|May 12-16, 2014
Download print version
Deadline extended for 2014 Provider Executive Survey on Supply Chain
drug safety communication: Eszopiclone containing sleep aids, including
Lunesta and generics, can cause next-day impairment
Measles virus used to put woman's cancer into remission
IAHCSMM Annual Conference & Expo Call for Presentations
are told to start including a neglected variable: Females
Northwestern, Cadence reach merger deal
accuses British GlaxoSmithKline executive in bribery case
Rubbermaid Healthcare recognized by KLAS Research for impact on nursing
efficiency and patient safety
Shorter men may live longer thanks to an enhanced longevity gene
for 2014 Provider Executive Survey on Supply Chain Management
Hospital and other healthcare facility senior administrators have until May
22 to participate in the 2014 Provider Executive Survey on Supply Chain
Management, conducted by the Association for Healthcare Resource & Materials
Management (AHRMM), a membership organization of the American Hospital
Association; Marquette University’s College of Business Administration -
Center for Supply Chain Management; and Jamie C. Kowalski Consulting, LLC.
This year’s survey theme is “Reform Continues; Is Supply Chain Leading,
Following or Getting in the Way?”
Since developer and veteran industry supply chain consultant Jamie Kowalski
began the survey in the 1980s, the purpose has remained the same: To
identify and understand the perceptions of hospital senior executives (CEO,
COO, CFO) regarding the role supply chain plays, its performance, as well as
their expectations of contributions supply chain must make toward achieving
hospital and IDN performance and success. It also compares those responses
from the Senior Executives with responses from Supply Chain leaders, to
identify and try to interpret the reason for any important gaps.
Funding for the latest survey was provided by “Presenting Sponsor” TECSYS
Inc., a supply chain management software company, and a group of five
contributing sponsors, including Owens & Minor Inc., a leading national
healthcare product distributor; Amerinet Inc., a leading national group
purchasing organization; Global Edge LLC, a risk management software
company; Aperek Inc., a Web-based supply chain analytics and expense
management software company; and Bellwether League Inc., the hall of fame
for healthcare supply chain leadership.
Survey results will provide valuable insights into the perceived importance
and impact of supply chain management strategies and initiatives, and guide
executives in the development of their own strategic plans to optimize their
organization’s supply chains. The online survey is being distributed to
hospital chief executive officers, chief financial officers, chief operating
officers, and healthcare supply chain leaders. Surveys can be completed by
Results of the survey will be tabulated by Marquette University’s College of
Business Center for Supply Chain Management and will be presented by
Kowalski at the 2014 AHRMM Annual Conference & Exhibition in Orlando on
August 4. Other venues are still being determined. The survey report will
allow the industry to examine the similarities and differences between the
views of C-suite executives and supply chain leaders, the challenges
Healthcare Reform presents to providers, and how supply chain management is
and can help providers deal with these challenges.
FDA drug safety
communication: Eszopiclone containing sleep aids, including Lunesta and
generics, can cause next-day impairment
FDA has notified health professionals and their medical care organizations
of a new warning that the insomnia drug Lunesta (eszopiclone) can cause
next-day impairment of driving and other activities that require alertness.
FDA recommends a decreased starting dose of Lunesta to 1 mg at bedtime.
Women and men are equally susceptible to impairment from Lunesta, so the
recommended starting dose of 1 mg is the same for both. FDA approved changes
to the Lunesta prescribing information and the patient Medication Guide to
include these new recommendations. The drug labels for generic eszopiclone
products will also be updated to include these changes.
A study of Lunesta found that the previously recommended dose of 3 mg can
cause impairment to driving skills, memory, and coordination that can last
more than 11 hours after receiving an evening dose. Despite these driving
and other problems, patients were often unaware they were impaired. The new
lower recommended starting dose of 1 mg at bedtime will result in less drug
in the blood the next day.
Healthcare professionals should follow the new dosing recommendations when
starting patients on Lunesta. Patients should continue taking their
prescribed dose of Lunesta and contact their healthcare professionals to ask
about the most appropriate dose for them. FDA is continuing to evaluate the
risk of impaired mental alertness with the entire class of sleep aid drugs,
including over-the-counter drugs available without a prescription, and will
update the public as new information becomes available.
Read the MedWatch safety alert.
used to put woman's cancer into remission
A woman with an incurable cancer is now in remission, thanks, doctors say,
to a highly concentrated dose of the measles virus. For 10 years, Stacy
Erholtz, 49, battled multiple myeloma, a deadly cancer of the blood. Doctors
at the Mayo Clinic say she had received every type of chemotherapy drug
available for her cancer and had undergone two stem cell transplants, only
to relapse time and again.
Then researchers gave her and five other multiple myeloma patients a dose of
a highly concentrated, lab-engineered measles virus similar to the measles
vaccine. In fact, the dose Erholtz received contained enough of the virus to
vaccinate approximately 100 million people.
"The idea here is that a virus can be trained to specifically damage a
cancer and to leave other tissues in the body unharmed," said the lead study
author, Dr. Stephen Russell.
It's a concept known as virotherapy, and it's been done before.
Mayo Clinic scientists say thousands of cancer patients have been treated
with viruses, but this is the first case of a patient with a cancer that had
spread throughout the body going into remission. Erholtz was cancer-free for
"I think we succeeded because we pushed the dose higher than others have
pushed it," Russell said. "And I think that is critical. The amount of virus
that's in the bloodstream really is the driver of how much gets into the
In simple terms, the measles virus makes cancer cells join together and
explode, Mayo Clinic researcher Dr. Angela Dispenzieri explains. There's
also some evidence to suggest, she says, that the virus is stimulating the
patient's immune system, helping it recognize any recurring cancer cells and
"mop that up."
This treatment is still in the early testing stages, though. Doctors
recently used radiation therapy to treat a small, localized tumor in
Erholtz's body. And the other patients in the trial did not go into
remission. Tests showed the virus helped shrink one woman's tumors, but they
started growing again soon after. The other patients' cancers did not
respond to the treatment.
Researchers also don't know whether this virotherapy will help other
patients or whether it can be applied to other types of cancer. The measles
virus worked with these multiple myeloma patients because they are already
immune-deficient, meaning their bodies can't fight off the virus before it
has a chance to attack the cancer cells.
More of the highly concentrated measles virus is being created now to be
used in a larger clinical trial, Mayo Clinic researchers say. They've
developed a manufacturing process that can produce large amounts of the
virus, Russell says.
Visit CNN for the article.
Annual Conference & Expo Call for Presentations
Be a part of the premier conference for Central Service Professionals by
presenting an educational session at the IAHCSMM 50th Annual Conference and
Expo. Each year's conference features some of the discipline's most dynamic
and knowledgeable speakers, and now is your chance to be one of them and
share your perspectives and knowledge with others in the CS field.
IAHCSMM is seeking subject matter experts for the following categories:
Decontamination, CS Management, Communication/Human Relations, Endoscopes,
Infection Control, Materials Management, Preparation/Packaging, Quality
Assurance, Regulations and Standards, Safety, Sterilization, and Surgical
Additionally, attendees from previous IAHCSMM Conference and Expos would
like to see presentations on the following: Agency Updates, Ambulatory
Surgery, Best Practices, Budget/Finance, Competency,
Decontamination/Disinfection, Endoscope Cleaning, Lean Topics, Loaner
Instrumentation, Management Topics, Policy and Procedures, Quality,
Sterilization, and Team Building.
Deadline for Presentation Proposals is July 1, 2014. Submit your proposal by
Labs are told to
start including a neglected variable: Females
Troubled by some drugs’ effects on women, the N.I.H. is urging researchers
to include more female animals in their studies. They've embarked on the
long journey toward a medical breakthrough by first experimenting on
laboratory animals. Mice or rats, pigs or dogs, they were usually male:
Researchers avoided using female animals for fear that their reproductive
cycles and hormone fluctuations would confound the results of delicately
That laboratory tradition has had enormous consequences for women. Name a
new drug or treatment, and odds are researchers know far more about its
effect on men than on women. From sleeping pills to statins, women have been
blindsided by side effects and dosage miscalculations that were not
discovered until after the product hit the market.
Now the National Institutes of Health says that this routine gender bias in
basic research must end.
The N.I.H. has already taken researchers to task for their failure to
include adequate numbers of women in clinical trials. The new announcement
is an acknowledgment that this gender disparity begins much earlier in the
“Most scientists want to do the most powerful experiment to get the most
durable, powerful answers,” Dr. Francis Collins, director of the N.I.H, said
in an interview. “For most, this has not been on the radar screen as an
important issue. What we’re trying to do here is raise consciousness.”
Women now make up more than half the participants in clinical research
funded by the institutes, but it has taken years to get to this point, and
women still are often underrepresented in clinical trials carried out by
drug companies and medical device manufacturers.
Partly as a result, women experience more severe side effects from new
treatments, studies have shown. The FDA last year told women to cut in half
their doses of the sleeping pill Ambien, for example, because new studies
showed they metabolize the active ingredient more slowly than men do.
Although statins are the most widely prescribed drugs in America, they were
tested mostly in men, and evidence of their benefit to women is limited.
Indeed, women respond differently from men to a broad array of treatments,
and often do not derive the same benefits from them as men.
The ideas for new treatments are often generated in the laboratory, where
gender bias in basic biomedical research and neuroscience is ingrained.
Bias in mammalian test subjects was evident in eight of 10 scientific
disciplines in an analysis of published research conducted by Irving Zucker,
a professor of psychology and integrative biology at the University of
California, Berkeley. The most lopsided was neuroscience, where single-sex
studies of male animals outnumbered those of females by 5.5 to 1.
Contrary to the conventional wisdom in laboratories, there is far more
variability among males than among females on a number of traits and
behaviors, Dr. Zucker has found. Yet even when researchers study diseases
that are more prevalent in women — anxiety, depression, thyroid disease and
multiple sclerosis among them — they often rely on male animals, according
to another analysis led by Dr. Zucker, who has written extensively on gender
bias in scientific research.
Jill Becker, a senior research scientist at the University of Michigan who
studies gender differences in addiction, has found that women increase their
drug use much more rapidly than men and that the hormone estradiol plays a
critical role in the escalation, especially during ovulation. Nonetheless,
researchers studying escalating drug use in rats and mice rely almost
entirely on males, she said.
The N.I.H. is directing scientists to perform their experiments with both
female and male animals, and grant reviewers will take the balance of each
study design into account when awarding grants. (If the subject is
gender-specific, like ovarian cancer or prostate cancer, then the rule will
probably not apply, Dr. Clayton said.)
N.I.H. officials will start rolling out the new policies in October, and the
details are still being ironed out. But they are likely to be met with
resistance from scientists who fear increased costs and difficulty in
performing their experiments.
Visit the New York Times for the report.
Cadence reach merger deal
Northwestern Memorial HealthCare and Cadence Health said Thursday they have
reached a deal to combine into a single health system that would rank among
the largest in the Chicago area.
Each system’s board of directors formally gave approval to the deal,
announced initially in March, leaving only state and federal regulatory
approval pending. That could come as soon as fall, a Cadence spokesman said.
The combined system would have four hospitals, more than 1,300 employed
physicians and combined annual revenue approaching $3 billion.
Northwestern, parent of Chicago's largest hospital, the 894-bed Northwestern
Memorial Hospital, and Cadence, which was created in 2011 after the merger
of Central DuPage and Delnor hospitals, would combine under the Northwestern
Medicine banner. Both systems are nonprofits.
The merger with Cadence would widen the pipeline of patients to
Northwestern's flagship Streeterville academic medical center, which offers
an array of highly specialized -- and profitable -- advanced medical
treatment programs. It also would strengthen the system's market power in
the western suburbs, where Cadence has flourished since Winfield-based
Central DuPage and Geneva-based Delnor combined.
Northwestern President and CEO Dean Harrison, who would lead the combined
entity, said, “Together, we are better positioned to provide care that is
safer, more effective, and better coordinated that utilizes the latest
breakthrough treatments and is accessible closer to where our patients live
Mike Vivoda, Cadence's president and chief executive, would become regional
president of the system, continuing to oversee Central DuPage and Delnor.
“The opportunity to partner with Northwestern will enhance the offerings of
high quality compassionate care in the Chicago’s western suburbs,” Vivoda
said, in a statement. “We believe this combination will create an integrated
approach to patient care, augment a culture of service excellence and
enhance and grow our clinical services to continue to position this system
as the health care provider of choice.”
Visit the Chicago Tribune for the story.
British GlaxoSmithKline executive in bribery case
Chinese police have accused a British executive in drugs maker
GlaxoSmithKline's China unit of ordering his salespeople to bribe doctors
and hospital officials to use the company's products. The announcement marks
the first time a foreign employee in China of British-based GSK has been
accused in connection with the bribery allegations against the company.
In a statement carried by the official Xinhua news agency, police in the
central city of Changsha said Mark Reilly was accused of pressing his sales
team to bribe doctors, hospital officials and health institutions. It said
that resulted in "illegal revenue" of billions of yuan.
The statement said Reilly and two Chinese executives also were accused of
bribing government officials in Beijing and Shanghai.
In April the GSK whistleblower Jarek Wisniewiski told the BBC's Panorama
program that company representatives paid doctors to boost prescriptions in
Poland. Another former GSK drug representative, who did not want to be
identified, said they paid doctors for lectures that never happened and this
would result in a greater number of prescriptions.
Wisniewiski said he had voiced his concerns with the drugs company but this
resulted in him being sidelined at work and eventually sacked.
The program said a criminal investigation was under way and 11 doctors and
one GSK regional manager had been charged in connection with corruption. If
the new allegations were well founded GSK may have violated both the UK's
Bribery Act and the US Foreign Corrupt Practices Act, the BBC program said.
It is illegal for companies based in the US or UK to bribe government
Visit the Guardian for the article.
Healthcare recognized by KLAS Research for impact on nursing efficiency and
Rubbermaid Healthcare, announced its high performance ratings, as indicated
by a new report from KLAS Research, a technology research firm that
independently measures and reports on vendor performance. According to the
April 2014 report titled, “Medication Cabinets, Carts, & BCMA 2014:
Technology’s Impact on Nurse Efficiency and Patient Safety,” Rubbermaid
Healthcare’s medication carts were rated highly in both nurse efficiency and
patient safety compared to five other vendors.
KLAS Research surveyed 177 nurses to find out how medication cabinets,
carts, and barcode medication administration (BCMA) affect nursing
efficiency and enhance patient safety. Additionally, nurses were asked to
rate various products based on their experience. Among medication carts,
Rubbermaid Healthcare had the highest percentage of customers who reported
that carts significantly help nurse efficiency. Providers using Rubbermaid
Healthcare’s carts were most likely to note significant gains in being able
to efficiently and safely care for patients.
Rubbermaid Healthcare carts enable nurses to store and transport medications
in their locked drawers, eliminating the time wasted to go back and forth
between the medication room and patient room to administer medications.
Their latest generation of medication carts allows users to manage and
monitor access to medication drawers remotely, making it easier to
proactively manage a fleet of carts.
Other findings from the report distinguish Rubbermaid Healthcare carts among
the leaders who have very few issues with the cart’s batteries as well as
positive interactions between users and Rubbermaid Healthcare’s customer
service team. None of the respondents reported that Rubbermaid Healthcare
medication carts hindered nursing efficiency or patient safety.
To learn more about Rubbermaid Healthcare solutions, please visit
Visit KLAS Research for the report.
Shorter men may
live longer thanks to an enhanced longevity gene
Guys who are less tall may feel as though they wound up with the short end
of the stick, but new research appearing in the peer-reviewed medical
journal PLOS ONE suggests that they are more likely to outlive their
taller male counterparts.
In the study, researchers from the Kuakini Medical Center, the University of
Hawaii’s John A. Burns School of Medicine (JABSOM) and the US Veteran
Affairs department concluded that shorter men were more likely to have a
protective form of the longevity gene, also known as FOXO3.
The presence of this gene results in smaller body size and a longer
lifespan, as well as lower blood insulin levels and a lower prevalence of
cancer. The authors studied over 8,000 American men of Japanese ancestry,
monitoring their health conditions closely for nearly five decades.
All of the subjects were participants in the Kuakini Honolulu Heart Program
(HHP) and the Kuakini Honolulu-Asia Aging Study (HAAS). The Kuakini HHP
began in 1965, and the 8,006 participants (all but three of whom also
participated in this study) were born between the year of 1900 and 1919.
“We split people into two groups – those who were 5-foot-2 and shorter, and
5-4 and taller,” Dr. Bradley Willcox, one of the researchers involved in the
study and a professor at JABSOM’s Department of Geriatric Medicine, said in
a statement. “The folks that were 5-2 and shorter lived the longest. The
range was seen all the way across from being 5-foot tall to 6-foot tall. The
taller you got, the shorter you lived.”
“This study shows, for the first time, that body size is linked to this
gene,” he added. “We knew that in animal models of aging. We did not know
that in humans. We have the same or a slightly different version in mice,
roundworms, flies, even yeast has a version of this gene, and it’s important
in longevity across all these species.”
Dr. Willcox and his colleagues emphasize that additional research is
required in order to verify the results of their work, as well as to make
sure that the findings can be applied to other ethnic groups of populations.
He added that there is no specific height or age range, because no matter
what a person’s height is, he or she can make up for having a regular FOXO3
gene and not a longevity-enhanced one by living a healthy lifestyle.
About 1,200 men who participated in the study lived into their 90s and 100s,
and nearly 250 of them are alive today. The project was funded by the
National Institutes of Health’s National Heart, Lung and Blood Institute (NHLBI)
and the National Institute on Aging, as well as the Kuakini Medical Center
and the Department of Veterans Affairs.
Visit Red Orbit for the study.
Download print version
fire for VA scandal Eric Shinseki faces grilling from Congress
outbreak becomes more urgent, WHO says
Outbreaks can happen anywhere, even Ohio
Hospitals performing too many unnecessary C-sections, Consumer Reports finds
Hospital shares how it reduced needlestick injuries by nearly 70 percent
Hurricanes Katrina and Rita may have caused up to half of recorded
stillbirths in worst hit areas
billion people still defecate in public despite health risks: UN
hospital financial woes caused by bad investment
Under fire for VA
scandal Eric Shinseki faces grilling from Congress
As reports of serious misconduct come in from VA hospitals across the
country, lawmakers are prepared to give Veterans Affairs Secretary Eric
Shinseki the grilling of a lifetime on Thursday when he appears before the
Senate Veterans' Affairs Committee.
Shinseki, a retired four-star Army general who has led the VA since 2009, is
prepared to tell the committee about the VA's response so far to reports
that at least 40 veterans died while waiting for care at the Phoenix VA
Health Care system. The Phoenix facility reportedly worked to cover up
patients' long wait times by creating a secret waiting list and later
destroying the evidence.
"If these allegations are true, they are completely unacceptable--to
Veterans, to me, and to our dedicated VHA employees," Shinseki's prepared
opening statement says. If they are substantiated by the VA Office of
Inspector General (OIG), the agency's independent watchdog, Shinseki says
that "responsible and timely action will be taken."
Shinseki will tell the Senate committee that he's placed three employees
from the Phoenix facility on administrative leave at the request of the OIG.
However, he will say the OIG advised the VA against providing information to
the public that could "potentially compromise" the ongoing investigation.
Lawmakers, however, want to hear about more than just the alleged misconduct
in Phoenix. Report after report suggests the same practice of using secret
waiting lists may be happening elsewhere.
Germaine Clarno, a VA social worker and employee representative in Chicago,
told CBS News' Wyatt Andrews that there are multiples secret waiting lists
of veterans kept at the Hines VA Medical Center. Veterans were put on secret
waiting lists when they called for appointments, Clarno said, but they
wouldn't formally get an appointment booked until one came up within a
The VA grants bonuses to executives and doctors partly based on whether
patients are seen within 14 days, giving VA workers incentive to conceal
delays in care. Clarno said the purpose of the secret lists was "to make
numbers look better for their own recognition and for bonuses."
Meanwhile, a VA employee at the VA Medical Center in Cheyenne, WY, has been
placed on administrative leave after CBS News obtained an email showing an
employee directing his staff on how to game the appointments system to make
it appear as though veterans were being seen within the VA's 14-day
As the stories come out, some lawmakers are demanding investigations and
Shinseki's resignation. At the very least, they're demanding answers.
Sen. John Cornyn, R-Texas, one of the senators who has called on Shinseki to
resign, sent a letter to Shinseki on Tuesday asking him to give "direct,
clear answers" in his testimony Thursday to several specific questions.
"According to recent reports, you have ordered a 'face-to-face audit' of all
Department of Veterans Affairs clinics," Cornyn wrote. "Can you describe in
detail how you intend for this audit to be conducted, its timeline for
completion, and what measures are being taken to ensure these audits are
conducted in an independent and transparent manner?"
Shinseki on Thursday, while acknowledging the reports of misconduct, is also
prepared to defend the VA. "It is important to understand the size and scope
of VA care--the largest integrated healthcare delivery system in the United
States," his prepared testimony says, noting the VA system conducts
approximately 236,000 healthcare appointments each day and approximately 85
million appointments each year.
"VA provides safe, effective healthcare, equal to or exceeding the industry
standard in many areas," his statement says. He notes that the American
Customer Satisfaction Index, the nation's only cross-industry measure of
customer satisfaction, ranks VA customer satisfaction among the best in the
nation--equal to or better than ratings for private sector hospitals.
Visit CBS News for the story.
becomes more urgent, WHO says
The spread of the potentially fatal Middle East respiratory syndrome has
become more serious and urgent, the World Health Organization said
At the same time, WHO said that -- for now, at least -- the illness known as
MERS does not constitute a global health emergency.
Declaring an emergency is "a major act" that can "raise anxieties," said Dr.
Keiji Fukuda, the organization's assistant director-general for health
security. Despite concerns about the syndrome, researchers have not found
"any increasing evidence of person-to-person transmissibility," he said.
There have been 571 confirmed cases of MERS, including 171 deaths, according
to the World Health Organization. The number of countries with confirmed
cases expanded to 18, with a case in the Netherlands, WHO reported
Many of the cases are in Saudi Arabia and the United Arab Emirates.
Even without any official worldwide alert, Anne Schuchat, the head of the
CDC's National Center for Immunization and Respiratory Diseases,
acknowledges that "this is a relatively new virus that does have a high
fatality rate," ample reason to pay attention. Authorities haven't pinned
down all the details about how exactly it arose and how it spreads, though
Schuchat said, "we don't have evidence right now that this is airborne ...
the way the measles virus is."
Two cases have been confirmed in the United States. Both patients are
healthcare providers who were working in Saudi Arabia. The first is in
Indiana; the second in Florida.
Two healthcare workers who came in contact with the Florida patient later
went to an emergency room with flu-like symptoms. But they tested negative
for MERS in a state test, the CDC said Wednesday.
The Florida MERS patient, specifically, was fever-free and continuing to
improve Wednesday while undergoing treatment at Orlando's Dr. P. Phillips
Hospital, the state's health department said.
Given the virus' apparent roots in the Arabian Peninsula, Schuchat said it's
important that healthcare workers ask anyone who has suspicious "respiratory
symptoms" where they have been in recent weeks. "More and more people are
going to be traveling the next couple of months, so we really want
clinicians to be on the lookout," she said.
Commercial airlines are on guard as well, including efforts to make sure
those who might have come into contact with the two MERS patients in the
United States didn't come down with the virus. American Airlines said in a
statement that it is "working very closely with the Centers for Disease
Control, and contacted our flight crew as soon as we learned of (one such)
diagnosis. The CDC is in the process of contacting passengers to advise them
of any necessary precautions."
And Delta Airlines said that, like all carriers, it "has a long-standing
protocol for working with the U.S. Centers for Disease Control, as we are in
this instance. The safety of our customers and employees is Delta's top
One traveler who was on one possibly affected flight told CNN affiliate WMKG
that the call she got about one confirmed case of MERS left her "really
scared." Twelve days after her flight, she said, her state health department
called and sent her a note asking whether she had symptoms such as fever or
cough, and also saying she should record her temperature for two weeks.
Four people -- each from different families -- have been tested in San
Antonio for MERS because they were on a plane with one of the two confirmed
U.S. patients, said San Antonio health department spokeswoman Carol
Schliesinger. None of those four had any suspicious symptoms, she added.
Tests for two of them have come back negative for MERS, while the other
results are expected in the next couple of days.
Dr. William Schaffner, head of preventive medicine of Vanderbilt Medical
Center explained Wednesday on CNN's "New Day" that MERS can "spread in the
context of providing healthcare. “That's very important. And it has
occasionally spread in Saudi Arabia from one family member to another. It
requires close, constant, over time exposure."
People who go to a doctor or hospital with respiratory symptoms should be
asked immediately whether they've traveled to the Middle East or been in
contact with someone who did. "If the answer is yes, you put that person in
isolation," Schaffner said. Specimens are then taken and sent to the CDC for
Florida's health secretary, Dr. John Armstrong, said Wednesday that the case
in his state "is contained."
Representatives of 13 countries made up the WHO emergency committee that
convened Tuesday through a phone conference, the WHO said. Affected
countries need to take immediate steps to improve infection prevention and
control, the WHO said. The majority of infections have taken place inside
The CDC is not recommending that anyone change travel plans. The U.S. State
Department has instructed its embassies and consulates in Saudi Arabia,
Oman, Qatar, Jordan, Kuwait, and the UAE to provide U.S. citizens with CDC's
general guidance for infection control, a State Department official said.
Visit CNN for the article.
happen anywhere, even Ohio
In many ways, Ohio is pretty average. It has about 51 percent women, 49
percent men. Its state flower is a carnation, and its official beverage is
tomato juice. But while 90.3 percent of Ohio’s children have received the
MMR vaccine — a number on par with the national average — the state is
seeing a surge in measles and mumps.
Why? Experts blame international travel and a bit of bad luck.
“People from all walks of life and all continents … are moving left, right
and center around the world every day,” said Dr. Frank Esper, an infectious
diseases expert at UH Rainbow Babies and Children’s Hospital in Cleveland,
While having a high enough vaccination rate can lead to herd immunity, which
limits the spread of a virus and helps protect unvaccinated individuals,
Esper said the ability to travel the world has changed the meaning of
“We can no longer think of our herd as the Ohio herd or as the U.S. herd.
We’re talking about the herd of the world,” he said.
Ohio has recorded 73 measles cases since March 22, which health officials
say makes it larger than any other state measles outbreak since 1996. It has
also seen 342 mumps cases this year, 201 of which have been linked to an
outbreak at Ohio State University.
The Ohio measles outbreak has been tied to unvaccinated people who traveled
to the Philippines, which has seen upwards of 26,000 measles cases since
January, according to the World Health Organization.
The Ohio outbreak numbers are in the hundreds rather than thousands because
so many people are vaccinated, Esper said. The measles vaccine is 99 percent
effective, and the mumps vaccine is about 88 percent effective in those who
have had two doses of it, according to the U.S. Centers for Disease Control
Still, Ohio has clusters of people who are hesitant to use vaccines for
personal reasons just as affluent communities on the east and west coast do.
Ohio also has a large Amish population, some of whom avoid vaccines because
of their faith, Esper said.
Many of those who have gotten sick in Ohio have received incomplete doses of
the MMR vaccine or skipped it altogether, according to a statement from
Ohio’s Morrow County Health Department, which is offering vaccine clinics in
response to the outbreaks.
Visit ABC News for the story.
performing too many unnecessary C-sections, Consumer Reports finds
Whether you have a Cesarean section may depend on where you give birth. A
new Consumer Reports investigation found that C-section rates vary greatly
from hospital to hospital, which has raised concerns that doctors are
performing too many unnecessary procedures.
Nearly 55% of pregnant women expecting a low-risk delivery — meaning the
mother has never had a C-section, won’t deliver prematurely and is only
carrying one baby who is in the correct position — had C-sections at Los
Angeles Community Hospital, according to the report.
However, the rate of C-sections for low-risk deliveries at California
Hospital Medical Center in Los Angeles was 15%. Denver Health Medical Center
had the lowest C-section rate at just 8%.
Consumer Reports examined data from more than 1,500 hospitals in 22 states.
They looked at births that took place during a two-year period between 2009
and 2012, depending on the state, and scored them according to the rate of
C-sections for low-risk deliveries.
The nonprofit said 66% of the hospitals earned the low or second-lowest
score for their high C-section rates, while only 12% earned the top two
“We think it’s time those hidden numbers are brought to light,” Consumer
Reports Health Dr. John Santa said in a release. “How you deliver your baby
should be determined by the safest delivery method, not which hospital you
Consumer Reports pointed out that some medical organizations have already
started taking measures to reduce the number of surgical births. In March,
the American College of Obstetricians and Gynecologists and the Society for
Maternal-Fetal Medicine released a joint paper outlining new guidelines for
performing C-sections, which they say they hope will curb the surgical
births among first-time mothers.
Visit the New York Daily News for the article.
how it reduced needlestick injuries by nearly 70 percent
An article published in the Spring 2014 issue of the Journal of the
Association of Occupational Health Professionals in Healthcare discusses
how a systematic, data-driven approach and the subsequent adoption of a
safety-engineered blood collection set helped Robert Wood Johnson University
Hospital (RWJUH), a leading academic medical center, reduce needlestick
injuries (NSIs) by nearly 70 percent among its patient care technicians and
In the article – "Successfully Reducing Wingset-related Needlestick
Injuries" – author Doris L. Dicristina, RN, BSN, MS, COHN-S/CM, Director –
Employee Health and Wellness Services for RWJUH, reports how her team
identified that forward-shielding safety blood collection sets accounted for
30 percent of the institution's NSIs in 2010 and 43 percent in 2011.
The financial impact of these NSIs on RWJUH ranged from $400-$6,000 per
injury, depending on whether the patient was known to carry a bloodborne
disease such as hepatitis C, hepatitis B or HIV/AIDS. Using a novel
financial model, RWJUH estimated that it would need to generate more than
$106,000 in additional revenue to cover the cost of each NSI from a
source-negative patient, with injuries from source-positive patients costing
"Our first instinct in 2010 was to retrain...," Dicristina wrote. "It became
clear that retraining – although important – was not the solution, and that
the current engineering control was in fact the problem."
Further investigation revealed that approximately 83 percent of injuries
with the forward-shielding safety blood collection sets occurred after
clinicians removed the needles from their patients' veins, but before they
activated the safety mechanism.
After an extensive search and evaluation of different safety blood
collection sets, the hospital selected the BD Vacutainer Push Button Blood
Collection Set (PBBCS), with a split-second retracting needle that offers
in-vein safety activation.
The study reports that, after staff training and full conversion to the new
safety device, NSIs at RWJUH dropped nearly 70 percent from 45 injuries in
2010 and 2011 to 14 in 2012 and 2013. The injury rate per 100,000 devices
purchased fell more than 64 percent – from 7.43 in 2010-2011 to 2.65 in
Visit BD for the report.
Katrina and Rita may have caused up to half of recorded stillbirths in worst
Hurricanes Katrina and Rita may have been responsible for up to half of all
recorded stillbirths in the worst hit areas, suggests research published
online in the Journal of Epidemiology & Community Health.
And the true fetal death toll may even be higher, because of the
displacement of people whose homes and way of life were destroyed, suggest
Hurricane Katrina struck the state of Louisiana, USA, on August 29 2005,
followed by Hurricane Rita a month later on September 24. Katrina was the
costliest natural disaster in American history, while Rita was the fourth
most intense hurricane ever recorded. Both hurricanes caused widespread
damage to property and infrastructure and left a trail of injury, death, and
trauma in their wake.
The researchers used composite figures from several government agencies,
showing that the hurricanes caused damage in 38 out of 64 areas (parishes)
in the state, with almost 205,000 housing units affected. In four parishes,
more than half of the local housing stock was damaged; in three others,
between 10% and 50% was damaged. Elsewhere, the level of damage to housing
stock was categorized as 1%-10%, or less than 1%.
The researchers then calculated the odds of a pregnancy resulting in a
stillbirth in damaged and undamaged areas (less than 1% damage) in the 20
months before, and the 28 months after, Katrina struck. But they also
looked at all birth data between 1999 and 2009 in Louisiana to gauge usual
patterns: during this period, 5194 stillbirths were recorded.
They then used space-time models to assess whether the extent of damage
wrought by the hurricanes was linked to the risk of stillbirths in a given
Their calculations indicated that the risk of a pregnancy ending in a
stillbirth was 40% higher in parishes where 10-50% of housing stock had been
damaged, and more than twice as high in areas where over 50% of the housing
stock had taken a hit.
After taking account of known risk factors, every 1% increase in the extent
of damage to housing stock was associated with a corresponding 7% rise in
the number of stillbirths.
Based on these figures, the researchers calculated that of the 410
stillbirths officially recorded in extensively damaged parishes, up to half
(117-205) may have been directly caused by the hurricanes and the subsequent
devastation. Their estimates suggest that stillbirths made up around 17.5%
to 30.5% of the total death toll in the wake of the hurricanes.
But the risk of stillbirth may have been even higher, suggest the
researchers. In the hardest hit areas, the number of live births was more
than 40% lower in 2007 than it was in 2004. And in parishes with more half
of the housing stock damaged, the live birth rate fell by 79% in the three
months following Katrina. This "precipitous decline" is likely to reflect
the well documented exodus of residents from the coastal parishes of
Louisiana into other areas, they suggest.
They point to previously published research, showing a link between maternal
stress, depression, and trauma and birth complications, including
And they warn that climate change scientists have predicted an increase in
the frequency, intensity, and duration of North Atlantic tropical cyclones
like Hurricanes Katrina and Rita.
Visit Medical News Today for the study.
people still defecate in public despite health risks: UN
One billion people worldwide still practice "open defecation" and they need
to be told that this leads to the spread of fatal diseases, U.N. experts
said at the launch of a study on drinking water and sanitation.
Societies that practice open defecation - putting them at risk from cholera,
diarrhea, dysentery, hepatitis A and typhoid - tend to have large income
disparities and the world's highest numbers of deaths of children under 5
years old. Attempts to improve sanitation among the poorest have long
focused on building latrines, but the United Nations says that money
literally went down the toilet. Attitudes, not infrastructure, need to
change, it said.
"In all honesty the results have been abysmal," said Rolf Luyendijk, a
statistician at the U.N.'s children's fund UNICEF. "There are so many
latrines that have been abandoned, or were not used, or got used as storage
sheds. We may think it's a good idea but if people are not convinced that
it's a good idea to use a latrine, they have an extra room."
Many countries have made great progress in tackling open defecation, with
Vietnam and Bangladesh - where more than one in three people relieved
themselves in the open in 1990 - virtually stamping out the practice
entirely by 2012.
The global number has fallen from 1.3 billion in 1990. But one billion
people - 90 percent of them living in rural areas - "continue to defecate in
gutters, behind bushes or in open water bodies, with no dignity or privacy",
the U.N. study said.
The practice is still increasing in 26 countries in sub-Saharan Africa.
Nigeria was the worst offender, with 39 million open defecators in 2012
compared to 23 million in 1990.
Although the prevalence of open defecation is in decline, it is often common
in fast-growing populations, so the total number of people doing it is not
falling so fast, or is even rising.
The country with the largest number of public defecators is India, which has
600 million. India's relatively "hands off" approach has long been at odds
with the more successful strategy of neighboring Bangladesh, which has put a
big focus on fighting water-borne diseases since the 1970s, Luyendijk said.
"The Indian government did provide tremendous amounts, billions of dollars,
for sanitation for the poorest," he said. "But this was disbursed from the
central level to the provinces and then all the provinces had their own
mechanisms of implementing. And as their own data showed, those billions of
dollars did not reach the poorest," added Luyendijk.
"What is shocking in India is this picture of someone practicing open
defecation and in the other hand having a mobile phone," said Maria Neira,
director of Public Health at the WHO.
Making the practice unacceptable has worked in more than 80 countries, the
U.N. says. The goal is to eliminate the practice entirely by 2025. Poverty
is no excuse, the study said, noting the role of cultural differences.
In the Democratic Republic of Congo, 14 percent of the populations are open
defecators. But where the head of the household is an Animist, the figure is
twice as high, at 30 percent. Among households headed by Jehovah's
Witnesses, it is only 9 percent. (Reuters)
Visit the Chicago Tribune for the article.
financial woes caused by bad investment
The Massachusetts Nurses Association is insisting very adamantly that North
Adams Regional Hospital makes money on patient care -- and has been making
money for many years. IRS documents, they say, show the financial crisis
that led to the hospital's abrupt closing on March 28, might be due to a
real estate deal that went south more than a decade ago.
MNA officials who commissioned the audit also want to be clear, they're not
alleging any nefarious activity, however they are still blaming the
financial difficulties incurred by NARH on an "ill-advised real estate
For the hundreds of former hospital employees who've been out of work for
more than a month, Tuesday night's news provided a glimmer of hope.
After the MNA examined IRS documents and bankruptcy briefs, they've
concluded that patient services revenue at NARH grew by 78 percent over a
12-year period between 2000 and 2013, while expenses rose by only 29
percent. That means the hospital has been making millions for Northern
Berkshire Healthcare (NBH). So why were they $30 million in debt?
"NBH's own chapter 11 filings outlines the reasons for its critical
financial status," said Mike Fadel, spokesman for the MNA. "Chief among
them, what they highlight was the ongoing debt burden of Sweet Brook and
Sweet Brook is a transitional care living center for seniors and Sweet Wood
is a retirement community, side by side in nearby Williamstown, property for
which NBH invested $25 million back in 1999, and later sold for $7 million.
"It was clearly a bad decision and it was a decision to spend a lot of money
in an area that's not related to the provision of hospital care," Fadel
said. While paying off the debt on the sour investments, NBH also trimmed
the work force and cut operating expenses at NARH.
"The reduction in reimbursement rates and the increase in the (seriousness)
of patients and their illnesses have caused the cost of care to go way up,"
Fadel says its important now for policy makers and decision makers to make
themselves familiar with the hospital's financial data so that they
understand the community can sustain a full-service hospital.
The community is still on target to reopen the emergency room on May 19.
Visit WYNT for the story.
Download print version
watch: Florida hospital staff exposed
insured, but the choices are narrowing
Master 3D printers to grow replacement body parts: breast, bone and
allows marketing of first prosthetic arm that translates signals from
person’s muscles to perform complex tasks
Disease rides the dogs of war as Polio, Measles, Typhoid capitalize on chaos
hospital reports high rate of black women seeking treatment for advanced
Study: Recycled blood better than donated blood for transfusions
Patient's immune system harnessed to attack cancer
Florida hospital staff exposed
Two Florida healthcare workers have developed flu-like symptoms after
exposure to the second U.S. case of Middle East coronavirus (MERS). They,
and 18 other healthcare workers at two Orlando hospitals, are being tested
for the virus, which can cause serious illness and death, medical officials
said at a media conference Tuesday. They were exposed to the patient in the
emergency room of Dr. P. Phillips Hospital before it was clear he was at
risk for MERS, officials told reporters.
One of the two with symptoms has been admitted to the hospital and the other
is in isolation at home. The patient himself, a 44-year-old Saudi Arabian
healthcare provider visiting family in the area, has a low-grade fever and a
slight cough and remains in isolation at the hospital.
Fifteen of the affected workers were involved in caring for the patient
himself, but the other five were exposed when the patient last week
accompanied another person to Orlando Regional Medical Center for an
unrelated medical procedure.
Meanwhile, a World Health Organization committee on MERS is meeting in
Geneva to discuss whether the recent surge in cases in the Middle East makes
the virus an international public health emergency.
Saudi Arabia, the center of the outbreak, has reported an additional four
cases, all of them in the capital, Riyadh, as well as five deaths, four of
them involving previously reported cases. The new report brings the Saudi
total to 495 cases and 152 deaths since the virus was first recognized in
The Saudi health ministry said on its website that three of the new cases
are in stable condition, but the fourth -- a 69-year-old man initially
admitted to the hospital for heart disease -- developed respiratory symptoms
on May 11 and died a day later.
On the other hand, the ministry said that six people diagnosed with the
virus have recovered and been discharged from hospital.
Visit MedPage Today for the story.
More insured, but
the choices are narrowing
In the midst of all the turmoil in healthcare these days, one thing is
becoming clear: No matter what kind of health plan consumers choose, they
will find fewer doctors and hospitals in their network — or pay much more
for the privilege of going to any provider they want.
These so-called narrow networks, featuring limited groups of providers, have
made a big entrance on the newly created state insurance exchanges, where
they are a common feature in many of the plans. While the sizes of the
networks vary considerably, many plans now exclude at least some large
hospitals or doctors’ groups. Smaller networks are also becoming more common
in healthcare coverage offered by employers and in private Medicare
Insurers, ranging from national behemoths like WellPoint, UnitedHealth and
Aetna to much smaller local carriers, are fully embracing the idea, saying
narrower networks are essential to controlling costs and managing care.
Major players contend they can avoid the uproar that crippled a similar push
in the 1990s.
But while there is evidence that consumers are willing to sacrifice some
choice in favor of lower prices, many critics, including political opponents
of the new healthcare law, remain wary about narrowing networks. A concern
is that insurers will limit access to specialists or certain hospitals
In response, state and federal regulators say they are more closely
monitoring the plans being offered in the coming year to be sure they are
clear and that consumers have sufficient access to hospitals and doctors. In
some cases, they are already insisting on changes.
Nonetheless, for people who are directly picking plans in the open markets,
insurers say price is turning out to be critical. People “are weighing
affordability and breadth of network,” said Karen Ignagni, the chief
executive of America’s Health Insurance Plans, an industry trade group.
“What we’re finding is individuals are experiencing a preference for
affordability,” she said.
Minnesota would seem to be a case in point. On the state exchange,
PreferredOne offered an inexpensive plan with a network of 13 hospitals, but
those low premiums helped the insurer grab 60 percent of the individual
While many insurers are including only those hospitals and doctors willing
to charge lower prices, experts say the makeup of the networks is likely to
evolve over time, focusing less directly on price and more on the ability of
providers to deliver coordinated and high-quality care.
Although a similar attempt to restrict choice failed in the early ‘90s,
after opposition to H.M.O.s and managed care, insurers insist these efforts
will not run into the same resistance because they are now working more
closely with providers, and customers are more concerned about costs. “It’s
a new era,” said Dr. Sam Ho, the chief medical officer for United
Blue Shield of California, for example, was able to recruit a fairly sizable
group of providers interested in discounting their rates. Just as the plans
must compete on the exchanges, “the doctors and hospitals are competing with
each other to get in,” said Juan Davila, an executive vice president with
the insurer. The next step, Davila said, is to work with providers to
develop more sophisticated networks, where the insurer will team with those
doctors and hospitals to provide better care.
Outside the exchanges, insurers are also promoting smaller networks for
employers as a way to reduce overall healthcare costs, said Larry Boress,
chief executive of the Midwest Business Group on Health. “The larger the
network is, the higher the cost,” he said.
Nonetheless, the bottom line is that more employers are considering smaller
networks. Many, like Walmart and General Electric, have gone so far as to
steer employees to specific hospitals for certain expensive procedures like
In 2010, 24 percent of the largest employers offered smaller networks,
chosen for their low costs or quality. Last year, 27 percent offered them
and 44 percent said they were considering them, according to Mercer, a
benefits consulting firm. Some companies are experimenting with different
tiers of networks, charging workers more if they go to the broadest network,
said Joseph Kra, a Mercer consultant.
There has been pushback, however. When United Healthcare reduced the size of
networks in some Medicare Advantage plans, consumer groups and regulators
balked. Dr. Ho, the chief medical officer, said the insurer offered patients
the opportunity to continue receiving certain treatments, like chemotherapy,
with their existing provider.
Medicare recently announced it would require Advantage plans to give advance
notice of any significant changes to a network and might allow beneficiaries
to switch during the year if the network underwent too much change after
they had already signed up. Federal officials, who had floated the idea of
requiring exchange plans to submit their networks for review, said they
would instead focus on specific types of doctors, like cancer specialists,
to make sure people have adequate access to care.
Visit the New York Times for the article.
printers to grow replacement body parts: breast, bone and cartilage
QUT and three of the world's leading research universities in the 3D
printing of replacement body parts have joined forces to offer the world's
first international masters in biofabrication whereby graduates will hold a
masters degree from an Australian university in addition to a masters degree
from a European university.
Biofabrication is a process by which scientists can regrow most types of
human tissue using 3D printers. QUT's biofabrication research is
well-advanced in printing 3D custom-made scaffolds using bio-ink infused
with the patient's stem cells to enable the body to grow a new breast after
All world leaders in biofabrication research, the four universities offering
the two-year, two-degree masters program are: QUT and the University of
Wollongong in Australia, the University Medical Center Utrecht in the
Netherlands and the University of Würzburg in Germany.
QUT Institute of Health and Biomedical Innovation's Professor Dietmar W.
Hutmacher leads QUT's biofabrication research. "This degree is a vital step
in ensuring Australia is a high-value, high-tech manufacturer in the
future," Professor Hutmacher said.
"Graduates will be at the forefront of an industry that will always be in
high demand given the ageing of populations around the world and which
cannot be easily replicated by any other country.
"The universities will each admit 10 students to the degree who will
graduate with a multidisciplinary outlook and expertise which would be
welcome anywhere in the world."
He said the Australian students would spend nine to 12 months studying at
one of the European universities and the European students would also study
at one of the Australian universities.
"Biofabrication can be used to repair cartilage, bone, muscles, nerves and
skin that have been damaged by trauma, disease or cancer. It is even
predicted that entire organs will be biofabricated within a few decades. At
QUT, we are already researching the use of such scaffolds to regrow breast
tissue in women who've had surgery for breast cancer."
He said this new field of medicine employed the 3D printers to build up
fine, intricate layers of different types of biomaterials into
individualized structures which dissolve into the body as the new tissue
grows. These tailor-made structures are then implanted into the body to act
as a scaffold on which the new tissue can grow.
Professor Hutmacher said although it would be up to five years until the
technique could be used to regrow a breast, biofabrication was already
successfully being used to repair broken and missing bone.
"For example, patients with a piece of skull missing have already been
successfully fitted with a 3D-printed scaffold custom-made to fit the hole.
The scaffolds contain the patient's bone cells and growth enhancers so that
the skull grows over and the scaffold is absorbed into the new bone."
Visit QUT for information.
marketing of first prosthetic arm that translates signals from person’s
muscles to perform complex tasks
The U.S. Food and Drug Administration (FDA) allowed marketing of the DEKA
Arm System, the first prosthetic arm that can perform multiple, simultaneous
powered movements controlled by electrical signals from electromyogram (EMG)
EMG electrodes detect electrical activity caused by the contraction of
muscles close to where the prosthesis is attached. The electrodes send the
electrical signals to a computer processor in the prosthesis that translates
them to a specific movement or movements.
The EMG electrodes in the DEKA Arm System convert electrical signals into up
to 10 powered movements, and it is the same shape and weight as an adult
arm. In addition to the EMG electrodes, the DEKA Arm System contains a
combination of mechanisms including switches, movement sensors, and force
sensors that cause the prosthesis to move.
The FDA reviewed clinical information relating to the device, including a
4-site Department of Veterans Affairs study in which 36 DEKA Arm System
study participants provided data on how the arm performed in common
household and self-care tasks. The study found that approximately 90 percent
of study participants were able to perform activities with the DEKA Arm
System that they were not able to perform with their current prosthesis,
such as using keys and locks, preparing food, feeding oneself, using
zippers, and brushing and combing hair.
The DEKA Arm System can be configured for people with limb loss occurring at
the shoulder joint, mid-upper arm, or mid-lower arm. It cannot be configured
for limb loss at the elbow or wrist joint.
The DEKA Arm System is manufactured by DEKA Integrated Solutions in
Visit the FDA for the release.
Disease rides the
dogs of war as Polio, Measles, Typhoid capitalize on chaos
Saudi Arabia is one of a handful of countries that require visitors from
Pakistan to be vaccinated against polio. Now Pakistan is preparing to
inoculate all travelers to meet new World Health Organization requirements
aimed at curbing a global resurgence of the crippling virus.
The WHO declared polio a global health emergency, less than two years after
the virus was driven to the brink of extinction. A ban on vaccinations by a
Taliban leader in retaliation for U.S. drone strikes, and attacks on
healthcare workers after a fake vaccination campaign was used to hunt down
Osama bin Laden, have hampered eradication efforts and enabled polio to
spread inside Pakistan and to Egypt, Israel, Syria and Iraq.
Pakistan’s army will start accompanying polio vaccinators said Major Waheed
Akhtar Bukhari, a spokesman for the military in Karachi. At least 168 people
were vaccinated at a new counter in Islamabad’s main hospital after the WHO
Pakistan isn’t alone in its struggle against a disease that piggybacks on
conflict. Somalia last year had 194 polio cases, mostly in areas controlled
by Islamist militants, six years after being declared free of the disease.
Syria, whose last case was in 1999, reported 35 last year as the health
system crumbles and vaccination rates plunge amid its three-year civil war.
Polio is not the only disease to rear its head in countries suffering from
war or disaster. Cases of typhoid; hepatitis A; and cutaneous leishmaniasis,
a disfiguring skin infection, have been reported in Syria, and at least 930
cases of measles, after vaccination rates fell to 65 percent from 90 percent
before the war, according to the WHO.
Measles is also spreading in the Central African Republic, which has been
gripped by violence since mainly-Muslim members of the disbanded Seleka
militia seized power in March 2013. Medecins Sans Frontieres this week
suspended all but emergency care in the country after three of its staff
were killed in an attack on a hospital.
By 2012, an $11.8 billion eradication campaign backed by Rotary
International and the Bill & Melinda Gates Foundation had polio cornered in
just three countries: Pakistan, Afghanistan and Nigeria. Cases fell to a
record low of 223 that year. The virus resurged last year, with 416 cases
reported in eight countries, according to the WHO. So far this year, 74
cases have been reported globally, compared with 26 in the same period last
year. Of those, 59 were in Pakistan, including 36 in North Waziristan, a
Taliban-dominated tribal region along the country’s border with Afghanistan.
Cases in Afghanistan, Syria and Iraq have all been linked to Pakistan, and
virus detected in sewage in Israel was a match for the strain circulating in
Pakistan, according to the WHO.
Vaccination efforts have also been hampered by rumors the inoculations cause
infertility and after the U.S. Central Intelligence Agency used a fake
vaccination program to help hunt down bin Laden. As many as 60 polio
vaccinators have been killed in Pakistan since December 2012, said Aziz
Memon, chairman of Rotary International in the country, which has been
active in polio eradication programs there.
Health officials at the Pakistan Institute of Medical Sciences hospital in
Islamabad have ordered 5,000 extra doses of the vaccine in anticipation of
increased demand at the new counter opened the day after the WHO’s
declaration, said Javed Akram, the institute’s head.
Pakistan already had vaccination booths at airports in six cities for
travelers to India and Georgia, whose governments require Pakistanis to be
vaccinated for polio before they travel, said Anwar ul Haque, a health
officer at the international airport in Karachi, Pakistan’s biggest city.
Haque said he’s now waiting for orders from the government to implement the
Saudi Arabia has for years vaccinated visitors from Pakistan upon their
arrival, such as those making the annual Hajj pilgrimage to Mecca. There are
also some vaccination booths at checkpoints along the country’s border with
Afghanistan, according to a government spokesman.
Visit Bloomberg for the article.
reports high rate of black women seeking treatment for advanced breast
Cancer specialists at MedStar Washington Hospital Center are trying to find
out why African American women are showing up for treatment with advanced
breast cancer at rates that are almost double the national average. Of 1,764
women who went to the hospital for breast cancer treatment from 2006 to
2011, 311 of them, or about 18 percent, had stage 3 or stage 4 breast
cancers. Nationwide, 10.5 percent of all breast cancer cases are stage 3 or
stage 4, according to National Cancer Institute data.
“We don’t know why we are having all these cases with advanced cancer,” said
Elmer E. Huerta, director of the cancer-prevention program at the hospital.
Of the 311 with advanced breast cancer, 169, or 54 percent, were women who
lived in the District, and most of them were black. And of those, 68 women,
or 40 percent, were residents of Ward 5, where the hospital is located. Ward
5 is mostly in Northeast Washington and includes the neighborhoods of
Brentwood, Brookland and Fort Lincoln.
Officials did not have ward breakdowns for the other cases. Ward 5 has the
highest breast cancer mortality rate of the city’s eight wards, according to
the D.C. Cancer Consortium, a nonprofit organization.
Initially, hospital researchers suspected that lack of access to healthcare
might be one reason for the higher rates of advanced cancer; it is a reason
the District has one of the country’s highest cancer mortality rates. But to
their surprise, hospital officials found that 97 percent of the Ward 5
patients with advanced breast cancer were African American women with
Hospital officials don’t know why that is happening. One possible reason is
fear, Huerta said. But another explanation may be that many women are
confused about the importance of mammograms because of conflicting studies
about their benefits and risks, he said.
The hospital has received a $100,000 grant from the Avon Foundation to begin
a community outreach program to educate women in Ward 5 about mammograms.
The hospital plans to hire a breast health educator from the community to
visit beauty parlors and other locations to increase awareness of screening,
diagnostic and treatment services.
Visit the Washington Post for the article.
blood better than donated blood for transfusions
During some surgeries, operating room personnel try to capture as much blood
as possible and return the red blood cells to your system, instead of, or in
addition to, donated blood from a blood bank. They find that patients have
better outcomes when transfused with their own blood.
A Johns Hopkins University study, published in the June issue of the journal
Anesthesia and Analgesia, explains one reason for that. As banked
blood sits on shelves for as long as 42 days, the membranes of red blood
cells become less able to change shape and squeeze through the smallest
capillaries to deliver critical oxygen to tissues.
"The smallest capillaries are five microns in diameter. Red blood cells are
seven microns," said Steven Frank, an associate professor in the Department
of Anesthesiology at the Johns Hopkins School of Medicine, who led the
research. In addition to its weakened ability to deliver oxygen, the red
blood cells can sometimes plug those capillaries, he said.
The irony is that blood banks sometimes face shortages of donated blood, and
red blood cell salvaging, as it is sometimes known, is cheaper than using
banked blood. Banked blood — whether obtained from the Red Cross, a practice
followed by smaller hospitals, or banked at major facilities such as Johns
Hopkins — costs about $240 per unit, Frank said. Recycled blood costs about
$120 for the plastic tubing and other equipment needed to salvage the first
unit, but nothing more once the equipment is set up in an operating room and
a person is brought in to run it.
Smaller hospitals may not have the equipment or personnel for such salvaging
but larger ones certainly do, Frank said. The technique, which can recapture
50 percent to 75 percent or more of a patient's blood, can be used during
heart surgery, vascular surgery, joint replacements, transplants, some
Caesarean sections and even trauma surgery, he said.
Recycling a patient's blood became popular in the 1980s, when the risk of
HIV in donated blood was higher. But now banked blood is considered so safe
that getting HIV or hepatitis from it carries the same risk as being struck
by lightning or killed in an airplane crash, Frank said.
Five large studies have shown that the amount of blood needed doesn't affect
the fresh versus stored equation either, Frank said. In all of those
studies, people receiving fresh blood were less likely, or no more likely,
to suffer heart attacks, strokes, death or infections after surgery, he
said. (The Washington Post)
Visit St. Louis Post-Dispatch for the article.
system harnessed to attack cancer
In a strategy that combines two of the hottest ideas in cancer research,
scientists at the National Institutes of Health said they successfully
attacked a woman's disease by using her immune system to home in on genetic
mutations unique to her tumors.
The findings, published by the journal Science, come from just one
patient—a 45-year-old woman in Montana. But researchers said her case, in
which she received billions of immune cells specially grown to target her
tumors, amounts to evidence the technique may be a way to treat many common
cancers now considered difficult to target with the immune system.
So-called immunotherapy has so far shown the most promise in relatively rare
cancers such as melanoma and kidney cancers. This new approach "represents
the blueprint for making immunotherapy available to treat common cancers,"
said Steven A. Rosenberg, chief of the Surgery Branch at the National Cancer
Institute's Center for Cancer Research and senior author of the study.
"We've figured out a way to target what is absolutely unique on each cancer.
That is the mutations that make the cancer a cancer."
But the method devised by Dr. Rosenberg and his colleagues is complex. It
involves sophisticated genetic sequencing and analysis and aggressive
treatments to destroy a patient's immune system before replacing it using
cell therapy with one that recognizes the cancer.
Oncology is being transformed on two major fronts: on the one hand, new
drugs that target specific genetic mutations responsible for tumor growth,
and on the other hand, immunotherapies. But for the most part, these
strategies have been moving forward on parallel tracks.
The new approach combines both. It is based on long-standing observations
that immune-system cells called T-cells often recognize tumors and travel to
their locations in the body, but aren't plentiful or strong enough to kill
the cancer cells. In the Science paper, researchers said they found a way to
create enough useful T-cells to marshal a better attack.
The patient is a paramedic and mother of six including two stepchildren. She
was diagnosed with bile duct cancer in 2009. She enrolled in Dr. Rosenberg's
research in March 2012 after surgery and regimens of chemotherapy had failed
to control the disease.
Though her tumors are rare, Dr. Rosenberg said they are representative of
colon, breast and other solid tumors of the type responsible for more than
80% of cancer deaths.
The researchers obtained a biopsy of one of her tumors, and in a process
that took several weeks, sequenced its DNA and found a match between a
mutation and certain T-cells from her body that reacted to the mutation.
They grew huge numbers of the T-cells to serve as her treatment. After she
had chemotherapy to knock out her immune system, she was given an infusion
that included 42 billion T-cells, about 10 billion of those targeted to the
For six months, her tumors shrank, the study found, and then stabilized for
another six months before they started to grow again. Last October, she
underwent a second treatment based on a biopsy from a different tumor, this
time with 126 billion cells, 95% of them matched to the mutation. Her cancer
responded almost immediately, researchers said. She isn't considered cured.
But she just had a six-month checkup, and the tumors had shrunk
Visit the Wall Street Journal for the article.
Download print version
visiting Orlando is second MERS virus case in the U.S.
discourages uterine procedure for cancer threat
United States: US Appeals Court upholds FTC hospital merger decision
Celebrate National Nurses Week
Medicare pays billions for 'low-value care'
Boston Scientific subpoenaed over defibrillator devices
Remotely monitoring heart patients with implanted defibrillators lowers risk
Bringing the UDI Regulation & the Global UDI Database (GUDID) to life
Orlando is second MERS virus case in the U.S.
A growing global threat of the potentially deadly MERS virus has spread to
Orlando with the case of a 44-year-old man visiting from Saudi Arabia,
health officials reported Monday.
He becomes the second U.S. patient with the respiratory illness, which has
infected more than 500 people worldwide and killed 114.
MERS — or Middle East Respiratory Syndrome — is considered serious because
of its fatality rate of about 30 percent and because there is no vaccine or
specific antiviral treatment. But health officials emphasize that it is
spread only through close contact, including touching, coughing or
contaminated fluids. About one-fifth of those infected are healthcare
workers, as is the Orlando patient.
The man, who works in a Saudi Arabia hospital, arrived in Orlando on May 1
but did not seek treatment until May 8, when he went to the Dr. P. Phillips
emergency room. A trio of laboratory tests confirmed MERS.
"The patient is in good condition and is improving," said Dr. Antonio Crespo,
an infectious-disease specialist and chief quality officer for the hospital,
part of Orlando Health. "We are taking every precaution, but believe the
risk of transmission from this patient is very low since his symptoms were
mild and he was not coughing when he arrived at the hospital."
Symptoms of the virus include congestion, cough, fever over 100.4 degrees,
shortness of breath, pneumonia, body aches and diarrhea.
The man's family members and hospital workers who had contact with him are
being monitored for signs of the disease. Following protocol from the
federal Centers for Disease Control and Prevention, the exposed hospital
workers are being placed on temporary paid leave and asked to stay home.
CDC officials said Monday they expected additional MERS cases in the United
States because of a recent spike in cases in the Arabian Peninsula,
primarily in Saudi Arabia. The virus was first identified there in 2012.
Florida Department of Health officials in Orlando emphasized that the
patient — whose name is not being released for privacy reasons — did not
visit local theme parks or other tourist spots. In the current case, the
patient left Saudi Arabia April 30 and began experiencing muscle aches,
health officials said. He flew first to London, then to Boston and Atlanta
before arriving in Orlando on May 1.
By then, he had a slight fever, and he later developed diarrhea and
ultimately a cough. According to CDC officials, more than 500 passengers on
U.S. segments of those flights were exposed and are being notified. So far,
no one exposed to the man has reported symptoms, which typically take five
to 14 days to develop.
Dr. Kevin Sherin, director of the state Health Department for Orange County,
said only those who have had some contact with an infected individual are at
The patient was placed in isolation once MERS was suspected. He remains
there in stable condition and is expected to make a full recovery, Crespo
said. The virus was confirmed through a series of laboratory tests on blood
and other bodily fluids.
So far most cases have been transmitted through caring for or living with an
infected person. The fatality rate is expected to drop as more patients with
mild symptoms or even no symptoms are identified through laboratory testing.
The first confirmed case of MERS in the United States was reported in a
traveler from Riyadh, Saudi Arabia. That person had traveled to London, then
on to Chicago and Indiana before being hospitalized in Indiana April 28. The
patient is now recovering, the CDC reported.
Visit the Orlando Sentinel for the story.
uterine procedure for cancer threat
The U.S. Food and Drug Administration is warning doctors against using a
popular method to remove the uterus or uterine fibroids without open surgery
because it can spread cancer cells.
The technique, called laparoscopic power morcellation, involves shaving down
the tissue or growths into pieces that can be removed through the tiny holes
used to insert the equipment. The agency found that 1 in 350 women who get a
hysterectomy or have their fibroids removed have a type of cancer that can
spread beyond the uterus with the approach.
Distribution of cancerous cells in the abdomen and pelvis can significantly
worsen the woman’s chances of long-term survival, the agency said in a
safety communication. Companies that make equipment for the procedure,
including Johnson & Johnson, were urged to ensure they give accurate
information about the risks on their product materials, the FDA said.
“The FDA’s primary concern as we consider the continued use of these devices
is the safety and well-being of patients,” said William Maisel, deputy
director for science and chief scientist at the FDA’s Center for Devices and
Radiological Health. “There is no reliable way to determine if a uterine
fibroid is cancerous prior to removal.”
The FDA’s Obstetrics and Gynecological Medical Devices Panel will meet to
discuss the risks and other information on to the procedure, the agency
Along with Johnson & Johnson’s Ethicon unit, the equipment for the process
is manufactured by closely-held companies including Karl Storz GmbH & Co.,
Richard Wolf Medical Instruments Corp., LiNA Medical and Blue Endo. While
Intuitive Surgical Inc.’s da Vinci robot doesn’t use morcellation, it
deserves mention since it is being used more often and the uterus must be
broken into smaller pieces to be removed from the abdomen during the
procedure, according to Hooman Noorchashm, a Boston-based cardiothoracic
Noorchashm filed a petition on Change.org to stop use of morcellation after
it was performed on his wife, also a Boston-based doctor. She was
subsequently diagnosed with cancer.
Visit Bloomberg for the article.
United States: US
Appeals Court upholds FTC hospital merger decision
Recently the US Court of Appeals for the Sixth Circuit upheld a Federal
Trade Commission (FTC) decision prohibiting the largest hospital in the
Toledo, OH, area from merging with a competing hospital. The decision
continues the FTC's recent string of successful, very focused attacks on a
limited number of hospital-related mergers. The case is notable for a number
of reasons, including:
1. the court's analysis of what presumptively proves an illegal merger;
2 .the extent to which the court referred to the parties' internal documents
and employee testimony as support for the FTC decision;
3. the court's noting the failure of the hospital, in the face of such
evidence, to offer any justification based on better quality, better access,
lower costs or some combination of these; and
4. the court's rejection of a "weakened competitor" or "flailing firm"
defense, because the evidence indicated a profitable competitor.
The case involved a proposed merger between two of the four hospital systems
in Lucas County, OH, (whose county center is Toledo): ProMedica, the
dominant hospital provider, and St. Luke's, an independent community
hospital. Post-merger, ProMedica was left with a market share above 50
percent in one relevant product market (the so-called primary and secondary
services) and above 80 percent in another (for obstetrical [OB] services).
An administrative law judge, and later the full FTC, found that the merger
would adversely affect competition in violation of Section 7 of the Clayton
Act. The FTC found that the merger increased ProMedica's market share far
above the threshold required to create a presumption that the merger would
lessen competition. It also found that a large body of other
evidence—documents and testimony from the merging parties themselves,
testimony from the managed care organizations (MCOs) and expert
testimony—confirmed that the merger would have a substantial anticompetitive
The Sixth Circuit denied ProMedica's petition for review, concluding that
the FTC's "analysis of this merger was comprehensive, carefully reasoned and
supported by substantial evidence in the record." Based on the increases in
market share in the relevant markets, and concentration in those markets
post-merger (as measured by the Herfindahl-Hirschman Index, or "HHI"), the
FTC found that the merger to be "presumptively illegal."
Visit Mondaq for the full report.
National Nurses Week
Leaders of national nursing organizations meet with HHS Secretary Kathleen
Sebelius, HRSA Administrator Mary K. Wakefield, PhD, RN and RADM Sylvia
Trent-Adams, PhD, RN and chief nurse officer, U.S. Public Health Service on
May 9, 2014 in Washington, DC.
Nurses Leading the Way in Primary Care are the first line of defense in the
prevention of illness and injury. They champion and promote the health of
National Nurses Week begins each year on May 6th and ends on May 12th, the
Birthday of Florence Nightingale, who is widely recognized as the founder of
modern nursing. This year we recognize nurses as healthcare leaders and
trusted advisers on health issues, thank nurses for their critical role in
implementing the Health Insurance Marketplace and Medicaid expansion, and
look ahead to how nurses will continue to improve patient outcomes in the
ever-evolving field of primary care.
Visit HRSA for the release.
billions for 'low-value care'
The Medicare system spent at least $1.9 billion in 2009 and probably much
more on "low-value" procedures and tests, such as cancer screening in
patients with end-stage renal disease in patients 75 and older, researchers
said. Depending on whether relatively sensitive versus specific measures of
low-value care were used, the percentage of overall Medicare Parts A and B
spending that went to such services ranged from 0.6% to 2.7%, according to
J. Michael McWilliams, MD, PhD, of Harvard Medical School, and colleagues.
Although these figures represented "modest proportions" of the total
Medicare budget, the researchers wrote online in JAMA Internal Medicine,
from one-quarter to more than 40% of all beneficiaries received at least one
of the 26 types of low-value service during the 1-year study period.
Because the 26 measures are probably not an exhaustive list of all tests,
procedures, and treatments that are unnecessary in older individuals,
overuse of such services may be substantially greater, McWilliams and
McWilliams and colleagues selected the 26 low-value services after scouring
the lists maintained by the American Board of Internal Medicine's Choosing
Wisely project, along with services receiving "D" recommendations from the
U.S. Preventive Services Task Force, "do not do" recommendations by the
U.K.'s National Institute for Health and Care Excellence, and those
identified as unnecessary in Canadian Agency for Drugs and Technologies
assessments. The authors also looked for others named as unnecessary in the
Medicare population in peer-reviewed, published papers.
Among the low-value tests identified by the authors:
Four were cancer screens. In addition to screening conducted in elderly
dialysis patients, these included PSA testing in older men with no prostate
cancer history, cervical cancer screening in older women, and colorectal
cancer screening in older patients of both sexes.
Four other types of diagnostic and preventive screening were included, such
as bone mineral density measurement within 2 years of a previous test.
Four kinds of preoperative testing were part of the list, such as chest
x-rays within 30 days of a low- to moderate-risk noncardiothoracic surgery.
Seven imaging tests were on the list, ranging from sinus CT scans for
uncomplicated rhinosinusitis to brain MRI scans in patients identified with
syncope as the primary diagnosis.
McWilliams and colleagues rounded off the list with five cardiovascular
procedures, such as carotid endarterectomy in asymptomatic patients, and two
other types of procedures, including certain surgeries for knee
osteoarthritis and osteoporotic spine fractures.
"Inherent in most of our claims-based measures of low-value care was a
trade-off between sensitivity (greater capture of inappropriate use) and
specificity (less misclassification of appropriate use as inappropriate,"
the authors noted. "For example, limiting the colorectal cancer screening
measure to beneficiaries older than 85 years instead of older than 75 years
decreases its sensitivity (fewer low-value instances detected) but increases
its specificity (smaller proportion of appropriate services classified as
Therefore, they defined most of these tests in two ways -- one to achieve
high sensitivity, and the other to be relatively specific. For example, the
sensitive measure of cancer screening in dialysis patients took in any
screening test performed in the study sample for breast, cervical, colon, or
prostate cancer; the specific measure excluded those performed in patients
younger than 75.
Similarly, any homocysteine test was considered low-value in the sensitive
analysis, whereas the specific measure included only those tests performed
in patients whose records contained no diagnosis of folate or B12 deficiency
and no prior claims for folate or B12 testing.
In terms of the number of beneficiaries receiving services deemed low-value,
those involving cancer screening and imaging were the most common,
accounting for about three-quarters of all claims for low-value services.
This was true irrespective of whether sensitive or specific measures were
In terms of spending, however, cardiovascular testing and procedures
accounted for the vast majority when sensitive measures were applied.
McWilliams and colleagues estimated that 1.9% of all Medicare spending was
for cardiovascular services that, according to the sensitive definitions,
"Our study findings illustrate the potential utility and limitations of a
direct approach to detect wasteful care," they wrote. "Despite their
imperfections, claims-based measures of low-value care could be useful for
tracking overuse and evaluating programs to reduce it. However, many direct
claims-based measures of overuse may be insufficiently accurate to support
targeted coverage or payment policies that have a meaningful effect on use
without resulting in unintended consequences."
Visit MedPageToday for the study.
subpoenaed over defibrillator devices
Medical device maker Boston Scientific Corp. said it received a subpoena
this week from the Department of Health and Human Services, seeking
information about the performance of some of its implanted defibrillators.
The subpoena, received May 5, requested information related to the 2008
launch of two brands of implanted cardiac defibrillators, or ICDs, made by
Boston Scientific, the company said in a regulatory filing Thursday. The
subpoena also sought information related to the performance of the devices
between 2007 and 2009, and the operation of a "Physician Guided Learning
Program," the filing said. The defibrillators are sold under the brand names
Cognis and Teligen.
The subpoena was issued by HHS's Office of the Inspector General, which is
responsible for identifying fraud and waste in government health programs
such as Medicare and Medicaid, according to the agency's website. Boston
Scientific said it is cooperating with the request.
Boston Scientific competes against companies including Medtronic Inc. and
St. Jude Medical Inc. in selling heart devices. The industry has come under
increased scrutiny in recent years for allegedly using kickbacks and other
illegal incentives to gain market share and increase the use of their
devices among physicians.
Earlier this week, St. Jude Medical said in a regulatory filing that it
received a civil investigative demand from the U.S. Department of Justice in
April related to its cardiac devices. The Justice Department said it was
investigating St. Jude for allegedly paying inducements to healthcare
providers in exchange for implanting St. Jude's devices, the company said in
the filing. St. Jude said it is working with the Justice Department in
responding to the civil investigative demand.
Medtronic paid $23.5 million in 2011 to settle Justice Department
allegations that it paid illegal kickbacks to physicians to induce them to
implant Medtronic pacemakers and defibrillators.
In October 2013, Boston Scientific agreed to pay $30 million to settle
Department of Justice allegations that its subsidiary Guidant Corp. had
knowingly sold defective defibrillators between 2002 and 2005 that were
implanted in Medicare patients. Boston Scientific acquired Guidant in 2006
in a deal valued at around $27 billion.
Visit the Wall Street Journal for the article.
monitoring heart patients with implanted defibrillators lowers risk of death
Patients with implantable cardioverter defibrillators (ICD) have
significantly lower risk of death and re-hospitalization if they are
followed through an automatic, wireless remote monitoring system, a Yale
clinical study has found.
ICDs are used to treat patients at high risk of sudden cardiac death. Remote
patient monitoring can help physicians keep an eye on patients once they are
home by wirelessly communicating with the implanted device to make sure it
is functioning properly and that the patient is doing well. But despite the
nearly universal availability of wireless technology in the United States,
less than half of eligible patients are monitored in this way.
The reasons why this technology is underutilized are not known, but one
potential reason is the relative absence of evidence of the impact of remote
monitoring on patient outcomes. To address this gap in knowledge, Yale
researchers partnered with the American College of Cardiology and Boston
Scientific, a manufacturer of ICDs, to examine the outomes of nearly 38,000
ICD patients. The study found that patients using remote monitoring were 33%
less likely to die and 20% less likely to be re-hospitalized in the three
years following device implantation.
Visit Yale for the study.
Bringing the UDI
Regulation & the Global UDI Database (GUDID) to life
HPN is helping to sponsor a UDI
Implementation Workshop May 20-22, 2014 in Baltimore, MD. The UDI
Implementation Workshop is for Class III Medical Device Manufacturers who
are in immediate need of information and guidance to meet the September 24,
2014 compliance deadline, or those that need to jumpstart their UDI adoption
The FDA UDI Team will be at the meeting for a roll-up-your sleeves /
deep-dive Workshop covering all components of the UDI Regulation and the
GUDID Guidance. This Workshop is strictly focused on critical information
exchange, expanded interaction, and heightened networking designed to
deliver immediate and actual results in your UDI implementation initiative.
Healthcare Purchasing News
subscribers receive a $100 Discount. Seating will be limited and will be
assigned on a first-come, first-served basis. Go to
http://udiconference.com/register.html and enter “HPN” in the
promotional code field line during online registration to receive $100 off
of the rate. Register by April 30th for the best rate.
For the complete Workshop agenda and the most up-to-date information, please
For information on the FDA UDI Regulation, visit
Download print version
Hospital wastewater releases antibiotic-resistant E. coli
Fixing HealthCare.gov would be top priority, HHS nominee Sylvia Mathews
Hospital CEOs predict more states will expand Medicaid
hospitals to undergo nationwide audit
Deadly illness in Nicaragua baffles experts
Georgia hospitals a focus of project to reduce maternal deaths
Hospital pricing initiative dead with new agreement
HPN invites you to experience the
Critical Care Exposition in Denver, May 20-22, 2014
wastewater releases antibiotic-resistant E. coli
Hospital wastewater is a potent reservoir of antibiotic-resistant organisms,
according to findings from a new study published online in Clinical
Infectious Diseases. The problem may be an important factor fueling the
spread of extended-spectrum beta-lactamase-producing Escherichia coli
Caroline Bréchet, PharmD, from the Service d’Hygiène Hospitalière,
Chrono-environnement, Centre Hospitalier Régional Universitaire, Université
de Franche-Comté, Besançon, France, and colleagues note that ESBLEC is
common in both hospital and community settings. For example, one study found
that 6% of healthy adults in Paris carried the bacteria in 2011.
That being the case, ESBLEC enters wastewater, eventually being routed
through treatment plants. However, there are few data quantifying the levels
of ESBLEC that enter or leave treatment plants. Therefore, the researchers
analyzed wastewater samples drawn from 11 sites throughout the wastewater
network of Besançon, a city of a quarter million residents.
The samples were collected weekly during a 10-week period in 2011. They
included discharge from 2 hospitals (containing only effluent and
rainwater), wastewater from sites unrelated to the hospital, and wastewater
collected before and after it went through the municipal wastewater
The authors also checked samples of digested sludge, derived from the
wastewater, that was used to fertilize farm land. They note, however, that
the wastewater network studied contains no effluent from livestock farming.
The overall concentration of E. coli was higher in urban wastewater
than in hospital wastewater. However, the concentration of ESBLEC was 30
times higher in hospital wastewater compared with in the urban samples. The
authors note that ESBLEC was found in nearly all the samples and that ESBLEC
accounted for about 0.3% of the total E. coli found in untreated
water headed to the plant for treatment.
Treatment at the plant did eliminate most of the E. coli and ESBLEC,
but not all. After treatment, 2% of the E. coli remained, and 6% of
ESBLEC survived treatment. In other words, after treatment, ESBLEC accounted
for 0.6% of the remaining E. coli.
In addition, the concentration of ESBLEC in sludge destined for farmland was
When the investigators tested isolates for antibiotic susceptibility, they
found that the ESBLEC in the hospital wastewater were more resistant to
antibiotics than those in the urban wastewater, particularly to ceftazidime
(P < .001) and ofloxacin (P < .001).
"Our results suggest that there is a need for improvements in the monitoring
of antibiotic-resistant microorganisms of human origin in effluent," they
Visit Medscape for the article.
HealthCare.gov would be top priority, HHS nominee Sylvia Mathews Burwell
Sylvia Mathews Burwell emerged mostly unscathed Thursday from the first of
two hearings on her nomination to head the Health and Human Services
Department, even though her chief role will be to continue implementing the
president’s controversial healthcare law.
Burwell, whose confirmation is likely, did not get much of a grilling and
even received strong vows of support from two influential Republicans: Sen.
John McCain (AZ), who introduced her warmly to the committee, and Sen.
Richard Burr (NC), who promised to vote to confirm her at her next hearing
before the Senate Finance Committee.
But the wide-ranging hearing also touched on some of the more contentious
aspects of the law that she would be mired in: the technical problems that
continue to plague the federal health insurance Web site, the unfinished job
of expanding Medicaid and the president’s broken promise that people who
liked their old plans could keep them.
Burwell also would inherit an agency that underwent major turmoil because of
the rocky rollout of the healthcare law last year.
The gentle treatment underscored the broad support Burwell enjoys in her
current role as head of the Office of Management and Budget, where she is
viewed as a competent leader. It marked a contrast with HHS Secretary
Kathleen Sebelius, who clashed often with Republicans prior to announcing
last month that she would resign.
Because of a change in Senate rules last year, Burwell only needs 51 votes
to be confirmed, a hurdle she could clear without the support of any
Republicans. Still, Burwell steered a cautious path at the Thursday hearing,
emphasizing her collaborative and leadership credentials and detailing her
management philosophies, rather than straying into controversial territory.
Burwell called the technical problems that initially plagued the Web site
“unacceptable.” But she said the Affordable Care Act is “making a difference
in the lives of our families and our communities while strengthening the
economy,” and said addressing the problems that still plague HealthCare.gov
would be a top priority.
Visit Washington Post for the article.
predict more states will expand Medicaid
Executives with some of the nation’s largest hospital companies predict that
Medicaid expansion is on the horizon for more states, including Tennessee.
Three for-profit hospital giants based in Middle Tennessee — HCA, Community
Health Systems and LifePoint Hospitals — all reported earnings recently, and
all were positive about the impact of health care reform on first-quarter
earnings, although HCA was the most cautiously optimistic of the three.
Executives at LifePoint and CHS, which both reported a notable positive
effect from Medicaid expansion, predict more states will follow suit. Though
these companies are based in Tennessee, they have facilities across the
country, and they say an increase in insured customers at hospitals anywhere
could help their bottom lines.
“Seven of our 20 states had expanded Medicaid,” LifePoint CFO Leif Murphy
said in the company’s recent earnings call. “(In the remaining states), we
are working hard ... to help foster a better understanding of participation,
and we believe that other states will ultimately expand coverage.”
CHS was also bullish on Medicaid expansion. “Three states of ours are trying
to expand Medicaid,” said CFO Larry Cash on the recent conference call.
“Hopefully, we’ll get that done.”
CHS CEO Wayne Smith connected the potential for Medicaid expansion with
political elections. “Most Republicans, in my understanding, are concerned
about the tea party knocking them off in this early (in the 2014 mid-term
elections).” But after that period is over, he added, states including
Pennsylvania, Missouri and Utah could potentially expand the program.
“And then, I think, as this continues to develop and people begin to get an
understanding of what it’s doing for the uninsured population, not only in
terms of coverage but in terms of improving their health, — [it’s] hard to
improve your health if you don’t have access to healthcare. I think you’ll
see those states come around.”
Visit the Tennessean for the story.
VA hospitals to
undergo nationwide audit
A House committee voted Thursday to subpoena records relating to a waiting
list at the Phoenix veterans hospital, and officials said Veterans Affairs
Secretary Eric Shinseki had ordered a nationwide audit of access to care
that the agency provides.
Meanwhile, Shinseki brushed aside calls for his resignation and got an
unexpected political lifeline from House Speaker John Boehner following
reports that 40 patients died because of delayed treatment at an agency
The American Legion and some in Congress have called for Shinseki's ouster
following allegations of patient deaths at the Phoenix VA hospital due to
delays in care and of a secret list the hospital kept of patients waiting
for appointments to hide the delays.
The House Veterans Affairs Committee voted unanimously to subpoena all
emails and other records in which Shinseki and other VA officials may have
discussed destruction of what the committee called "an alternate or interim
waitlist" for veterans seeking care in Phoenix.
A top VA official had told congressional staff last month that the "secret
list" referred to in news reports may have been an "interim list" created by
the hospital. And the committee had asked the VA on May 1 to answer why it
was created, when it was destroyed, who authorized destruction and under
Shinseki answered in a letter Wednesday that VA employees used "transitory
or interim notes ... for reference purposes" as they were moving information
to the new electronic waitlist system. Regulations of the National Archives
and Records Administration require that such notes be destroyed when they
are no longer needed for reference, the VA says.
Dissatisfied with that response, the committee subpoenaed all documents
relating to the destruction and gave Shinseki until 9 a.m. May 19 to produce
them. The VA said in a statement that it will review the subpoena and
Earlier Thursday, Shinseki told CBS that he sent inspectors to Phoenix
immediately after he learned of reports about the deaths. "I take every one
of these incidents and allegations seriously, and we're going to go and
investigate," he said.
The VA also announced Thursday that Shinseki in recent days had ordered the
Veterans Health Administration to do a "a face-to-face" audit over the next
several weeks at all clinics at VA medical centers to make sure employees
understand VA's policy and the need for continued integrity in managing
patient access to care.
And at a Capitol Hill news conference, Boehner, R-Ohio, said: "I'm not ready
to join the chorus of people calling on him to step down." He added that
there is a "systemic management issue throughout the VA that needs to be
Shinseki announced last week that three officials at the Phoenix facility
have been placed on leave while the VA inspector general investigates.
The Department of Veterans Affairs has long had a seemingly endless backlog
and exceedingly long delays for treatment.
White House spokesman Josh Earnest said President Barack Obama has full
confidence in Shinseki. He said Shinseki shares the president's passion for
living up to the commitment that the U.S. has made to its veterans.
Earnest told reporters traveling with Obama in California that the VA has
made tremendous progress in reducing the case backlog. He said while the
backlog is moving in the right direction, the White House won't be satisfied
until it is eliminated.
The VA has acknowledged that 23 patients have died as a result of delayed
care in recent years. The VA's Office of Medical Inspector said clerks at a
Fort Collins, CO, clinic were instructed last year on how to falsify
appointment records. Other problems have occurred in Pittsburgh, Atlanta and
Visit the Clarion-Ledger for the story.
Deadly illness in
Nicaragua baffles experts
CHICHIGALPA, Nicaragua — During the harvest season, when exhausted workers
spend seven days a week cutting sugar cane, the signs of illness were hard
to spot at first. It was in the off-season, out on the baseball field, that
some residents noticed a change. Base-stealers were lethargic. Pitchers were
losing their aim. In the evening, outfielders were burning up as if standing
under the scorching sun of the day.
Across Central America, a painful disease that affects the kidneys has
killed at least 20,000 people over the past decade and has become the
leading cause of deaths in hospitals among men in El Salvador. But the
illness, often called chronic kidney disease of unknown causes, or CKDu, is
so poorly understood that it still does not have a universally agreed-upon
Theories vary drastically, citing a combination of possible factors,
including heat stress, chronic dehydration, toxic chemicals, painkillers,
sugar consumption and even volcanic ash.
But there is a rare point of consensus, many researchers say: Nicaragua’s
sugar cane heartland — in particular Chichigalpa, the town that is home to
the country’s largest sugar mill — has been one of the hardest hit places in
the world. Cane-cutting fathers and sons in the same family have died, and
seemingly healthy young men are quickly wasting away.
The Nicaraguan government, the country’s sugar mills, even the World Bank,
which has poured tens of millions of dollars into the sugar industry here,
all say that until the mystery of the disease is solved, there is little
they can do to prevent it. Now, after years of inconclusive research, the
Centers for Disease Control and Prevention is stepping in to help with some
of the most ambitious studies of the illness yet. But the sick former sugar
cane workers here have little faith that more studies will bring
improvements anytime soon. The fact that the research will be funded
entirely by the sugar industry is only fueling the distrust.
“I don’t think anybody has clean hands,” said Kristen Genovese, a lawyer who
helped sick former workers file a complaint against the World Bank’s lending
arm in 2008 for lending $55 million to the sugar mill here, called San
Antonio, without looking into the disease or the possibility that it might
be connected to the industry.
“The government of Nicaragua has done nothing to help these people,” said
Genovese, who was with the Center for International Environmental Law in
Washington when she filed the complaint. And the World Bank, she argued,
“should have spotted this problem, and didn’t do anything about it, and
continued to invest in sugar in the region.”
Before each harvest, workers must take blood or urine tests that measure
kidney function to determine whether they will be allowed to return to the
fields. In preparation, some ingest concoctions of fresh tamarind juice and
linseed oil, avoid the sun and force themselves to rest. Others simply pray.
The complete dependence on the industry, whatever the risks may be, is
stark. Glassy-eyed men are convinced that something in the water or the
fields made them sick. Yet they are desperate to return to work, borrowing
their wives’ and sisters’ identity numbers in a furtive attempt to stay
employed. In one neighborhood, even conservative studies show that one in
three men have the illness.
Radically different perceptions of the cause have stirred debate over who
should cover the enormous costs of treating patients with the disease.
Mario Amador, general manager of Nicaragua’s National Committee of Sugar
Producers, one of the groups financing the C.D.C. studies, said the sugar
cane business in Nicaragua had quadrupled over the past 10 years into a
$500-million-a-year industry, supplying everything from Coca-Cola to rum
makers. But he said the annual kidney exams, which he called necessary to
avoid putting sick workers at additional risk, had created the false
impression that the mills were linked to the disease.
Lawmakers in El Salvador and Sri Lanka, where similar kidney problems have
emerged, have moved to ban certain herbicides. But few of the researchers
who are focusing on Nicaragua — the country with the highest death rate from
the disease, according to the Pan American Health Organization — are willing
to say the answer is that simple.
Agricultural chemicals alone, they say, do not explain why the disease has
been detected in some Nicaraguan miners at similar rates, why women who grew
up on the sugar mill’s grounds have generally been unscathed, or why workers
here are affected at much higher rates than people exposed to the same
chemicals elsewhere. Perhaps extreme heat, dehydration, the intensity of the
labor or other factors play a role, the researchers say.
Residents say they began noticing the sickness shortly after the Nicaraguan
government, which had nationalized the sugar industry, returned the mills to
private owners in 1992. As the operations at San Antonio rapidly expanded,
driven partly by American and European appetites for sugar and a move into
ethanol production, families say the cane cutters — many of whom had been
born in a hospital on the mill grounds and went to a school there — grew
sick in larger numbers.
“CKD is not a common disease in the sugar sector worldwide, so I.F.C. did
not look into this issue at appraisal,” said the spokesman, Aaron Rosenberg,
based in Washington. The institution has lent more than $100 million to
Nicaraguan sugar mills over the past decade.
After the complaint, the mill agreed to provide food and other assistance to
widows and sick workers. It also agreed to open its door to a team of
Yet “nature can be very reluctant to give up its secrets,” said Daniel
Brooks, a researcher from Boston University, which was selected to
investigate the disease by a committee that included mill executives and
sick workers. Five years later, Dr. Brooks has as many questions about the
disease as answers. His report published in 2012 neither entirely ruled out
nor formally endorsed any theory. Now, Dr. Brooks and his team from Boston
University will be leading the charge in three C.D.C. Foundation studies,
which he believes could have implications far beyond Nicaragua.
“We don’t know if this is the tip of the iceberg yet,” he said. “If this is
heat stress and the climate is changing in the direction of getting hotter
over time, are we seeing something that will happen much more in the future
and maybe extend its geographic range?”
For now his team is more focused on two other areas: whether the disease has
a genetic component and its presence in children. Research into work-related
risk factors is also planned, but sugar industry funding so far covers only
preliminary work. The C.D.C. says that numerous measures are in place to
protect the research from undue influence. Some others are suspicious.
Visit the New York Times for the article.
a focus of project to reduce maternal deaths
ATLANTA -- Twenty-two Georgia hospitals have joined a project to reduce
maternal death rates in the United States, a nursing group announced. The
Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) has
launched an initiative to improve the treatment of pregnancy-related
complications, and is focusing on birthing hospitals in Georgia and New
Georgia ranks 50th among states in maternal deaths. That’s a prime reason
why the state was one of the two selected for the project. Gwinnett Medical
Center in Lawrenceville was one of four hospitals studied in a care
transitions project. Another reason is Georgia’s large number of delivery
hospitals, said Lashea Wattie, the Georgia section chair for AWHONN.
The 22 hospitals selected range from such large urban/suburban facilities as
Grady Memorial Hospital in downtown Atlanta, Gwinnett Medical Center in
suburban Atlanta and Memorial Health University Medical Center in Savannah
to such small-town/rural facilities as Stephens County Hospital in Toccoa
and Colquitt Regional Medical Center in Moultrie. The goal was to have a
variety of hospitals throughout the state, AWHONN said.
The Washington-based organization points out that U.S. women experience a
greater risk of maternal death than women in 46 other countries.
The Georgia estimate of 35 maternal deaths per 100,000 live births in 2011
reflected a rise. The estimate was 20.5 for the period from 2001 to 2006.
That increase has kept the state “at the bottom of the pile when it comes to
maternal mortality,’’ Dr. Seema Csukas, director of the Maternal and Child
Health Section for the state Department of Public Health, told GHN in
The Georgia General Assembly, citing that ranking, passed legislation
earlier this year that requires that Public Health establish a committee to
review maternal deaths and to report on their causes.
The nation as a whole has seen its maternal mortality rate rise from 13.3
deaths per 100,000 live births in 2006 to a currently estimated mortality
rate of about 21 per 100,000 live births in 2010.
AWHONN’s Postpartum Hemorrhage (PPH) Project has brought together 54
birthing hospitals in Georgia and New Jersey to improve clinical practices.
Their kickoff meeting will be held in June, Wattie said, with the 18-month
project starting in August.
The first initiative focuses on improving the treatment of obstetric
hemorrhage — bleeding too much during childbirth — a leading cause of death
during labor and delivery. While two to three women die every day in the
U.S. from pregnancy-related complications, more than half of those deaths
are preventable. Incidents of obstetric hemorrhage have increased in recent
years along with an overuse of induced labor, AWHONN says.
Research suggests that women who have these inductions have a greater risk
of postpartum hemorrhage. And African-American women are disproportionately
affected by birthing complications, with three to four times more deaths
than women of all other racial and ethnic groups, according to AWHONN.
Participating hospitals will work with national experts to identify the best
practices for treatment.
The project is supported by a grant from Merck for Mothers, a 10-year, $500
million initiative created by the pharmaceutical giant to improve maternal
health in more than 30 countries.
Visit the Rome News-Tribune for the article.
initiative dead with new agreement
A pair of ballot propositions that targeted hospital pricing and CEO pay in
California have been dropped as part of an agreement between the California
Hospital Association (CHA), some of its member hospitals and the Service
Employees International Union-Healthcare Workers West (SEIU-UHW).
SEIU-UHW hosted a Fresno event in February to collect signatures for the
Fair Healthcare Pricing Act of 2014, which would have prevented hospitals
from charging more than 25 percent above the actual cost of providing
The other proposition, the Charitable Hospital Executive Compensation Act of
2014, would prohibit nonprofit charitable hospital executives in the state
from receiving more than $450,000 in annual compensation.
C. Duane Dauner, CHA president and CEO, held up last night's agreement as
"This moves us forward in new and bold ways to improve healthcare in a
responsible way," Dauner said in a teleconference with reporters.
The centerpiece of the agreement, which runs through 2017, is the
establishment of a $100 million joint advocacy fund to reform the state's
medical programs, with a specific goal of increasing reimbursements through
Dave Regan, president of SEIU-UHW, said the money would help fund
educational, legislative and regulatory fixes to the problem, which could
lead up to a possible ballot initiative in 2016.
Not all member hospitals and organizations in the CHA have signed the
agreement, though Regan said of his 85,000-90,000 SEIH-UHW members, the
"overwhelming majority" of workers in institutions would be covered by the
agreement. In addition, the parties have agreed to a code of conduct in
their interactions, attempting to add an air of positivity and
problem-solving to what has been at times a contentious relationship.
Regan said the code of conduct would remove "lowest-common denominatorism
and negativity" from the relationship between union and employer. It wasn't
clear how the agreement, which is not being made public, affects ongoing
union organization efforts.
SEIU-UHW made quite a splash earlier this year with its propositions,
hosting press conferences around the state denouncing hospitals for
overcharging patients for services and products. State statistics showed
markups of 143-321 percent for services at Central Valley hospitals.
At the time Tim Joslin, CEO of Community Medical Centers, said the SEIU
pricing initiative would be "highly disruptive to the delicate financial
balance" hospitals currently face. He estimates if it was approved, the
proposition would cost Community Medical Centers tens of millions of dollars
in lost revenue annually. "And anyone can see what that would mean —
decreasing reinvestment, scaling down services, and limiting patient
access," Joslin wrote in a memo. "In that scenario, patients, healthcare
professionals, and the community at large would all be losers."
Regan and Dauner insisted that hospital price controls are still part of the
discussion between the parties, and that reforming Medi-Cal reimbursement
could go a long way in improving revenue streams.
Visit the Business Journal for the story.
HPN invites you to experience the
Critical Care Exposition in Denver, May 20-22, 2014
Supply Chain/Materials/Purchasing Managers and their staff are cordially
invited to attend the 2014 Critical Care Exposition at the Colorado
Convention Center in Denver, CO, May 20 - May 22, 2014 on a complimentary
(fee-waived) admission basis.
The Critical Care Exposition is the largest tradeshow featuring healthcare
equipment and supplies for acute and critical care nurses in the U.S. The
three-day show features more than 200 exhibitors of products, devices,
technology and pharmaceuticals used or administered by nurses who care for
critically ill patients. The Critical Care Exposition is produced by the
American Association of Critical-Care Nurses (AACN) as part of their annual
conference, which attracts more than 6,000 nurses each year.
Healthcare Purchasing News,
in conjunction with AACN, hosts its 10th annual pair of panel discussions
that explore how supply chain professionals collaborate with critical care
nurses to facilitate buying decisions, inventory levels, customer service
and patient care. Critical care nursing and supply chain management
panelists discuss the good, the bad and the ugly experiences they shared in
ordering and using the right products when and where they needed them.
They’ll also examine some of the challenges critical care nurses and supply
chain professionals face when communications break down between the two
areas, demand for products spike and supplies run low, if not out. From
those discussions and an active question-and-answer time, attendees learn
tips and tricks for success, as well as what went right during the successes
and what went wrong during the failures. Listening to “real world” case
studies help you apply the lessons learned to your own situations. The
session will be held on the Purchasing Stage on Tuesday, May 20 (11:15 AM -
11:45 AM) and Wednesday, May 21 (2:15 PM - 2:45 PM) in Booth 1025.
To request the "HPN Registration Special" (fee-waived registration
information) send an email with your name, title and employer’s name to
firstname.lastname@example.org or call the AACN Exhibits Director Randy Bauler at (800)
394-5995, ext. 366.
When you request the HPN Registration Special by email or phone, you’ll
receive a complimentary registration certificate (good for free admission),
plus a list of the participating exhibitors and access to the NTI 2014
exhibits floor plan. You and your staff may visit the show May 20-22, using
the show’s generic "Exhibits Only" badges for relative anonymity on the show
floor. We look forward to seeing you in Denver.
For more information about the conference visit here.
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