medical-device regulator to step down

“Meaningful Use” to spur healthcare IT spending in 2010

Democrats will have votes for health bill, Obama aide says

AHRMM announces 2010 Award for Excellence in Healthcare Supply Chain Innovation

Dementia in extreme elderly population expected to become epidemic according to the 90+ study

Accelerated radiation therapy reduces toxicity in patients with advanced head and neck cancers

HPN special HIMSS10 product coverage

The cost of doing nothing on healthcare

“Hands off my health care,” goes one strain of populist sentiment. But what if? Suppose Congress and President Obama fail to overhaul the system now, or just tinker around the edges, or start over, as the Republicans propose — despite the Democrats’ latest and possibly last big push that began last week at a marathon televised forum in Washington. Then “my health care” stays the same, right? Far from it, health policy analysts and economists of nearly every ideological persuasion agree. The unrelenting rise in medical costs is likely to wreak havoc within the system and beyond it, and pretty much everyone will be affected, directly or indirectly.

“People think if we do nothing, we will have what we have now,” said Karen Davis, the president of the Commonwealth Fund, a nonprofit healthcare research group in New York. “In fact, what we will have is a substantial deterioration in what we have.”

Nearly every mainstream analysis calls for medical costs to continue to climb over the next decade, outpacing the growth in the overall economy and certainly increasing faster than the average paycheck. Those higher costs will translate into higher premiums, which will mean fewer individuals and businesses will be able to afford insurance coverage. More of everyone’s dollar will go to healthcare, and government programs like Medicare and Medicaid will struggle to find the money to operate. Policy makers, in the end, may be forced to address the issue.

“It will break all of our banks if we do nothing,” said Peter V. Lee, who oversees national health policy for the Pacific Business Group on Health, which represents employers that offer coverage to workers. “It is a course that is literally bankrupting the federal government and businesses and individuals across the country.”

Even those families that enjoy generous insurance now are likely to see the cost of those benefits escalate. The typical price of family coverage now runs about $13,000 a year, but premiums are expected to nearly double, to $24,000, by 2020, according to the Commonwealth Fund. That equals nearly a quarter of the median family income today.

While some employers will continue to contribute the lion’s share of those premiums, there will be less money for employees in the form of raises or bonuses. The higher premiums will also persuade more businesses, especially smaller ones, to decide not to offer insurance. More people who buy coverage on their own or are asked to pay a large share of premiums will find the price too high. It doesn’t take too many 39-percent increases, like the recent one proposed in California that has garnered so much attention, to put insurance out of reach.

While estimates vary, the number of people without insurance is expected to increase by more than a million a year, said Ron Pollack, the executive director of Families USA, a Washington consumer advocacy group that favors the Democrats’ approach. The Urban Institute, for example, predicts that the number of uninsured individuals will increase from about 49 million today to between 57 million and 66 million by 2019. The Democrats’ plan is expected to cover as many as 30 million individuals who now are uninsured.

There will be a cost in lives, too. Pollack’s organization estimates that as many as 275,000 people will die prematurely over the next 10 years because they do not have insurance. Even people with insurance will find their coverage providing much less protection from financial catastrophe than it does now. Individuals will pay significantly more in deductibles and co-payments, for example. “More and more families will experience huge debts and bankruptcies,” Pollack said.

Federal and state governments will also feel the squeeze. Medicare, the federal program for the elderly, is already the subject of much hand-wringing as its spending balloons. Medicaid, a joint program of the federal government and the states, is already struggling as states try to balance budgets hit hard by the economic downturn. Many states may be forced to cut benefits sharply as well as reduce financing for community health centers and state hospitals that serve the poor.

Exactly how politicians, or anyone else, will react to the increasing pressures on the system is anyone’s guess. If the system actually collapses, could there be a movement to adopt a government-run system, something like Medicare for all, where the whole healthcare system would be much more heavily regulated? Or maybe employers would take up the effort to figure out a better way of providing coverage. What seems unlikely, say policy analysts, is that Congress would try to pass anything nearly as ambitious as the bills that went through the House and Senate last year.

“If we fail this time, you’re not going to get this Congress to take this up on a big scale,” said Len Nichols, a health policy analyst at George Mason University who says he thinks the Democrats should go ahead and pass legislation. But few policy analysts think Congress can afford to do absolutely nothing. Lawmakers are instead likely to try a series of smaller fixes, said Stuart Butler, a health policy analyst at the Heritage Foundation, a research group that favors market solutions over a larger government role. Visit the New York Times for the article.

Key FDA medical-device regulator to step down

The director of the Office of Device Evaluation, one of the highest-ranking positions at the Food and Drug Administration, is leaving this month to join the Washington lobbying office of Microsoft Corp., according to an email she sent Monday morning. Donna-Bea Tillman, who has been with the FDA's Center for Devices and Radiological Health since 1994, said in the email that she will become part of the software giant's health-solutions group as the director of regulations and policy. The FDA confirmed her departure. Microsoft didn't immediately return messages seeking comment.

Dr. Tillman came under fire last year in an FDA report about the agency's December 2008 approval of a knee-surgery device called Menaflex, made by ReGen Biologics Inc. of New Jersey. The decision to clear the device was made over the objections of a half-dozen FDA scientists and managers during a four-year battle. Dr. Tillman had opposed approving the device using an abbreviated process called 510(k), but she changed her position late in 2008.

The agency began a review of the ReGen situation last year after stories in The Wall Street Journal described the role of political influence and lobbying in the approval. In a September 2009 report criticizing the handling of the device, the FDA said that the Office of Device Evaluation director—Dr. Tillman—felt there was pressure from the then-commissioner to produce an outcome "in favor of ReGen."

"Further, the decision-making process of the ODE director may have been affected by her sense of professional loyalty," it said. It added, "The ODE director felt a duty to back the center director who by then had decided in favor" of granting approval under the abbreviated process. The director of the device division, Dan Schultz, resigned last August, before the release of the ReGen report. Since the ReGen review, the agency has begun preparing a complete overhaul of the 510(k) decision-making process, which the Government Accountability Office, Congress' watchdog, said last year has been overused. Visit the Wall Street Journal for the article.

“Meaningful Use” to spur healthcare IT spending in 2010

Meaningful use” – a concept introduced only a year ago – appears to be spurring an increase in healthcare information technology (IT) spending along with a brightening economy, suggests results of the 21st Annual Healthcare Information and Management Systems Society (HIMSS) Leadership Survey. Signed February 17, 2009, the American Reinvestment and Recovery Act (ARRA) promises financial incentives to providers and hospitals for the “meaningful use” of certified healthcare IT products. Although criteria for meaningful use won’t be established until later this year, nearly four-fifths (59 percent) of the 398 respondents to this year’s survey say they plan to make additional investments to position themselves to qualify for the incentives. 

Driven by meaningful use incentives and a rebounding economy, nearly three quarters (72 percent) of respondents said they expect their IT operating budgets to increase, bringing that response back to the levels of two years ago. Last year, only 55 percent of respondents expected an increase in their budgets. Nearly half (49 percent) who said their budgets would increase this year reported that meaningful use would be a driver. Another 45 percent reported the increase would be due to an overall growth in the number of system and technologies at their organization.

Asked to identify their single IT priority during the next two years, 42 percent of respondents identified meeting meaningful use criteria. Many likely will be doing so by implementing clinical systems: when asked to identify their organization’s primary clinical IT focus, 35 percent said it would be ensuring their organization has a fully functional electronic medical record (EMR) in place and 27 percent said it would focus on installing a computerized provider order entry (CPOE) system.

Meaningful use was reflected in other answers throughout the survey. For instance, more than one-third (38 percent) said government issues were the business issue they felt would have the biggest impact on healthcare in the next two years, whereas last year, only six percent thought that was the case. This year’s response reflects compliance with new regulations regarding meaningful use, as well as coding upgrades and claim processes impacted by ICD-10 (the World Health Organization’s International Classification of Diseases) and the updated version of HIPAA (5010). Financial considerations (such as demand for capital and finding new revenue resources) was identified as the top business issue last year, chosen by 54 percent of respondents. This year, 23 percent identified it as the top business issue.

Security concerns continue to remain consistent. One third of respondents (34 percent) said an internal breach of security was their top security concern, and nearly one-quarter (23 percent) said their organization had a security breach in the past year. Thirty percent said their major security concern was compliance with Health Insurance Portability and Accountability Act (HIPAA) security regulations and Centers for Medicare & Medicaid (CMS) security audits. 

Healthcare organizations continue to make progress on EMR adoption. Nearly half (48 percent) said they have a fully operational EMR in at least one facility, compared to 41 percent last year. Nearly a quarter (22 percent) said they have a fully operation EMR throughout their entire organization, up from 17 percent last year. Almost a third (32 percent) have begun to install an EMR in at least one facility. Supply chain IT expenses were a low priority. Visit HIMSS for the survey results.

Democrats will have votes for health bill, Obama aide says

Raising the prospect of a "simple up-or-down vote" on healthcare reform, White House adviser Nancy-Ann DeParle said on Sunday she thinks Democrats will secure enough ayes on the measure and signaled that the administration could be moving toward trying to pass it along party lines.

President Obama is planning to tell Democrats his preferred strategy this week. After letting the effort play out in Congress for many months, he recently stepped in to lead it. He issued his own proposal, held a bipartisan summit and is preparing to direct the next legislative steps.

Increasingly, the White House appears to favor having the House pass a version of the measure that cleared the Senate with 60 votes in December. The Senate would then pass changes to the bill to satisfy some demands of House Democrats. That Senate vote would take place under a parliamentary procedure known as reconciliation, which requires 51 votes rather than 60.

It remains unclear whether Democrats have enough votes within their ranks for this strategy to work. At the same time, it is only "one option" the president is considering, a senior White House official said Sunday.

Still, DeParle suggested Obama could endorse that option in the next few days. "Health-care reform has already passed both the House and the Senate with not only a majority in the Senate but a supermajority. And we're not talking about changing any rules here," DeParle, the director of the White House Office of Health Reform, said on NBC's “Meet the Press.” She added: "All the president is talking about is: Do we need to address this problem, and does it make sense to have a simple up-or-down vote on whether or not we want to fix these problems?"

Republicans oppose the 10-year, $1 trillion package under consideration, and have demanded that the administration scrap the bill and start over. Without any Republicans onboard, Democrats must persuade their most vulnerable lawmakers to support legislation that could be used against them in November's midterm elections.

As Democrats fanned out on television to bolster their party's prospects for passing healthcare legislation, House Speaker Nancy Pelosi (D-CA) said it will require "courage" from members of her party. "Why are we here? We're not here just to self-perpetuate our service in Congress," she said on ABC's “This Week.” "We're here to do the job for the American people; to get them results that give them not only health security but economic security, because the health issue is an economic issue for America's families." Visit the Washington Post for the article.

AHRMM announces 2010 Award for Excellence in Healthcare Supply Chain Innovation

Excellence in innovation deserves recognition. That's why AHRMM is proud to announce the launch of the 2010 Award for Excellence in Healthcare Supply Chain Innovation. Sponsored by Cardinal Health, the award recognizes healthcare supply chain professionals whose creative concepts have positively impacted the field.

With over 4,000 members, AHRMM's collective intelligence has grown as have the creative solutions supply chain professionals throughout the industry come up with to do their jobs effectively and efficiently. More than ever, with healthcare organizations challenged with economic pressure, it is important that these ideas are shared.

AHRMM is asking professionals of healthcare organizations to submit innovative ideas and concepts that have demonstrated positive results in the healthcare supply chain. The goal of this award will be not only to recognize a healthcare organization and team for the leading innovation but also to share submissions with the AHRMM membership through the Knowledge Center on AHRMM's Web site.

The award will be presented at the 48th Annual Conference and Exhibition, AHRMM10. Two additional submissions will receive special recognition in an article in AHRMM's newsletter and on the Knowledge Center of AHRMM's Web site. Complete details, including application forms, eligiblity requirements, rules, guidelines, the selection process, and deadline for application are available on AHRMM's Web site, www.ahrmm.org.

Dementia in extreme elderly population expected to become epidemic according to the 90+ study

University of California researchers found that the incidence rate for all causes of dementia in people age 90 and older is 18.2% annually and significantly increases with age in both men and women. This research, called "The 90+ Study," is one of only a few to examine dementia in this age group, and the first to have sufficient participation of centenarians. Findings of the study appear in the February issue of Annals of Neurology, a journal published by Wiley-Blackwell on behalf of the American Neurological Association.

Dementia (senility) is a progressive, degenerative disorder that affects memory, language, attention, emotions, and problem solving capabilities. A variety of diseases cause dementia including Alzheimer's disease, stroke, and other neurodegenerative disorders. According to a 2000 report from the World Health Organization (WHO), approximately 6%-10% of the population 65 years and older in North America have dementia, with Alzheimer's disease accounting for two-thirds of those cases.

Analysis was completed on 330 participants who were primarily women (69.7%) between the ages of 90 to 102, and who showed no signs of dementia at baseline. Researchers identified 140 new cases of dementia during follow-up with 60% of those cases attributed to Alzheimer's disease (AD), 22% vascular dementia, 9% mixed AD and vascular dementia and 9% with other or unknown cause.

Dr. Maria Corrada, Sc.D., explained, "Our findings show dementia incidence rates almost double every five years in those 90 and older." Researchers found the overall incidence rate based on 770 person-years of follow-up was 18.2% per year. Rates increased with age from 12.7% per year in the 90-94 age group, to 21.2% per year in the 95-99 age group, to 40.7% per year in the 100+ age group. Incidence rates were very similar for men and women. Previous results from The 90+ Study found higher estimates of dementia prevalence in women (45%) compared to men (28%), a result also seen in other similar studies.

Prior reports estimate there were 2 million Americans aged 90 and older in 2007 and the number is expected to reach 8.7 million by 2050, making the oldest-old the fastest growing segment of the U.S. population. "In contrast to other studies, we found that the incidence of dementia increases exponentially with age in both men and women past age 90," said Dr. Corrada. "Given the population projections for this age group along with our findings, dementia in the oldest-old threatens to become an epidemic with enormous public health impact." Visit PhysOrg.com for the article.

Accelerated radiation therapy reduces toxicity in patients with advanced head and neck cancers

Using an accelerated, shorter course of radiation therapy for patients with advanced head and neck cancer allows doctors to reduce the amount of chemotherapy, thus reducing toxicity, according to a study presented at the Multidisciplinary Head and Neck Cancer Symposium, sponsored by AHNS, ASCO, ASTRO and SNM.

Between July 2002 and May 2005, this multi-institutional randomized phase III trial analyzed 721 patients with stage III-IV carcinoma of the oral cavity, oropharynx, hypopharynx or larynx, with 360 receiving accelerated radiation and 361 receiving standard radiation with two and three cycles of cisplatin, respectively.

After a median follow up of 4.8 years, the overall survival of accelerated radiation patients versus standard radiation patients was 59 percent and 56 percent respectively. Disease-free survival rates were 45 percent and 44 percent respectively and local-regional failure and metastasis rates were also very similar at 31 and 28 percent and 18 and 22 percent, respectively.

"Accelerated fractionation concurrent with two doses of high dose cisplatinum has the potential to reduce toxicity related to the chemotherapy regimen by not exposing patients to a third cycle," said, Phuc Felix Nguyen-Tan, M.D., presenter of the study for the RTOG and assistant professor of radiation oncology at CHUM Notre-Dame in Montreal, Canada. Visit Science Daily for the article.

March 1, 2010   Download print version

StatSpin Express 4 Centrifuges Model 510: Class 1 Recall

New gestational diabetes guidelines could find more women at risk

Studies on neck-artery stents show different findings

CT scan makers to install radiation controls

LifeScan issues OneTouch SureStep Test Strips recall

How healthcare is paid for appears to impact outcome

The sound of melanoma can help doctors find cancer

HPN special HIMSS10 product coverage

StatSpin Express 4 Centrifuges Model 510: Class 1 Recall

FDA notified healthcare professionals of a Class I recall of the StatSpin Express 4 Centrifuges, Model #510, Serial Numbers 00100 through 001679, manufactured and distributed from November, 2007 through January, 2010. The rotor of the centrifuge may break and separate from the motor, striking a safety microswitch so it fails to shut down the centrifuge. The loose rotor may strike the lid of the centrifuge housing which may cause the lid to open and eject pieces of the rotor. These pieces may cause serious physical injury to bystanders and may expose them to blood-borne infectious micro-organisms. Read the complete FDA recall notice.

New gestational diabetes guidelines could find more women at risk

New blood sugar measurements used to determine gestational diabetes could mean that lower levels may pose risks for mother and baby. The findings, released Friday and published in the March issue of Diabetes Care, were based on a study that included more than 23,000 women in nine countries. Researchers discovered that a fasting blood sugar level of 92 or higher, a one-hour level of 180 or higher on a glucose tolerance test or a two-hour level of 153 or higher on a glucose tolerance test may present grave risks to both mother and child. Before, these numbers were believed to be in the normal range. If healthcare providers go by these levels, far more pregnant women could be diagnosed with gestational diabetes.

Researchers are finding more about what may trigger gestational diabetes. A study published this week in the journal Obstetrics & Gynecology found that women who gain weight in the first trimester of pregnancy were at a higher risk for gestational diabetes than women who did not, and obese women who gained weight during that period were especially at risk. Visit the Los Angeles Times for the article.

Studies on neck-artery stents show different findings

Two large medical studies arrived at different findings about whether putting metal stents in neck arteries to stop plaque from causing strokes, rather than removing plaque surgically, puts patients more at risk. Doctors can remove plaque by opening the artery, or, in less-invasive procedures, they can thread stents into place through an incision in the groin. Abbott Laboratories, Johnson & Johnson, Boston Scientific Corp. and Ev3 Inc. all make such devices.

A study published in the British medical journal The Lancet tracked about 1,700 patients who had either surgery or stents. The study will run for years, but at an early four-month review, it showed a greater risk of stroke, death or heart attacks for the stent patients. A portion of these patients weren't treated with systems designed to keep debris from flowing upstream during stent procedures. Still, while study authors said a longer review is needed, regular plaque-removal surgery "should remain the treatment of choice" for now among symptomatic patients with narrowed carotid arteries.

But another study that includes both a long- and short-term view and had about 800 more patients found what cardiologists described as very low rates of both heart attacks and strokes for patients treated with both methods.

The Lancet report, called the "International Carotid Stenting Study" or ICSS, was released late Thursday night, while results from the bigger study, known as "Crest," were reported at a conference Friday. In Crest, there were more strokes among stent patients within an initial one-month follow-up window, but doctors said this was due to a higher number of minor events and not disabling strokes. There were more heart attacks, meantime, among patients treated with surgery, although some of these were also deemed minor.

Doctors said Crest results support both methods for treating clogged neck arteries. "All the outcomes turned out to be incredibly good," said Ken Rosenfield, a stent-implanting cardiologist at Massachusetts General Hospital in Boston, and one of the study's main investigators. He has served on the advisory board at Abbott, which partially funded Crest and provided the stents. The company said the study shows stenting and surgery are "equally safe and effective." The National Institutes of Health also backed the big, long-running study.

Among Crest findings, both surgery and stents led to similar rates of death and dangerous events an average 2.5 years after patients were treated. During the initial one-month period, the stroke rate was 4.1% in stent patients compared with 2.3% in surgery patients. The rate of "disabling stroke," however, was below 1% for both types of procedures, according to Gary Roubin, a stent-implanting cardiologist at Lenox Hill Hospital in New York. He is also a study investigator and Abbott adviser.

Carotid stents don't have the same high profile as heart stents, both because of tight reimbursement rules under Medicare and a narrow patient population approved by the FDA. Crest may broaden horizons for carotid stents, but the study published in Lancet could leave some questions unanswered. Visit the Wall Street Journal for the article.

CT scan makers to install radiation controls

A medical imaging trade group said Thursday that manufacturers of CT scanners will begin installing safety controls to prevent patients from receiving excessive radiation. The dosing checks, which will begin before the end of the year, will alert operators whenever the machine’s settings exceed recommended levels. Hospitals and clinics will also be able to set maximum dosing levels for their machines.

The announcement from the Medical Imaging & Technology Alliance was made two weeks after the Food and Drug Administration said it would crack down on excessive radiation scanning. The changes will be implemented by the five makers of CT scanners: General Electric Co., Siemens AG, Toshiba Corp., Philips, and Hitachi. The group’s director said manufacturers had been working on the changes for months, though their unveiling occurred one day before a congressional hearing on the safety of imaging scanners.

Last year, three California hospitals reported hundreds of acute radiation overdoses from CT scanners, with many patients reporting hair loss and skin redness. The average American’s total radiation exposure has nearly doubled in the past three decades, largely because of next-generation imaging tests, according to the FDA.

When the agency announced its initiative it also targeted other types of scanners, including nuclear imaging machines. The trade group said it is still working to implement changes with manufacturers of those machines. The safety changes outlined by the industry will be made to older machines via software changes, though the effort will take time. Visit the Boston Globe for the article.

LifeScan issues OneTouch SureStep Test Strips recall

LifeScan, Inc. is conducting a voluntary recall in the United States of eight lots of OneTouch SureStep Test Strips, used by people with diabetes to measure their blood glucose levels at home. The test strips are being recalled because they may provide falsely low glucose results when the glucose level is higher than 400 mg/dL.

LifeScan estimates approximately fourteen thousand packages (50- and 100-count) of consumer OneTouch SureStep Test Strips were distributed nationwide between August 1, 2009 and January 28, 2010. No injuries associated with these recalled test strips have been reported. However, if patients use the falsely low test results to determine their insulin dose, they may give themselves too little insulin, which could result in poor blood glucose control. Patients with high blood glucose may or may not have certain symptoms including increased thirst, frequent urination, headaches, difficulty with concentration, blurred vision and fatigue (weak, tired feeling). High blood glucose must be recognized and treated promptly to avoid serious complications, such as coma and death.

Hospitals, clinics and other multi-patient facilities using SureStepPro, SureStepFlexx or OneTouch SureStep Hospital Systems have also been notified of this issue. All three of these systems use SureStepPro Test Strips which also may provide inaccurately low test results when the blood glucose reading is greater than 400 mg/dL. LifeScan has advised these facilities of the appropriate actions to take in order to continue to use these SureStepPro Test Strips. However, healthcare facilities with access to alternative means of testing should consider temporarily discontinuing their use of their SureStep Systems until replacement test strips are available. Visit the FDA for more information.

How healthcare is paid for appears to impact outcome

Whether an individual is treated for a hip fracture at a hospital reimbursed by Medicare or is treated at a Department of Veterans Affairs Medical Center makes a significant difference in what happens to the patient after release from the medical facility, according to a large study which may contribute to the ongoing debate on how to pay for healthcare.

The seven–year study, which appears in the February 2010 issue of the Journal of the American Medical Directors Association, found that while 49 percent of those who had a Medicare reimbursed procedure went to nursing homes, only 35 percent of those treated at VA facilities were discharged to a nursing home. The complete explanation for this difference requires future study of institutional differences, patient transitions between care settings, and other issues as well as reimbursement policies.

VA hospitals do not have the financial incentives that impact the decision to discharge that exist outside the VA. Hip fracture patients at a VA facility were hospitalized for an average of 14 days as opposed to seven days at non-VA facilities. Death rates were similar for veterans with hip fracture whether cared for under Medicare or at a VA hospital.

The study looked at post-hip fracture surgery data from 43,165 veterans hospitalized at Medicare paid facilities and 12,539 veterans treated at VA hospitals. The average age of the veterans was 79 years and men constituted 95.8 percent of the patient population. Hip fractures are the second most common type of osteoporotic fracture worldwide.

"While we think it makes sense for patients to have shorter hospital stays, we need to realize that the length of stay in the hospital is only part of the equation of the cost of the healthcare of that individual. It may be that we should make the hospital stay longer to enable the individual to be discharged in optimal condition for the next phase of their care," said corresponding author Dustin French, Ph.D., Regenstrief Institute investigator and assistant professor of medicine at the Indiana University School of Medicine. Dr. French is a health economist who studies health outcomes.

"Under the current Medicare reimbursement system, the healthcare system is not given an incentive to help patients live independently and age successfully after they are discharged. Further investigation is needed, but we believe our findings point to the importance of patient-centric restorative care both prior to and after discharge as being good for the health-care system as well as the patient," said Dr. French, who is also a research scientist with the Center of Excellence on Implementing Evidence Based Practice at the Richard A. Roudebush VA Medical Center. Visit Science Daily for the article.

The sound of melanoma can help doctors find cancer

Knowing the stage of a patient's melanoma is important when choosing the best course of treatment. When the cancer has progressed to the lymph nodes, a more aggressive treatment is needed. Examining an entire lymph node for cancer takes much effort and time; a new technique might help make the process more efficient. University of Missouri researchers in the Christopher S. Bond Life Sciences Center are studying how photoacoustics, or a laser-induced ultrasound, could help scientists locate the general area of the lymph node where melanoma cells could be residing. This new technology could help doctors identify the stage of melanoma with more accuracy.

"This method can be used to determine if the cancer has spread from stage 2, where the melanoma is still just in the skin lesion, to stage 3, where the melanoma has spread to the lymph nodes," said John Viator, assistant professor in the Department of Biological Engineering and Department of Dermatology . "If the cancer is still at stage 2, a simple procedure can remove that lesion. If the cancer has progressed from the initial skin lesion into the lymphatic region and possibly the bloodstream, doctors have to make serious decisions about patient care. The cancer may have possibly spread to other organs, such as the liver, lungs or brain."

"It's very similar to identifying a prize inside a cake," Viator said. "Instead of looking through the entire cake, we can use our ultrasound to pinpoint a slice or two that might contain the 'prize.' In the case of the lymph nodes, when you get a signal, this alerts the pathologist that this is an area of the node that might contain cancer cells. At that point, a pathologist would be able to narrow down the search, saving time and money."

In the photoacoustic method, a tabletop device scans a lymph node biopsy with laser pulses. About 95 percent of melanoma cells contain melanin, the pigment that gives skin its color, so they react to the laser's beam, absorbing the light. The laser causes the cells to heat and cool rapidly, which makes them expand and contract. This produces a popping noise that special sensors can detect. This method would examine the entire biopsy and identify the general area of the node that has cancer, giving pathologists a better idea of where to look for the cancer. Visit PhysOrg.com for the article.

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