| October 2007
October
31, 2007
Download print version
Microsoft to acquire healthcare technology and
assets from Global Care Solutions
Chinese chemicals flow unchecked to world drug
market
774 arrests in China
over safety
New cancer recommendations; Diet,
weight, alcohol and red meat
consumption all implicated in cancer risk
Kimberly-Clark Professional video contest is truly
out of this world
Targeted cleaning of hand-touch surfaces
could reduce
MRSA transmission in hospitals
Targeting hand-touch surfaces in hospitals that are likely to be
contaminated by meticillin-resistant Staphylococcus aureus (MRSA), rather
than a focus on removing visible dirt, is a feasible short-term strategy for
tackling the transmission of MRSA, according to a Review in The Lancet
Infectious Diseases to be published Online, October 31. Further, this
additional cleaning would be easier to implement than improvements in
hand-hygiene compliance. The public associate visibly dirty wards with
increasing rates of MRSA, but there is little evidence for the effectiveness
of basic cleaning on reducing the risk of acquiring MRSA in health-care
institutions. Furthermore, hospital hygiene is usually assessed visually,
but this does not necessarily correlate with microbiological risk and fails
to recognise that microorganisms, including human pathogens such as MRSA,
are invisible to the naked eye.
However, the current standards for assessing hospital hygiene use visible
cleanliness as a performance criterion. Dr. Stephanie Dancer (South
General Hospital, Glasgow, UK) presents a robust case for targeted hospital
cleaning as a strategy for controlling MRSA by reviewing the evidence for
the potential impact of cleaning on each stage of the staphylococcal
transmission cycle between patients, staff, and their environment. The
author notes that cleaning is already accepted as an important factor in the
control of other hardy environmental pathogens, such as Clostridium
difficile, vancomycin-resistant enterococci, norovirus, and Acinetobacter
spp, but argues that the role of near-patient hand-touch sites, such as door
handles, bed rails, infusion pumps, and switches, in the transmission of
MRSA and other pathogens, has not been given the priority it deserves.
According Dr. Dancer, in the
UK, ward
cleaners work to a set specification that gives emphasis to the cleaning of
floors and toilets, and yet the evidence for MRSA contamination of a huge
variety of hospital items, and particularly hand-touch sites is
overwhelming. Indeed, the author notes that these hand-touch sites, which
might harbor and transmit microbial pathogens, are poorly cleaned. The
author concludes: “There can be no doubt that prioritizing hand hygiene is
the single most beneficial intervention in the control of MRSA…[but] even if
everyone does wash their hands properly, the effects of exemplary hand
hygiene are eroded if the environment is heavily contaminated by MRSA”. She
adds: “The increasing prevalence of MRSA and other multi-drug-resistant
bacteria in UK hospitals support prioritization of cleaning and other
control measures before definitive validation”. For more information see
THIS LINK

HHS
announces project to help 3.6 million consumers reap benefits of electronic
health records
HHS Secretary Mike Leavitt announced a five-year demonstration project that
will encourage small to medium-sized physician practices to adopt electronic
health records (EHRs). “This demonstration is designed to show that
streamlining health care management with electronic health records will
reduce medical errors and improve quality of care for 3.6 million
Americans. By linking higher payment to use of EHRs to meet quality
measures, we will encourage adoption of health information technology at the
community level, where 60 percent of patients receive care,” Secretary
Leavitt said. “We also anticipate that EHRs will produce significant savings
for Medicare over time by improving quality of care. This is another step in
our ongoing effort to become a smart purchaser of healthcare; paying for
better, rather than simply paying for more.”
Conducted by the Centers for Medicare & Medicaid Services (CMS),
the demonstration would be open to participation by up to 1,200 physician
practices beginning in the spring. Over a five-year period, the program will
provide financial incentives to physician groups using certified EHRs to
meet certain clinical quality measures. A bonus will be provided each year
based on a physician group’s score on a standardized survey that assesses
the specific EHR functions a group employs to support the delivery of care.
Under the CMS demonstration, all participating practices will be required to
use a certified EHR system to perform specific functions that can positively
affect patient care processes, such as clinical documentation and ordering
prescriptions. The system, which must be in place by the end of the second
year, must also be approved by a certification body officially recognized by
HHS. The core incentive payment to practices will be based on performance on
the quality measures, with an enhanced bonus based on the how well
integrated the EHR is in helping manage patient care. During the five-year
project, it is estimated that 3.6 million consumers will be directly
affected as their primary care physicians adopt certified EHRs in their
practices. In order to amplify the effect of this demonstration project, CMS
is encouraging private insurers to offer similar incentives for EHR
adoption.

Microsoft to acquire healthcare technology and assets from Global Care
Solutions
Microsoft Corp. has agreed to acquire software, intellectual property and
other assets from Global Care Solutions (GCS), a privately held company
based in Bangkok, Thailand, that develops enterprise-class health
information systems. The acquisition complements Microsoft’s portfolio of
health solutions and will provide hospitals across international markets
with a new alternative to achieve improved workflow and patient safety
through information technology. GCS employees will join Microsoft’s Health
Solutions Group, which will manage product development and delivery.
Financial terms were not disclosed.
Global Care Solutions designed and developed its end-to-end system in
collaboration with Bumrungrad International hospital, an internationally
accredited facility based in Bangkok. The hospital, which treats more than
1.2 million patients from 190 countries each year, uses the GCS solution to
efficiently manage clinical workflow, billing, regulatory compliance and
medical records. Microsoft will continue to work closely with Bumrungrad to
further build out the functionality and features of the GCS technology. “We
have a diverse patient population at Bumrungrad, with over 400,000 foreign
patients every year; half of the 3,200 patients we see each day arrive
without appointments,” said Mack Banner, the chief executive officer of the
hospital. “The GCS solution has allowed us to manage scheduling demands,
multiple languages and medical records so efficiently that the average
waiting time to see a doctor is only 17 minutes. The GCS software is a key
to our service delivery, medical quality and financial performance, and we
look forward to collaborating with Microsoft on extending its applications
across our organization.”
Global Care Solution's system is a fully integrated suite of 50 clinical and
back-office application modules designed and optimized to run all hospital
clinical and administrative operations on Microsoft Windows Server 2003 and
Microsoft SQL Server 2005. The new Microsoft offering based on the GCS
technology will complement the company's current Azyxxi solution, which
provides a data integration capability for hospitals with legacy systems
already in place.

Chinese
chemicals flow unchecked to world drug market
In January, Honor International Pharmtech was accused of shipping
counterfeit drugs into the
United States.
Even so, the Chinese chemical company, whose motto is “Thinking Much of
Honor”, was openly marketing its products in October to thousands of buyers
in Milan at the world’s biggest trade show for pharmaceutical ingredients.
Other Chinese chemical companies made the journey to the annual show as
well, including one manufacturer recently accused by American authorities of
supplying steroids to illegal underground labs and another whose
representative was arrested at the 2006 trade show for patent violations.
Also attending were two exporters owned by China’s government that had sold
poison mislabeled as a drug ingredient, which killed nearly 200 people and
injured countless others in Haiti and in Panama. Yet another chemical
company, Orient Pacific International, reserved an exhibition booth in
Milan, but its owner, Kevin Xu, could not attend. He was in a
Houston
jail on charges of selling counterfeit medicine for schizophrenia, prostate
cancer, blood clots and Alzheimer’s disease, among other maladies.
While these companies hardly represent all of the nearly 500
Chinese exhibitors, more than from any other country, they do point to a
deeper problem: Pharmaceutical ingredients exported from China are often
made by chemical companies that are neither certified nor inspected by
Chinese drug regulators, The New York Times has found. Because the
chemical companies are not required to meet even minimal drug-manufacturing
standards, there is little to stop them from exporting unapproved,
adulterated or counterfeit ingredients. The substandard formulations made
from those ingredients often end up in pharmacies in developing countries
and for sale on the Internet, where more Americans are turning for cheap
medicine.
In Milan, The Times identified at least 82 Chinese chemical companies
that said they made and exported pharmaceutical ingredients, yet not one was
certified by the State
Food and Drug
Administration in China, records show. Nonetheless, the companies
were negotiating deals at the pharmaceutical show. One of them was the Wuxi
Hexia Chemical Company. When The Times showed Yan Jiangying, a top
Chinese drug regulator, a list of 186 products being advertised by the
company, including active pharmaceutical ingredients and finished drugs, Yan
said, “This is definitely against the law.” Yet in
China,
chemical manufacturers that sell drug ingredients fall into a regulatory
hole. Pharmaceutical companies are regulated by the food and drug agency.
Chemical companies that make products as varied as fertilizer and industrial
solvents are overseen by other agencies. The problem arises when chemical
companies cross over into drug ingredients. “We have never investigated a
chemical company,” said Yan, deputy director of policy and regulation at the
State Food and Drug Administration. “We don’t have jurisdiction.”
China
has an estimated 80,000 chemical companies, and the United States Food and
Drug Administration does not know how many sell ingredients used in drugs
consumed by Americans. A House hearing on F.D.A. oversight of foreign drug
manufacturers is scheduled for Thursday. (The New York Times) For the
complete story see
THIS LINK

774 arrests in China over safety
The Chinese government revealed that it had arrested 774 people over the
last two months as part of a nationwide crackdown on the production and sale
of tainted food, drugs and agricultural products. Government regulators
hailed the arrests as a major step forward for food and drug safety, and
said the “criminal suspects” were detained during nationwide inspections of
thousands of restaurants, food and drug production plants and wholesale food
markets. Determined to counter accusations that it has been producing and
also exporting tainted goods, China has vowed to revamp its food and drug
safety regulations and to close illegal manufacturers and exporters. In the
summer, the government even executed the former head of the nation’s food
and drug administration,
Zheng Xiaoyu,
after he was convicted of accepting bribes and failing to properly supervise
food and drug companies, some of which had sold counterfeit drugs. But the
government also acknowledged that problems remain.
In its announcement, it said that this month only 82 percent of food tested
in medium and large cities in China met safety standards, and nearly 30
percent of the restaurants surveyed by regulators had failed food safety
inspections. The announcement of the arrests offered few details about the
nature and seriousness of the food and drug safety violations involved, or,
indeed, who had been arrested or the size of their businesses. The
government said only that it had investigated 626 criminal cases. The
arrests came after nearly a year of high-profile recalls involving
everything from tainted pet food ingredients to problem toys, and after
repeated promises on the part of government regulators to crack down on
tainted goods and restore confidence in the Made in China label. As part of
its effort, the government is also trying to counter widespread concerns
that the quality and safety of the food and drugs sold to its own citizens
is far worse than the products it exports. In fact, China acknowledged this
year that while it believes 99 percent of its food exports meet safety
standards, only about 80 percent of food sold domestically has passed
inspections. Today, the government said that a four-month campaign to root
out bad food and drug producers and sellers was paying dividends.
In a separate announcement, the Ministry of Agriculture said that it was
revoking the registration of 11 highly toxic pesticides because of food
safety concerns. The government also said this week that since July,
inspectors working at Chinese ports have destroyed or recalled over 1,000
tons of fake products. China is also working with American and European
regulators to cooperate on product safety and to put into place new methods
to detect harmful products. (The New York Times) For the complete article
see
THIS LINK

New cancer recommendations; Diet, weight, alcohol and red
meat
consumption all implicated in cancer risk
A team of top scientists from around the world spent five years reviewing
7,000 medical studies and concluded that diet and weight directly affect
whether you'll get cancer. The landmark study also linked consumption of
alcohol, red meat and processed meat to an increased risk of cancer. ABC
News medical editor Dr. Tim Johnson broke down the new recommendations. You
can also find more information at
www.dietandcancerreport.org.
Recommendations include: Limit body fat. Your body mass index
should be between 18.5 to 24.9. Weight around the waist is most dangerous.
Limit red meat to 2.5 ounces a day. An additional 1.7 ounces a day increases
cancer risk by 15 percent. That means an 8 ounce steak or a quarter-pound
hamburger would be the limit for a week. Limit alcohol to two drinks a day
for men, one drink a day for women. Limit salt intake to 2 grams a day.
That’s about a teaspoon a day, instead of the teaspoon and a half that most
people eat. To give you an idea of how much salt is in food, just one cup of
cottage cheese has half the salt you should eat in a day: half a teaspoon.
Processed foods are almost always higher in salt. Get nutrients from whole
foods, not vitamin supplements. Mothers should breast-feed children. (ABC
News) See THIS
LINK

Kimberly-Clark Professional video contest is truly out of this world
After boldly going where
no health and hygiene company had gone before with its launch of the first
electronic touchless bath tissue dispenser, Kimberly-Clark Professional is
now set to enter alien territory. And this time the public is invited to
travel along, through a contest being announced today at
www.aliendroppings.com.
To enter, contestants must first
view a quirky two-part video of a hapless earthling’s encounter with a
superior life form inside a men’s room stall. The brief vignettes depict
what happens when an alien competes with a human for access to a new
restroom technology. The contest challenge is to watch both videos and
create a three-minute script treatment for the duo’s close encounter of the
third time. The grand prize winner will have their video produced and will
also receive a SONY HD video camera. Additional prizes will be awarded for
first and second place. Full contest rules and prize information are
available at
http://www.aliendroppings.com/welcome.html.
The first video installment surfaces today. The second will materialize in
late November. Contest entries must be received by January 31, 2008.

October
30, 2007
Download print version
Fire-related patient load lands on UCSD’s
Hillcrest burn unit
Participants left
uninformed in some halted medical trials
FDA issues early communication about an ongoing safety
review of Aprotinin injection
Influx of medical students creates concern;
Enrollment increase
means resident training needs to expand
Getinge contracts with GE Healthcare and Premier
More
than 700 healthcare facilities respond to Cardinal Health
patient safety grant challenge
Fire-related patient load lands on UCSD’s Hillcrest
burn unit
The
tenacity with which the 18-bed the burn unit at the University
of California, San Diego (UCSD) Medical Center in Hillcrest
(CA) has tackled the strains of an unprecedented fire
emergency has once again made the hospital a hub of media
attention, this time for treating victims of the devastating
fires this week. Recognized as the only specialized burn unit
in the San Diego and Imperial counties, the hospital has
treated many of the area’s fire victims. To date, the unit has
treated 47 fire-related injuries due to surface or inhalation
burns. Currently, there are eight patients in critical
condition and 10 in rehabilitation. Nineteen out of the 20
other patients that were previously in critical care have been
upgraded to the hospital’s general ward. Laura Everett, an
administrative assistant, described last week in the burn unit
as “chaotic, but in control.” Burn Unit Charge Nurse Janine
Dubina, like all of the staff, underwent a harrowing week
dealing with crisis conditions in the unit. Living between
Lakeside and Ramona, she had to evacuate early in the week,
but still came to work ready and able. Most patients came in
during the first two days of the fire, and while new cases
have tapered off for the moment, Dubina said she expects the
number of patients to increase as the weeks progress. She said
that more people will likely start trickling in now that the
fires have died down and residents are returning to their
normal routines like after 2003’s Cedar Fires, the disaster
that put the burn unit in the national spotlight.
The current patients’ burn degrees range from 20-90 percent, some of them
being treated for inhalation as well as surface burns. Although response
efforts brought victims in quickly enough to be intubated before any
internal swelling choked off their airways, some patients’ bodies have
swelled so much internally that removal of intubation tubes is now
impossible. Dubina said that one of the major health concerns from the fires
is smoke inhalation. Having burned through many commercial and residential
developments, smoke is rife with plastics, paint and other chemical
pollutants that can cause lung damage. Smaller particles in the air farther
away from the fires can be more hazardous than the smoke and ash closer to
the fires themselves. In order to protect patients and staff from the
outside air, high-efficiency particulate air filters are stationed near the
unit’s doors, and indoor air quality is checked daily to ensure a sterile
environment.
Lasting impressions from the Cedar Fires pushed the county to make sure that
the same mistakes would not be repeated. For instance, the implementation of
a reverse-911 program saved many more lives last week, allowing people to
evacuate properly and be informed ahead of time of the disaster. The
hospital also now has a better-developed relationship with Cal Fire,
allowing for stronger lines of communication, Dubina said. “For everyone
that complains about UCSD running disaster drills, this is the reason we
knew what to do,” she said. The staff prides itself on a strong sense of
camaraderie, a bond that staff members said helped strengthen their team’s
efficiency when patients began to piling up at the burn unit. Many nurses
and doctors ignored orders to evacuate their homes, instead coming in to
work 12-hour shifts and occasionally overtime, just to make sure the unit
wasn’t left short-handed. On Oct. 21, the unit was graced with extra nurses,
according to registered nurse Jami Lewellen. “Night shift nurses stepped
outside and smelled smoke on the air, they just knew to come in,” she said.
Even students from UCSD who normally volunteer at the hospital came to help,
retrieving any extra equipment or blood that was needed, even though campus
had shut down for the week. (UCSD Guardian) To read the original article see
THIS LINK

City hospital in
Brooklyn reviews care of a boy, 12
Officials at
Kings
County Hospital Center said yesterday that they were “closely examining” why
doctors
there failed to detect a drug-resistant staph infection in a 12-year-old
Brooklyn boy who died this month. The boy, Omar Rivera, was given only
allergy medication at the hospital and was then sent home, a lawyer for the
boy’s family said yesterday. A hospital spokeswoman, Hope Mason, confirmed
that Omar was treated at the hospital shortly after midnight on Oct. 13. She
said that the hospital would look into “what more could have been done to
detect the infection at that time.” Omar was pronounced dead at Brookdale
University Hospital and Medical Center in Brooklyn at
10:25 a.m. on Oct. 14, city officials said. School
officials have said that Omar, a student at Intermediate School 211 in
Canarsie, was sick and stayed home from school on Oct. 9. On Oct. 9 or 10,
his mother, Aileen Rivera, took him to a clinic, First Medcare, on Flatlands
Avenue in Canarsie, said the family’s lawyer, Paul B. Weitz.
At First Medcare, Weitz said, doctors noted that Omar had one or two
pus-filled
boils on
his buttocks, diagnosed an infection and prescribed an
antibiotic,
amoxicillin, along with ibuprofen. A manager at First Medcare said she could
not comment on the case because of privacy laws. Late on Oct. 12, Weitz
said, Omar still had a high
fever, so
his mother took him to the emergency room at
Kings
County, a city-run hospital in
East Flatbush, with one of the city’s busiest emergency
rooms. Mason said she was not allowed to disclose who had treated Omar.
Whoever it was, said Weitz, decided that Omar had an allergic reaction to
ibuprofen and gave him Benadryl. Weitz’s account of Omar’s treatment at
Kings County was reported yesterday in The New York Post. Blood tests
done after Omar’s death determined that he was infected with the bacterium
methicillin-resistant Staphylococcus aureus, or MRSA, health officials said.
A determination on whether MRSA caused Omar’s death is not expected for
several weeks. A student at another school in the metropolitan region,
Trinity
Elementary School, in
New
Rochelle, came down with an MRSA infection, but school officials said
yesterday that the child was recovering. Custodians at the school were doing
special cleaning before today’s classes, the officials said. (The New York
Times)

Participants left
uninformed in some halted medical trials
When Congress passed a bill last month requiring makers of
drugs and medical devices to disclose the results of clinical
trials for all approved products, advocates of greater study
disclosure applauded the move. But a provision that would have
mandated disclosures for another group of products never made
it into the final version of the bill. It would have covered
products tested on patients, but dropped before marketing.
“Trial sponsors can still choose to keep information about
some trials confidential, creating serious ethical concerns,”
said Dr. Deborah A. Zarin, the director of
ClinicalTrials.gov, a Web site run by the National
Library of Medicine. Many experts said the recent
Congressional debate underscored a troubling fact: some
patients in clinical studies never learn about test results.
The problem may be particularly relevant to those implanted
with medical devices that stay with them long after a trial is
over. For manufacturers and researchers alike, “there is a
tremendous incentive to go on, to forget about the old and
move on to the new,” said Drummond Rennie, a deputy editor at
The Journal of the
American Medical Association.
There are no data available for the number of patients who
participate in studies of drugs and medical devices that never
make it to the marketplace, though it is likely that the
number runs into the thousands. A product may not reach the
market for a variety of reasons; it may not perform well in
trials, for example, or it may be rejected by regulators.
Although researchers conducting clinical studies are not
required to disclose test results to study participants, they
must alert patients taking part in a test to emerging product
dangers. Companies also have to keep promises made to
regulators at the time a trial began, like agreements to
follow the health of study patients. Such promises are often
required to get approval to begin trials in the first place.
But researchers and manufacturers do not always fulfill even
those minimal requirements. And such failing may be
particularly acute in trials of implanted devices, since those
products remain inside patients. In August, for example, the
Food and Drug Administration sent a warning to Boston Scientific after
investigators discovered the company’s diligence in following up with
patients faltered around the time it dropped a product under development.
The product being tested was an experimental stent intended to prevent the
rupturing of an aneurysm in the major abdominal artery. Among other things,
agency investigators found that Boston Scientific, which halted development
of the stent last year after a study showed it frequently fractured, had
neglected to tell patients in that trial about the problem’s scope.
Because of loopholes in the recently passed
Congressional bill, device makers like Boston Scientific will
still have discretion whether to publicly reveal the results
of studies like that of the failed stent. Under the law,
device producers will have to report such “premarketing”
studies and their results to the F.D.A. But that data will
remain in a confidential “black box” until a product is
approved; if a device is rejected or dropped, a company will
not have to disclose those results or even publicly
acknowledge that the trials occurred. Device makers lobbied
against mandating disclosure for failed products, arguing that
releasing such data would be confusing to patients and would
give away valuable information to a company’s competitors
about devices under development that might succeed in
subsequent trials. “Such disclosures could have the unintended
consequence of eliminating many small device makers from the
marketplace,” Stephen J. Ubl, chief executive of the Advanced
Medical Technology Association trade group, testified before
Congress in June.
The new bill does allow for a mechanism under which
the secretary of the
Health
and Human Services Department could release trial
data about unapproved products if a public health issue
exists, but such moves would be argued case by case. “This was
a disappointment,” said Dr. Steven E. Nissen, the chairman of
the cardiology department at the Cleveland Clinic, who helped
draft the House version of the bill. (The
New York Times) To read the original article
see
THIS LINK

FDA issues early communication about an ongoing
safety review of Aprotinin injection
The U.S. Food and Drug Administration (FDA) issued an Early Communication
about an Ongoing Safety Review of Aprotinin Injection (marketed as Trasylol),
a drug used to control bleeding during heart surgery.
Last week, FDA was notified that a Canadian research group
stopped a study on Trasylol because the drug appeared to increase the risk
for death compared to the other antifibrinolytic drugs used in the study.
Antifibrinolytic drugs help slow the breakdown of blood clots and subsequent
excessive bleeding. The data also suggested that fewer patients receiving
the drug experienced serious bleeding events.
This most recent data support the results from other comparison studies of
Trasylol. The comparison studies were discussed at a September 2007 joint
meeting of FDA’s Cardiovascular and Renal Drugs and Drug Safety and Risk
Management Advisory Committees. FDA anticipates further review of the risk
and benefits of Trasylol, which may result in additional labeling or other
regulatory action. FDA will work with the sponsor of the recently terminated
study to evaluate the data fully. In the meantime, FDA recommends that
healthcare providers review the risks and benefits of Trasylol outlined in
the label and in the Early Communication about an Ongoing Safety Review, and
discuss the information with their patients. In 2006, FDA revised the
labeling for Trasylol to strengthen its safety warning and limit its
approved usage to patients at an increased risk for blood loss and blood
transfusion during coronary bypass graft surgery. Trasylol is marketed by
Bayer Pharmaceuticals Corp.,
Leverkusen, Germany. Full text of the Early Communication about an Ongoing
Safety Review can be found at
http://www.fda.gov/cder/drug/early_comm/aprotinin.htm.

Influx of
medical students creates concern;
Enrollment increase
means resident training needs to expand
Enrollment is increasing sharply at medical schools across the country, a
trend that’s expected to help the nation combat a worsening shortage of
physicians. But it’s also focusing attention on the need to expand the other
half of the physician pipeline: residency programs. “If you don’t increase
the second stage of the education process, you don’t end up with more
practicing physicians,” said Edward Salsberg, director of the Association of
American Medical Colleges’ center for workforce studies. A record number of
students enrolled at medical schools this fall, including those in Houston,
Salsberg’s group reported recently. But the higher numbers also mean more
training positions in hospitals will be needed after those students graduate
in four years. The enrollment jump was largely in response to the AAMC’s
appeal to the nation’s 126 medical schools last year to increase class size
by nearly one-third by 2015. This year’s increase to about 17,800 first-year
students represents an 8 percent increase since 2002, the group’s benchmark
year. Medical schools in Houston are contributing to that increase.
The University of Texas Medical School at Houston enrolled 230 first-year
students this fall, up 12 percent from 206 students in 2002. And Baylor
College of Medicine plans to increase its first-year class to 200 by 2011, a
19 percent increase over the 168 students in 2002. “We think the gradual
increase will allow us to accommodate people and not affect their
education,” said Dr. Stephen Greenberg, Baylor’s dean of medical education.
Because the UT Medical School has added seats in recent years, enrollment
will remain stable for the next few years, said Dr. Judianne Kellaway,
assistant dean of admissions. But the number of applicants, which already
has outpaced the increase in class size, is expected to continue to rise.
Nearly 3,700 aspiring physicians applied this year, 5 percent more than last
year. Though medical school enrollment is on the rise, increasing the number
of residency positions is arguably more difficult. That’s mainly because
programs in most states depend largely on funding from the federal
government through Medicare, and that funding has remained static for the
past few years. State funding in Texas, however, is improving. The
Legislature this year approved an increase to $63 million for residency
programs, the highest level ever and more than double the $25 million
appropriated last year. Some state money could go toward a new neurology
residency program at the UT Medical School here. Dr. Dong Kim, chairman of
the department of neurosurgery, said seven positions could be approved by
January. Until then, the university offers residency in every specialty
except neurology, he said.
Like the rest of the country, Texas does not have enough physicians to keep
up with a growing population that demands more specialty services. It ranked
42nd in the country for its patient-to-resident ratio in 2005, with 194
patient-care physicians per 100,000 residents, according to the American
Medical Association. Lately, however, more doctors have applied for licenses
in Texas, likely because of new limits in medical malpractice lawsuits that
make it more appealing for physicians to practice here. The number of
residency positions available in Texas climbed to 7,260 slots during the
2005-06 school year, an increase of about 4 percent in two years, according
to the Accreditation Council for Graduate Medical Education. That’s far
fewer slots than other populous states; New York, for example, had more than
twice as many residents that year, partly because the state secured
nongovernmental funding. Without enough positions for its graduates, Texas
could lose physicians-in-training to other states. Nationwide, the number
of residency slots is increasing at a similar rate. About 115,100 positions
were available across the country during the 2005-06 school year, the ACGME
reported. There's good reason to keep graduates in Texas for training,
according to the Texas Medical Association, which represents physicians and
medical students. The group reported that physicians who complete both
medical school and residency here are nearly three times more likely to stay
in the state to practice. (Houston
Chronicle) To read the original article see
THIS LINK

Getinge contracts with GE Healthcare and Premier
Getinge USA,
Rochester, NY, has entered into an agreement with GE Healthcare to service
GETINGE washer/disinfectors and steam sterilizers in more than 200
facilities that contract with GE Healthcare to provide a host of asset
management services, the company has announced. Getinge USA also has been
awarded a contract with Premier Inc., one of the nation’s largest healthcare
purchasing networks, to offer detergents and cleaners to 1,700 hospitals and
more than 47,000 other healthcare sites. Getinge AB is a manufacturer and
distributor of advanced infection control equipment, medical systems and
extended care products for OR, ED, ICU, sterile processing and life science
applications. For more information, see
THIS LINK.

More
than 700 healthcare facilities respond to Cardinal Health patient safety
grant challenge
More than
10 percent of the nation’s healthcare facilities are seeking grants from
Cardinal Health through a $1 million fund set up by the company to help
improve patient safety. Company officials said more than 700 hospitals,
health systems and community health clinics responded to their announcement
in August about the grant program, which is the largest and first of its
kind in the private sector. To support initiatives that enhance patient
safety and quality of care, Cardinal Health will grant up to $50,000 per
facility to fund new and innovative programs that establish or implement
creative and replicable methods to address challenges in providing quality
patient care and to help drive improvements. The company expects to fund up
to 40 of the 730 grant requests.
In selecting grant recipients, Cardinal Health’s selection
committee will look for: projects that respond to a clearly identified, high
priority safety issue; projects that apply new thinking and approaches to
development of solutions; collaborative programs; demonstrable and
sustainable measures to assure that improvements hold up over time; model
programs that can be replicated at other organizations. To be eligible for
funding, facilities must be designated as 501(c)(3) by the IRS and were
required to submit a letter of intent to submit a proposal by October 12.
Approximately 100 to 150 institutions will be asked to submit a full
proposal, with grants announced in March 2008.

October
29, 2007
Download print version
3M and Zargis announce global marketing
alliance
Universal flu vaccine recommendation may be coming
WHO update: Avian influenza situation in
Indonesia
Pediatricians urge autism screening
Cancer patients not getting live-saving flu and
pneumonia shots
Health officials try to calm parents about staph
3M and Zargis announce global marketing
alliance
3M and Zargis Medical Corp., a spin-off from Siemens Corporate Research and
a majority-owned subsidiary of Speedus Corp. announced an exclusive
multi-year marketing agreement involving Zargis’ heart sound analysis
software and 3M Littmann’s next-generation electronic stethoscope. Under the
agreement, Zargis will support 3M in its efforts to develop a
next-generation stethoscope that will be compatible with Zargis’ heart sound
analysis software. The date on which Zargis’ software will become available
for use with a Littmann stethoscope has not yet been announced.
In addition, the alliance
provides Zargis with a wide-range of marketing and promotional opportunities
along with exclusive rights to sell its heart sound analysis software
through the global distribution network of the Littmann brand. The agreement
grants 3M a minority equity position in Zargis, following the first sale of
Zargis’ software through the 3M distribution channel, and a seat on Zargis’
board of directors.

State fines 9 hospitals; Under new law,
California
hospitals
penalized for putting the lives of patients at risk
State health officials fined nine California hospitals Thursday for
infractions that put patients at imminent risk of injury or death, including
a notorious case at Martin Luther King Jr.-Harbor Hospital in May in which a
woman died after writhing unattended on the floor of the emergency room
lobby. Glendale Memorial Hospital and Health Center, Garden Grove Hospital
and Medical Center, and Kaiser Foundation Hospital Santa Clara were among
the hospitals fined. King-Harbor and one other hospital, Feather River
Hospital in Paradise, were fined for two infractions each. Each fine is for
$25,000, the most allowed under the first phase of a law that went into
effect Jan. 1. The hospitals have 10 days to file a notice of appeal. The
fines are the first the state has levied against hospitals. And the
penalties will bring hospitals in line with nursing homes and health plans,
which already had been subject to fines.
Hospital
industry representatives had managed until last year’s legislative session
to resist fines, but their opposition was undermined by a series of
transplant fiascoes in recent years and by the long history of lapses at
King-Harbor, formerly known as King-Drew. The new law is intended to give
state regulators more teeth, said Kathleen Billingsley, deputy director of
the Center for Healthcare Quality at the California Department of Public
Health. With fines, she said, “There is a sense of immediacy and
responsiveness on the part of the provider to correct or modify the
processes that have led to these quality problems.” Glenn Melnick, a health
economist for Rand Corp., agreed, even though the fine in question, which
can reach $50,000 as the law is phased in, is half the amount that can be
levied against nursing homes. “The dollar amount of the fine is only one
potential source of leverage,” he said. “What is the impact on the
hospital’s reputation in the community? What’s the impact on the staff and
the people who work there? If they take it seriously, that could be much
more important than a $25,000 fine.” In a statement, Glendale Memorial
Hospital and Health Center, which was fined for failing to follow policies
and procedures for the safe administration of medication, said that hospital
officials were taking the matter “very seriously.” “In collaboration with
the California Department of Public Health, we have conducted a thorough
investigation of this incident and taken appropriate action to protect all
patients’ safety while in our facility,” the statement said.
Garden Grove
Hospital
and Medical Center, which was fined for being unaware of a drug’s possible
adverse effects, issued a statement that said, “The state notified the
hospital late in the day on March 20. . . that its practices did not conform
with Medicare standards of participation. Overnight, the hospital developed
a plan of corrective action which was accepted by the state the next morning
at 9 a.m.” As for King-Harbor, the Los Angeles County-owned hospital closed
its emergency room and in-patient beds in August after failing a string of
federal inspections and losing federal funding. It now offers urgent care
and out-patient clinics but no hospital services. “Both of the incidents
described are unacceptable and do not reflect the department’s commitment to
operate our hospitals in a manner that meets state and federal standards,”
said Bruce Chernof, director and chief medical officer of the county
Department of Health Services. The second incident involved a 38-year-old
man with a headache and swelling in the brain who languished in the
emergency room for four days in February before his family drove him to
another hospital, where he received emergency surgery. (Los Angeles Times)

Universal flu vaccine recommendation may be coming
The
time may soon come when doctors recommend that every American man, woman and
child be vaccinated every year for influenza, an idea offered Wednesday by a
leading expert in vaccines and preventive medicine. Dr. Gregory Poland,
director of the Vaccine Research Group at the Mayo Clinic in Rochester, MN,
testified Wednesday at a meeting of the Advisory Committee on Immunization
Practices (ACIP), the subcommittee at the Centers for Disease Control and
Prevention that issues federal recommendations for the use of vaccines in
the United States. In his testimony, Poland recommended that the United
States should move to a so-called “universal recommendation” for vaccination
against influenza, the virus that causes the flu. A universal recommendation
would make official that Americans of all ages should receive an influenza
vaccination every year. The testimony came at a time when the committee is
considering a smaller step of recommending that all school-age children
receive a yearly vaccine. “I think it’s a good idea to expand [vaccination]
to all school-age children,” Poland said. “But a better idea is to say,
‘let’s not just go age group by age group; let’s just recommend that
everybody get it.’”
Review of recent changes in the CDC recommendations shows that
ACIP has been steadily increasing the indications for a flu vaccine for
several years. Current estimates are that more than 70 percent of the U.S.
population now meets one of the 15 published criteria for recommendation of
a yearly flu vaccine. “We’ve changed the recommendation every year or two
since ‘97,” Poland said. “It’s sort of a creeping incrementalism.” Instead
of marking out ever-increasing numbers of groups that should get the flu
vaccine yearly, Poland espoused a universal recommendation that all
Americans should be getting the shot, with particular emphasis on vulnerable
groups. “Let’s just make a universal recommendation, that all Americans
should get vaccinated. But then note that there are particular high-risk
groups that should be particularly recommended to get the vaccine.”
Such
a move would not come without difficulty. Currently, less than 40 percent of
America’s
300 million people receive yearly flu shots, and many of those for whom it
is recommended do not receive their immunizations. Other vaccine experts
pointed out that any effort to vaccinate all Americans would face many
logistical hurdles. Concerns included the availability of enough flu vaccine
for the entire American population and the lack of a public health
infrastructure to deliver that many vaccines. A move to vaccinate everyone
could also face significant financial hurdles. “Who is going to pay for all
of this?” asked Dr. William Schaffner, chair of the department of preventive
medicine at Vanderbilt University. “For example, we know that there are 40
million people who don’t have medical insurance. Who is going to get the
vaccine to those people?” According to Poland, though, vaccine supplies have
been increasing steadily since the widely publicized vaccine shortages from
several years ago. “This year, manufacturers are going to make 130 million
doses in America. Last year and we threw away about 12 million doses,” he
said.
According to Poland, there could be a very important hidden benefit to
addressing these issues now: Americans would learn how to be prepared in
case of a bioterrorist attack or a pandemic infectious disease. “Once you’ve
made a recommendation and then implement the recommendations, you go a long
way towards figuring out the ways to operationalize the ways to administer
these things to all Americans,” Poland said. “You can’t make that happen in
the middle of an emergency.” Schaffner agreed that the development of such
public health infrastructure could be a critically important step for the
future. “If we undertook to vaccinate a very substantial proportion of the
U.S. population each year, you'd have to organize everything from vaccine
development to production to delivery,” he said. “It’d be like a training
session or a fire drill that we'd conduct each year. So if we had to do it
in any kind of emergent situation, for example, anthrax, smallpox vaccine,
delivering cipro [antibiotics], we’d have a trained provider network and a
trained public,” he said.
“It may be something that could lay the groundwork for something
looming down the line in the form of an avian flu pandemic,” said Dr. Peter
Hotez, chair of the Department of Microbiology, Immunology and Tropical
Medicine at The George Washington University. “By getting this
infrastructure into place by vaccinating the whole population against
[seasonal] flu, you lay the groundwork to combat deadly avian influenza.”
But according to Poland, this type of recommendation would likely need some
advance warning to allow for the infrastructure to be built. “I suggest we
make the recommendation in advance,” Poland said. “For example, something
like ‘starting next year, we’ll be recommending all Americans get a flu
vaccine.’” (ABC News)

WHO update: Avian influenza situation in
Indonesia
According to the World Health Organization, the Ministry of Health of
Indonesia has announced a new case of human infection of H5N1 avian
influenza. A 5-year-old female from the Tangerang District, Banten Province
developed symptoms on October 14, was hospitalized on October 20 and died in
an AI referral hospital on October 22. The investigation found that there
were poultry deaths in the case’s neighborhood in the two weeks prior to her
onset of symptoms. Of the 110 cases confirmed to date in Indonesia, 89 have
been fatal.

Pediatricians urge autism screening
The
country’s leading pediatricians group is making its strongest push yet to
have all children screened for autism twice by age 2, warning of symptoms
such as babies who don’t babble at 9 months and 1-year-olds who don’t point
to toys. The advice is meant to help both parents and doctors spot autism
sooner. There is no cure for the disorder, but experts say that early
therapy can lessen its severity. Symptoms to watch for and the call for
early screening come in two new reports. They are being released by the
American Academy of Pediatrics on Monday at its annual meeting in
San Francisco
and will appear in the November issue of the journal Pediatrics and
on the group’s Web site,
http://www.aap.org/.
The reports list numerous warning signs, such as a 4-month-old not smiling
at the sound of Mom or Dad’s voice, or the loss of language or social skills
at any age. Experts say one in 150 U.S. children have the troubling
developmental disorder. “Parents come into your office now saying ‘I’m
worried about autism.’ Ten years ago, they didn’t know what it was,” said
Dr. Chris Johnson of the University of Texas Health Science Center in San
Antonio. She co-authored the reports.
The academy’s renewed effort reflects growing awareness since its
first autism guidelines in 2001. A 2006 policy statement urged autism
screening for all children at their regular doctor visits at age 18 months
and 24 months. The authors caution that not all children who display a few
of these symptoms are autistic and they said parents shouldn't overreact to
quirky behavior. Just because a child likes to line up toy cars or has
temper tantrums “doesn't mean you need to have concern, if they're also
interacting socially and also pretending with toys and communicating well,”
said co-author Dr. Scott Myers, a neurodevelopmental pediatrician in
Danville, PA. “With awareness comes concern when there doesn’t always need
to be,” he said. “These resources will help educate the reader as to which
things you really need to be concerned about.”
Another educational tool, a Web site that debuted in mid-October, offers
dozens of video clips of autistic kids contrasted with unaffected children's
behavior. That Web site,
http://www.autismspeaks.org/, is sponsored by two nonprofit
advocacy groups: Autism Speaks and First Signs. They hope the site will
promote early diagnosis and treatment to help children with autism lead more
normal lives. The two new reports say children with suspected autism should
start treatment even before a formal diagnosis. They also warn parents about
the special diets and alternative treatments endorsed by celebrities, saying
there’s no proof those work. Recommended treatment should include at least
25 hours a week of intensive behavior-based therapy, including educational
activities and speech therapy, according to the reports. They list several
specific approaches that have been shown to help. For very young children,
therapy typically involves fun activities, such as bouncing balls back and
forth or sharing toys to develop social skills; there is repeated praise for
eye contact and other behavior autistic children often avoid. (The
Associated Press) For more information see
THIS LINK or see
THIS LINK

Cancer patients not getting live-saving flu and pneumonia
shots
Although flu and pneumonia can be lethal for cancer patients, more than one
quarter of patients undergoing radiation therapy are not complying with
national guidelines to be vaccinated against these potentially
life-threatening yet preventable illnesses, according to a study presented
October 28, at the American Society for Therapeutic Radiology and Oncology’s
49th Annual Meeting in Los Angeles. While Centers for Disease Control and
Prevention guidelines and the Joint Commission recommend an annual flu
(influenza) vaccine for cancer patients aged 50 years or older, 25 percent
of patients 50 years or older reported never having received the flu
vaccine. Similarly, the pneumonia (pneumococcus) vaccine is recommended to
all cancer patients 65 year or older; however, over one-third (36 percent)
of cancer patients in this age range reported never having received the
vaccine. Cancer patients are at a higher risk of acquiring and dying from
these illnesses due to a weaker immune system, among other factors.
Three reasons accounted for almost 80 percent of why patients didn’t receive
either vaccine: Patients either believed they didn’t need the vaccines, they
didn’t know about the recommended vaccination guidelines or their physicians
didn’t recommend the vaccines. While 44 percent of patients who received
either vaccine reported that they were asked or informed about these
vaccines by their family physicians or internists, only seven percent
reported being asked or informed by their oncologists. “People undergoing
cancer treatment and their loved ones should ask their oncologists about
these vaccines. They are a very simple, yet very effective, way for people
living with cancer to extend their lives,” said Neha Vapiwala, M.D., a study
author and a radiation oncologist at the Hospital of the
University
of Pennsylvania in Philadelphia. “Oncologists have the opportunity to talk
to patients about recommended vaccines during their frequent interactions
with patients, whether it be before, during, or after cancer therapy. This
discussion could result in better cancer care and ultimately save lives.”
This was the first study done to find out whether cancer patients receiving
radiation therapy complied with national vaccination guidelines.

Health
officials try to calm parents about staph
Some angry and nervous parents kept their children out of a Brooklyn (NY)
middle school, after learning about the death of a student who had been
infected with a virulent, drug-resistant strain of bacteria. But school and
health officials tried to assure parents that all the proper procedures had
been followed and that there was no cause for panic. The city’s health
commissioner, Dr.
Thomas R. Frieden,
said yesterday that the bacteria was the probable cause of the death of the
boy, Omar Rivera, 12. But he added, speaking at a news conference at health
department headquarters in Manhattan, that it would be impossible to know
for certain whether the bacteria had caused the death until an autopsy was
complete, which could take several weeks. Omar had been absent from school
since Oct. 9, Schools Chancellor Joel I.Klein told reporters at the news
conference. After the boy died on Oct. 14, the principal notified health
officials, who determined that the boy had been infected with the bacteria,
methicillin-resistant Staphylococcus aureus, or MRSA. Dr. Frieden said that
because the boy had not been involved in any organized team sport at school,
there was no need to screen every student. He emphasized that the most
important precaution was for students to wash their hands and not share
personal items like towels and sports uniforms.
Officials at the school, Intermediate School 211 in Canarsie, notified
parents of the boy’s death in a letter sent home with students on Thursday.
In the letter, parents were told that the school would remain open and that
health officials were available to answer questions. A complete wash-down of
the school began on Wednesday and was completed on Thursday, school
officials said. Over the last month, several schools in the New York region
and in other states have reported cases of students infected with the MRSA
bacteria. Health officials cautioned again that it was unclear whether there
had been more cases, or simply more reports in the news media. Some parents
at I.S. 211 expressed frustration that they had not been told sooner of the
boy’s death, or had a personal phone call from school officials. Joel
Lonergan, the head of school facilities at I.S. 211, said that in their
wash-down of the school, custodians wiped off all flat surfaces with a
disinfecting solution. The cleaning was completed Thursday night. A complete
cleaning is done about three or four times a year, Lonergan said. Dr.
Frieden commented: “Just please remember that cleaning of the environment is
very unlikely to make any difference in the spread of infection. It’s
something that’s done so people feel better, but this isn’t what’s going to
reduce the spread of bacteria.”
School and health officials said they did not plan a scrub at
other schools. Several students said soap at the school was often difficult
or impossible to find. Lonergan said that soap dispensers were checked each
morning and that there should be soap readily available. “It’s a custodial
issue,” he said. “We inspect the schools on a regular basis, unannounced. So
we would pick that up. But it could have been that a child was in there
before and emptied the soap dispensers.” Across the region, health and
education officials are scrambling to keep better track of MRSA cases in
schools, and to educate teachers, students and parents on how to prevent the
infection’s spread. Yesterday the Connecticut governor,
M. Jodi Rell,
authorized a new program that will enable the state health lab to pinpoint
MRSA outbreaks more quickly by using DNA to determine whether bacteria from
different patients are related. In some cases, school districts have learned
about the infections only after the fact. (The New York Times) To read the
original article see
THIS LINK
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