September 17, 2008   Download print version

E.R. patients often left confused after visits

Joint Commission urges patients to ‘speak up’ about pain; Education campaign coincides with Pain Awareness Month

FDA issues warning letters to Ranbaxy Laboratories Ltd., and an import alert for drugs from two
Ranbaxy plants in India

Common chemical BPA under scrutiny as study links it to diabetes, cardiovascular disease

Consumer ads for medical devices subject of Senate panel

Health and safety of residents, responders at risk in flood conditions

McCain healthcare plan transforms health insurance but few gains in numbers of insured;
Analysis shows number of uninsured likely to grow

Common bronchodilator linked to increased deaths

E.R. patients often left confused after visits

A vast majority of emergency room patients are discharged without understanding the treatment they received or how to care for themselves once they get home, researchers say. And that can lead to medication errors and serious complications that can send them right back to the hospital.

In a new study, researchers followed 140 English-speaking patients discharged from emergency departments in two Michigan hospitals and measured their understanding in four areas — their diagnosis, their E.R. treatment, instructions for their at-home care and warning signs of when to return to the hospital.

The study, published online in July by the Annals of Emergency Medicine, found that 78 percent of patients did not understand at least one area and about half did not understand two or more areas. The greatest confusion surrounded home care — instructions about things like medications, rest, wound care and when to have a follow-up visit with a doctor. “We’re finding that people are just not prepared for self-care, and that’s what is bringing them back,” said Dr. Eric Coleman, director of the Care Transitions Program at the University of Colorado, who was not involved in the study.

The researchers described a woman in her 20s who went to the emergency room with abdominal pain. After extensive testing, doctors there diagnosed pelvic inflammatory disease, a sexually transmitted infection. But when interviewed by a researcher, the woman said that she was not aware of any diagnosis, that she did not realize she had been sent home with an antibiotic (she took only the pain medication she was given), and that she did not know she should abstain from sex, tell her partner or have follow-up care.

Dr. Paul M. Schyve, senior vice president of the Joint Commission, the main organization that accredits hospitals, said: “This study showed that this is much more common than you think. It’s not the rare patient.” Similar results have been found for patients leaving hospitals, not just emergency rooms. And experts say they help explain why about 18 percent of Medicare patients discharged from a hospital are readmitted within 30 days.

Doctors and patients say that with hospitals pressed to see more patients faster, patients get less attention. “When I start my shift, I know what I’d like to accomplish, but by the end of the shift, my main concern is that nobody dies, and the other things become less important,” said Dr. Michael S. Radeos, research director in the department of emergency medicine at New York Hospital Medical Center of Queens.

Everything is exaggerated in the emergency department. Doctors are harried, they have little time to go over complicated information and they do not know the patients. Most patients are anxious, upset and not likely to be thinking clearly.

The problem is particularly acute when it comes to drugs. A patient-education program used in 130 health delivery systems across the country found that about 40 percent of patients 65 or older have a medication error after they leave the hospital. A 2006 report by the Institute of Medicine found that doctors and nurses were contributing to these errors by not providing information in an effective way.

The new study found that people were not aware of what they did not understand, suggesting that simply asking a patient if he understands is not enough. Older patients are particularly vulnerable. “They have the kinds of communication barriers we might expect, with vision and hearing problems,” said Dr. Susan N. Hastings, an instructor in geriatrics at Duke.

Hospitals are now being forced to face their communication inadequacies. “We’ve raised the bar of what’s expected of hospitals,” said Dr. Schyve, of the Joint Commission. At the same time, the Medicare Payment Advisory Commission has recommended a policy change that would reduce payments to hospital with excessive readmission rates. It has also asked Medicare to allow hospitals to reward physicians who help lower readmission rates.

Experts in doctor-patient communication recommend a “teach back” approach, in which the patient, preferably accompanied by a relative, friend or caregiver, has to repeat the instructions back to the doctor. Dr. Rade B. Vukmir, an emergency physician at the University of Pittsburgh and spokesman for the American College of Emergency Physicians, recommends a “dual discharge” approach: the physician talks to the patient about the results, treatment plan and follow-up care. Then a nurse follows up with computerized discharge instructions. (New York Times) Read the entire article.

Joint Commission urges patients to ‘speak up’ about pain; Education campaign coincides with Pain Awareness Month

Pain is just a part of life, right? Maybe not. Pain is actually one the main reasons that Americans seek medical treatment, and untreated pain can have serious effects – slowed recovery times, poor quality of life and higher healthcare costs.

The Joint Commission is launching a national campaign to help Americans work with their healthcare professionals to better manage pain. The new education campaign is part of The Joint Commission’s award-winning Speak Up program that helps patients become more informed and involved in their health care, and coincides with Pain Awareness Month in September. 

“Effective pain management is a crucial component of good healthcare, and treating pain is the responsibility of all caregivers,” said Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission. “The Joint Commission encourages patients to ask the right questions so that they can find relief.” 

Beginning in 2000, The Joint Commission has made pain assessment and management a priority in its national standards and accreditation process. The new campaign includes a brochure entitled “What You Should Know about Pain Management,” which identifies questions and answers that will help patients find out more about pain treatments that can be used for pain caused by injury, illness, or surgery. Among the topics are: talking about and describing pain, understanding pain treatments, managing pain, and questions to ask caregivers. The brochure encourages patients to ask their caregivers specific questions about pain medication, including doses and times that medication should be taken, side effects, how long the medication will take to work, and what to do if the medication does not work.

The framework of the Speak Up program urges patients to: Speak up if you have questions or concerns, and if you don't understand, ask again. Pay attention to the care you are receiving. Make sure you're getting the right treatments by the right healthcare professionals. Educate yourself about your diagnosis, the medical tests you are undergoing, and your treatment plan. Ask a trusted family member or friend to be your advocate. Know what medications you take and why you take them. Use a hospital, clinic, surgery center, or other type of healthcare organization that has undergone a rigorous on-site evaluation against established state-of-the-art quality and safety standards, such as that provided by The Joint Commission. Participate in all decisions about your treatment.

Speak Up brochures also are available on understanding caregivers, understanding medical tests, recovering after leaving the hospital, preventing medication mistakes, preventing infections, preparing to become a living organ donor, avoiding wrong site surgery and preventing errors in care. Brochures can be found at www.jointcommission.org.   

FDA issues warning letters to Ranbaxy Laboratories Ltd., and an import alert for drugs from two Ranbaxy plants in India

The Food and Drug Administration (FDA) issued two Warning Letters to Ranbaxy Laboratories Ltd., of the Republic of India, and an Import Alert for generic drugs produced by Ranbaxy's Dewas and Paonta Sahib plants in India.

The Warning Letters identify the agency's concerns about deviations from U.S. current Good Manufacturing Practice (cGMP) requirements at Ranbaxy's manufacturing facilities in Dewas and Paonta Sahib (including the Batamandi unit), in India. Because of the extent and nature of the violations, FDA issued an Import Alert, under which U.S. officials may detain at the U.S. border, any active pharmaceutical ingredients (API) and both sterile and non-sterile finished drug products manufactured at these Ranbaxy facilities and offered for import into the United States. While this action does not involve removing products from the market, FDA has no evidence to date that Ranbaxy has shipped defective products.

Today's announcement does not impact products from Ranbaxy's other plants which are not affected by today's actions. FDA has inspected those facilities and, to date, they have met U.S. cGMP requirements for drug manufacturing.

The FDA recommends that consumers continue taking their medications manufactured by Ranbaxy and not disrupt their drug therapy, which could jeopardize their health. Patients who are concerned about their medications should discuss their concerns with their healthcare professional.

The FDA informed Ranbaxy that until it resolves the deficiencies at each of these two facilities and the plants come into compliance with U.S. cGMP requirements, FDA's drug compliance office will recommend denial of approval of any New Drug Applications (NDAs) and Abbreviated New Drug Applications (ANDAs) that list the Paonta Sahib or Dewas plants respectively as the manufacturer of APIs or finished drug products. Ranbaxy is one of the largest foreign suppliers of generic drugs to the U.S. 

The FDA Import Alert covers more than 30 different generic drug products (See the FDA Drug List) produced in multiple dosage forms and dosage amounts at these two locations. FDA has evaluated whether these actions would create any potential drug shortages in the U.S., and has determined that other suppliers can meet market demand, with one exception. Because Ranbaxy is the sole supplier to the U.S. of one drug product, Ganciclovir oral capsules (an antiviral drug), to avoid creating a shortage of the drug, FDA generally will not detain shipments of this product, and plans to arrange for additional oversight and controls until the company resolves these manufacturing issues.

Consumers and healthcare professionals can report adverse events to FDA's MedWatch program at www.fda.gov/medwatch/report.htm.

For more information see http://www.fda.gov/bbs/topics/NEWS/2008/NEW01886.html

Common chemical BPA under scrutiny as study links it to diabetes, cardiovascular disease

Industry representatives and health advocates gave federal officials vastly different assessments Tuesday of the effects of exposure to a chemical so prevalent that it can be found in the system of almost every American. Bisphenol A, commonly known as BPA, is used extensively in the linings of food and drink containers, plus countless consumer products, including baby bottles and sippy cups. The chemical also has been found in drinking water, dental sealants and even household dust.

Adding to a growing sense of unease about the chemical's potential effects was a study released before federal hearings Tuesday that linked exposure to bisphenol A with cardiovascular disease, type 2 diabetes and liver-enzyme abnormalities in adults.

Researchers said the study, in Wednesday's Journal of the American Medical Association, offered the first scientific evidence that adults with higher levels of BPA in their bodies were more likely to develop such diseases. This month the federal National Toxicology Program reported the chemical may affect the development of the brains and prostate glands of fetuses and young children.

Pressure has been growing for more government and corporate action on BPA, in part because the chemical is so common that it is difficult for consumers to avoid it. Some state and federal lawmakers have sought to ban BPA in children's products, and some companies have decided not to produce or sell BPA products. Wal-Mart is phasing out sales of baby bottles containing BPA from its U.S. stores next year, and Nalgene is removing BPA from its popular water bottles.

On Capitol Hill, Sen. Charles Grassley (R- IA) cited the study as he opened an investigation of the way the U.S. Food and Drug Administration has regulated the chemical. At Tuesday's hearing, the FDA defended a draft assessment it issued last month declaring that FDA-regulated products on the market that contain BPA are safe. "Right now, our tentative conclusion is that it's safe, so we're not recommending any change in habits," said Laura Tarantino, head of the FDA's office of food additive safety. The agency said more research was needed.

For the study released Tuesday, Dr. David Melzer and colleagues from the Peninsula Medical School in Exeter, England, divided a representative sample of 1,455 U.S. residents ages 18 to 74 into quartiles based on BPA concentrations in their urine. The BPA data came from a 2003-04 survey conducted by the Centers for Disease Control and Prevention. The researchers found that people in the group with the highest concentration of BPA had almost three times the odds of cardiovascular disease as did those in the lowest quartile, even when factors such as race, income and education levels were accounted for. That group had a 2.4 times higher risk of diabetes. Higher BPA levels also were associated with clinically abnormal concentrations of three liver enzymes.

Steven G. Hentges, executive director of the Polycarbonate/BPA Global Group of the American Chemistry Council, an industry trade group, noted several limitations of the research. "Urinary concentrations tell you the exposure over the last 24 hours, but heart disease and diabetes do not occur overnight," he said. "Bisphenol A would have to be measured over the time period when heart disease or diabetes is actually occurring, so that's a major limitation of the study." Hentges also said the study showed that people were being exposed to very low levels of the chemical, "levels that are far below scientific-based safety standards established by government agencies."

The authors cautioned that further research is needed to confirm their findings. "From this one study we can say that the effects of BPA in humans need to be examined more closely," said Melzer, a professor of epidemiology and public health. (Chicago Tribune, Tribune wire services) Read the complete story.

Consumer ads for medical devices subject of Senate panel

As makers of medical devices like artificial knees and heart stents increasingly pitch their products directly to consumers, some lawmakers, medical groups and others are calling for restrictions on such advertisements, claiming they mislead patients.

The amount of medical device advertising directed to consumers on television or over the Internet, an estimated $193 million last year, represents just a small fraction of the volume of consumer advertising for prescription drugs, according to TNS Media Intelligence, a consulting firm.

But some experts maintain that the advertising of a medical device can have more of an impact on a patient’s well-being than a drug, because devices often require surgery to implant and may remain inside the body for years. “The results are irreversible because you are kind of stuck with a device,” said Dr. Kevin J. Bozic, a professor of orthopedics at the University of California, San Francisco.

On Wednesday, the Senate Special Committee on Aging plans to hold a hearing about direct-to-consumer promotions of medical devices. Dr. Bozic, who was an author of a recent medical journal article critical of consumer advertising, is among those scheduled to testify.

In a statement, the committee’s chairman, Herb Kohl, Democrat of Wisconsin, said he was holding the hearing because he thought that the Food and Drug Administration might have to increase its scrutiny of medical device promotions, much as it had done for pharmaceutical advertisements. “The medical device industry is just beginning to get into the game,” Kohl said.

David Nexon, a senior official at the Advanced Medical Technology Association, a trade group in Washington that represents medical device makers, said the organization thought that current F.D.A. rules governing direct-to-consumer advertising were adequate. He added that while an advertisement might stimulate a patient to ask a doctor about a device, the process of receiving one involves a discussion of its benefits and risks. “You may take a pill because it doesn’t involve very much,” Nexon said. “But you don’t undergo surgery unless you think you have a serious need for it.”

In 2007, spending by medical device makers on direct-to-consumer advertising was nearly double the amount in 2005, according to data provided to the Congressional Research Service by TNS. Over the last three years, a variety of device makers have started ad campaigns. Stryker, for instance, has run ads for a ceramic replacement hip, a device that some patients have since complained squeaks loudly enough to be heard while they walk. Another orthopedics maker, Zimmer Holdings, has advertised a replacement knee created for women, and Medtronic, a maker of heart devices, has run consumer promotions about heart defibrillators.

At the hearing on Wednesday, an official of Consumers Union, the publisher of Consumer Reports magazine, is expected to testify that current rules requiring consumer drug advertisements to provide balance between a medication’s benefits and risks should be extended to cover medical devices. (New York Times) Read the original story.

Health and safety of residents, responders at risk in flood conditions

Since Hurricane Ike threw trees across houses, streets and power lines, Christus St. Elizabeth Hospital in Beaumont, TX, has seen three people with significant chainsaw injuries. With people running generators because of power outages, the hospital has seen five people suffering from symptoms of carbon monoxide poisoning. Often, those cases are caused when generators are used in an enclosed space, said Cindy Powers, director of infection control at St. Elizabeth. “That means an attached garage or close enough to an air conditioner that it sucks in the exhaust or under the eave intakes of a house,” she added. No one has died in the Golden Triangle area from carbon monoxide poisoning yet, but people have been treated for symptoms.

There are quite a few other hurricane- and flood-related illnesses or injuries that Powers expects to see in the coming weeks, including gastric problems caused by flood waters, wounds caused by careless cleaning up, animal bites from wild animals or strays and allergy-related respiratory complaints caused by either mold or just the environmental stir-up from the hurricane. “If you get wounded, antibiotic ointment is recommended and make sure your tetanus shot is up-to-date, especially if you are injured in the flood waters,” said Powers

As for those waters, Powers has two words: Stay out. “Flood water-related illnesses that we see include stomach illnesses, Hepatitis A is associated with flooding, and, in the U.S. we don’t see cholera often, but it is associated with floodwater,” she said. “Do not allow children – or adults – to play in flood water or near storm drains. There could be boards with nails in them, alligators and snakes and sewage, so there a lot of good reasons to avoid that.”

Powers also warns to wear heavy gloves and watch where you put your hands because wild animals such as snakes and alligators are moving into the flooded areas. Mosquitoes are another concern with so much water sitting around. Powers advised people to empty bird baths, put chlorine in pools and empty anything that holds water, such as old tires.

In addition, Powers said anyone with medical issues related to salt intake should be careful of city and county water supplies for the time being. The storm surge added salt water to the water supply, giving it a high salt content. A press release from Southeast Texas Emergency Management, the high salt content in Beaumont’s city water may last another three to five days before clearing.

-From Cindy Powers, director of infection control, Christus St. Elizabeth Hospital (Beaumont Enterprise) For the complete article, including safety tips see Read the complete article, including safety tips.

McCain healthcare plan transforms health insurance but few gains in numbers of insured; Analysis shows number of uninsured likely to grow

A paper published in the journal Health Affairs highlights the cost and coverage implications of Senator John McCain's healthcare plan and describes its likely impact on the level and stability of insurance coverage as well as the healthcare costs faced by families. The plan would eliminate the current tax exclusion of employer payments for health coverage, replace the exclusion with a refundable tax credit for those who purchase coverage, and encourage Americans to move to a national market for non-group insurance.

According to the authors, these changes would have little impact on the number of uninsured people in the beginning, but over time the numbers of uninsured are likely to grow as the value of the tax credit falls relative to rising healthcare costs. The article, published today as a web exclusive, can be accessed via this link.

"Moving toward a relatively unregulated non-group market will tend to raise costs, reduce benefits, and leave people with less consumer protection," said Sherry Glied, PhD, professor and chair of the Department of Health Policy and Management at Columbia University Mailman School of Public Health and one of the paper's authors. "The system Senator McCain envisions is one in which many more, perhaps most, insured Americans would buy health insurance and health services in a national, relatively unregulated, competitive market. Because this is a radical departure from the current system, its likely effects deserve close attention."

According to Dr. Glied, the elimination of the income tax preference for employer-sponsored insurance would cause 20 million Americans to lose coverage, but the effect could be much larger especially if employers are quick to drop health benefits in response to the McCain plan, or if employers drop coverage for low wage workers. She suggests that "while initially there will be no real change in the number of people covered as a result of the McCain plan, people are likely to have far less generous policies than those they have today."

The McCain health plan also would have a significant effect on the private health insurance system. The authors note that at first glance, average premiums in the non-group market often appear to be lower than premiums for group coverage, but the apparent advantage of non-group coverage is an illusion. Coverage in this market carries much higher administrative expenses than does coverage in the group market. Non-group plans also appear less costly because they offer less coverage and quoted prices are for coverage sold to healthier people.

Senator McCain has acknowledged the deep flaws in today's non-group market, and his plan proposes state-based high-risk pools for the sick (called Guaranteed Access Plans) and "innovative multi-year health insurance plans." However, high-risk pools would need to be well funded, and the authors contend that the $7 billion to $10 billion that Senator McCain proposes spending to subsidize high-risk pools is not nearly enough to make high-risk pools work to cover significant numbers of the uninsured. His proposed multi-year health insurance plans are unlikely to emerge. Even if they did, they would be unlikely to fix the shortcomings of the non-group market, especially since people do not want to be locked into the same health insurance plan year after year.

The authors believe that several modifications of the McCain proposal could preserve the basic structure of the plan while ameliorating some of its likely negative effects.

Common bronchodilator linked to increased deaths

A common bronchodilator drug which has been used for more than a decade by patients with chronic obstructive pulmonary disease (COPD) has been linked to a one-third higher risk of cardiovascular-related deaths. The drug, ipratropium, is sold under the brand names Atrovent and Combivent, the latter a combination product that contains ipratropium.

A new study from Northwestern University's Feinberg School of Medicine found that veterans with recently diagnosed COPD using ipratropium were 34 percent more likely to die of a heart attack or of arrhythmia than COPD patients using only albuterol (another bronchodilator) or patients not using any treatment. The study is published in the Sept. 15 issue of the Annals of Internal Medicine.

"This medication may be having some systemic cardiovascular effect that is increasing the risk of death in COPD patients," said Todd Lee, lead author and research assistant professor in the Institute for HealthCare Studies at the Feinberg School.

COPD is an umbrella term for respiratory diseases that include chronic bronchitis and emphysema. The primary cause is smoking. An estimated 12 million people in the U.S. have COPD. The disease is the fourth leading cause of death in the U.S. and is expected to grow to the third leading cause by 2020 due largely to an aging population with a higher historical rate of smoking.

Todd noted his study is observational and indicates the need for researchers to take a closer look at this medication, which has been considered safe for many years. The study looked at the cause of death of 145,000 veterans with newly diagnosed COPD from 1999 to 2003.

"The safety of drugs for COPD patients has flown under the radar," Lee said. "We decided to look into the safety of respiratory medications for COPD patients because of some concerns that had been raised in asthma drugs. We were curious as to whether there were safety problems with these medications in patients with COPD."

Todd said patients and providers should be aware of the potential risk. "When they make treatment decisions they need to weigh these potential risks against other medications that are available for COPD," he noted.

September 16, 2008   Download print version

Receding waters leave toxic mix

Port Arthur, Texas hospital damaged by Hurricane Ike

AHRQ releases two new resources to help consumers and clinicians prevent dangerous blood clots

Staten Island hospital pays $88M in fraud claims 

Code aims to aid nurses; Group says foreign hires need protection

B. Braun again ranked “Best In Klas” for smart pumps

Is re-emerging superbug the next MRSA? Loyola physicians warn Clostridium difficile next emerging disease threat

US FDA approves Sancuso; first and only patch for preventing nausea and vomiting in cancer patients undergoing chemotherapy

Receding waters leave toxic mix

GALVESTON, TX — As the search continued here for people killed or stranded by Hurricane Ike, the authorities said Monday that they were faced with much larger challenges than simply clearing roadways and restoring electricity before they could let residents back onto this debris-strewn island.

The sludge left in homes and on roads as floodwaters recede represents a “toxic soup” of mud, human waste, asbestos, lead and gasoline that poses serious health risks and must be removed before people return, they said. Homes must be inspected for structural damage and for leaks before natural gas service can be restored. And before debris can be hauled away, hazardous material has to be separated from what can be sent to recycling centers, burned or chipped into mulch.

Total damages to the island are estimated to be more than $10 billion, city officials said. Officials said that they did not expect electricity and natural gas to be restored on the entire island for at least a month and that it might take more than a year to remove all the debris. Water should be running within the next couple of weeks, they said.

City officials said the death toll on the island remained at four. They estimated that 15,000 to 20,000 people had stayed on the island, and they pleaded with them to leave. “Quite frankly, we are reaching a health crisis for those that are remaining on the island,” said Steve LeBlanc, the city manager. “We’re asking and strongly encouraging those that are here to leave, a­­nd we’re certainly telling those that are away to stay away.” He added, “We don’t want to go in a downward spiral.”

Officials said the bridge onto the island would remain closed to all but emergency workers for several more days, or at least until safety concerns could be addressed.

The pools of standing water were creating breeding zones for mosquitoes, which were beginning to fill the air, and city officials asked the county to begin spraying to kill the larvae. One man was found on the street with more than 1,000 mosquito bites, said Alicia Cahill, a spokeswoman for the city. He was airlifted to a hospital.

City officials said search and rescue teams had inspected 90 percent of the city and identified 150 buildings and homes that had collapsed. “We expect the number of condemned structures to grow greatly in the next several days,” Cahill said.

Among the thousands of residents who ignored evacuation orders, some have begun using small generators, but city officials warned that in waterlogged homes, these people were creating fire and electrocution risks. The fumes from the generators, most of which run on diesel, also create risks of carbon monoxide poisoning, they said.

Many of the 20,000 homes on the island are old and lack devices that automatically cut off the flow of natural gas if a pilot light goes off or there is a leak. As a result, explosions are a concern, and the gas company plans to check on every house, city officials said.

“The toxic soup is also a serious issue,” said Brandon Wade, the deputy city manager who is overseeing the logistics of restoring power and water, as he described the floodwaters that fill many residents’ homes and garages.

Household chemicals, stored lead-based paints, gasoline, sewage and construction debris — sometimes with asbestos — have created a dangerous mixture, he said. The water table and drinking water are at risk of being contaminated. And when the sludge dries, the film on the walls and in floors as well as the dust in the air could lead to serious respiratory concerns.

Officials also instructed everyone to stay off the beaches and out of the water for fear that the water in the Gulf is contaminated. The Coast Guard was doing sonar scans of the port and along the island’s shoreline to search for sunken debris. The Environmental Protection Agency will begin taking samples of the sludge and floodwater this week to check for contaminants, city officials said. (New York Times) Read the complete story.

Port Arthur, Texas hospital damaged by Hurricane Ike

IASIS Healthcare LLC announced today that The Medical Center of Southeast Texas, located in Port Arthur, TX, was damaged during Hurricane Ike. During an initial inspection of the hospital on Sunday, IASIS employees found damage to the roof and water inside the facility. There is no municipal power service available in the community at this time. The Medical Center remains closed for further assessment and repairs.

The hospital was successfully evacuated on Friday prior to the hurricane’s landfall. There were no patients or staff in the hospital during the hurricane.

IASIS cannot yet estimate the amount of damage to the facility, when operations will resume or the ultimate financial impact of Hurricane Ike. The Company maintains property and business interruption insurance coverage on the facility, subject to policy deductibles.

“We are deeply saddened by the damage caused by Hurricane Ike in the Port Arthur area and in other affected communities. We extend our heartfelt sympathy to the many people, including our own employees, who have suffered personal losses. We are committed to providing hospital services here and will work fervently to repair The Medical Center so that it can reopen as soon as possible,” said David R. White, chairman and chief executive officer of IASIS Healthcare.

The Medical Center is a 224-bed full-service community hospital that opened in April 2005. IASIS, located in Franklin, TN, is an owner and operator of medium-sized acute care hospitals in high-growth urban and suburban markets.

AHRQ releases two new resources to help consumers and clinicians prevent dangerous blood clots

Two new guides to help consumers and clinicians prevent and treat deep vein thrombosis were released by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ).

Not all blood clots are harmful but deep vein thrombosis, a blood clot that forms in the deep veins of the body, most commonly in the lower leg or thigh, is a potentially deadly medical problem that affects at least 350,000 and possibly as many as 600,000 Americans each year, according to The Surgeon General's Call to Action to Prevent Deep Vein Thrombosis and Pulmonary Embolism that was also released today. AHRQ's resources are independent of the Call to Action.

AHRQ's consumer booklet, Your Guide to Preventing and Treating Blood Clots, is a 12-page easy-to-read resource that helps both patients and their families identify the causes and symptoms of dangerous blood clots, learn tips on how to prevent them and know what to expect during treatment.

The clinician guide, Preventing Hospital-Acquired Venous Thromboembolism: A Guide for Effective Quality Improvement, is a comprehensive tool to help hospitals and clinicians implement processes to prevent dangerous blood clots. The 60-page guide details how to start, implement, evaluate and sustain a quality improvement strategy. It includes case studies, as well as examples of forms that clinicians in the field can use.

Dangerous blood clots can form when a person is stationary for a long period of time, such as when recovering from surgery, being hospitalized or traveling long distances. A blood clot that travels to the lung is called a pulmonary embolism.

The AHRQ guides were developed from toolkits originally created by experts funded through AHRQ's Partnerships in Implementing Patient Safety grant program. Treatment for blood clots often includes blood thinning medications such as Coumadin (generic name: warfarin). AHRQ recently published Your Guide to Coumadin/Warfarin Therapy to help these patients better understand their treatment. This guide also originated from an AHRQ-funded patient safety project.

Free, single copies of all AHRQ publications are available by calling the AHRQ Publications Clearinghouse at (800) 358-9295 or by sending an E-mail to AHRQPubs@ahrq.hhs.gov. More info: AHRQ resource release.

Staten Island hospital pays $88M in fraud claims 

Staten Island University Hospital (SIUH) has agreed to pay the federal government $74.032 million to settle claims that the hospital defrauded Medicare, Medicaid and the military’s health insurance program, TRICARE. In addition, the hospital will pay the State of New York $14,883,883, representing damages sustained by the state’s Medicaid Program. In total, SIUH will pay $88,916,448.   

The settlement, in part, resolves whistleblower suits filed on behalf of the government in the U.S. District Court for the Eastern District of New York by two individuals. Dr. Miguel Tirado, a former SIUH director of Chemical Dependency Services, who filed suit under the federal False Claims Act and the New York State False Claims Act, alleged that the hospital had fraudulently billed Medicaid and Medicare for inpatient alcohol and substance abuse detoxification treatment.   

The government’s investigation established that, during the period July 1, 1994 through June 30, 2000, SIUH submitted claims for payment for detoxification treatment provided to patients in beds for which SIUH had received no certificate of operation from the New York State Office of Alcoholism and Substance Abuse Services (OASAS).  

Although SIUH was authorized to provide inpatient detoxification care to patients in 56 beds, it administered treatment in 12 additional beds located in a locked, separate wing and concealed the existence of the wing from OASAS. SIUH has agreed to pay the federal government $11,824,056 and $14,883,883 to the state of New York according to an agreement that has been approved by U.S. District Judge Edward R. Korman.   

Elizabeth M. Ryan, widow of an SIUH cancer patient, asserted in her federal False Claims Act suit that SIUH fraudulently billed Medicare for stereotactic body radiosurgery treatment that was provided on an out-patient basis to cancer patients. 

The investigation established that from1996 through 2004, SIUH defrauded Medicare and TRICARE by knowingly using incorrect billing codes for cancer treatment performed at the hospital. By using incorrect codes, SIUH obtained reimbursement for treatment that was not covered by Medicare or TRICARE. SIUH will pay the United States $25,022,766 to settle this claim according to an agreement that has been approved by U.S. District Judge John Gleeson.  

As a result of the settlement, Tirado will receive $2.3 million from the federal government and $2.97 million from New York. Ryan will receive $3.75 million as her portion of the federal recovery. The federal False Claims Act and newly-enacted New York state False Claims Act permit private individuals to file suits on behalf of the government and receive a portion of the recovery.   

The government’s other two claims were resolved prior to the filing of suit. The federal government had determined that SIUH deliberately inflated its resident count from the 1996 cost report year through the 2003 cost report year. Medicare pays a share of the cost of Graduate Medical Education at teaching hospitals such as SIUH.  

The amount paid is determined by Medicare annually based upon “cost reports” submitted by the hospitals. SIUH has agreed to pay the United States $35,706,754 to settle this claim. 

Also, the settlement concerns SIUH’s billings to Medicare and Medicaid for treatment of psychiatric patients in unlicensed beds during the period July 2003 through September, 2005. The hospital has agreed to pay the United States $1,478,989 to settle this claim.   

In addition, SIUH has agreed to enter into a Corporate Integrity Agreement with the Office of Inspector General, Department of Health and Human Services (OIG-HHS) under which the hospital will maintain a compliance program to help ensure against a recurrence of fraud. (The North Country Gazette) Read the full story.

Code aims to aid nurses; Group says foreign hires need protection

A coalition of healthcare groups this month unveiled a code of ethics it hopes will protect nurses from other countries from abusive employment practices when they take jobs in the United States.

"It's our feeling that if we're going to recruit foreign-educated nurses, we need to do so responsibly and ethically," said Cheryl Peterson, director of the department of nursing practice and policy for the American Nurses Association, one of the groups that helped write the guidelines. She called the code a first step.

Since the late 1990s, the United States has struggled to recruit enough nurses to serve its rapidly aging population. The Department of Health and Human Services calculates that by 2020 the country will need about 2.9 million nurses, and will only have about 1.8 million, a 36 percent shortfall. The shortage has prompted many hospitals, nursing homes and other medical facilities to look overseas for qualified candidates. A 2004 survey found that about 4 percent of all registered nurses in the United States had been educated abroad.

But not all who arrive in this country find what they expect. The coalition that prepared the ethics guidelines says that some are given jobs beneath their skill level, jobs that American nurses are reluctant to do, or are not placed in the hospitals or medical facilities they were promised. Others may not be paid fairly compared with their American counterparts. "We've heard anecdotal stories of nurses who are abused – there are pay issues, working-condition issues," Peterson said.

The four-page code of ethics lays out guidelines on those issues as well as summaries of relevant employment laws. The document offers examples of ways in which hospitals and other employers can train and support nurses from overseas. The code is designed to be used by employers and recruitment agencies and as a primer for nurses who'd like to work in the United States but aren't clear on what rights they might have.

The code will be voluntary, but medical institutions that subscribe must agree to independent monitoring. The coalition, which included industry representatives as well as unions, will begin work on how to monitor aspects of the code later this year, according to Patricia Pittman, executive vice president of AcademyHealth. Her organization, which serves researchers, policy analysts and practitioners, helped bring the interest groups together to write the standards.

According to the American Hospital Association, about 17 percent of U.S. hospitals recruit staff from overseas. As of 2007, there were more than 300 specialized nurse recruiting agencies, a nearly tenfold increase over the past decade. Officials at a handful of Washington area employers including Adventist HealthCare and Georgetown Medical Center have recruited nurses from overseas and say they have extensive programs in place to support them.

Not everyone in the healthcare industry thinks that recruitment abroad is the best way for Americans to address the nursing shortage. Others have said the best solution is to expand domestic training programs and to improve working conditions for nurses.

And the new ethics code encourages U.S. companies to refrain from recruiting in countries already facing severe shortages of medical personnel, coalition members said. While most foreign-trained nurses come from the Philippines, India, the United Kingdom and Canada, others come from countries that have been identified by the World Health Organization as experiencing a "health-care workforce crisis." Most seriously threatened is sub-Saharan Africa; for example, 34 percent of nurses trained in Zimbabwe were working in richer countries in 2006, according to WHO. (Washington Post) Read the original article.

B. Braun again ranked “Best In Klas” for smart pumps

Exemplifying its commitment to translating customer needs into products with unmatched quality, cost-effectiveness, environmental responsibility and safety across key markets, B. Braun Medical Inc. announced today it has achieved “Best in KLAS” for Smart Pump Technology in KLAS’s 2008 Top 20: Best in KLAS Awards for Medical Equipment Report. Recognized as a category leader for two years in a row, and most recently ranked “Best in KLAS” for Smart Pumps in the 2007 Year End Report, B. Braun continued to improve its position on the customer feedback-based ranking.

Detailed information on the KLAS recognition is available on a special Web site, www.bbraunusa-smartpumps.com/news.

The KLAS report, which is published semi-annually as a report card of vendor performance, is based on the opinions of healthcare executives, managers and clinicians. The summary of performance data collected over the past 13 months ranks the top overall vendors, as well as leaders in each market segment.

Customers gave B. Braun smart pumps the highest ratings in several key categories, including “needed functionality” and overall vendor/product satisfaction. The company’s attention to detail and quality of customer service also earned B. Braun high marks in the “Keeps Promises” and “Proactive Service” scores. In fact, B. Braun’s Outlook Safety Infusion System was the only smart pump to improve its scores from the previous year’s ratings, increasing an average of four percentage points above the competition and also achieving top marks in “Delivery of New Technology,” “Ease of Use” and “Product Uptime” categories.

B. Braun’s Outlook Safety Infusion System offers a variety of features that improve the safety of IV medication delivery. It features an extensive drug library, barcoding capabilities and a flexible platform that can be upgraded as a facility’s needs change. This enables clinicians to improve patient safety as they streamline care. The Outlook system is designed to ensure the right patient is receiving the right drug and the right dose by an authorized clinician. The system’s open architecture design allows it to interface with hospital or pharmacy information management systems, making it customizable to various healthcare environments. Information on the pumps and the Best in KLAS recognition is available at www.bbraunusa-smartpumps.com/news.

Is re-emerging superbug the next MRSA? Loyola physicians warn Clostridium difficile next emerging disease threat

MAYWOOD, IL – Dr. Ed Corboy had no idea what was afflicting his 80-year-old mother, Joan Corboy. All he knew for certain was that since being treated for what was a routine diarrheal infection, she seemed to be wasting away and none of her doctors or other health specialists could explain why. “She lost almost 55 pounds between July Fourth and Christmas in 2006,” said Corboy, a resident of Wilmette. “She was so sick, so weak and despite the best care of her doctors, she was getting weaker. It was clear she was in big trouble.”

Afraid that his mother was running out of time, Corboy called the Centers for Disease Control in Atlanta for advice. Dr. Clifford McDonald told him the infection his mother probably had was of the NAP1 type of the bacteria Clostridium difficile, a virulent strain of a common intestinal bacteria currently plaguing hospitals that now rivals the superbug Methicillin-resistant staphylococcus aureus (MRSA) as one of the top emerging disease threats to humans.

“Disease caused by Clostridium difficile can range from nuisance diarrhea to life-threatening colitis that could lead to the surgical removal of the colon, and even death,” said Dr. Stuart Johnson, associate professor of medicine, division of infectious diseases, Loyola University Chicago Stritch School of Medicine. “It's a very hardy strain and it seems to persist.”

C-diff, as it is better known, is a bacterium that was discovered in 1978 to be the cause of antibiotic-associated diarrhea and colitis, said Johnson, one of the world's top C-diff researchers and physicians, and who successfully treated Joan Corboy's infection. Although C-diff sickens about 500,000 Americans a year and has reached epidemic proportions in 38 states including Illinois, most people have not yet heard of it.

“I don't think that people appreciate the urgency and severity of this disease,” said Dr. Dale Gerding, professor of medicine, division of infectious diseases, Stritch School of Medicine, and associate chief of staff for Research, Hines VA Hospital.

Hospitals in Quebec have been particularly hard hit by C-diff. In the 12 hospitals affected, about 2,000 deaths were directly attributable to the antibiotic resistant strain between the 2003 and 2004. In the United Kingdom, deaths from C-diff leaped by 28% in 2007 to more than 8,000, according to the nation's Department of Health. "What was surprising was not just the rates, but the number of severe cases," said Johnson, who helped treat Joan Corboy's illness.

Similar to MRSA, C-diff is an infection that is mainly acquired in a hospital or nursing home, although like MRSA there is some evidence that a community-acquired strain may be developing, according to the CDC. “When a patient is in the hospital getting antibiotics for some type of infection, one of the potential complications is that the normal bacterium that lives in the colon is disturbed with that antibiotic. That makes you susceptible to an infection with Clostrium difficile,” Johnson said. “The great majority of cases occur in people who have recently used antibiotics.”

When C-diff is not actively dividing, it forms very tough spores that can exist on surfaces for months and years, making it very difficult to kill, Johnson said. “Antibiotics are very effective against the growing form of the bacteria but it doesn't do anything to the spores,” Johnson said. “If there are spores they can sit around like stealth bombs. Once the antibiotic is gone, these spores can germinate again and spread their toxins.”

Since its discovery, C-diff has grown increasingly resistant to antibiotics, according to Johnson and Gerding, who has been studying the bacteria since 1980. Though it is appearing more often in younger people, those 65 years and older face a greater risk of developing infection from C-diff and has more severe outcomes and higher death rates. Relapse is common with about 25 percent of patient experiencing a second bout of disease within two months after their first. Patients who have had two or more episodes of disease have a 30 percent to 65 percent risk of another bout.

Symptoms of C-diff include profuse diarrhea and abdominal pain and distention of the abdomen. An infection is also frequently accompanied by fever, nausea and dehydration. In some rare cases blood may be present in the stool. The infection is spread by spores that contaminate the hospital environment and hands of healthcare workers who can transmit the spores to patients. The resistance of the spores to hospital cleaning agents and to alcohol hand disinfectants makes it extremely difficult to eradicate.

US FDA approves Sancuso; first and only patch for preventing nausea and vomiting in cancer patients undergoing chemotherapy

ProStrakan Group plc announced the U.S. Food and Drug Administration (F.D.A) approval of SANCUSO (Granisetron Transdermal System), the first and only patch to provide up to five consecutive days of control of nausea and vomiting for patients receiving a moderately and/or highly nausea-inducing chemotherapy regimen.

Chemotherapy-induced nausea and vomiting (CINV) are commonly cited by patients undergoing chemotherapy as highly feared side effects. In addition to its social and emotional effects, if left untreated, CINV can lead to dehydration, malnutrition, treatment delay, or even discontinuation of treatment.

Despite advances in treatment, CINV remains a significant issue. Some patients expect to endure unpleasant symptoms in order to continue chemotherapy and may suffer at home while not under the supervision of a healthcare professional. With one application of Sancuso, patients receive up to five consecutive days of CINV treatment.

Sancuso is a transdermal system, or skin patch, that delivers granisetron, its active component and an established inhibitor of nausea and vomiting, through a thin layer of adhesive that attaches the patch to the skin. The medicine is then released slowly and continuously into the bloodstream for up to five consecutive days.

The F.D.A. approved Sancuso for the prevention of CINV based on the results of a multicenter Phase III randomized, double-blind, double-dummy controlled study comparing the efficacy, tolerability and safety of Sancuso with once-daily oral granisetron (2 mg). The trial enrolled 641 patients who received moderately or highly nausea-inducing multi-day chemotherapy, and met its primary endpoint of achieving complete control of CINV, working as well as oral granisetron. Complete control was defined as no vomiting and/or retching, no more than mild nausea and no rescue medication from first administration of Sancuso until 24 hours after the last day of chemotherapy.

ProStrakan has developed a patient assistance program to ensure that Sancuso is available to any qualified patients who would benefit from it.

September 15, 2008   Download print version

Health facilities flush estimated 250M pounds of drugs a year

U.S. hospitals and long-term care facilities annually flush millions of pounds of unused pharmaceuticals down the drain, pumping contaminants into America's drinking water, according to an ongoing Associated Press investigation. These discarded medications are expired, spoiled, over-prescribed or unneeded. Some are simply unused because patients refuse to take them, can't tolerate them or die with nearly full 90-day supplies of multiple prescriptions on their nightstands. 

Few of the country's 5,700 hospitals and 45,000 long-term care homes keep data on the pharmaceutical waste they generate. Based on a small sample, though, the AP was able to project an annual national estimate of at least 250 million pounds of pharmaceuticals and contaminated packaging, with no way to separate out the drug volume. 

One thing is clear: The massive amount of pharmaceuticals being flushed by the health services industry is aggravating an emerging problem documented by a series of AP investigative stories — the commonplace presence of minute concentrations of pharmaceuticals in the nation's drinking water supplies, affecting at least 46 million Americans. Researchers are finding evidence that even extremely diluted concentrations of pharmaceutical residues harm fish, frogs and other aquatic species in the wild. Also, researchers report that human cells fail to grow normally in the laboratory when exposed to trace concentrations of certain drugs. 

The original AP series in March prompted federal and local legislative hearings, brought about calls for mandatory testing and disclosure, and led officials in more than two dozen additional metropolitan areas to analyze their drinking water.

And while most pharmaceutical waste is unmetabolized medicine that is flushed into sewers and waterways through human excretion, the AP examined institutional drug disposal and its dangers because unused drugs add another substantial dimension to the problem. 

Such facilities, along with hospitals and hospices, pose distinct challenges because they handle large quantities of powerful and toxic drugs — often more powerful and more toxic than the medications people use at home. Tests of sewage from several hospitals in Paris and Oslo uncovered hormones, antibiotics, heart and skin medicines and pain relievers. Hospital waste is particularly laden with both germs and antibiotics, says microbiologist Thomas Schwartz at Karlsruhe Research Center in Germany. 

In tests of wastewater retrieved near other European hospitals and one in Davis County, Utah, scientists were able to link drug dumping to virulent antibiotic-resistant germs and genetic mutations that may promote cancers, according to scientific studies reviewed by the AP. 

Some contaminated packaging and drug waste are incinerated; more is sent to landfills. But it is believed that most unused pharmaceuticals from health care facilities are dumped down sinks or toilets, usually without violating state or federal regulations. 

In an attempt to quantify the problem, the AP examined records in Minnesota, where state regulators have pushed hospital administrators to keep closer track than elsewhere. Fourteen facilities were surveyed, in a range of settings from rural to urban. The AP projected those annual totals onto the national patient population for hospitals and adjusted for the relatively lower pharmaceutical use of Minnesotans. Since long-term care facilities generate more drug waste than hospitals, the AP conservatively doubled the number. 

That calculation produced an estimate of at least 250 million pounds of annual drug waste from hospitals and long-term care centers, further complicated by the fact experts say drugs might account for only up to half of pharmaceutical waste, while the rest is packaging. 

The EPA is considering whether to impose the first national standard for how much drug waste may be released into waterways by the medical services industry, but Ben Grumbles, the EPA's top water administrator, says a decision won't be made until next year, at the earliest. So far, regulators have done little more than politely ask the medical care industry to stop pouring drugs into the wastewater system. "Treating the toilet as a trash can isn't a good option," says Grumbles. (AP – USA Today) Visit here for the complete story

Older drug treatments for Schizophrenia in children as effective as new expensive drugs

A new government study being published today has found that the medicines most often prescribed for schizophrenia in children and adolescents are no more effective than older, less expensive drugs, and are more likely to cause some harmful side effects. The standards for treating the disorder should be changed to include some older medications that have fallen out of use, the study's authors said. The results, being published online by The American Journal of Psychiatry, are likely to alter treatment for an estimated 1 million children and teenagers with schizophrenia, and to intensify a broader controversy in child psychiatry over the newer medications, experts said. 

Prescription rates for the newer drugs, called atypical anti-psychotics, have increased more than fivefold for children over the past decades and a half, and doctors now use them to settle outbursts and aggression in children with a wide variety of diagnoses, despite serious side effects. A consortium of state Medicaid directors is currently evaluating the use of these drugs in children on state Medicaid rolls, to ensure they are being prescribed properly. 

The study compared two of the newer anti-psychotics, Zyprexa from Eli Lilly and Risperdal from Janssen, with an older medication and found that all three relieved symptoms of schizophrenia, like auditory hallucinations, in many young patients.

Yet half of the children in the study stopped taking their drug within two months, either because it had no effect or was causing serious side effects, like rapid weight gain. The children receiving Zyprexa gained so much weight that a government oversight panel monitoring safety ordered that they be taken off the drug. 

Dr. Jon McClellan of the University of Washington, a co-author of the new study and of the current guidelines for treating childhood schizophrenia, said in a telephone interview that older schizophrenia drugs should now be considered as an alternative in some cases. (Herald Tribune) Visit here for the complete story 

Broadlane introduces new version of OnRamp Client Portal

Broadlane, has announced the newest version of its client portal, OnRamp. Broadlane clients use OnRamp as the primary tool for accessing contract and product information, receiving relevant communications, accessing reports and more.

Broadlane’s proprietary Contract Management System (CMS) was first released to clients in 2001.  OnRamp was released in 2005 to provide access to relevant industry information, Broadlane news, additional applications and online reports. The new version of OnRamp just released ntegrates CMS with the OnRamp client portal for a seamless user experience. It also provides Broadlane the ability to index and categorize all the information, users and applications within a single, simple enterprise-wide directory.  

The informatics reporting function, available within OnRamp, supplements and enhances Broadlane clients’ purchasing knowledge. Clients can access reports related to contracts, capital equipment, pharmacy and other key area of spend management. Utilizing the informatics tool with BroadLink provides users detailed intelligence to reveal tactical actions to improve operational performance.  

Clients can continually gain knowledge and also earn continuing education (CE) credit by accessing online training through Broadlane University on OnRamp. Online and live training courses are listed, and CE credits are noted.  Content includes clinical and non-clinical supplier-sponsored education, Supply Chain Education Program (SCEP) classes, nursing courses, pharmacy courses and leadership development. For more information visit www.broadlane.com

Novation’s Failure-To-Supply Recovery Program recoups more than $1 million for members
in pharmacy costs 

Each year millions of dollars are lost when healthcare providers are forced to pay a higher price for drugs because the lower priced product is unavailable. When the lower priced product is a Novation contract product, Novation works to recover the price difference for the pharmacy. Launched in December 2007, Novation’s Failure-to-Supply Recovery program simplifies the collection of those lost pharmacy dollars by removing the administrative burden from members of VHA Inc., University HealthSystem Consortium (UHC), and Provista. As the only group purchasing organization (GPO) to widely offer this service, Novation has collected more than $1 million in recovered funds since the inception of the program.   

Novation’s failure-to-supply recovery service team is dedicated to the retrieval of failure-to-supply funds. The team processes the reports and collects the funds on behalf of members. Recovered dollars are returned to members in the form of a wholesaler credit-on-account.  

Newly found gene variants account for kidney diseases among African-Americans 

For the first time, researchers have identified variations in a single gene that are strongly associated with kidney diseases disproportionately affecting African-Americans. This work was conducted by researchers at the National Institutes of Health (NIH) and by NIH-funded investigators at the Johns Hopkins University. The findings are published online today in two papers in Nature Genetics and will be published in the October print issue.  

The researchers studied nondiabetic kidney diseases that can lead to chronic kidney disease and, in severe cases, to kidney failure requiring long-term dialysis or a kidney transplant. One of these diseases, focal segmental glomerulosclerosis (FSGS), is a kidney disease that leads to kidney failure in more than half of those with the disease over a period of about 10 years. Chronic kidney disease is caused by many different diseases and conditions and affects 26 million Americans. More than 106,000 individuals develop kidney failure and more than 485,000 receive dialysis or transplantation in the United States each year.  

Using a type of genome association that relies on differences in the frequency of gene variants between populations, the NIH researchers identified several variations in the MYH9 gene as major contributors to excess risk of kidney disease among African-Americans. The NIH researchers shared their discovery with the Johns Hopkins scientists, who replicated the findings in participants from earlier studies of kidney disease. 

Both research teams found statistically significant associations of MYH9 variants with FSGS, HIV-associated FSGS, and all nondiabetic kidney failure. They also found that these variants were much more frequent among people of African ancestry than among whites. The increased risk among African-Americans with these variants is more than 300 percent for FSGS, more than 500 percent for HIV-associated FSGS, and more than 100 percent for all nondiabetic kidney failure. Sixty percent of African-Americans carry the risk variants in contrast to 4 percent of whites.  

Though FSGS affects African-Americans more than whites, the rate of progression to kidney failure is believed to the same for both populations. FSGS associated with HIV infection is almost exclusively found in individuals of African descent and, without treatment, progresses more rapidly to kidney failure compared to other forms of kidney disease. FSGS often affects adolescents and young adults as well as older individuals.  

In the NIH study, the researchers scanned the genome of 190 African-Americans known to have FSGS, including the form associated with HIV infection, and 222 who did not have FSGS and replicated these findings in additional cases. The Johns Hopkins researchers, members of the Family Investigation of Nephropathy and Diabetes (FIND) consortium, studied more than 2,100 participants of the FIND study and the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) study. FIND, one of the largest multi-center genetic studies of kidney disease ever conducted, has been funded by the NIDDK since 1999.  

Though diabetes is one of the leading causes of kidney failure, both research teams found no association between the MYH9 variants and diabetes-related kidney failure in African-Americans. "This finding suggests that the mechanisms leading from onset of chronic kidney disease to kidney failure may differ based on the inciting cause," said W.H. Linda Kao, M.H.S., Ph.D., and Rulan S. Parekh, M.D., M.S., the lead and senior authors of the Hopkins study. "Therefore, understanding the role that MYH9 plays in kidney failure may ultimately lead to development of drug therapies that target more specific, rather than common, genetic pathways to prevent kidney disease progression more effectively." 

The different frequencies of genetic variants between African Americans and European Americans have potential implications for future screening strategies for African-Americans with hypertension. It remains unclear whether hypertension is particularly likely to damage the kidney in individuals with these MYH9 variants, and further research will be needed to determine whether individuals identified as having hypertensive kidney disease actually have undiagnosed FSGS. Visit here for more information.
 

Safety gear a must to prevent kids' sports injuries

Children who play school sports need to wear proper safety gear to reduce their risk of injuries, emphasizes the director of sports medicine at Cincinnati Children's Hospital Medical Center. Dr. Jon Divine recommends the following equipment for young athletes:Mouth guards protect the mouth, teeth, cheeks and tongue by cushioning blows that cause lost or broken teeth, concussions or jaw fractures. Mouth guards should be worn for all contact and collision sports.  

Face guards and face protectors (polycarbonate lenses) prevent tens of thousands of injuries each year in contact/collision sports such as hockey and football. Shin guards protect soccer players from shin contusions. Parents need to make sure their children's shin guards fit well. Rapidly growing children may require new shin guards each year. Helmets should be worn in sports such as football, baseball or softball to prevent concussion and other serious head injuries. 

Concussion is the most common type of sports-related brain injury, according to the U.S. Centers for Disease Control and Prevention. About 300,000 sports-related concussions occur each year in the United States. 

"If a young athlete comes off the field after a blow to the head in any sport feeling dizzy, faint or has a lapse in memory, it's vital that they tell their coach or a team trainer. Equally as important, coaches, trainers and parents need to be observant of head injury symptoms, because athletes may not report them," Divine said in a Cincinnati Children's news release. 

"But of utmost importance, athletes younger than 18 who have any post-blow-to-the-head symptoms affecting their thought process should not return to the same practice, game or contest and be evaluated be a physician prior to return to play," said Divine, who directs the concussion clinic at Cincinnati Children's. (Healthday ) http://kidshealth.org/kid/watch/out/sport_safety.html