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February 2-6, 2009
Diet supplement king gets 50 months in prison for selling knockoff prescription drugs on Internet Constant compressions critical to CPR Poor people suffer disproportionately from chronic infections Tamiflu no longer works for dominant flu strain More than a million cancer survivors declining care due to cost concerns Methamphetamine use cost the US about $23 billion in 2005 Swedish Hospital announces layoffs Hiawatha Community Hospital implements IntelliDOT Barcode Point-of-Care Patient Safety Solution ECRI Institute issues high priority alert on bassinet warmers involved in fire on newborn Diet supplement king gets 50 months in prison for selling knockoff prescription drugs on Internet Writing the final chapter in a strange criminal saga, a federal judge has sentenced the president of a Georgia company that manufactures popular lines of herbal dietary supplements to 50 months in prison for illegally selling knockoff prescription drugs over the Internet. U.S. District Judge Jack T. Camp also fined Hi-Tech Pharmaceuticals CEO Jared Wheat $50,000 and ordered him, the company and other individual company defendants to forfeit $3 million in proceeds from the scheme. In a plea bargain, the defendants admitted to operating a manufacturing facility in Belize that made generic versions of such pharmaceuticals as Xanax, Valium, Ambien, Vioxx, Zoloft, Viagra and Cialis and selling them over the Internet without requiring prescriptions. The sentencing ends an unusual criminal case that explored both illegal online pharmacies and the legal but barely regulated U.S. dietary supplements industry. Prosecutors initially accused Wheat of running a “continuing criminal enterprise” — a racketeering statute typically used to prosecute organized crime syndicates — that could have sent him to prison for a minimum of 20 years and resulted in the forfeiture of his company. That charge was dropped during plea negotiations. While the case grew narrower as it progressed, prosecutors said the scheme to sell generic versions of prescription drugs manufactured in an unsanitary warehouse in Belize was fraught with peril for unsuspecting purchasers. In a statement announcing the guilty pleas in August 2008, David E. Nahmais, U.S. attorney for the northern district of Georgia, said the defendants exposed customers to unknown health risks and violated patents in the name of “greed, pure and simple.”
Among Hi-Tech’s leading products are Stamina-Rx, which it describes as a
"maximum sexual stimulant," Lipodrene, "for advanced appetite control and
metabolic stimulation," and Metanabol, a "revolutionary catalyst for
increasing lean mass and strength." (MSNBC) Read
the original story.
Constant compressions critical to CPR Interrupting chest compressions during resuscitation reduces the chances of heartbeat return after defibrillation. New research published in the open access journal BMC Medicine shows that for every second of a pause in compressions there is a 1% reduction in the likelihood of success. Kenneth Gundersen from the University of Stavanger, Norway, worked with a team of researchers to quantify the effect of compression interruptions on the probability of a return of spontaneous circulation (ROSC). He said, "We analysed data from 911 interruptions and found that every second without the blood perfusion generated by chest compressions has a negative impact on the estimated probability of ROSC". The American Heart Association's first aid guidelines were updated last year, suggesting that the 'mouth-to-mouth' component of CPR was unnecessary. This new research supports that position, in that the pause in compressions required to perform artificial respiration may reduce the patient's chances of recovering their heartbeat.
Gundersen said, "The first priority when witnessing a cardiac arrest is to
make an emergency call. Beyond this our results show that performing
powerful chest compressions with minimal interruptions is of utmost
importance. The quality of CPR matters and everyone should practice their
CPR skills at regular intervals."
See an overview of the study.
Poor people suffer disproportionately from chronic infections Kids from low-income families are much more likely to suffer from serious infections such as herpes or hepatitis A than their counterparts in wealthier households. Two recent University of Michigan studies show a startlingly strong correlation between income and chronic infection in both adults and children, with lower income populations suffering much higher rates of chronic infections and clusters of infections than higher income families. For example, in the context of six infections measured, results showed that while the higher income populations might have been exposed to one or two of these common infections, lower income populations in the same age range may have been exposed to as many as four or five. This is concerning since most of these persistent infections are carried throughout life and have been implicated in several chronic diseases. In the adults study, results showed: Individuals without a high school education had roughly 50 percent higher odds of having an additional infection compared to those with a degree. Those with a postsecondary education had 50 percent lower odds. Low income was associated with 33 percent higher odds of additional infection. High income was associated with 45 percent lower odds compared to the middle income group. The paper examining children showed similar startling results: Non-Hispanic black children are over twice as likely to be infected with H Pylori, and 1.4 times as likely to be infected with HSV-1 compared to white children. Each additional year of parental education is associated with roughly 8 percent lower odds of a child being infected with H Pylori, and roughly 11 percent lower odds of HSV-1. As family income doubles, a child's odds of having CMV decline by 21 percent; HSV-1 by 32 percent; and Hepatitis A by 29 percent. Access the abstract: "Socioeconomic and race/ethnic patterns in persistent infection burden among U.S. adults." Access
the abstract: "Early
origins of health disparities: burden of infection, health, and
socioeconomic status in U.S. children."
Tamiflu no longer works for dominant flu strain A milder than usual U.S. flu season is masking a growing concern about widespread resistance to the antiviral drug Tamiflu and what that means for the nation's preparedness in case of a dangerous pandemic flu. Tamiflu, the most commonly used influenza antiviral and the mainstay of the federal government's emergency drug stockpile, no longer works for the dominant flu strain circulating in much of the country, government officials said Tuesday. Of samples tested since October, almost 100% of the strain -- known as type A H1N1 -- showed resistance to Tamiflu. In response, the Centers for Disease Control and Prevention issued new guidelines to physicians in December. Doctors were told to substitute an alternative antiviral, Relenza, for Tamiflu, or to combine Tamiflu with an older antiviral, rimantadine, if the H1N1 virus was the main strain circulating in their communities. Each flu season, several types of flu viruses circulate, and various ones can dominate in different regions and times. Only the H1N1 virus is showing signs of Tamiflu resistance, CDC officials said, speaking at an influenza conference in Washington. Other flu viruses currently circulating are not Tamiflu-resistant. Each year, the three most prominent flu strains -- two type A's and one type B -- are chosen for the creation of the flu vaccine. Unlike last year, both of the A viruses matched this year's vaccine, although the B did not, officials said. Public health experts recommend flu shots as the best way to avoid the virus.
Health officials have long urged constraint in using antivirals out of fear
that, as with antibiotics, misuse could lead flu viruses to develop a
resistance, rendering the drug ineffective when it was truly needed. (LA
Times)
Read the original story.
More than a million cancer survivors declining care due to cost concerns More than a million cancer survivors living in the United States are foregoing what they believe is necessary medical care due to the cost, and Hispanics and African-Americans are twice as likely to go without services, according to data presented at the American Association for Cancer Research conference on the Science of Health Care Disparities. "These survivors are either going without, or significantly delaying, dental care, general medical care, mental health care or prescription drugs," said Kathryn Weaver, Ph.D., a cancer prevention fellow at the National Cancer Institute. Although insurance status did play a role, foregoing care due to cost still persisted among the insured. "There are significant out-of-pocket expenses, even for those with insurance," said Weaver. Weaver and colleagues used data from the Center for Disease Control's National Health Interview Survey to identify 6,602 adult cancer survivors. Of these survivors, 64.3 percent were female, 4.8 percent were Hispanic, 6.4 percent were non-Hispanic black and 88.8 percent were non-Hispanic white. The survey is conducted annually and questions about 30,000 to 40,000 households. Overall, the prevalence of foregoing medical care due to cost was 7.8 percent for general medical care, 9.9 percent for prescription medication, 11.3 percent for dental care and 2.7 percent for mental health care.
"Efforts to expand insurance coverage might go some way toward addressing
these problems, but absent that, clinicians need to be more aware that their
patients are not getting these services and work to try to connect them to
charity or low-cost care," said Weaver.
http://www.aacr.org/
Methamphetamine use cost the US about $23 billion in 2005 The economic cost of methamphetamine use in the United States reached $23.4 billion in 2005, including the burden of addiction, premature death, drug treatment and many other aspects of the drug, according to a new RAND Corporation study. The RAND study is the first effort to construct a comprehensive national assessment of the costs of the methamphetamine problem in the United States. Although methamphetamine causes some unique harm, the study finds that many of the primary issues that account for the burden of methamphetamine use are similar to those identified in economic assessments of other illicit drugs. Given the uncertainty in estimating the costs of methamphetamine use, researchers created a range of estimates. The lowest estimate for the cost of methamphetamine use in 2005 was $16.2 billion, while $48.3 billion was the highest estimate. Researchers' best estimate of the overall economic burden of methamphetamine use is $23.4 billion The RAND analysis found that nearly two-thirds of the economic costs caused by methamphetamine use resulted from the burden of addiction and an estimated 900 premature deaths among users in 2005. The burden of addiction was measured by quantifying the impact of the lower quality of life experienced by those addicted to the drug. Crime and criminal justice expenses account for the second-largest category of economic costs, according to researchers. These costs include the burden of arresting and incarcerating drug offenders, as well as the costs of additional non-drug crimes caused by methamphetamine use, such as thefts committed to support a drug habit. Other costs that significantly contribute to the RAND estimate include lost productivity, the expense of removing children from their parents' homes because of methamphetamine use and spending for drug treatment.
Methamphetamine was the primary drug of abuse in 59 percent of the treatment
admissions in Hawaii in 2004 and accounted for 38 percent of such admissions
in Arizona in 2004. The report, "The Economic Costs of Methamphetamine Use
in the United States - 2005," is available at
www.rand.org.
Swedish Hospital announces layoffs SEATTLE - Western Washington's largest hospital chain has announced significant layoffs. Swedish Hospital plans to eliminate 200 jobs, including more than two dozen senior executives. An internal memo went out to workers Tuesday detailing who will lose their jobs and what will be happening to the non-profit company in the coming months. According to the memo, the first round of layoffs targets upper management: four vice presidents and 22 directors have left or will be gone by the end of the week. Another 175 managers and support staff will be let go sometime next week. The layoffs are aimed at cutting operating costs. Swedish Hospital will save between $20-25 million. Swedish Hospital CEO Rod Hochman tells employees these decisions were difficult but necessary. "Since we made the pledge last year that there would be no cyclical layoffs, the world has changed dramatically," Hochman said in the memo. "Current conditions are not part of the boom and bust cycle industry we described, but rather a complete re-setting of the global economy."
Doctors, nurses and nursing assistants will not be affected by the layoffs,
just upper management. Swedish Hospital reassures that health care will
remain top notch. (MSNBC)
Read the original story.
Hiawatha Community Hospital implements IntelliDOT Barcode Point-of-Care Patient Safety Solution IntelliDOT Corporation, a provider of wireless, handheld barcode point-of-care (BPOC) solutions to hospitals, today announced that IntelliDOT Bedside Medication Administration (IntelliDOT BMA) is now being used by 55 U.S. hospitals. Hiawatha Community Hospital became the 55th customer to go live with the IntelliDOT System on January 20, 2009. Stillwater Medical Center, Stillwater, OK, was the first hospital to implement IntelliDOT BMA in 2004. At that time, IntelliDOT and Stillwater's nurses, pharmacists and management worked closely together to fine tune and enhance the system. For example, one of Stillwater's nurses suggested scanning a DOT to notify the pharmacy to replace a missing medication. IntelliDOT quickly incorporated that idea, which helped make the product even more efficient for nurses. As
the 55th hospital to go live with IntelliDOT BMA, Hiawatha Community
Hospital, a critical access hospital in Hiawatha, KS, has already seen
improvements in patient safety. One key benefit is the system's ability to
provide 24-hour drug interaction checking, even when the pharmacy is closed.
The system is designed to prevent workarounds, helping clients achieve 95
percent or higher user compliance rates, based on actual usage data. The
IntelliDOT System satisfies Joint Commission standards for patient
identification and assures accuracy by verifying the five rights of
medication administration: right medication, right dose, right route, right
patient, right time; as well as ensuring required follow-up documentation,
such as pain scale, is performed in a timely manner and accurately recorded.
More information can be found at
www.intellidotcorp.com.
ECRI Institute issues high priority alert on bassinet warmers involved in fire on newborn ECRI Institute, an independent, nonprofit organization that researches the best approaches to improving patient care, has issued a high priority medical device alert for several older models of infant radiant warmers. ECRI Institute recommends the removal from service of a series of warmer models manufactured by Borning and Hill-Rom. Draeger purchased the product line from Hill-Rom in 2004 but did not sell any units, which were last made in 1998. The complete findings and recommendations are posted for free public access on ECRI Institute's Web site in its Patient Safety Center.
These recommendations are based, in part, on ECRI Institute's involvement in
the investigation of a hospital nursery fire that resulted in burn injuries
to an eleven-hour-old infant receiving oxygen.
February 5, 2009 Download print version S.C. hospitals partner to reduce healthcare-related infections Obama signs children’s health insurance bill In colon cancer drug study, more wasn't better Mercury in corn syrup? Food made with ingredient may have traces of toxic metal FDA alert on Xigris for critical care healthcare professionals Mold at St. Joseph's killed 3 children, lawsuit says Injured man dies after rejection by 14 hospitals Nominate your team for HPN’s 17th annual 2009 CS/SPD Department of the Year award S.C. hospitals partner to reduce healthcare-related infections South Carolina’s private and university research hospitals are banding together to identify and curb hospital infections, the group announced Wednesday. Curbing infections could save the state’s hospitals as much as $40 million a year and reduce the length of stay of patients by up to 24,000 days annually, according to the newly formed South Carolina Healthcare Quality Trust. The trust is a partnership of Health Sciences South Carolina, S.C. Hospital Association and the Premier healthcare alliance, which offers purchasing networks and clinical and financial information to 2,100 not-for-profit hospitals nationwide. The partners will invest more than $1.7 million over three years. The Health Sciences-supported Center for Healthcare Quality will lead research efforts. The trust plans to create a website where hospitals can research the causes and prevention of healthcare-related infections and track their progress against national standards. Later, the trust wants to tackle improvements in treatment of illnesses including diabetes, cancer and heart disease. “We will be using our state’s best researchers to determine the causes of specific infections,” Health Sciences chief executive Jay Moskowitz said in a statement. “We will test solutions in our state’s four largest health systems (including Columbia-based Palmetto Health), which today treat about 30 percent of all patients.” “We will then share the best practices, products and services that result with all South Carolina hospitals" he added. "We believe this approach has the potential to make our state’s hospitals safer for patients, families and employees.” The
trust said this is the first time a state’s university research hospitals
are teaming with the members of a state hospital trade association. (The
State)
Read the original story.
Obama signs children’s health insurance bill The House gave final approval on Wednesday to a bill extending health insurance to millions of low-income children, and President Obama signed it this afternoon, in the first of what he hopes will be many steps to guarantee coverage for all Americans. Speaker Nancy Pelosi announced the tally, 290 to 135. Forty Republicans voted for the bill, and 2 Democrats voted against it. The roll call ended a two-year odyssey for the child health legislation, which President George W. Bush adamantly opposed on the ground it would lead to “government-run healthcare for every American.” Representative Henry A. Waxman, the California Democrat who is chairman of the Energy and Commerce Committee, said, “While this bill is short of our ultimate goal of health reform, it is a down payment, and is an essential start.” Another Republican, Representative Tom McClintock of California, said the children’s health program was “slowly replacing employer health plans with government-paid health plans, with spiraling costs to taxpayers.” The program, created with bipartisan support in 1997, is intended for children in families that earn too much to qualify for Medicaid, but too little to afford private health insurance. The Congressional Budget Office says the bill will enable states to cover more than four million uninsured children by 2013, while continuing coverage for seven million youngsters. The bill will increase tobacco taxes to offset the increase in spending, estimated at more than $32 billion over four and a half years. In a major change, the bill allows states to cover certain legal immigrants — namely, children under 21 and pregnant women — as well as citizens.
Until now, legal immigrants have generally been barred from Medicaid and the
State Children’s Health Insurance Program for five years after they enter
the United States. States will now be able to cover those immigrants without
the five-year delay. The bill requires states to verify that people covered
by the children’s health program are United States citizens or legal
residents. But states are given a new option. Instead of requiring people to
produce documents showing citizenship, states can try to verify eligibility
by matching a person’s name and Social Security number against federal
records. (NY Times)
Read the original story.
In colon cancer drug study, more wasn't better (AP) Doctors thought that combining two newer drugs that more precisely attack cancer would help people with advanced colon cancer. Instead, it made the cancer worse and made the patients more miserable, a study found. The surprising findings underscore the importance of doing rigorous studies before rushing to mix these pricey, new-generation drugs, the Dutch researchers and other experts said. The doctors tried combining Erbitux and Avastin because lab tests and an earlier small study had shown promising results. For the study, Eli Lilly & Co.'s Erbitux was added to standard treatment, which includes Genentech Inc.'s Avastin. Since both are "targeted" drugs and attack tumors in different ways, the thinking was that the combo would do a better job of keeping the cancer from growing. But the results show "more is not always better," said Dr. Robert Mayer, of Dana-Farber Cancer Institute in Boston. He wrote an editorial published with the study in Thursday's New England Journal of Medicine. What makes the results even more compelling, Mayer said, is that another similar study reached the same conclusion. "This is the first time we've seen harm by combining targeted therapies and it tells us we need to be cautious," said Dr. Jordan Berlin, a gastrointestinal cancer specialist at Vanderbilt-Ingram Cancer Center in Nashville, TN. Berlin, who had no role in the research, stressed that the drugs do help patients, just not when given together. The 755 study patients had colon cancer that had spread. They all received Avastin, also known as bevacizumab, and two chemotherapy drugs. Half of them also got Erbitux, also called cetuximab. They were followed for nearly two years. The group that got Erbitux saw their cancer get worse sooner, the researchers found. On average, their cancer progressed after 9.4 months compared to 10.7 months for those who didn't get Erbitux. The Erbitux group also had lower quality-of-life scores. The
overall survival in both groups was about the same. Off-label use "needs to
be cautious and this proves it," said Berlin. (Washington Post-AP)
Read the original story.
Mercury in corn syrup? Food made with ingredient may have traces of toxic metal A swig of soda or a bite of a candy bar might be sweet, but a new study suggests that food made with corn syrup also could be delivering tiny doses of toxic mercury. For the first time, researchers say they have detected traces of the silvery metal in samples of high-fructose corn syrup, a widely used sweetener that has replaced sugar in many processed foods. The study was published Monday in the peer-reviewed journal Environmental Health. The study raises concerns about a previously unknown dietary source of mercury, which has been linked to learning disabilities in children and heart disease in adults. The source of the metal appears to be caustic soda and hydrochloric acid, which manufacturers of corn syrup use to help convert corn kernels into the food additive. A handful of plants across the nation still make the soda and acid by mixing a briny solution in electrified vats of mercury. Some of the toxic metal ends up in the final product, according to industry documents cited in the study. Corn syrup manufacturers insisted their products are mercury-free. But the study said at least one maker of caustic soda that has used the mercury-based technology listed the corn syrup industry as a client.
There is no established safe dose for elemental mercury, the type discovered
in corn syrup. But the U.S. Environmental Protection Agency says an
average-sized woman should limit her exposure to 5.5 micrograms a day of
methylmercury, the kind found in fish. If that same woman regularly ate corn
syrup contaminated at the highest level detected in the study—0.57
micrograms per gram—the researchers estimated that she could end up
consuming an amount of mercury that is five times higher than the EPA's safe
dose. (Chicago Tribune)
Read the original story.
FDA alert on Xigris for critical care healthcare professionals FDA
is aware of a recently published study, a retrospective medical record
review of 73 patients who receive Drotrecogin alfa (activated), marketed as
Xigris, indicated for the reduction of mortality in adult patients with
severe sepsis who have a high risk of death. The study reported an increased
risk of serious bleeding events and of death in patients with sepsis and
baseline bleeding risk factors who received this product. Serious bleeding
events occurred in 7 of 20 patients (35%) who had a bleeding risk factor vs.
only 2 of 53 (3.8%) patients without any bleeding risk factors. The finding
by Gentry et al. of an increased risk of death and serious bleeding events
in patients treated with Xigris who also have baseline bleeding risk factors
is consistent with the information in the current product label. Prescribers
should refer to the product label for the specific contraindications,
warnings, and, precautions and carefully weigh the increased risk of
bleeding against the benefits of Xigris.
Mold at St. Joseph's killed 3 children, lawsuit says TAMPA — Last spring, three young cancer patients died within a month of one another after stays at St. Joseph's Hospital. But cancer didn't kill them, according to a lawsuit filed Tuesday. Attorney Steve Yerrid says the children were exposed to a dangerous fungus released during a hospital construction project. Their immune systems already weakened by disease, the children succumbed to mold-related infections, the suit alleges. Though she could not comment specifically on the lawsuit or the patients, St. Joseph's spokeswoman Lisa Patterson said the hospital is careful to use barriers and filter the air around its construction areas. "Anytime we do any kind of construction we follow all the necessary precautions," she said. "Obviously, patient safety is the top priority for the children's hospital." The children represented in Yerrid's lawsuit had been formally admitted to the hospital, and spent many of their final days in rooms one floor above the construction activity. The lawsuit says the hospital did not guard those rooms from contaminated dust and airborne particles generated by the demolition and removal of plaster walls and ceiling tiles. Last March, the parents of one of the patients, expressed concerns to St. Joseph's infection control nurse about fumes and odors that seeped into their son's room from smokers and vehicles outside the hospital. They also worried about children sharing the same passageways with construction workers when they were transported to the main hospital for services, the lawsuit states. That month, doctors removed most of their son’s nose due to an invasive nasal sinus fungal infection. He died on April 16, 3½ weeks after doctors discharged him. An autopsy showed that his death was caused by chemotherapy and a fungi infection. Another cancer patient was admitted to St. Joseph's several times in early 2008 for pneumonia, sinusitis and a cancer relapse. In April, after her cancer was back in remission, she returned to the oncology ward for treatment. After several weeks there, she experienced significant respiratory distress and, according to the lawsuit, contracted a fatal lung infection caused by mold. Her autopsy listed the cause of death as fungal pneumonia with underlying leukemia. Another 2 year old patient, suffered from infantile acute lymphoblastic leukemia. She spent three weeks at St. Joseph's Hospital in January 2008 getting treated for an allergic drug reaction. Tests showed no recurrent cancer. By February, she developed a lung infection caused by mold. She died May 13 of respiratory failure. Each child's infection was linked to aspergillus, a common mold found virtually everywhere, including in soil, air and construction dust. Most people breathe it in every day without harm. But the mold can cause serious or deadly infections in people who have undergone chemotherapy or organ transplants. Patterson, the hospital spokeswoman, said St. Joseph's has an infection control team that works to ensure a clean and healthy environment. Hospital procedure includes preventive maintenance rounds and measuring air quality, she said.
Yerrid says those efforts fell short. "There are simple protocols," he said,
"that should and could have been followed." (St. Petersburg Times)
Read the original story.
Injured man dies after rejection by 14 hospitals TOKYO – A 69-year-old Japanese man injured in a traffic accident died after paramedics spent more than an hour negotiating with 14 hospitals before one admitted him, a fire department official said Wednesday. The man, whose bicycle collided with a motorcycle, waited at the scene in an ambulance because the hospitals said they could not accept him, citing a lack of specialists, equipment, beds and staff. One of the 14 finally admitted the man when the paramedics called it for a second time. It was the latest in a string of recent cases in Japan in which patients were denied treatment, underscoring the country's healthcare woes that include a shortage of doctors. The man, who suffered head and back injuries, initially showed stable vital signs, but his condition gradually deteriorated. He died from hemorrhagic shock about an hour and half after arriving at the hospital. Hemorrhagic shock occurs when cells do not receive enough oxygen and nutrients to function. A spokesperson said the victim might have survived if a hospital accepted him more quickly. The death prompted the city to issue a directive ordering paramedics to better coordinate with an emergency call center so patients can find a hospital within 15 minutes. But hospitals still cannot be punished for turning away patients if they are already full. More
than 14,000 emergency patients were rejected at least three times by
Japanese hospitals before getting treatment in 2007, according to the latest
government survey. In the worst case, a woman in her 70s with a breathing
problem was rejected 49 times in Tokyo. (Yahoo)
Read the original article.
Nominate your team for HPN’s 17th annual 2009 CS/SPD Department of the Year award The winning Central Service/Sterile Processing Department will be featured on the cover of the May 2009 issue of Healthcare Purchasing News as recognition of the winning department’s outstanding contributions to patient care and to the CS/SPD profession. HPN is looking for entries that tell the story of the many ways that CS/SPD professionals add to the valuable mix of patient care and safety. Entries will be judged on elements in the following 5 areas:
Customer service – How the department has handled supply processing and
distribution for internal customers, including the operating room and
nursing floors. Teamwork – How well department staff members work together; how they work to make the department greater than the sum of its parts. Education and training – How well the department prepares staff members to do a safe, cost-effective, efficient job; how well it prepares members for career advancement. Strategic outlook – Does the department have a strategic plan? What does it entail? What are its elements of innovation, creativity, and originality? There are no limits on the length of your entry, and it is helpful to document any claims made. A judging panel of respected central service professionals from across the country, as well as HPN staff representatives and our editorial advisory board, will evaluate each nomination in the five areas above. For the nomination, highlight as many specific, measurable achievements and goals over the past year. Please don’t forget these elements about the nominated department: name, telephone number, number of full-time equivalents, scope of responsibilities, and number of beds at the facility. Also, for your nomination to qualify, please be sure to comply with the following rules: 1. Any nomination must be original and exclusive to HPN and not have been submitted – either original or edited – to any other publication or online media outlet currently or within the previous year. 2. GPO, distributor, manufacturer, software company and consultant support is commendable, but we’re looking for internally driven details beyond those contributions. 3. Any nominated organization must be willing to share relevant basic financial details with us (in dollar and/or percentage format), including annual revenues, annual expenses, annual purchasing volume and annual savings. Deadline for nominations is Monday, March 2, 2009.
Document your accomplishments in these five areas and submit by to Editor,
Healthcare Purchasing News, 2477 Stickney Point Rd., Suite 315B,
Sarasota, FL 34231 Fax: (941) 927-9588 or e-mail:
editor@hpnonline.com.
February 4, 2009 Download print version Obama says he erred in nominations of Daschle and Killefer Bitter medicine: Washington Regional hospital trims pay, 401(k) funding for all employees SMI provider members announce support for data standards adoption FDA panel approves Lilly drug for clotting New vaccine developed for preventing 'uncommon cold' virus Rapist worked at L.A. County hospitals despite reviews of record Pennsylvania hospitals select Sentri7 to improve infection prevention New IV dressing benefits both the patient and clinician Obama says he erred in nominations of Daschle and Killefer President Obama acknowledged yesterday that he had "made a mistake" in trying to exempt some candidates for positions in his administration from strict ethics standards and accepted the withdrawal of two top nominees, including former Senate majority leader Thomas A. Daschle, in the first major setback of his young presidency. Daschle's exit from consideration to lead the Department of Health and Human Services after a firestorm over his failure to pay $146,000 in taxes on time came as a shock to the president's supporters in Washington. Just a day earlier, Obama had pledged his full support for the former Democratic Senate leader who was widely expected to be confirmed. And just hours before Daschle bowed out, Nancy Killefer, Obama's nominee for the newly created position of chief performance officer, also stepped aside because of a $967 tax lien that was placed on her Washington home in 2005 after she did not pay unemployment compensation taxes on household help. And perhaps most significant, the move threatened Obama's plans to overhaul the healthcare system, a central policy initiative and one so important that he had chosen Daschle for a perch both at the Department of Health and Human Services and in the White House itself. Daschle withdrew from consideration for both posts yesterday, and advisers said they did not know whether the next nominee would serve in dual roles, a measure of the disarray the controversy had caused. Daschle disclosed the decision in a joint statement with Obama, acknowledging that questions about his tax lapses had become "a distraction." "I will not be the architect of America's health system reform, but I remain one of its most fervent supporters," he said. The
administration had initially ignored criticism of Daschle after the
disclosure last Friday that he had not paid taxes on a car and driver that a
private equity firm had made available to him. As recently as Monday, it
still appeared that he would be confirmed by the Senate, where he still had
the near-unanimous loyalty of his former Democratic colleagues. (Washington
Post)
Read the original story.
Bitter medicine: Washington Regional hospital trims pay, 401(k) funding for all employees Washington Regional Medical Center in Fayetteville, AR has announced a plan to cut the pay of its 2,150 employees by 2.9 percent and reduce its contributions to employee 401(k) plans in a move designed to save 60-70 jobs. Executives and department heads will see a 3-percent pay reduction. The employer contribution to 401(k) plans will drop from 6 to 5 percent, and no bonuses will be paid to employees in 2009 for performance in 2008. The employee pay cuts were implemented instead of layoffs. In a letter from WRMC CEO Bill Bradley to employees of the hospital and its related system of clinics and other facilities, Bradley wrote that WRMC "must confront a 'perfect storm' of issues that have been compounded by or are directly attributable to the current economic crisis." Chief among those, he said, is the dramatic increase in the number of people who don't pay for the care they receive at the hospital or its related facilities. The bad debt experienced by WRMC grew from $18.5 million in 2007 to $22.9 million last year, a 23.7-percent increase. Hospital officials said the reduction in pay and benefits will save about $2 million annually. Steve Clark, president of the Fayetteville Chamber of Commerce, said the loss of 60 to 70 jobs would have been a significant hit on the local economy. Hospital officials said they did consider other options, such as mandatory unpaid days off, but the nature of its workforce - a 24-hours-a-day, seven-days-a-week staff dealing with medical care - made the across-the-board pay and benefit reduction the most palatable for everyone involved.
Among the other factors Bradley cited as contributing to the hospital's
economic condition: Declining volumes and associated revenues because
patients are deferring discretionary or optional services; Increased market
competition from for-profit hospitals; Increased pressure on debt and
capital reserves due to the ongoing need to invest in costly technology.
(Arkansas Democrat-Gazette)
Read the
original news item.
SMI provider members announce support for data standards adoption Thirty-two Industry Provider members of the Strategic Marketplace Initiative (SMI), displaying the collaborative spirit that SMI has become associated with, have announced their support to work with trading partners to implement the GS1 US Healthcare data standards by the publicly announced sunrise dates. The standards body GS1 US Healthcare announced sunrise dates for data standards adoption are: Adoption of the Global Location Number standard (GLN) for standardized account/location identification and eliminate custom account numbers by December 2010; Adoption of the Global Trade Item Number (GTIN) for standardized product identification by December 2012. Since SMI’s establishment in 2006, the provider and supplier members of SMI have been at the forefront of the healthcare supply chain industry’s data standards movement, first by helping to found the Healthcare Supply Chain Standards Coalition, then by fostering early adopter workgroups, assuming leadership positions with GS1 US Healthcare, educating members and the industry, piloting processes, and encouraging others to join the effort. “These thirty-two SMI Industry Provider members realize that data standards adoption cannot be realized without collaboration and support among all trading partners and stakeholders.” said Tom Hughes, SMI’s Executive Director. “Like other leaders in our industry, these SMI members understand the need to stay focused and to work together so real positive changes take place.” Carl Manley, SMI’s Chairman of the Board and Vice President of Supply Chain at Sentara Healthcare said “These SMI members are all industry leaders dedicated to seeing our entire industry support data standards adoption through collaboration. Adopting data standards helps all trading partners in the supply chain to ensure that the correct products are delivered to the correct locations at the correct time -- creating a safer, more efficient, and less expensive healthcare system.” For
the list of SMI Industry Provider members supporting the adoption of the
standards by the sunrise dates
read the SMI news release.
FDA panel approves Lilly drug for clotting Potentially posing the first real challenge to Bristol-Myers Squibb’s near monopoly on blood-thinning drugs, a federal advisory panel on Tuesday recommended that the Food and Drug Administration approve a new medicine from Eli Lilly & Company. The drug, called prasugrel, is meant to prevent blood clots in patients who are at risk for heart attacks and strokes. For the last six years, the Bristol-Myers drug Plavix has dominated the market for blood-thinning pills. Plavix had global sales of $7.3 billion in 2007, making it the world’s second-best-selling drug after Pfizer’s cholesterol treatment Lipitor, according to sales data compiled by IMS Health, a healthcare information company. The drug, which Lilly plans to market the under the brand name Effient, is not without risks. During the hearing, an FDA cardiology expert said that prasugrel’s tradeoff for increased effectiveness is higher risks of bleeding, according to a study, published in The New England Journal of Medicine in 2007, in which about 13,600 people were randomly assigned to take either the new drug or clopidogrel. In
the prasugrel group, there was a higher incidence of bleeding among people
who had previously had strokes, people age 75 or older and people who
weighed less than 132 pounds. Because of those findings, industry analysts
predicted that the FDA would restrict the use of the new drug to certain
patient groups. (NY Times)
Read the original story.
New vaccine developed for preventing 'uncommon cold' virus Human adenovirus type-3 is known as the "uncommon cold" because the infection's symptoms—runny nose, sore throat, cough and fever—are eerily similar to those of the common cold which is caused by the rhinovirus. The difference is that, unlike the common cold, the symptoms of the uncommon cold are typically much more severe and can even be fatal. Adenovirus-3 thrives in nations with dense urban populations and has recently become prevalent in southern China and neighboring countries. It may also emerge in less likely locales with dense populations, such as schools, healthcare facilities and military training bases in the U.S. Adenovirus outbreaks are difficult to control because the virus can live for weeks on environmental surfaces and spreads quickly through direct contact, aerosol and contaminated drinking water. According to the Centers for Disease Control and Prevention (CDC), the human adenovirus was first seen in the 1950s and is associated with a wide spectrum of illnesses including conjunctivitis, upper respiratory infections, pneumonia and gastrointestinal disease. More than 50 unique serotypes of the virus have been identified, with even more expected to be isolated.
Researchers from George Mason University, the University of Hong Kong,
Guangzhou Children's Hospital, the South China Institute of Technology and
the Graduate School of Chinese Academy of Sciences have developed a
DNA-based vaccine that has effectively protected mice from the infection.
Their findings will appear in the February 18, 2009 print edition of the
journal Vaccine and are
currently available online.
Rapist worked at L.A. County hospitals despite reviews of record A
man who raped women as an on-duty Los Angeles police officer, threatening
them with arrest and jail if they did not submit, was hired by Los Angeles
County as an X-ray technologist after he got out of prison, even though the
job would leave him working alone and unsupervised with female patients. His
hiring at County-USC Medical Center a decade ago was not an oversight. The
employment of a convicted rapist at a hospital indicates a significant
breakdown in the county's vetting of health department staffers, county
officials said. Perhaps most seriously, it raises questions about how many
more county employees have criminal histories incompatible with their jobs,
something county supervisors have yet to address.
Pennsylvania hospitals select Sentri7 to improve infection prevention Pharmacy OneSource, Inc., providing software as a service provider to more than 1,300 hospitals in the United States, announced that a group of nine Pennsylvania hospitals has chosen to adopt Sentri7 to improve infection control and prevention.
Sentri7 is a surveillance system that continuously analyzes data stored in
disparate clinical information systems and highlights at-risk patients in a
password-protected dashboard, aiding in early intervention. The dashboard is
organized to assist staff with the goal of reducing infections for more
patients. With Sentri7, hospital staff members are also able to review
patients' various lab results in an easy-to-read format. The hospitals will
use Sentri7 to help comply with the Pennsylvania state mandate requiring
hospitals to report their healthcare-associated infection data. Visit
www.pharmacyonesource.com
for more
information.
New IV dressing benefits both the patient and clinician 3M announced the launch of Tegaderm IV Dressing for the BD Nexiva Catheter System. Specifically designed for BD’s catheter system, the dressing offers a new alternative to address catheter movement, dislodgements and fall-outs. These types of catheter complications have the potential to cause discomfort for the patient, making for a much-needed advancement in how catheter systems are designed and kept in place. The dressing is specially designed to cover the size and contours of the built-in stabilization platform, which is unique to the BD Nexiva Catheter System. Improving catheter stability is commonly believed to decrease the potential for catheter movement after insertion, thereby limiting possible complications, such as dislodging of the catheter and inflammation of the vein (phlebitis). The dressing features a J-shaped slit that fits snugly around the built-in extension tubing, helping to secure both the tubing and the catheter. The dressing is constructed of the same materials as other Tegaderm products and offers similar benefits. It has a thin, highly breathable polyurethane film backing coated with latex-free, moist skin adhesive, making it comfortable, conformable and able to stick well to skin. In a
recent study, the new dressing was perceived by clinicians to wear longer
than current standard film dressings. In the two-week clinical evaluation of
more than 100 IV clinicians, 96 percent preferred Tegaderm IV Dressing for
the BD Nexiva Catheter System over current dressings for use with the BD
Nexiva Catheter System and rated it as an excellent alternative. A clinical
trial is currently underway at a Midwest healthcare system with results
anticipated later this year.
Get more information from 3M.
February 3, 2009 Download print version Pressure mounts for tougher helicopter safety rules New oral cancer tests: crucial or wasteful? Quick tests for cancer of colon reviewed FDA releases Luer Misconnections safety calendar FDA panel votes to recommend a ban on Darvon, a painkiller that's been around for 50 years Late move on drugs by Bush FDA could be dangerous Educating patients before they leave the hospital reduces readmissions, ED visits and saves money
ACP: State of America's healthcare is poor Pressure mounts for tougher helicopter safety rules A recent rise in the number of fatal helicopter crashes is prompting the industry to concede that years of voluntary federal regulations have resulted in an unacceptably low safety level. On Tuesday, the National Transportation Safety Board will open a set of wide-ranging hearings on helicopter safety that is expected to ratchet up pressure on the Federal Aviation Administration to take a tougher stance on a segment of commercial aviation that has so far avoided the kind of intense scrutiny airline travel has faced. The NTSB for years has championed stricter standards to protect the estimated two million Americans who ride in helicopters annually. But the FAA, along with much of the helicopter industry, has resisted implementing many of the recommendations for stricter oversight, saying formal regulations typically take too long to put in place and could force many smaller operators out of business. Helicopter operators and manufacturers have successfully argued against across-the-board requirements for increased maintenance and additional safety equipment, such as ground-collision warning systems and night-vision goggles, on the grounds that they are costly and unnecessary. They instead have preferred voluntary compliance. But some recent incidents have highlighted a safety situation that chopper manufacturers and operators now say is untenable. By some measures the odds of being in a serious chopper accident are roughly 300 times greater than for U.S. airline passengers. Emergency-medical crashes alone claimed at least 35 lives since late 2007, roughly twice as many as during the previous 12 months. The FAA's focus on voluntary industry compliance was intended to provide "a good head start" to improve safety, according to spokeswoman Laura Brown. The FAA said it now will likely step up its oversight and is "considering possible rule making," Brown said. The agency favors drafting a "long-term safety initiative" requiring installation of flight-data recorders on helicopters and enhanced training for dispatchers of emergency-medical choppers, she said. (Wall Street Journal) Read the original story.
New oral cancer tests: crucial or wasteful? Though relatively rare, it is one of the easiest cancers to spot and diagnose. And if treated early, it is usually curable. So why do experts find oral cancer so vexing? Despite the many advances against cancer in recent decades, the statistics on this form of it remain discouraging: more than 60 percent of cases are diagnosed in the late stages, and the five-year survival rate is a disappointing 59 percent. Moreover, oral cancer is increasing in people traditionally at low risk, a phenomenon partly attributed to the rise of the cancer-causing human papillomavirus, or HPV, which can be transmitted through oral sex. Now some dentists — whose visual examinations have long been a first line of defense against oral cancer — are using screening devices that they say may help identify cancers and premalignant lesions. But these new tests have set off a debate over cost and effectiveness. Experts are divided on whether they will reduce mortality from oral cancer or simply lead to a wave of expensive and unnecessary biopsies. An estimated 35,300 Americans learned they had oral cancer last year, and about 7,600 died from the disease. Indeed, no one knows for sure whether even a visual examination in the dentist’s office saves lives, though most oral cancer experts believe it does. Now medical companies are marketing several new screening tests and devices to dentists, saying they will vastly improve early detection of oral cancer. The devices, which can cost several thousand dollars, use rinses, dyes and different types of lights to detect abnormal cells. Some experts say the new technology will lead to earlier detection, if only by encouraging dentists to do a screening exam. Yet no extensive studies of the general population show that these devices are any better than the naked eye for screening, and they have not been shown to reduce mortality. In small studies, the devices successfully detected potentially malignant lesions that experienced specialists missed with the naked eye. For example, in one group of subjects a scanning system identified all of the cases of moderate to severe dysplasia, or potentially precancerous cells, compared with just 68 percent for a visual exam. The screening tests can cost the patient $35 to $65, though some dentists do not charge extra for it. And the tests have a high false-positive rate that may lead to unnecessary biopsies. If a suspicious lesion is detected, dentists typically ask the patient to return in two weeks to see if it has improved. If not, the patient may be given a biopsy or referred to a specialist. (NY Times) Read the original story.
Quick tests for cancer of colon reviewed The most widely used quick test for colon cancer is a fecal occult blood test in which a small amount of stool is smeared onto a piece of cardboard impregnated with guaiac, a substance that quickly turns blue when exposed to blood. Because precancerous lesions can bleed periodically, a positive test suggests their presence. But the test is not specific for human blood, and consuming certain foods, medicines or vitamin supplements can produce false readings. In a new study that appears Tuesday, in The Annals of Internal Medicine, German researchers tested guaiac against six new screens, called fecal immunochemical tests, which use antibodies to detect human hemoglobin and which cannot be falsified by diet or medicine. The researchers screened 1,319 men and women before their scheduled colonoscopies, then compared the results with results of the colonoscopies. All the immunochemical tests were more accurate than the guaiac screen. The two most accurate detected more than 25 percent of those with benign lesions larger than one centimeter, the ones most likely to become cancerous. They also correctly identified, respectively, 93 and 97 percent of those who had no lesions. The guaiac test correctly classified 9.7 percent of those who had lesions, and 95.9 percent of those who had none. Experts disagree about when to screen with fecal blood testing and when to use colonoscopy. But this study shows that there are better fecal blood tests than the one most often used in the U.S. “The new tests have been used in other countries since 1996, and shown to work,” Dr. James E. Allison, an emeritus professor of medicine at the University of California, San Francisco, said. “Why are we still talking about them instead of using them?” (NY Times) Read the original story.
FDA releases Luer Misconnections safety calendar Patient injuries and deaths have occurred when different device delivery systems are mistakenly connected to each other. These errors are often facilitated by fittings called Luer connectors, which can allow different systems to be easily, but erroneously, connected. The 2009 Medical Device Safety Calendar (Luer Misconnections) is one of FDA’s efforts to help educate healthcare professionals about these dangerous misconnections. The calendar provides a graphic depiction of a variety of misconnection cases, coupled with recommendations from The Joint Commission (TJC) on ways to prevent these types of errors. On this website, you can download or print the calendar, case studies, and additional resources about Luer misconnections and how to help prevent them. To use and distribute this material – either in its entirety or in part, visit http://www.fda.gov/cdrh/luer/
FDA panel votes to recommend a ban on Darvon, a painkiller that's been around for 50 years Associated Press - Government medical advisers Friday recommended a ban on Darvon, a prescription medicine that's been used to treat pain for more than 50 years but left a trail of problems such as addiction and suicide. A FDA advisory panel voted 14-12 to recommend withdrawing Darvon after a daylong hearing examining its risks and benefits. The FDA is not required to follow the recommendations of its advisers, but often does so. Darvon was first approved in 1957, when there were few alternatives for treating pain except aspirin and powerful narcotics. Now mainly marketed as Darvocet, which includes a dose of acetaminophen, the drug remains one of the top 25 most commonly prescribed medications. More than 20 million prescriptions were written in 2007. The consumer group Public Citizen had petitioned the FDA to withdraw Darvon because the drug offers relatively weak pain relief and poses an overdose risk, with the potential to be used in suicides. Two companies that market the drug — Xanodyne Pharmaceuticals and Qualitest/Vintage Pharmaceuticals, say the medication is safe and effective when used as directed. In documents filed with the FDA, the companies said doctors need a range of options to treat pain, and noted that many other painkillers have become drugs of abuse — some with far worse consequences. The top three were suicide, drug dependence and overdoses. The United Kingdom banned its version of Darvon in 2005. If the FDA decides not to follow suit, it may take other steps, such as requiring stiffer warnings, safety studies or special education efforts aimed at doctors and patients. In a separate analysis, the FDA office that handles painkillers said Darvon is a weak pain reliever. Most studies show that in Darvocet, the widely used combination drug, the Darvon component appears to contribute "little or no" additional pain relief beyond that provided by the acetaminophen component, reviewers said. (Star Tribune) Read the original story. For the FDA meeting agenda: http://tinyurl.com/cg5k5a
Late move on drugs by Bush FDA could be dangerous In the waning days of the Bush administration, the Food and Drug Administration finalized new guidelines to make it easier for drug manufacturers to promote "off-label" prescription drug uses, which can be deadly for patients. The move came despite criticism from Bush's own Department of Veterans Affairs, which said the change "favors business interests over public safety" and could lead to a "decline in drug safety." It also was crafted despite efforts by state and federal law-enforcement experts to clamp down on off-label drug marketing. As the Obama administration reviews all the midnight rules that the departing Bush administration issued, it will have to decide whether to try to modify or reverse this last-minute change in the FDA's oversight of off-label drug marketing. Congressional leaders from both parties criticized the guideline when it was proposed last year. Sen. Charles Grassley (R-IA,) who's repeatedly investigated the FDA, said he had serious concerns about the proposal, which he said would deem appropriate something that "the FDA once considered evidence of unlawful marketing." In the House of Representatives, Rep. Henry Waxman, a California Democrat, called the guideline a "long-coveted parting gift" for the pharmaceutical industry that "fundamentally undermines" the FDA's authority. The use of drugs "off-label" — for reasons the FDA hasn't approved — has long been tolerated, and sometimes encouraged. For certain ailments, it can be helpful. The practice also can be dangerous, however. Nearly every drug has side effects, some of them serious. Those risks can be worth the potential benefit that comes with an FDA-approved, on-label use. With an off-label use, however, the risks remain but the benefits are far less certain. While it's legal for physicians to prescribe drugs off-label — often based on their reading of the latest medical research — it's illegal for drug makers to push such uses. In its final week, the Bush administration opened the door to some off-label marketing. In a "guidance" document, the FDA specified how drug companies could hand out medical journal articles that highlight potential off-label drug uses. The guidance was complicated, and the main players in the issue still disagree about what it means for FDA oversight of off-label marketing. The drug industry generally endorsed the guidance as helpful to doctors and patients. The Washington Legal Foundation, which has accused the FDA of overstepping its authority, said that any FDA involvement in the issue was an unfair restriction on free speech and that drug makers should be free to share off-label information with doctors. (McClatchy) Read the original article.
Educating patients before they leave the hospital reduces readmissions, ED visits and saves money Patients who have a clear understanding of their after-hospital care instructions, including how to take their medicines and when to make follow-up appointments, are 30 percent less likely to be readmitted or visit the emergency department than patients who lack this information, according to a new study funded by the Agency for Healthcare Research and Quality (AHRQ). The study is published in the February 3, 2009, issue of the Annals of Internal Medicine. Fewer hospital readmissions and emergency department (ED) visits also translate to lower total costs. The study found that total costs (a combination of actual hospitalization costs and estimated outpatient costs) were an average of $412 lower for the patients who received complete information than for those who did not. Currently, one in five patients has a complication or an adverse event, such as a drug interaction, after being discharged from the hospital. These can impair patients' recovery and can cause patients a trip to the emergency department or to be readmitted to the hospital, both of which are costly. One reason why patients have adverse events after they leave the hospital is a lack of understanding about their follow-up care, such as which medications to take or how to take care of their condition. This information is contained in a discharge summary, a standard document that previous studies have shown hospitals often do not make available to patients' primary care doctors in a timely fashion. Boston University Medical Center 's Department of Family Medicine, developed a multi-faceted program to educate patients about their post-hospital care plans. It is called the Re-Engineered Hospital Discharge Program, or RED, and it was tested through a randomized controlled trial. The program used specially trained nurses to help one group of patients arrange follow-up appointments, confirm medication routines, and understand their diagnoses using a personalized instruction booklet. A pharmacist contacted patients between two and four days after hospital discharge to reinforce the medication plan and answer any questions. Read the original story.
ACP: State of America's healthcare is poor "The state of America's healthcare is poor," Jeffrey P. Harris, MD, FACP, president of the American College of Physicians (ACP), reported yesterday at the annual State of the Nation's Health Care briefing. "There are too many uninsured and underinsured people. We have too few primary care physicians." "The problems are big, so the solutions must also be big," Dr. Harris declared. At the briefing, ACP provided recommendations on how President Obama and Congress can take immediate, sustained, and dramatic steps to provide affordable and accessible healthcare to all Americans and provide every American with access to a primary care physician. The Institute of Medicine (IOM), a private, non-governmental organization, recently announced that the U.S. needs 16,000 more primary care physicians just to meet the needs of currently underserved areas. The shortage will grow to 40,000 or more physicians, assuming current rates of health insurance coverage, according to two recent studies. At a time when America's aging population is increasing, the demand for general internists and family physicians will continue to grow at a much faster rate than primary care physician supply, in the absence of policies to immediately and substantially increase primary care workforce capacity. "Giving all Americans an insurance card will not guarantee that everyone will have access to care," Dr. Harris emphasized. "There are not enough primary care physicians to care for them." To underscore the importance of the timing, Dr. Harris added: "Given the fact that it takes a minimum of seven years to train a primary care physician (medical school and residency combined), the U.S. cannot afford to delay implementation of policies to attract more new physicians to primary care and to sustain those already in practice." Therefore, policies to expand primary care workforce capacity need to be implemented immediately and go hand-in-hand with coverage expansions. We need to act now to influence the career choices of medical students and physicians already in residency programs, and the retirement and career decisions of primary care physicians already in practice." A paper published by the ACP in the Annals of Internal Medicine that compared U.S. healthcare with care in other industrialized countries found that the best performing healthcare systems abroad, unlike the United States, are built on a strong foundation of primary care. Read the original release.
, 2009 Download print version Obama to order full review of FDA operations Spinach and peanuts, with a dash of radiation Hospital executive arrested for allegedly using homeless people in medical fraud Feds may make health insurance easier after layoff 'Normal' levels of bad cholesterol may be too high Hospira’s Precedex phase IV study published in JAMA Disruptive innovation, applied to healthcare Obama to order full review of FDA operations President Barack Obama is ordering a “complete review” of the Food and Drug Administration after it failed to detect shipments of salmonella-contaminated peanut products that have sickened more than 500 people and may be linked to as many as eight deaths, he told TODAY co-host Matt Lauer. In an interview that aired this morning, Obama said the agency’s failure to recognize and intercept the products was only the latest of numerous “instances over the last several years” in which “the FDA has not been able to catch some of these things as quickly as I expect them to catch.” He did not cite what other incidents he was referring to. But critics have accused the administration of former President Bush of having crippled the agency by cutting its budget over the last eight years. “At bare minimum, we should be able to count on our government keeping our kids safe when they eat peanut butter,” Obama told Lauer in the interview, which was conducted Sunday at the White House.
Obama said, “we are going to make sure that we retool the FDA, that it’s
operating in a highly professional fashion and, most importantly, that we
prevent these things, as opposed to trying to catch them after they’ve
already occurred.” (MSNBC)
Read the original story.
Spinach and peanuts, with a dash of radiation Before the recent revelation that peanut butter could kill people, even before the spinach scare of three summers ago, the nation’s food industry made a proposal. It asked the government for permission to destroy germs in many processed foods by zapping them with radiation. That was about nine years ago, in the twilight of the Clinton administration. The government has taken limited action since. After spinach tainted with a strain of E. coli killed three people and sickened more than 200 others in 2006, the Food and Drug Administration gave permission for irradiation of spinach and iceberg lettuce. It has yet to begin. Meat irradiation is permitted but rarely used. Among common items on the grocery shelf, only spices and some imported products, like mangoes from India, are routinely treated with radiation. The technology to irradiate food has been around for the better part of a century. The federal government says that it is safe, and many experts believe that it could reduce or even eliminate the food scares that periodically sweep through American society. It might even have killed the salmonella that reached grocery shelves in recent weeks after a factory in Georgia shipped tainted peanut butter and peanut paste, which wound up in products as diverse as cookies and dog treats. But irradiation has not been widely embraced in this country. Food manufacturers worry that the apparent benefits do not justify the cost or the potential consumer backlash. Some consumer groups complain that widespread irradiation of food after processing would simply cover up the food industry’s hygiene problems. And some advocacy groups question the long-term safety of irradiation. Amid all these doubts, one thing is certain — food poisoning continues. The cases that rise to public attention are only the tip of the iceberg. The Centers for Disease Control and Prevention estimates that there are 76 million cases of food-borne illness each year in the United States. The vast majority is mild, but the agency estimates there are 5,000 deaths from food-borne disease and 325,000 hospitalizations each year. Food is irradiated by brief exposure to X-rays, gamma rays or an electron beam. The process is intended to reduce or eliminate harmful bacteria, insects and parasites, and it also can also extend the life of some products. Advocates say it is particularly effective at killing pathogens in items like ground beef and lettuce, where they might be mixed into the middle of the product or hiding in a crevice that is hard to clean by traditional means. The
U.S. is dotted with irradiation centers, but they are generally used to
sterilize medical supplies like bandages and implants, not food. Food
industry officials, meanwhile, remain wary of irradiation because of the
upfront costs and the potential public reaction to any technique with the
word “radiation” in it. (Irradiation leaves no traces of radioactive
material in food. (NY Times)
Read the original story.
Hospital executive arrested for allegedly using homeless people in medical fraud A hospital executive was arrested last week for allegedly paying homeless people for unnecessary medical treatment in a scheme to bilk government health programs of millions of dollars. Robert Bourseau, who once helped run City of Angels Medical Center, was taken in to custody at his Los Angeles home by federal investigators as part of an ongoing probe into a massive fraud scheme using thousands of homeless people from skid row as patients.
Bourseau will appear on charges of conspiracy to commit healthcare fraud and
of taking illegal kickbacks as part of the scheme to defraud Medicare and
Medi-Cal, said Asst. U.S. Atty. Vince Farhat. He was slated to appear before
a federal magistrate in a downtown court. (LA Times)
Feds may make health insurance easier after layoff It will get vastly cheaper for most people to keep health insurance after losing a job if the government's stimulus plan becomes law. Some nickel and dime cuts in health coverage for the poor will be reversed, too. Geek jobs in medicine will grow. The billions to be poured into healthcare from the economic stimulus package will do little if anything about the chronic conditions behind the nation's stubbornly large ranks of uninsured. Under a dramatic, temporary expansion of COBRA, the law that lets the unemployed keep health insurance from their old job for up to 18 months if they pay for it in full, costs would drop by about two-thirds for a year. Moreover, people who lose a job they've had for 10 years could stay on COBRA at their expense all the way to age 65, when Medicare takes over, if they don't get another job with insurance first. People 55 and over could do the same without meeting the 10-year requirement. People who lose jobs at businesses that employ fewer than 20 people don't qualify for COBRA. For them, the government would bring many more jobless people under Medicaid's wing. The feds would pay for this, plus give states much more money to run cost-shared part of the program. In return, states taking the extra money would have to back down on some of the cuts they've made to the program recently. Altogether it's a pricey lifeline: $40 billion to subsidize health insurance for the unemployed and more than twice that to support Medicaid. The recovery plan also sets aside $20 billion for medical record-keeping, a sum likely to grow jobs in information technology. Four
in five doctors still rely on old-fashioned paper files. Digital records are
bound to cut administrative costs and improve care by making it easy to
share patient information. But conversion is a huge task, for which Obama
wants to spend $50 billion over five years. (Mercury News)
Read the original story.
'Normal' levels of bad cholesterol may be too high Two new studies indicate that the threshold of what doctors consider "normal" levels of bad cholesterol, or LDL, may be too high, leaving thousands of people vulnerable to heart attacks and strokes. One of the studies, led by Gregg Fonarow of UCLA, examined 131,000 hospital admissions for heart disease and found that at least half of the patients had normal LDL levels. The other study, called JUPITER, involved 18,000 people. It showed that giving a cholesterol-lowering statin to older people with normal LDL cut their risk of heart attack and stroke in half. Taken together, doctors say, the studies suggest that accepted notions of normal LDL are wrong — and that current treatment guidelines miss at least half of those who should be getting a statin. JUPITER suggests that millions more older people — as many as 11 million, Yale researcher Erica Spatz reported this month — should be getting statins. That would bring the total to about 45 million people, or 80% of all men older than 50 and all women older than 60. But UCLA's Fonarow, whose study was published in the American Heart Journal, says there's another possibility. "There are two potential implications," he says. "Either the threshold of what was set as an ideal LDL was set outrageously high, thus allowing the vast majority of patients to be missed, or LDL isn't much of a risk factor. Current guidelines recommend that doctors prescribe a statin for anyone whose LDL is 100 milligrams per deciliter of blood or higher. Doctors may treat patients with lower LDL at their discretion. But Fonarow notes that "half of all heart attacks are occurring below 100 (mg/dl)." Sidney Smith of the University of North Carolina-Chapel Hill, an authority on treatment guidelines and one of Fonarow's co-authors, says the study supports the wisdom of a push to drive LDL even lower, in many cases down to 70 mg/dl. JUPITER offers a crucial clue to another potent risk factor, inflammation, that is gaining wider recognition. That's because the study was designed to find out whether statins can prevent heart attacks and strokes in people who have normal cholesterol but whose arteries show signs of being inflamed. The findings offer strong evidence that statins relieve inflammation. If LDL is cardiovascular dynamite, inflammation is the fuse. Here's why: LDL carries cholesterol into the bloodstream, where it collects in artery walls. Inflammatory cells sometimes attack these deposits, causing them to burst. When that happens, blood clots and other debris float downstream into the arteries that nourish the heart. A blockage in a critical vessel may cut off the heart's blood supply. Some critics have challenged Paul Ridker of Brigham and Women's Hospital in Boston and JUPITER's lead author’s emphasis on inflammation and the validity of the test he helped to develop. Ridker has disclosed that he holds patents on the test, which measures C-reactive protein (CRP), a signal of artery inflammation. Ridker asserts that testing for inflammation simplifies the picture. It appeared, in JUPITER, to trump such accepted traits as obesity as a predictor of heart-attack risk. "If
you were a thin person with high CRP or an obese person with high CRP, the
risk was identical," he says. "Inflammation was the common driver." (USA
Today)
Read the original story.
Hospira’s Precedex phase IV study published in JAMA The Journal of the American Medical Association (JAMA) has published phase IV study results demonstrating Hospira, Inc.'s alpha-2 agonist Precedex (dexmedetomidine hydrochloride) for intravenous sedation provides comparable effectiveness to commonly used gamma-aminobutyric acid (GABA)-agonist midazolam for greater-than-24-hour sedation of mechanically ventilated patients in the intensive care unit (ICU). The study results also showed that patients sedated with Precedex were removed from mechanical ventilation almost two days earlier, and the prevalence of delirium in Precedex-treated patients was 22.6 percent less than in patients treated with midazolam. These study conclusions appear in the Feb. 4 issue of JAMA. According to the article, the incidence of delirium during treatment among patients was 54 percent in Precedex-treated patients vs. 76.6 percent in midazolam-treated patients. Median time to removal from mechanical ventilation was 3.7 days in the Precedex-treated patients vs. 5.6 days in the midazolam-treated patients, a difference of 44 hours. Precedex-treated patients were more likely to develop bradycardia, or slow heartbeat, but had a lower likelihood of tachycardia (fast heartbeat) or hypertension that required treatment.
There are more than 5 million patients treated annually in the ICU. In 2003,
there were nearly 300,000 prolonged mechanical ventilation discharges in the
United States at an annual aggregated hospital cost of more than $16
billion. At a cost of more than $1,500 per patient-day, mechanical
ventilation represents a significant contribution to overall expenses in the
intensive care setting and drives a disproportionate share of resource
utilization. Learn more at
www.hospira.com.
Disruptive innovation, applied to healthcare An article for the New York Times by Janet Rae-Dupree, a science/technology writer, says the healthcare system in America is on life support. It costs too much and saps economic vitality, achieves far too little return on investment and isn’t distributed equitably. As the Obama administration tries to diagnose and treat what ails the system, however, reformers shouldn’t be worried only about how to pay for it. Instead, the country needs to innovate its way toward a new healthcare business model — one that reduces costs yet improves both quality and accessibility. Two main causes of the system’s ills are century-old business models, for the general hospital and the physician’s practice, both of which are based on treating illness, not promoting wellness. Hospitals and doctors are paid by insurers and the government for the healthcare equivalent of piecework: hospitals profit from full beds and doctors profit from repeat visits. There is no financial incentive to keep patients healthy. “The business models were all created decades ago, and acute disease drove those costs at the time,” says Steve Wunker, a senior partner at the consulting firm Innosight. “Most businesses in this industry are looking at their business model as entirely immutable. They’re looking for innovative offerings that fit this frozen model.” Advances in technology and medical research are making it possible to envision an entirely new healthcare system that provides more individualized care without necessarily increasing costs, some healthcare experts say. For instance, genetic breakthroughs have helped reveal time and again that what we thought was one disease — Type 2 diabetes, for instance — actually represents a score or more of distinct illnesses, each of which responds best to a different type of therapy, according to medical professionals. As researchers develop ways to define diagnoses more precisely, more effective treatments can be prescribed, says Matthew Holt, founder of the Health Care Blog and co-founder of the biannual conference Health 2.0. Ultimately, those therapies can be administered by nurse practitioners or others trained to handle routine ailments. The expensive “intuitive medicine” practiced by doctors trained to wade through a thicket of mysterious symptoms in search of an accurate diagnosis can then focus on those cases that truly require their services. Using innovation management models previously applied to other industries, Clayton M. Christensen, a Harvard Business School professor, argues in “The Innovator’s Prescription” that the concepts behind “disruptive innovation” can reinvent health care. The term “disruptive innovation,” which he introduced in 2003, refers to an unexpected new offering that through price or quality improvements turns a market on its head. Disruptive innovators in healthcare aim to shape a new system that provides a continuum of care focused on each individual patient’s needs, instead of focusing on crises. Mr. Christensen and his co-authors argue that by putting the financial interests of hospitals and doctors at the center, the current system gives routine illnesses with proven therapies the same intensive and costly specialized care that more complicated cases require. It’s coming, though. Some healthcare suppliers have set up fixed-fee integrated systems, and accept monthly payments from members in exchange for a promise of cradle-to-grave healthcare. Each usually also charges a small co-payment for treatment. Routine cases are handled through lower-cost facilities, leaving more complicated cases to higher-cost hospitals and specialists. Such systems include Kaiser Permanente, Intermountain Healthcare in Utah, the Mayo Clinic, the Geisinger Health System in Pennsylvania and the Veterans Health Administration. By
creating a continuum of care that follows patients wherever they go within
an integrated system, says the Princeton University economist Uwe Reinhardt,
care providers can stay on top of what preventive measures and therapies are
most effective. Tests aren’t needlessly duplicated, competing medications
aren’t prescribed by different doctors, and everyone knows what therapies a
patient has received. As a result, integrated systems like Kaiser’s provide
22 percent greater cost efficiency than competing systems, according to a
2007 study by Hewitt Associates. (NY Times)
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