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         Clinical intelligence for supply chain leadership


hpnonline Daily Update


May 12-16, 2014
May 12 May 13 May 14 May 15 May 16


May 16, 2014   Download print version

Deadline extended for 2014 Provider Executive Survey on Supply Chain Management

FDA drug safety communication: Eszopiclone containing sleep aids, including Lunesta and generics, can cause next-day impairment

Measles virus used to put woman's cancer into remission

2015 IAHCSMM Annual Conference & Expo Call for Presentations

Labs are told to start including a neglected variable: Females

Northwestern, Cadence reach merger deal

China accuses British GlaxoSmithKline executive in bribery case

Rubbermaid Healthcare recognized by KLAS Research for impact on nursing efficiency and patient safety

Shorter men may live longer thanks to an enhanced longevity gene

Deadline extended for 2014 Provider Executive Survey on Supply Chain Management

Hospital and other healthcare facility senior administrators have until May 22 to participate in the 2014 Provider Executive Survey on Supply Chain Management, conducted by the Association for Healthcare Resource & Materials Management (AHRMM), a membership organization of the American Hospital Association; Marquette University’s College of Business Administration - Center for Supply Chain Management; and Jamie C. Kowalski Consulting, LLC. This year’s survey theme is “Reform Continues; Is Supply Chain Leading, Following or Getting in the Way?”

Since developer and veteran industry supply chain consultant Jamie Kowalski began the survey in the 1980s, the purpose has remained the same: To identify and understand the perceptions of hospital senior executives (CEO, COO, CFO) regarding the role supply chain plays, its performance, as well as their expectations of contributions supply chain must make toward achieving hospital and IDN performance and success. It also compares those responses from the Senior Executives with responses from Supply Chain leaders, to identify and try to interpret the reason for any important gaps.

Funding for the latest survey was provided by “Presenting Sponsor” TECSYS Inc., a supply chain management software company, and a group of five contributing sponsors, including Owens & Minor Inc., a leading national healthcare product distributor; Amerinet Inc., a leading national group purchasing organization; Global Edge LLC, a risk management software company; Aperek Inc., a Web-based supply chain analytics and expense management software company; and Bellwether League Inc., the hall of fame for healthcare supply chain leadership.

Survey results will provide valuable insights into the perceived importance and impact of supply chain management strategies and initiatives, and guide executives in the development of their own strategic plans to optimize their organization’s supply chains. The online survey is being distributed to hospital chief executive officers, chief financial officers, chief operating officers, and healthcare supply chain leaders. Surveys can be completed by visiting here.

Results of the survey will be tabulated by Marquette University’s College of Business Center for Supply Chain Management and will be presented by Kowalski at the 2014 AHRMM Annual Conference & Exhibition in Orlando on August 4. Other venues are still being determined. The survey report will allow the industry to examine the similarities and differences between the views of C-suite executives and supply chain leaders, the challenges Healthcare Reform presents to providers, and how supply chain management is and can help providers deal with these challenges.



FDA drug safety communication: Eszopiclone containing sleep aids, including Lunesta and generics, can cause next-day impairment

FDA has notified health professionals and their medical care organizations of a new warning that the insomnia drug Lunesta (eszopiclone) can cause next-day impairment of driving and other activities that require alertness. FDA recommends a decreased starting dose of Lunesta to 1 mg at bedtime.

Women and men are equally susceptible to impairment from Lunesta, so the recommended starting dose of 1 mg is the same for both. FDA approved changes to the Lunesta prescribing information and the patient Medication Guide to include these new recommendations. The drug labels for generic eszopiclone products will also be updated to include these changes.

A study of Lunesta found that the previously recommended dose of 3 mg can cause impairment to driving skills, memory, and coordination that can last more than 11 hours after receiving an evening dose. Despite these driving and other problems, patients were often unaware they were impaired. The new lower recommended starting dose of 1 mg at bedtime will result in less drug in the blood the next day.

Healthcare professionals should follow the new dosing recommendations when starting patients on Lunesta. Patients should continue taking their prescribed dose of Lunesta and contact their healthcare professionals to ask about the most appropriate dose for them. FDA is continuing to evaluate the risk of impaired mental alertness with the entire class of sleep aid drugs, including over-the-counter drugs available without a prescription, and will update the public as new information becomes available. Read the MedWatch safety alert.



Measles virus used to put woman's cancer into remission

A woman with an incurable cancer is now in remission, thanks, doctors say, to a highly concentrated dose of the measles virus. For 10 years, Stacy Erholtz, 49, battled multiple myeloma, a deadly cancer of the blood. Doctors at the Mayo Clinic say she had received every type of chemotherapy drug available for her cancer and had undergone two stem cell transplants, only to relapse time and again.

Then researchers gave her and five other multiple myeloma patients a dose of a highly concentrated, lab-engineered measles virus similar to the measles vaccine. In fact, the dose Erholtz received contained enough of the virus to vaccinate approximately 100 million people.

"The idea here is that a virus can be trained to specifically damage a cancer and to leave other tissues in the body unharmed," said the lead study author, Dr. Stephen Russell.

It's a concept known as virotherapy, and it's been done before.

Mayo Clinic scientists say thousands of cancer patients have been treated with viruses, but this is the first case of a patient with a cancer that had spread throughout the body going into remission. Erholtz was cancer-free for nine months.

"I think we succeeded because we pushed the dose higher than others have pushed it," Russell said. "And I think that is critical. The amount of virus that's in the bloodstream really is the driver of how much gets into the tumors."

In simple terms, the measles virus makes cancer cells join together and explode, Mayo Clinic researcher Dr. Angela Dispenzieri explains. There's also some evidence to suggest, she says, that the virus is stimulating the patient's immune system, helping it recognize any recurring cancer cells and "mop that up."

This treatment is still in the early testing stages, though. Doctors recently used radiation therapy to treat a small, localized tumor in Erholtz's body. And the other patients in the trial did not go into remission. Tests showed the virus helped shrink one woman's tumors, but they started growing again soon after. The other patients' cancers did not respond to the treatment.

Researchers also don't know whether this virotherapy will help other patients or whether it can be applied to other types of cancer. The measles virus worked with these multiple myeloma patients because they are already immune-deficient, meaning their bodies can't fight off the virus before it has a chance to attack the cancer cells.

More of the highly concentrated measles virus is being created now to be used in a larger clinical trial, Mayo Clinic researchers say. They've developed a manufacturing process that can produce large amounts of the virus, Russell says. Visit CNN for the article.



2015 IAHCSMM Annual Conference & Expo Call for Presentations

Be a part of the premier conference for Central Service Professionals by presenting an educational session at the IAHCSMM 50th Annual Conference and Expo.  Each year's conference features some of the discipline's most dynamic and knowledgeable speakers, and now is your chance to be one of them and share your perspectives and knowledge with others in the CS field.

IAHCSMM is seeking subject matter experts for the following categories: Decontamination, CS Management, Communication/Human Relations, Endoscopes, Infection Control, Materials Management, Preparation/Packaging, Quality Assurance, Regulations and Standards, Safety, Sterilization, and Surgical Instruments.

Additionally, attendees from previous IAHCSMM Conference and Expos would like to see presentations on the following: Agency Updates, Ambulatory Surgery, Best Practices, Budget/Finance, Competency, Decontamination/Disinfection, Endoscope Cleaning, Lean Topics, Loaner Instrumentation, Management Topics, Policy and Procedures, Quality, Sterilization, and Team Building.  

Deadline for Presentation Proposals is July 1, 2014. Submit your proposal by visiting here.



Labs are told to start including a neglected variable: Females

Troubled by some drugs’ effects on women, the N.I.H. is urging researchers to include more female animals in their studies. They've embarked on the long journey toward a medical breakthrough by first experimenting on laboratory animals. Mice or rats, pigs or dogs, they were usually male: Researchers avoided using female animals for fear that their reproductive cycles and hormone fluctuations would confound the results of delicately calibrated experiments.

That laboratory tradition has had enormous consequences for women. Name a new drug or treatment, and odds are researchers know far more about its effect on men than on women. From sleeping pills to statins, women have been blindsided by side effects and dosage miscalculations that were not discovered until after the product hit the market.

Now the National Institutes of Health says that this routine gender bias in basic research must end.

The N.I.H. has already taken researchers to task for their failure to include adequate numbers of women in clinical trials. The new announcement is an acknowledgment that this gender disparity begins much earlier in the research process.

“Most scientists want to do the most powerful experiment to get the most durable, powerful answers,” Dr. Francis Collins, director of the N.I.H, said in an interview. “For most, this has not been on the radar screen as an important issue. What we’re trying to do here is raise consciousness.”

Women now make up more than half the participants in clinical research funded by the institutes, but it has taken years to get to this point, and women still are often underrepresented in clinical trials carried out by drug companies and medical device manufacturers.

Partly as a result, women experience more severe side effects from new treatments, studies have shown. The FDA last year told women to cut in half their doses of the sleeping pill Ambien, for example, because new studies showed they metabolize the active ingredient more slowly than men do.

Although statins are the most widely prescribed drugs in America, they were tested mostly in men, and evidence of their benefit to women is limited. Indeed, women respond differently from men to a broad array of treatments, and often do not derive the same benefits from them as men.

The ideas for new treatments are often generated in the laboratory, where gender bias in basic biomedical research and neuroscience is ingrained.

Bias in mammalian test subjects was evident in eight of 10 scientific disciplines in an analysis of published research conducted by Irving Zucker, a professor of psychology and integrative biology at the University of California, Berkeley. The most lopsided was neuroscience, where single-sex studies of male animals outnumbered those of females by 5.5 to 1.

Contrary to the conventional wisdom in laboratories, there is far more variability among males than among females on a number of traits and behaviors, Dr. Zucker has found. Yet even when researchers study diseases that are more prevalent in women — anxiety, depression, thyroid disease and multiple sclerosis among them — they often rely on male animals, according to another analysis led by Dr. Zucker, who has written extensively on gender bias in scientific research.

Jill Becker, a senior research scientist at the University of Michigan who studies gender differences in addiction, has found that women increase their drug use much more rapidly than men and that the hormone estradiol plays a critical role in the escalation, especially during ovulation. Nonetheless, researchers studying escalating drug use in rats and mice rely almost entirely on males, she said.

The N.I.H. is directing scientists to perform their experiments with both female and male animals, and grant reviewers will take the balance of each study design into account when awarding grants. (If the subject is gender-specific, like ovarian cancer or prostate cancer, then the rule will probably not apply, Dr. Clayton said.)

N.I.H. officials will start rolling out the new policies in October, and the details are still being ironed out. But they are likely to be met with resistance from scientists who fear increased costs and difficulty in performing their experiments. Visit the New York Times for the report.



Northwestern, Cadence reach merger deal

Northwestern Memorial HealthCare and Cadence Health said Thursday they have reached a deal to combine into a single health system that would rank among the largest in the Chicago area.

Each system’s board of directors formally gave approval to the deal, announced initially in March, leaving only state and federal regulatory approval pending. That could come as soon as fall, a Cadence spokesman said. The combined system would have four hospitals, more than 1,300 employed physicians and combined annual revenue approaching $3 billion.

Northwestern, parent of Chicago's largest hospital, the 894-bed Northwestern Memorial Hospital, and Cadence, which was created in 2011 after the merger of Central DuPage and Delnor hospitals, would combine under the Northwestern Medicine banner. Both systems are nonprofits.

The merger with Cadence would widen the pipeline of patients to Northwestern's flagship Streeterville academic medical center, which offers an array of highly specialized -- and profitable -- advanced medical treatment programs. It also would strengthen the system's market power in the western suburbs, where Cadence has flourished since Winfield-based Central DuPage and Geneva-based Delnor combined.

Northwestern President and CEO Dean Harrison, who would lead the combined entity, said, “Together, we are better positioned to provide care that is safer, more effective, and better coordinated that utilizes the latest breakthrough treatments and is accessible closer to where our patients live and work.”

Mike Vivoda, Cadence's president and chief executive, would become regional president of the system, continuing to oversee Central DuPage and Delnor. “The opportunity to partner with Northwestern will enhance the offerings of high quality compassionate care in the Chicago’s western suburbs,” Vivoda said, in a statement. “We believe this combination will create an integrated approach to patient care, augment a culture of service excellence and enhance and grow our clinical services to continue to position this system as the health care provider of choice.”

Visit the Chicago Tribune for the story.



China accuses British GlaxoSmithKline executive in bribery case

Chinese police have accused a British executive in drugs maker GlaxoSmithKline's China unit of ordering his salespeople to bribe doctors and hospital officials to use the company's products. The announcement marks the first time a foreign employee in China of British-based GSK has been accused in connection with the bribery allegations against the company.

In a statement carried by the official Xinhua news agency, police in the central city of Changsha said Mark Reilly was accused of pressing his sales team to bribe doctors, hospital officials and health institutions. It said that resulted in "illegal revenue" of billions of yuan.

The statement said Reilly and two Chinese executives also were accused of bribing government officials in Beijing and Shanghai.

In April the GSK whistleblower Jarek Wisniewiski told the BBC's Panorama program that company representatives paid doctors to boost prescriptions in Poland. Another former GSK drug representative, who did not want to be identified, said they paid doctors for lectures that never happened and this would result in a greater number of prescriptions.

Wisniewiski said he had voiced his concerns with the drugs company but this resulted in him being sidelined at work and eventually sacked.

The program said a criminal investigation was under way and 11 doctors and one GSK regional manager had been charged in connection with corruption. If the new allegations were well founded GSK may have violated both the UK's Bribery Act and the US Foreign Corrupt Practices Act, the BBC program said. It is illegal for companies based in the US or UK to bribe government employees abroad. Visit the Guardian for the article.



Rubbermaid Healthcare recognized by KLAS Research for impact on nursing efficiency and patient safety

Rubbermaid Healthcare, announced its high performance ratings, as indicated by a new report from KLAS Research, a technology research firm that independently measures and reports on vendor performance. According to the April 2014 report titled, “Medication Cabinets, Carts, & BCMA 2014: Technology’s Impact on Nurse Efficiency and Patient Safety,” Rubbermaid Healthcare’s medication carts were rated highly in both nurse efficiency and patient safety compared to five other vendors.

KLAS Research surveyed 177 nurses to find out how medication cabinets, carts, and barcode medication administration (BCMA) affect nursing efficiency and enhance patient safety. Additionally, nurses were asked to rate various products based on their experience.  Among medication carts, Rubbermaid Healthcare had the highest percentage of customers who reported that carts significantly help nurse efficiency. Providers using Rubbermaid Healthcare’s carts were most likely to note significant gains in being able to efficiently and safely care for patients.

Rubbermaid Healthcare carts enable nurses to store and transport medications in their locked drawers, eliminating the time wasted to go back and forth between the medication room and patient room to administer medications. Their latest generation of medication carts allows users to manage and monitor access to medication drawers remotely, making it easier to proactively manage a fleet of carts.

Other findings from the report distinguish Rubbermaid Healthcare carts among the leaders who have very few issues with the cart’s batteries as well as positive interactions between users and Rubbermaid Healthcare’s customer service team. None of the respondents reported that Rubbermaid Healthcare medication carts hindered nursing efficiency or patient safety.

To learn more about Rubbermaid Healthcare solutions, please visit www.rubbermaidhealthcare.com.

Visit KLAS Research for the report.



Shorter men may live longer thanks to an enhanced longevity gene

Guys who are less tall may feel as though they wound up with the short end of the stick, but new research appearing in the peer-reviewed medical journal PLOS ONE suggests that they are more likely to outlive their taller male counterparts.

In the study, researchers from the Kuakini Medical Center, the University of Hawaii’s John A. Burns School of Medicine (JABSOM) and the US Veteran Affairs department concluded that shorter men were more likely to have a protective form of the longevity gene, also known as FOXO3.

The presence of this gene results in smaller body size and a longer lifespan, as well as lower blood insulin levels and a lower prevalence of cancer. The authors studied over 8,000 American men of Japanese ancestry, monitoring their health conditions closely for nearly five decades.

All of the subjects were participants in the Kuakini Honolulu Heart Program (HHP) and the Kuakini Honolulu-Asia Aging Study (HAAS). The Kuakini HHP began in 1965, and the 8,006 participants (all but three of whom also participated in this study) were born between the year of 1900 and 1919.

“We split people into two groups – those who were 5-foot-2 and shorter, and 5-4 and taller,” Dr. Bradley Willcox, one of the researchers involved in the study and a professor at JABSOM’s Department of Geriatric Medicine, said in a statement. “The folks that were 5-2 and shorter lived the longest. The range was seen all the way across from being 5-foot tall to 6-foot tall. The taller you got, the shorter you lived.”

“This study shows, for the first time, that body size is linked to this gene,” he added. “We knew that in animal models of aging. We did not know that in humans. We have the same or a slightly different version in mice, roundworms, flies, even yeast has a version of this gene, and it’s important in longevity across all these species.”

Dr. Willcox and his colleagues emphasize that additional research is required in order to verify the results of their work, as well as to make sure that the findings can be applied to other ethnic groups of populations. He added that there is no specific height or age range, because no matter what a person’s height is, he or she can make up for having a regular FOXO3 gene and not a longevity-enhanced one by living a healthy lifestyle.

About 1,200 men who participated in the study lived into their 90s and 100s, and nearly 250 of them are alive today. The project was funded by the National Institutes of Health’s National Heart, Lung and Blood Institute (NHLBI) and the National Institute on Aging, as well as the Kuakini Medical Center and the Department of Veterans Affairs. Visit Red Orbit for the study.



May 15, 2014   Download print version

Under fire for VA scandal Eric Shinseki faces grilling from Congress

MERS outbreak becomes more urgent, WHO says

Outbreaks can happen anywhere, even Ohio

Hospitals performing too many unnecessary C-sections, Consumer Reports finds

Hospital shares how it reduced needlestick injuries by nearly 70 percent

Hurricanes Katrina and Rita may have caused up to half of recorded stillbirths in worst hit areas

One billion people still defecate in public despite health risks: UN

MNA: hospital financial woes caused by bad investment

Under fire for VA scandal Eric Shinseki faces grilling from Congress

As reports of serious misconduct come in from VA hospitals across the country, lawmakers are prepared to give Veterans Affairs Secretary Eric Shinseki the grilling of a lifetime on Thursday when he appears before the Senate Veterans' Affairs Committee.

Shinseki, a retired four-star Army general who has led the VA since 2009, is prepared to tell the committee about the VA's response so far to reports that at least 40 veterans died while waiting for care at the Phoenix VA Health Care system. The Phoenix facility reportedly worked to cover up patients' long wait times by creating a secret waiting list and later destroying the evidence.

"If these allegations are true, they are completely unacceptable--to Veterans, to me, and to our dedicated VHA employees," Shinseki's prepared opening statement says. If they are substantiated by the VA Office of Inspector General (OIG), the agency's independent watchdog, Shinseki says that "responsible and timely action will be taken."

Shinseki will tell the Senate committee that he's placed three employees from the Phoenix facility on administrative leave at the request of the OIG. However, he will say the OIG advised the VA against providing information to the public that could "potentially compromise" the ongoing investigation.

Lawmakers, however, want to hear about more than just the alleged misconduct in Phoenix. Report after report suggests the same practice of using secret waiting lists may be happening elsewhere.

Germaine Clarno, a VA social worker and employee representative in Chicago, told CBS News' Wyatt Andrews that there are multiples secret waiting lists of veterans kept at the Hines VA Medical Center. Veterans were put on secret waiting lists when they called for appointments, Clarno said, but they wouldn't formally get an appointment booked until one came up within a 14-day window.

The VA grants bonuses to executives and doctors partly based on whether patients are seen within 14 days, giving VA workers incentive to conceal delays in care. Clarno said the purpose of the secret lists was "to make numbers look better for their own recognition and for bonuses."

Meanwhile, a VA employee at the VA Medical Center in Cheyenne, WY, has been placed on administrative leave after CBS News obtained an email showing an employee directing his staff on how to game the appointments system to make it appear as though veterans were being seen within the VA's 14-day directive.

As the stories come out, some lawmakers are demanding investigations and Shinseki's resignation. At the very least, they're demanding answers.

Sen. John Cornyn, R-Texas, one of the senators who has called on Shinseki to resign, sent a letter to Shinseki on Tuesday asking him to give "direct, clear answers" in his testimony Thursday to several specific questions. "According to recent reports, you have ordered a 'face-to-face audit' of all Department of Veterans Affairs clinics," Cornyn wrote. "Can you describe in detail how you intend for this audit to be conducted, its timeline for completion, and what measures are being taken to ensure these audits are conducted in an independent and transparent manner?"

Shinseki on Thursday, while acknowledging the reports of misconduct, is also prepared to defend the VA. "It is important to understand the size and scope of VA care--the largest integrated healthcare delivery system in the United States," his prepared testimony says, noting the VA system conducts approximately 236,000 healthcare appointments each day and approximately 85 million appointments each year.

"VA provides safe, effective healthcare, equal to or exceeding the industry standard in many areas," his statement says. He notes that the American Customer Satisfaction Index, the nation's only cross-industry measure of customer satisfaction, ranks VA customer satisfaction among the best in the nation--equal to or better than ratings for private sector hospitals. Visit CBS News for the story.



MERS outbreak becomes more urgent, WHO says

The spread of the potentially fatal Middle East respiratory syndrome has become more serious and urgent, the World Health Organization said Wednesday.

At the same time, WHO said that -- for now, at least -- the illness known as MERS does not constitute a global health emergency.

Declaring an emergency is "a major act" that can "raise anxieties," said Dr. Keiji Fukuda, the organization's assistant director-general for health security. Despite concerns about the syndrome, researchers have not found "any increasing evidence of person-to-person transmissibility," he said.

There have been 571 confirmed cases of MERS, including 171 deaths, according to the World Health Organization. The number of countries with confirmed cases expanded to 18, with a case in the Netherlands, WHO reported Wednesday.

Many of the cases are in Saudi Arabia and the United Arab Emirates.

Even without any official worldwide alert, Anne Schuchat, the head of the CDC's National Center for Immunization and Respiratory Diseases, acknowledges that "this is a relatively new virus that does have a high fatality rate," ample reason to pay attention. Authorities haven't pinned down all the details about how exactly it arose and how it spreads, though Schuchat said, "we don't have evidence right now that this is airborne ... the way the measles virus is."

Two cases have been confirmed in the United States. Both patients are healthcare providers who were working in Saudi Arabia. The first is in Indiana; the second in Florida.

Two healthcare workers who came in contact with the Florida patient later went to an emergency room with flu-like symptoms. But they tested negative for MERS in a state test, the CDC said Wednesday.

The Florida MERS patient, specifically, was fever-free and continuing to improve Wednesday while undergoing treatment at Orlando's Dr. P. Phillips Hospital, the state's health department said.

Given the virus' apparent roots in the Arabian Peninsula, Schuchat said it's important that healthcare workers ask anyone who has suspicious "respiratory symptoms" where they have been in recent weeks. "More and more people are going to be traveling the next couple of months, so we really want clinicians to be on the lookout," she said.

Commercial airlines are on guard as well, including efforts to make sure those who might have come into contact with the two MERS patients in the United States didn't come down with the virus. American Airlines said in a statement that it is "working very closely with the Centers for Disease Control, and contacted our flight crew as soon as we learned of (one such) diagnosis. The CDC is in the process of contacting passengers to advise them of any necessary precautions."

And Delta Airlines said that, like all carriers, it "has a long-standing protocol for working with the U.S. Centers for Disease Control, as we are in this instance. The safety of our customers and employees is Delta's top priority."

One traveler who was on one possibly affected flight told CNN affiliate WMKG that the call she got about one confirmed case of MERS left her "really scared." Twelve days after her flight, she said, her state health department called and sent her a note asking whether she had symptoms such as fever or cough, and also saying she should record her temperature for two weeks.

Four people -- each from different families -- have been tested in San Antonio for MERS because they were on a plane with one of the two confirmed U.S. patients, said San Antonio health department spokeswoman Carol Schliesinger. None of those four had any suspicious symptoms, she added. Tests for two of them have come back negative for MERS, while the other results are expected in the next couple of days.

Dr. William Schaffner, head of preventive medicine of Vanderbilt Medical Center explained Wednesday on CNN's "New Day" that MERS can "spread in the context of providing healthcare. “That's very important. And it has occasionally spread in Saudi Arabia from one family member to another. It requires close, constant, over time exposure."

People who go to a doctor or hospital with respiratory symptoms should be asked immediately whether they've traveled to the Middle East or been in contact with someone who did. "If the answer is yes, you put that person in isolation," Schaffner said. Specimens are then taken and sent to the CDC for further testing.

Florida's health secretary, Dr. John Armstrong, said Wednesday that the case in his state "is contained."

Representatives of 13 countries made up the WHO emergency committee that convened Tuesday through a phone conference, the WHO said. Affected countries need to take immediate steps to improve infection prevention and control, the WHO said. The majority of infections have taken place inside hospitals.

The CDC is not recommending that anyone change travel plans. The U.S. State Department has instructed its embassies and consulates in Saudi Arabia, Oman, Qatar, Jordan, Kuwait, and the UAE to provide U.S. citizens with CDC's general guidance for infection control, a State Department official said. Visit CNN for the article.



Outbreaks can happen anywhere, even Ohio

In many ways, Ohio is pretty average. It has about 51 percent women, 49 percent men. Its state flower is a carnation, and its official beverage is tomato juice.  But while 90.3 percent of Ohio’s children have received the MMR vaccine — a number on par with the national average — the state is seeing a surge in measles and mumps.

Why? Experts blame international travel and a bit of bad luck.

“People from all walks of life and all continents … are moving left, right and center around the world every day,” said Dr. Frank Esper, an infectious diseases expert at UH Rainbow Babies and Children’s Hospital in Cleveland, OH.

While having a high enough vaccination rate can lead to herd immunity, which limits the spread of a virus and helps protect unvaccinated individuals, Esper said the ability to travel the world has changed the meaning of “herd.”

“We can no longer think of our herd as the Ohio herd or as the U.S. herd. We’re talking about the herd of the world,” he said.

Ohio has recorded 73 measles cases since March 22, which health officials say makes it larger than any other state measles outbreak since 1996. It has also seen 342 mumps cases this year, 201 of which have been linked to an outbreak at Ohio State University.

The Ohio measles outbreak has been tied to unvaccinated people who traveled to the Philippines, which has seen upwards of 26,000 measles cases since January, according to the World Health Organization.

The Ohio outbreak numbers are in the hundreds rather than thousands because so many people are vaccinated, Esper said. The measles vaccine is 99 percent effective, and the mumps vaccine is about 88 percent effective in those who have had two doses of it, according to the U.S. Centers for Disease Control and Prevention.

Still, Ohio has clusters of people who are hesitant to use vaccines for personal reasons just as affluent communities on the east and west coast do. Ohio also has a large Amish population, some of whom avoid vaccines because of their faith, Esper said.

Many of those who have gotten sick in Ohio have received incomplete doses of the MMR vaccine or skipped it altogether, according to a statement from Ohio’s Morrow County Health Department, which is offering vaccine clinics in response to the outbreaks. Visit ABC News for the story.



Hospitals performing too many unnecessary C-sections, Consumer Reports finds

Whether you have a Cesarean section may depend on where you give birth. A new Consumer Reports investigation found that C-section rates vary greatly from hospital to hospital, which has raised concerns that doctors are performing too many unnecessary procedures.

Nearly 55% of pregnant women expecting a low-risk delivery — meaning the mother has never had a C-section, won’t deliver prematurely and is only carrying one baby who is in the correct position — had C-sections at Los Angeles Community Hospital, according to the report.

However, the rate of C-sections for low-risk deliveries at California Hospital Medical Center in Los Angeles was 15%. Denver Health Medical Center had the lowest C-section rate at just 8%.

Consumer Reports examined data from more than 1,500 hospitals in 22 states. They looked at births that took place during a two-year period between 2009 and 2012, depending on the state, and scored them according to the rate of C-sections for low-risk deliveries.

The nonprofit said 66% of the hospitals earned the low or second-lowest score for their high C-section rates, while only 12% earned the top two scores.

“We think it’s time those hidden numbers are brought to light,” Consumer Reports Health Dr. John Santa said in a release. “How you deliver your baby should be determined by the safest delivery method, not which hospital you choose.”

Consumer Reports pointed out that some medical organizations have already started taking measures to reduce the number of surgical births. In March, the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine released a joint paper outlining new guidelines for performing C-sections, which they say they hope will curb the surgical births among first-time mothers. Visit the New York Daily News for the article.



Hospital shares how it reduced needlestick injuries by nearly 70 percent

An article published in the Spring 2014 issue of the Journal of the Association of Occupational Health Professionals in Healthcare discusses how a systematic, data-driven approach and the subsequent adoption of a safety-engineered blood collection set helped Robert Wood Johnson University Hospital (RWJUH), a leading academic medical center, reduce needlestick injuries (NSIs) by nearly 70 percent among its patient care technicians and nursing staff.

In the article – "Successfully Reducing Wingset-related Needlestick Injuries" – author Doris L. Dicristina, RN, BSN, MS, COHN-S/CM, Director – Employee Health and Wellness Services for RWJUH, reports how her team identified that forward-shielding safety blood collection sets accounted for 30 percent of the institution's NSIs in 2010 and 43 percent in 2011.

The financial impact of these NSIs on RWJUH ranged from $400-$6,000 per injury, depending on whether the patient was known to carry a bloodborne disease such as hepatitis C, hepatitis B or HIV/AIDS. Using a novel financial model, RWJUH estimated that it would need to generate more than $106,000 in additional revenue to cover the cost of each NSI from a source-negative patient, with injuries from source-positive patients costing even more.

"Our first instinct in 2010 was to retrain...," Dicristina wrote. "It became clear that retraining – although important – was not the solution, and that the current engineering control was in fact the problem."

Further investigation revealed that approximately 83 percent of injuries with the forward-shielding safety blood collection sets occurred after clinicians removed the needles from their patients' veins, but before they activated the safety mechanism.

After an extensive search and evaluation of different safety blood collection sets, the hospital selected the BD Vacutainer Push Button Blood Collection Set (PBBCS), with a split-second retracting needle that offers in-vein safety activation.

The study reports that, after staff training and full conversion to the new safety device, NSIs at RWJUH dropped nearly 70 percent from 45 injuries in 2010 and 2011 to 14 in 2012 and 2013. The injury rate per 100,000 devices purchased fell more than 64 percent – from 7.43 in 2010-2011 to 2.65 in 2012-2013. Visit BD for the report.



Hurricanes Katrina and Rita may have caused up to half of recorded stillbirths in worst hit areas

Hurricanes Katrina and Rita may have been responsible for up to half of all recorded stillbirths in the worst hit areas, suggests research published online in the Journal of Epidemiology & Community Health.

And the true fetal death toll may even be higher, because of the displacement of people whose homes and way of life were destroyed, suggest the authors.

Hurricane Katrina struck the state of Louisiana, USA, on August 29 2005, followed by Hurricane Rita a month later on September 24. Katrina was the costliest natural disaster in American history, while Rita was the fourth most intense hurricane ever recorded.  Both hurricanes caused widespread damage to property and infrastructure and left a trail of injury, death, and trauma in their wake.

The researchers used composite figures from several government agencies, showing that the hurricanes caused damage in 38 out of 64 areas (parishes) in the state, with almost 205,000 housing units affected.  In four parishes, more than half of the local housing stock was damaged; in three others, between 10% and 50% was damaged. Elsewhere, the level of damage to housing stock was categorized as 1%-10%, or less than 1%.

The researchers then calculated the odds of a pregnancy resulting in a stillbirth in damaged and undamaged areas (less than 1% damage) in the 20 months before, and the 28 months after, Katrina struck.  But they also looked at all birth data between 1999 and 2009 in Louisiana to gauge usual patterns: during this period, 5194 stillbirths were recorded.

They then used space-time models to assess whether the extent of damage wrought by the hurricanes was linked to the risk of stillbirths in a given area.

Their calculations indicated that the risk of a pregnancy ending in a stillbirth was 40% higher in parishes where 10-50% of housing stock had been damaged, and more than twice as high in areas where over 50% of the housing stock had taken a hit.

After taking account of known risk factors, every 1% increase in the extent of damage to housing stock was associated with a corresponding 7% rise in the number of stillbirths.

Based on these figures, the researchers calculated that of the 410 stillbirths officially recorded in extensively damaged parishes, up to half (117-205) may have been directly caused by the hurricanes and the subsequent devastation. Their estimates suggest that stillbirths made up around 17.5% to 30.5% of the total death toll in the wake of the hurricanes.

But the risk of stillbirth may have been even higher, suggest the researchers. In the hardest hit areas, the number of live births was more than 40% lower in 2007 than it was in 2004. And in parishes with more half of the housing stock damaged, the live birth rate fell by 79% in the three months following Katrina. This "precipitous decline" is likely to reflect the well documented exodus of residents from the coastal parishes of Louisiana into other areas, they suggest.

They point to previously published research, showing a link between maternal stress, depression, and trauma and birth complications, including stillbirths.

And they warn that climate change scientists have predicted an increase in the frequency, intensity, and duration of North Atlantic tropical cyclones like Hurricanes Katrina and Rita. Visit Medical News Today for the study.



One billion people still defecate in public despite health risks: UN

One billion people worldwide still practice "open defecation" and they need to be told that this leads to the spread of fatal diseases, U.N. experts said at the launch of a study on drinking water and sanitation.

Societies that practice open defecation - putting them at risk from cholera, diarrhea, dysentery, hepatitis A and typhoid - tend to have large income disparities and the world's highest numbers of deaths of children under 5 years old. Attempts to improve sanitation among the poorest have long focused on building latrines, but the United Nations says that money literally went down the toilet. Attitudes, not infrastructure, need to change, it said.

"In all honesty the results have been abysmal," said Rolf Luyendijk, a statistician at the U.N.'s children's fund UNICEF. "There are so many latrines that have been abandoned, or were not used, or got used as storage sheds. We may think it's a good idea but if people are not convinced that it's a good idea to use a latrine, they have an extra room."

Many countries have made great progress in tackling open defecation, with Vietnam and Bangladesh - where more than one in three people relieved themselves in the open in 1990 - virtually stamping out the practice entirely by 2012.

The global number has fallen from 1.3 billion in 1990. But one billion people - 90 percent of them living in rural areas - "continue to defecate in gutters, behind bushes or in open water bodies, with no dignity or privacy", the U.N. study said.

The practice is still increasing in 26 countries in sub-Saharan Africa. Nigeria was the worst offender, with 39 million open defecators in 2012 compared to 23 million in 1990.

Although the prevalence of open defecation is in decline, it is often common in fast-growing populations, so the total number of people doing it is not falling so fast, or is even rising.

The country with the largest number of public defecators is India, which has 600 million. India's relatively "hands off" approach has long been at odds with the more successful strategy of neighboring Bangladesh, which has put a big focus on fighting water-borne diseases since the 1970s, Luyendijk said.

"The Indian government did provide tremendous amounts, billions of dollars, for sanitation for the poorest," he said. "But this was disbursed from the central level to the provinces and then all the provinces had their own mechanisms of implementing. And as their own data showed, those billions of dollars did not reach the poorest," added Luyendijk.

"What is shocking in India is this picture of someone practicing open defecation and in the other hand having a mobile phone," said Maria Neira, director of Public Health at the WHO.

Making the practice unacceptable has worked in more than 80 countries, the U.N. says. The goal is to eliminate the practice entirely by 2025. Poverty is no excuse, the study said, noting the role of cultural differences.

In the Democratic Republic of Congo, 14 percent of the populations are open defecators. But where the head of the household is an Animist, the figure is twice as high, at 30 percent. Among households headed by Jehovah's Witnesses, it is only 9 percent. (Reuters) Visit the Chicago Tribune for the article.



MNA: hospital financial woes caused by bad investment

The Massachusetts Nurses Association is insisting very adamantly that North Adams Regional Hospital makes money on patient care -- and has been making money for many years. IRS documents, they say, show the financial crisis that led to the hospital's abrupt closing on March 28, might be due to a real estate deal that went south more than a decade ago.

MNA officials who commissioned the audit also want to be clear, they're not alleging any nefarious activity, however they are still blaming the financial difficulties incurred by NARH on an "ill-advised real estate scheme."

For the hundreds of former hospital employees who've been out of work for more than a month, Tuesday night's news provided a glimmer of hope.

After the MNA examined IRS documents and bankruptcy briefs, they've concluded that patient services revenue at NARH grew by 78 percent over a 12-year period between 2000 and 2013, while expenses rose by only 29 percent. That means the hospital has been making millions for Northern Berkshire Healthcare (NBH). So why were they $30 million in debt?

"NBH's own chapter 11 filings outlines the reasons for its critical financial status," said Mike Fadel, spokesman for the MNA. "Chief among them, what they highlight was the ongoing debt burden of Sweet Brook and Sweet Wood."

Sweet Brook is a transitional care living center for seniors and Sweet Wood is a retirement community, side by side in nearby Williamstown, property for which NBH invested $25 million back in 1999, and later sold for $7 million.

"It was clearly a bad decision and it was a decision to spend a lot of money in an area that's not related to the provision of hospital care," Fadel said. While paying off the debt on the sour investments, NBH also trimmed the work force and cut operating expenses at NARH.

"The reduction in reimbursement rates and the increase in the (seriousness) of patients and their illnesses have caused the cost of care to go way up," Jones said.

Fadel says its important now for policy makers and decision makers to make themselves familiar with the hospital's financial data so that they understand the community can sustain a full-service hospital.

The community is still on target to reopen the emergency room on May 19.

Visit WYNT for the story.



May 14, 2014   Download print version

MERS watch: Florida hospital staff exposed

More insured, but the choices are narrowing

Master 3D printers to grow replacement body parts: breast, bone and cartilage

FDA allows marketing of first prosthetic arm that translates signals from person’s muscles to perform complex tasks

Disease rides the dogs of war as Polio, Measles, Typhoid capitalize on chaos

D.C. hospital reports high rate of black women seeking treatment for advanced breast cancer

Study: Recycled blood better than donated blood for transfusions

Patient's immune system harnessed to attack cancer

MERS watch: Florida hospital staff exposed

Two Florida healthcare workers have developed flu-like symptoms after exposure to the second U.S. case of Middle East coronavirus (MERS). They, and 18 other healthcare workers at two Orlando hospitals, are being tested for the virus, which can cause serious illness and death, medical officials said at a media conference Tuesday. They were exposed to the patient in the emergency room of Dr. P. Phillips Hospital before it was clear he was at risk for MERS, officials told reporters.

One of the two with symptoms has been admitted to the hospital and the other is in isolation at home. The patient himself, a 44-year-old Saudi Arabian healthcare provider visiting family in the area, has a low-grade fever and a slight cough and remains in isolation at the hospital.

Fifteen of the affected workers were involved in caring for the patient himself, but the other five were exposed when the patient last week accompanied another person to Orlando Regional Medical Center for an unrelated medical procedure.

Meanwhile, a World Health Organization committee on MERS is meeting in Geneva to discuss whether the recent surge in cases in the Middle East makes the virus an international public health emergency.

Saudi Arabia, the center of the outbreak, has reported an additional four cases, all of them in the capital, Riyadh, as well as five deaths, four of them involving previously reported cases. The new report brings the Saudi total to 495 cases and 152 deaths since the virus was first recognized in 2012.

The Saudi health ministry said on its website that three of the new cases are in stable condition, but the fourth -- a 69-year-old man initially admitted to the hospital for heart disease -- developed respiratory symptoms on May 11 and died a day later.

On the other hand, the ministry said that six people diagnosed with the virus have recovered and been discharged from hospital. Visit MedPage Today for the story.



More insured, but the choices are narrowing

In the midst of all the turmoil in healthcare these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.

These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in healthcare coverage offered by employers and in private Medicare Advantage plans.

Insurers, ranging from national behemoths like WellPoint, UnitedHealth and Aetna to much smaller local carriers, are fully embracing the idea, saying narrower networks are essential to controlling costs and managing care. Major players contend they can avoid the uproar that crippled a similar push in the 1990s.

But while there is evidence that consumers are willing to sacrifice some choice in favor of lower prices, many critics, including political opponents of the new healthcare law, remain wary about narrowing networks. A concern is that insurers will limit access to specialists or certain hospitals

In response, state and federal regulators say they are more closely monitoring the plans being offered in the coming year to be sure they are clear and that consumers have sufficient access to hospitals and doctors. In some cases, they are already insisting on changes.

Nonetheless, for people who are directly picking plans in the open markets, insurers say price is turning out to be critical. People “are weighing affordability and breadth of network,” said Karen Ignagni, the chief executive of America’s Health Insurance Plans, an industry trade group. “What we’re finding is individuals are experiencing a preference for affordability,” she said.

Minnesota would seem to be a case in point. On the state exchange, PreferredOne offered an inexpensive plan with a network of 13 hospitals, but those low premiums helped the insurer grab 60 percent of the individual insurance market.

While many insurers are including only those hospitals and doctors willing to charge lower prices, experts say the makeup of the networks is likely to evolve over time, focusing less directly on price and more on the ability of providers to deliver coordinated and high-quality care.

Although a similar attempt to restrict choice failed in the early ‘90s, after opposition to H.M.O.s and managed care, insurers insist these efforts will not run into the same resistance because they are now working more closely with providers, and customers are more concerned about costs. “It’s a new era,” said Dr. Sam Ho, the chief medical officer for United Healthcare.

Blue Shield of California, for example, was able to recruit a fairly sizable group of providers interested in discounting their rates. Just as the plans must compete on the exchanges, “the doctors and hospitals are competing with each other to get in,” said Juan Davila, an executive vice president with the insurer. The next step, Davila said, is to work with providers to develop more sophisticated networks, where the insurer will team with those doctors and hospitals to provide better care.

Outside the exchanges, insurers are also promoting smaller networks for employers as a way to reduce overall healthcare costs, said Larry Boress, chief executive of the Midwest Business Group on Health. “The larger the network is, the higher the cost,” he said.

Nonetheless, the bottom line is that more employers are considering smaller networks. Many, like Walmart and General Electric, have gone so far as to steer employees to specific hospitals for certain expensive procedures like joint replacements.

In 2010, 24 percent of the largest employers offered smaller networks, chosen for their low costs or quality. Last year, 27 percent offered them and 44 percent said they were considering them, according to Mercer, a benefits consulting firm. Some companies are experimenting with different tiers of networks, charging workers more if they go to the broadest network, said Joseph Kra, a Mercer consultant.

There has been pushback, however. When United Healthcare reduced the size of networks in some Medicare Advantage plans, consumer groups and regulators balked. Dr. Ho, the chief medical officer, said the insurer offered patients the opportunity to continue receiving certain treatments, like chemotherapy, with their existing provider.

Medicare recently announced it would require Advantage plans to give advance notice of any significant changes to a network and might allow beneficiaries to switch during the year if the network underwent too much change after they had already signed up. Federal officials, who had floated the idea of requiring exchange plans to submit their networks for review, said they would instead focus on specific types of doctors, like cancer specialists, to make sure people have adequate access to care. Visit the New York Times for the article.



Master 3D printers to grow replacement body parts: breast, bone and cartilage

QUT and three of the world's leading research universities in the 3D printing of replacement body parts have joined forces to offer the world's first international masters in biofabrication whereby graduates will hold a masters degree from an Australian university in addition to a masters degree from a European university.

Biofabrication is a process by which scientists can regrow most types of human tissue using 3D printers. QUT's biofabrication research is well-advanced in printing 3D custom-made scaffolds using bio-ink infused with the patient's stem cells to enable the body to grow a new breast after mastectomy.

All world leaders in biofabrication research, the four universities offering the two-year, two-degree masters program are: QUT and the University of Wollongong in Australia, the University Medical Center Utrecht in the Netherlands and the University of Würzburg in Germany.

QUT Institute of Health and Biomedical Innovation's Professor Dietmar W. Hutmacher leads QUT's biofabrication research. "This degree is a vital step in ensuring Australia is a high-value, high-tech manufacturer in the future," Professor Hutmacher said.

"Graduates will be at the forefront of an industry that will always be in high demand given the ageing of populations around the world and which cannot be easily replicated by any other country.

"The universities will each admit 10 students to the degree who will graduate with a multidisciplinary outlook and expertise which would be welcome anywhere in the world."

He said the Australian students would spend nine to 12 months studying at one of the European universities and the European students would also study at one of the Australian universities.

"Biofabrication can be used to repair cartilage, bone, muscles, nerves and skin that have been damaged by trauma, disease or cancer. It is even predicted that entire organs will be biofabricated within a few decades. At QUT, we are already researching the use of such scaffolds to regrow breast tissue in women who've had surgery for breast cancer."

He said this new field of medicine employed the 3D printers to build up fine, intricate layers of different types of biomaterials into individualized structures which dissolve into the body as the new tissue grows. These tailor-made structures are then implanted into the body to act as a scaffold on which the new tissue can grow.

Professor Hutmacher said although it would be up to five years until the technique could be used to regrow a breast, biofabrication was already successfully being used to repair broken and missing bone.

"For example, patients with a piece of skull missing have already been successfully fitted with a 3D-printed scaffold custom-made to fit the hole. The scaffolds contain the patient's bone cells and growth enhancers so that the skull grows over and the scaffold is absorbed into the new bone."

Visit QUT for information.



FDA allows marketing of first prosthetic arm that translates signals from person’s muscles to perform complex tasks

The U.S. Food and Drug Administration (FDA) allowed marketing of the DEKA Arm System, the first prosthetic arm that can perform multiple, simultaneous powered movements controlled by electrical signals from electromyogram (EMG) electrodes.

EMG electrodes detect electrical activity caused by the contraction of muscles close to where the prosthesis is attached. The electrodes send the electrical signals to a computer processor in the prosthesis that translates them to a specific movement or movements.

The EMG electrodes in the DEKA Arm System convert electrical signals into up to 10 powered movements, and it is the same shape and weight as an adult arm. In addition to the EMG electrodes, the DEKA Arm System contains a combination of mechanisms including switches, movement sensors, and force sensors that cause the prosthesis to move.

The FDA reviewed clinical information relating to the device, including a 4-site Department of Veterans Affairs study in which 36 DEKA Arm System study participants provided data on how the arm performed in common household and self-care tasks. The study found that approximately 90 percent of study participants were able to perform activities with the DEKA Arm System that they were not able to perform with their current prosthesis, such as using keys and locks, preparing food, feeding oneself, using zippers, and brushing and combing hair.

The DEKA Arm System can be configured for people with limb loss occurring at the shoulder joint, mid-upper arm, or mid-lower arm. It cannot be configured for limb loss at the elbow or wrist joint.

The DEKA Arm System is manufactured by DEKA Integrated Solutions in Manchester, NH.

Visit the FDA for the release.



Disease rides the dogs of war as Polio, Measles, Typhoid capitalize on chaos

Saudi Arabia is one of a handful of countries that require visitors from Pakistan to be vaccinated against polio. Now Pakistan is preparing to inoculate all travelers to meet new World Health Organization requirements aimed at curbing a global resurgence of the crippling virus.

The WHO declared polio a global health emergency, less than two years after the virus was driven to the brink of extinction. A ban on vaccinations by a Taliban leader in retaliation for U.S. drone strikes, and attacks on healthcare workers after a fake vaccination campaign was used to hunt down Osama bin Laden, have hampered eradication efforts and enabled polio to spread inside Pakistan and to Egypt, Israel, Syria and Iraq.

Pakistan’s army will start accompanying polio vaccinators said Major Waheed Akhtar Bukhari, a spokesman for the military in Karachi. At least 168 people were vaccinated at a new counter in Islamabad’s main hospital after the WHO declaration.

Pakistan isn’t alone in its struggle against a disease that piggybacks on conflict. Somalia last year had 194 polio cases, mostly in areas controlled by Islamist militants, six years after being declared free of the disease. Syria, whose last case was in 1999, reported 35 last year as the health system crumbles and vaccination rates plunge amid its three-year civil war.

Polio is not the only disease to rear its head in countries suffering from war or disaster. Cases of typhoid; hepatitis A; and cutaneous leishmaniasis, a disfiguring skin infection, have been reported in Syria, and at least 930 cases of measles, after vaccination rates fell to 65 percent from 90 percent before the war, according to the WHO.

Measles is also spreading in the Central African Republic, which has been gripped by violence since mainly-Muslim members of the disbanded Seleka militia seized power in March 2013. Medecins Sans Frontieres this week suspended all but emergency care in the country after three of its staff were killed in an attack on a hospital.

By 2012, an $11.8 billion eradication campaign backed by Rotary International and the Bill & Melinda Gates Foundation had polio cornered in just three countries: Pakistan, Afghanistan and Nigeria. Cases fell to a record low of 223 that year. The virus resurged last year, with 416 cases reported in eight countries, according to the WHO. So far this year, 74 cases have been reported globally, compared with 26 in the same period last year. Of those, 59 were in Pakistan, including 36 in North Waziristan, a Taliban-dominated tribal region along the country’s border with Afghanistan.

Cases in Afghanistan, Syria and Iraq have all been linked to Pakistan, and virus detected in sewage in Israel was a match for the strain circulating in Pakistan, according to the WHO.

Vaccination efforts have also been hampered by rumors the inoculations cause infertility and after the U.S. Central Intelligence Agency used a fake vaccination program to help hunt down bin Laden. As many as 60 polio vaccinators have been killed in Pakistan since December 2012, said Aziz Memon, chairman of Rotary International in the country, which has been active in polio eradication programs there.

Health officials at the Pakistan Institute of Medical Sciences hospital in Islamabad have ordered 5,000 extra doses of the vaccine in anticipation of increased demand at the new counter opened the day after the WHO’s declaration, said Javed Akram, the institute’s head.

Pakistan already had vaccination booths at airports in six cities for travelers to India and Georgia, whose governments require Pakistanis to be vaccinated for polio before they travel, said Anwar ul Haque, a health officer at the international airport in Karachi, Pakistan’s biggest city. Haque said he’s now waiting for orders from the government to implement the WHO’s recommendations.

Saudi Arabia has for years vaccinated visitors from Pakistan upon their arrival, such as those making the annual Hajj pilgrimage to Mecca. There are also some vaccination booths at checkpoints along the country’s border with Afghanistan, according to a government spokesman. Visit Bloomberg for the article.



D.C. hospital reports high rate of black women seeking treatment for advanced breast cancer

Cancer specialists at MedStar Washington Hospital Center are trying to find out why African American women are showing up for treatment with advanced breast cancer at rates that are almost double the national average. Of 1,764 women who went to the hospital for breast cancer treatment from 2006 to 2011, 311 of them, or about 18 percent, had stage 3 or stage 4 breast cancers. Nationwide, 10.5 percent of all breast cancer cases are stage 3 or stage 4, according to National Cancer Institute data.

“We don’t know why we are having all these cases with advanced cancer,” said Elmer E. Huerta, director of the cancer-prevention program at the hospital.

Of the 311 with advanced breast cancer, 169, or 54 percent, were women who lived in the District, and most of them were black. And of those, 68 women, or 40 percent, were residents of Ward 5, where the hospital is located. Ward 5 is mostly in Northeast Washington and includes the neighborhoods of Brentwood, Brookland and Fort Lincoln.

Officials did not have ward breakdowns for the other cases. Ward 5 has the highest breast cancer mortality rate of the city’s eight wards, according to the D.C. Cancer Consortium, a nonprofit organization.

Initially, hospital researchers suspected that lack of access to healthcare might be one reason for the higher rates of advanced cancer; it is a reason the District has one of the country’s highest cancer mortality rates. But to their surprise, hospital officials found that 97 percent of the Ward 5 patients with advanced breast cancer were African American women with insurance coverage.

Hospital officials don’t know why that is happening. One possible reason is fear, Huerta said. But another explanation may be that many women are confused about the importance of mammograms because of conflicting studies about their benefits and risks, he said.

The hospital has received a $100,000 grant from the Avon Foundation to begin a community outreach program to educate women in Ward 5 about mammograms. The hospital plans to hire a breast health educator from the community to visit beauty parlors and other locations to increase awareness of screening, diagnostic and treatment services. Visit the Washington Post for the article.



Study: Recycled blood better than donated blood for transfusions

During some surgeries, operating room personnel try to capture as much blood as possible and return the red blood cells to your system, instead of, or in addition to, donated blood from a blood bank. They find that patients have better outcomes when transfused with their own blood.

A Johns Hopkins University study, published in the June issue of the journal Anesthesia and Analgesia, explains one reason for that. As banked blood sits on shelves for as long as 42 days, the membranes of red blood cells become less able to change shape and squeeze through the smallest capillaries to deliver critical oxygen to tissues.

"The smallest capillaries are five microns in diameter. Red blood cells are seven microns," said Steven Frank, an associate professor in the Department of Anesthesiology at the Johns Hopkins School of Medicine, who led the research. In addition to its weakened ability to deliver oxygen, the red blood cells can sometimes plug those capillaries, he said.

The irony is that blood banks sometimes face shortages of donated blood, and red blood cell salvaging, as it is sometimes known, is cheaper than using banked blood. Banked blood — whether obtained from the Red Cross, a practice followed by smaller hospitals, or banked at major facilities such as Johns Hopkins — costs about $240 per unit, Frank said. Recycled blood costs about $120 for the plastic tubing and other equipment needed to salvage the first unit, but nothing more once the equipment is set up in an operating room and a person is brought in to run it.

Smaller hospitals may not have the equipment or personnel for such salvaging but larger ones certainly do, Frank said. The technique, which can recapture 50 percent to 75 percent or more of a patient's blood, can be used during heart surgery, vascular surgery, joint replacements, transplants, some Caesarean sections and even trauma surgery, he said.

Recycling a patient's blood became popular in the 1980s, when the risk of HIV in donated blood was higher. But now banked blood is considered so safe that getting HIV or hepatitis from it carries the same risk as being struck by lightning or killed in an airplane crash, Frank said.

Five large studies have shown that the amount of blood needed doesn't affect the fresh versus stored equation either, Frank said. In all of those studies, people receiving fresh blood were less likely, or no more likely, to suffer heart attacks, strokes, death or infections after surgery, he said. (The Washington Post) Visit St. Louis Post-Dispatch for the article.



Patient's immune system harnessed to attack cancer

In a strategy that combines two of the hottest ideas in cancer research, scientists at the National Institutes of Health said they successfully attacked a woman's disease by using her immune system to home in on genetic mutations unique to her tumors.

The findings, published by the journal Science, come from just one patient—a 45-year-old woman in Montana. But researchers said her case, in which she received billions of immune cells specially grown to target her tumors, amounts to evidence the technique may be a way to treat many common cancers now considered difficult to target with the immune system.

So-called immunotherapy has so far shown the most promise in relatively rare cancers such as melanoma and kidney cancers. This new approach "represents the blueprint for making immunotherapy available to treat common cancers," said Steven A. Rosenberg, chief of the Surgery Branch at the National Cancer Institute's Center for Cancer Research and senior author of the study. "We've figured out a way to target what is absolutely unique on each cancer. That is the mutations that make the cancer a cancer."

But the method devised by Dr. Rosenberg and his colleagues is complex. It involves sophisticated genetic sequencing and analysis and aggressive treatments to destroy a patient's immune system before replacing it using cell therapy with one that recognizes the cancer.

Oncology is being transformed on two major fronts: on the one hand, new drugs that target specific genetic mutations responsible for tumor growth, and on the other hand, immunotherapies. But for the most part, these strategies have been moving forward on parallel tracks.

The new approach combines both. It is based on long-standing observations that immune-system cells called T-cells often recognize tumors and travel to their locations in the body, but aren't plentiful or strong enough to kill the cancer cells. In the Science paper, researchers said they found a way to create enough useful T-cells to marshal a better attack.

The patient is a paramedic and mother of six including two stepchildren. She was diagnosed with bile duct cancer in 2009. She enrolled in Dr. Rosenberg's research in March 2012 after surgery and regimens of chemotherapy had failed to control the disease.

Though her tumors are rare, Dr. Rosenberg said they are representative of colon, breast and other solid tumors of the type responsible for more than 80% of cancer deaths.

The researchers obtained a biopsy of one of her tumors, and in a process that took several weeks, sequenced its DNA and found a match between a mutation and certain T-cells from her body that reacted to the mutation. They grew huge numbers of the T-cells to serve as her treatment. After she had chemotherapy to knock out her immune system, she was given an infusion that included 42 billion T-cells, about 10 billion of those targeted to the mutation.

For six months, her tumors shrank, the study found, and then stabilized for another six months before they started to grow again. Last October, she underwent a second treatment based on a biopsy from a different tumor, this time with 126 billion cells, 95% of them matched to the mutation. Her cancer responded almost immediately, researchers said.  She isn't considered cured. But she just had a six-month checkup, and the tumors had shrunk considerably. Visit the Wall Street Journal for the article.



May 13, 2014   Download print version

Man visiting Orlando is second MERS virus case in the U.S.

FDA discourages uterine procedure for cancer threat

United States: US Appeals Court upholds FTC hospital merger decision

Celebrate National Nurses Week

Medicare pays billions for 'low-value care'

Boston Scientific subpoenaed over defibrillator devices

Remotely monitoring heart patients with implanted defibrillators lowers risk of death

Bringing the UDI Regulation & the Global UDI Database (GUDID) to life

Man visiting Orlando is second MERS virus case in the U.S.

A growing global threat of the potentially deadly MERS virus has spread to Orlando with the case of a 44-year-old man visiting from Saudi Arabia, health officials reported Monday.

He becomes the second U.S. patient with the respiratory illness, which has infected more than 500 people worldwide and killed 114.

MERS — or Middle East Respiratory Syndrome — is considered serious because of its fatality rate of about 30 percent and because there is no vaccine or specific antiviral treatment. But health officials emphasize that it is spread only through close contact, including touching, coughing or contaminated fluids. About one-fifth of those infected are healthcare workers, as is the Orlando patient.

The man, who works in a Saudi Arabia hospital, arrived in Orlando on May 1 but did not seek treatment until May 8, when he went to the Dr. P. Phillips emergency room. A trio of laboratory tests confirmed MERS.

"The patient is in good condition and is improving," said Dr. Antonio Crespo, an infectious-disease specialist and chief quality officer for the hospital, part of Orlando Health. "We are taking every precaution, but believe the risk of transmission from this patient is very low since his symptoms were mild and he was not coughing when he arrived at the hospital."

Symptoms of the virus include congestion, cough, fever over 100.4 degrees, shortness of breath, pneumonia, body aches and diarrhea.

The man's family members and hospital workers who had contact with him are being monitored for signs of the disease. Following protocol from the federal Centers for Disease Control and Prevention, the exposed hospital workers are being placed on temporary paid leave and asked to stay home.

CDC officials said Monday they expected additional MERS cases in the United States because of a recent spike in cases in the Arabian Peninsula, primarily in Saudi Arabia. The virus was first identified there in 2012.

Florida Department of Health officials in Orlando emphasized that the patient — whose name is not being released for privacy reasons — did not visit local theme parks or other tourist spots. In the current case, the patient left Saudi Arabia April 30 and began experiencing muscle aches, health officials said. He flew first to London, then to Boston and Atlanta before arriving in Orlando on May 1.

By then, he had a slight fever, and he later developed diarrhea and ultimately a cough. According to CDC officials, more than 500 passengers on U.S. segments of those flights were exposed and are being notified. So far, no one exposed to the man has reported symptoms, which typically take five to 14 days to develop.

Dr. Kevin Sherin, director of the state Health Department for Orange County, said only those who have had some contact with an infected individual are at risk.

The patient was placed in isolation once MERS was suspected. He remains there in stable condition and is expected to make a full recovery, Crespo said. The virus was confirmed through a series of laboratory tests on blood and other bodily fluids.

So far most cases have been transmitted through caring for or living with an infected person. The fatality rate is expected to drop as more patients with mild symptoms or even no symptoms are identified through laboratory testing.

The first confirmed case of MERS in the United States was reported in a traveler from Riyadh, Saudi Arabia. That person had traveled to London, then on to Chicago and Indiana before being hospitalized in Indiana April 28. The patient is now recovering, the CDC reported. Visit the Orlando Sentinel for the story.



FDA discourages uterine procedure for cancer threat

The U.S. Food and Drug Administration is warning doctors against using a popular method to remove the uterus or uterine fibroids without open surgery because it can spread cancer cells.

The technique, called laparoscopic power morcellation, involves shaving down the tissue or growths into pieces that can be removed through the tiny holes used to insert the equipment. The agency found that 1 in 350 women who get a hysterectomy or have their fibroids removed have a type of cancer that can spread beyond the uterus with the approach.

Distribution of cancerous cells in the abdomen and pelvis can significantly worsen the woman’s chances of long-term survival, the agency said in a safety communication. Companies that make equipment for the procedure, including Johnson & Johnson, were urged to ensure they give accurate information about the risks on their product materials, the FDA said.

“The FDA’s primary concern as we consider the continued use of these devices is the safety and well-being of patients,” said William Maisel, deputy director for science and chief scientist at the FDA’s Center for Devices and Radiological Health. “There is no reliable way to determine if a uterine fibroid is cancerous prior to removal.”

The FDA’s Obstetrics and Gynecological Medical Devices Panel will meet to discuss the risks and other information on to the procedure, the agency said.

Along with Johnson & Johnson’s Ethicon unit, the equipment for the process is manufactured by closely-held companies including Karl Storz GmbH & Co., Richard Wolf Medical Instruments Corp., LiNA Medical and Blue Endo. While Intuitive Surgical Inc.’s da Vinci robot doesn’t use morcellation, it deserves mention since it is being used more often and the uterus must be broken into smaller pieces to be removed from the abdomen during the procedure, according to Hooman Noorchashm, a Boston-based cardiothoracic surgeon.

Noorchashm filed a petition on Change.org to stop use of morcellation after it was performed on his wife, also a Boston-based doctor. She was subsequently diagnosed with cancer. Visit Bloomberg for the article.



United States: US Appeals Court upholds FTC hospital merger decision

Recently the US Court of Appeals for the Sixth Circuit upheld a Federal Trade Commission (FTC) decision prohibiting the largest hospital in the Toledo, OH, area from merging with a competing hospital. The decision continues the FTC's recent string of successful, very focused attacks on a limited number of hospital-related mergers. The case is notable for a number of reasons, including:

1. the court's analysis of what presumptively proves an illegal merger;

2 .the extent to which the court referred to the parties' internal documents and employee testimony as support for the FTC decision;

3. the court's noting the failure of the hospital, in the face of such evidence, to offer any justification based on better quality, better access, lower costs or some combination of these; and

4. the court's rejection of a "weakened competitor" or "flailing firm" defense, because the evidence indicated a profitable competitor.

The case involved a proposed merger between two of the four hospital systems in Lucas County, OH, (whose county center is Toledo): ProMedica, the dominant hospital provider, and St. Luke's, an independent community hospital. Post-merger, ProMedica was left with a market share above 50 percent in one relevant product market (the so-called primary and secondary services) and above 80 percent in another (for obstetrical [OB] services).

An administrative law judge, and later the full FTC, found that the merger would adversely affect competition in violation of Section 7 of the Clayton Act. The FTC found that the merger increased ProMedica's market share far above the threshold required to create a presumption that the merger would lessen competition. It also found that a large body of other evidence—documents and testimony from the merging parties themselves, testimony from the managed care organizations (MCOs) and expert testimony—confirmed that the merger would have a substantial anticompetitive effect.

The Sixth Circuit denied ProMedica's petition for review, concluding that the FTC's "analysis of this merger was comprehensive, carefully reasoned and supported by substantial evidence in the record." Based on the increases in market share in the relevant markets, and concentration in those markets post-merger (as measured by the Herfindahl-Hirschman Index, or "HHI"), the FTC found that the merger to be "presumptively illegal."

Visit Mondaq for the full report.



Celebrate National Nurses Week

Leaders of national nursing organizations meet with HHS Secretary Kathleen Sebelius, HRSA Administrator Mary K. Wakefield, PhD, RN and RADM Sylvia Trent-Adams, PhD, RN and chief nurse officer, U.S. Public Health Service on May 9, 2014 in Washington, DC.

Nurses Leading the Way in Primary Care are the first line of defense in the prevention of illness and injury. They champion and promote the health of our nation.

National Nurses Week begins each year on May 6th and ends on May 12th, the Birthday of Florence Nightingale, who is widely recognized as the founder of modern nursing. This year we recognize nurses as healthcare leaders and trusted advisers on health issues, thank nurses for their critical role in implementing the Health Insurance Marketplace and Medicaid expansion, and look ahead to how nurses will continue to improve patient outcomes in the ever-evolving field of primary care. Visit HRSA for the release.



Medicare pays billions for 'low-value care'

The Medicare system spent at least $1.9 billion in 2009 and probably much more on "low-value" procedures and tests, such as cancer screening in patients with end-stage renal disease in patients 75 and older, researchers said. Depending on whether relatively sensitive versus specific measures of low-value care were used, the percentage of overall Medicare Parts A and B spending that went to such services ranged from 0.6% to 2.7%, according to J. Michael McWilliams, MD, PhD, of Harvard Medical School, and colleagues.

Although these figures represented "modest proportions" of the total Medicare budget, the researchers wrote online in JAMA Internal Medicine, from one-quarter to more than 40% of all beneficiaries received at least one of the 26 types of low-value service during the 1-year study period.

Because the 26 measures are probably not an exhaustive list of all tests, procedures, and treatments that are unnecessary in older individuals, overuse of such services may be substantially greater, McWilliams and colleagues suggested.

McWilliams and colleagues selected the 26 low-value services after scouring the lists maintained by the American Board of Internal Medicine's Choosing Wisely project, along with services receiving "D" recommendations from the U.S. Preventive Services Task Force, "do not do" recommendations by the U.K.'s National Institute for Health and Care Excellence, and those identified as unnecessary in Canadian Agency for Drugs and Technologies assessments. The authors also looked for others named as unnecessary in the Medicare population in peer-reviewed, published papers.

Among the low-value tests identified by the authors:

·         Four were cancer screens. In addition to screening conducted in elderly dialysis patients, these included PSA testing in older men with no prostate cancer history, cervical cancer screening in older women, and colorectal cancer screening in older patients of both sexes.

·         Four other types of diagnostic and preventive screening were included, such as bone mineral density measurement within 2 years of a previous test.

·         Four kinds of preoperative testing were part of the list, such as chest x-rays within 30 days of a low- to moderate-risk noncardiothoracic surgery.

·         Seven imaging tests were on the list, ranging from sinus CT scans for uncomplicated rhinosinusitis to brain MRI scans in patients identified with syncope as the primary diagnosis.

McWilliams and colleagues rounded off the list with five cardiovascular procedures, such as carotid endarterectomy in asymptomatic patients, and two other types of procedures, including certain surgeries for knee osteoarthritis and osteoporotic spine fractures.

"Inherent in most of our claims-based measures of low-value care was a trade-off between sensitivity (greater capture of inappropriate use) and specificity (less misclassification of appropriate use as inappropriate," the authors noted. "For example, limiting the colorectal cancer screening measure to beneficiaries older than 85 years instead of older than 75 years decreases its sensitivity (fewer low-value instances detected) but increases its specificity (smaller proportion of appropriate services classified as inappropriate)."

Therefore, they defined most of these tests in two ways -- one to achieve high sensitivity, and the other to be relatively specific. For example, the sensitive measure of cancer screening in dialysis patients took in any screening test performed in the study sample for breast, cervical, colon, or prostate cancer; the specific measure excluded those performed in patients younger than 75.

Similarly, any homocysteine test was considered low-value in the sensitive analysis, whereas the specific measure included only those tests performed in patients whose records contained no diagnosis of folate or B12 deficiency and no prior claims for folate or B12 testing.

In terms of the number of beneficiaries receiving services deemed low-value, those involving cancer screening and imaging were the most common, accounting for about three-quarters of all claims for low-value services. This was true irrespective of whether sensitive or specific measures were used.

In terms of spending, however, cardiovascular testing and procedures accounted for the vast majority when sensitive measures were applied. McWilliams and colleagues estimated that 1.9% of all Medicare spending was for cardiovascular services that, according to the sensitive definitions, were low-value.

"Our study findings illustrate the potential utility and limitations of a direct approach to detect wasteful care," they wrote. "Despite their imperfections, claims-based measures of low-value care could be useful for tracking overuse and evaluating programs to reduce it. However, many direct claims-based measures of overuse may be insufficiently accurate to support targeted coverage or payment policies that have a meaningful effect on use without resulting in unintended consequences."

Visit MedPageToday for the study.



Boston Scientific subpoenaed over defibrillator devices

Medical device maker Boston Scientific Corp. said it received a subpoena this week from the Department of Health and Human Services, seeking information about the performance of some of its implanted defibrillators.

The subpoena, received May 5, requested information related to the 2008 launch of two brands of implanted cardiac defibrillators, or ICDs, made by Boston Scientific, the company said in a regulatory filing Thursday. The subpoena also sought information related to the performance of the devices between 2007 and 2009, and the operation of a "Physician Guided Learning Program," the filing said. The defibrillators are sold under the brand names Cognis and Teligen.

The subpoena was issued by HHS's Office of the Inspector General, which is responsible for identifying fraud and waste in government health programs such as Medicare and Medicaid, according to the agency's website. Boston Scientific said it is cooperating with the request.

Boston Scientific competes against companies including Medtronic Inc. and St. Jude Medical Inc. in selling heart devices. The industry has come under increased scrutiny in recent years for allegedly using kickbacks and other illegal incentives to gain market share and increase the use of their devices among physicians.

Earlier this week, St. Jude Medical said in a regulatory filing that it received a civil investigative demand from the U.S. Department of Justice in April related to its cardiac devices. The Justice Department said it was investigating St. Jude for allegedly paying inducements to healthcare providers in exchange for implanting St. Jude's devices, the company said in the filing. St. Jude said it is working with the Justice Department in responding to the civil investigative demand.

Medtronic paid $23.5 million in 2011 to settle Justice Department allegations that it paid illegal kickbacks to physicians to induce them to implant Medtronic pacemakers and defibrillators.

In October 2013, Boston Scientific agreed to pay $30 million to settle Department of Justice allegations that its subsidiary Guidant Corp. had knowingly sold defective defibrillators between 2002 and 2005 that were implanted in Medicare patients. Boston Scientific acquired Guidant in 2006 in a deal valued at around $27 billion. Visit the Wall Street Journal for the article.



Remotely monitoring heart patients with implanted defibrillators lowers risk of death

Patients with implantable cardioverter defibrillators (ICD) have significantly lower risk of death and re-hospitalization if they are followed through an automatic, wireless remote monitoring system, a Yale clinical study has found.

ICDs are used to treat patients at high risk of sudden cardiac death. Remote patient monitoring can help physicians keep an eye on patients once they are home by wirelessly communicating with the implanted device to make sure it is functioning properly and that the patient is doing well. But despite the nearly universal availability of wireless technology in the United States, less than half of eligible patients are monitored in this way.

The reasons why this technology is underutilized are not known, but one potential reason is the relative absence of evidence of the impact of remote monitoring on patient outcomes. To address this gap in knowledge, Yale researchers partnered with the American College of Cardiology and Boston Scientific, a manufacturer of ICDs, to examine the outomes of nearly 38,000 ICD patients. The study found that patients using remote monitoring were 33% less likely to die and 20% less likely to be re-hospitalized in the three years following device implantation. Visit Yale for the study.



Bringing the UDI Regulation & the Global UDI Database (GUDID) to life

HPN is helping to sponsor a UDI Implementation Workshop May 20-22, 2014 in Baltimore, MD. The UDI Implementation Workshop is for Class III Medical Device Manufacturers who are in immediate need of information and guidance to meet the September 24, 2014 compliance deadline, or those that need to jumpstart their UDI adoption effort!

The FDA UDI Team will be at the meeting for a roll-up-your sleeves / deep-dive Workshop covering all components of the UDI Regulation and the GUDID Guidance. This Workshop is strictly focused on critical information exchange, expanded interaction, and heightened networking designed to deliver immediate and actual results in your UDI implementation initiative.

Healthcare Purchasing News subscribers receive a $100 Discount. Seating will be limited and will be assigned on a first-come, first-served basis. Go to http://udiconference.com/register.html and enter “HPN” in the promotional code field line during online registration to receive $100 off of the rate. Register by April 30th for the best rate.

For the complete Workshop agenda and the most up-to-date information, please visit www.UDIconference.com.

For information on the FDA UDI Regulation, visit www.FDA.gov/UDI.



May 12, 2014   Download print version

Hospital wastewater releases antibiotic-resistant E. coli

Fixing HealthCare.gov would be top priority, HHS nominee Sylvia Mathews Burwell says

Hospital CEOs predict more states will expand Medicaid

VA hospitals to undergo nationwide audit

Deadly illness in Nicaragua baffles experts

Georgia hospitals a focus of project to reduce maternal deaths

Hospital pricing initiative dead with new agreement

HPN invites you to experience the Critical Care Exposition in Denver, May 20-22, 2014

Hospital wastewater releases antibiotic-resistant E. coli

Hospital wastewater is a potent reservoir of antibiotic-resistant organisms, according to findings from a new study published online in Clinical Infectious Diseases. The problem may be an important factor fueling the spread of extended-spectrum beta-lactamase-producing Escherichia coli (ESBLEC).

Caroline Bréchet, PharmD, from the Service d’Hygiène Hospitalière, Chrono-environnement, Centre Hospitalier Régional Universitaire, Université de Franche-Comté, Besançon, France, and colleagues note that ESBLEC is common in both hospital and community settings. For example, one study found that 6% of healthy adults in Paris carried the bacteria in 2011.

That being the case, ESBLEC enters wastewater, eventually being routed through treatment plants. However, there are few data quantifying the levels of ESBLEC that enter or leave treatment plants. Therefore, the researchers analyzed wastewater samples drawn from 11 sites throughout the wastewater network of Besançon, a city of a quarter million residents.

The samples were collected weekly during a 10-week period in 2011. They included discharge from 2 hospitals (containing only effluent and rainwater), wastewater from sites unrelated to the hospital, and wastewater collected before and after it went through the municipal wastewater treatment plant.

The authors also checked samples of digested sludge, derived from the wastewater, that was used to fertilize farm land. They note, however, that the wastewater network studied contains no effluent from livestock farming.

The overall concentration of E. coli was higher in urban wastewater than in hospital wastewater. However, the concentration of ESBLEC was 30 times higher in hospital wastewater compared with in the urban samples. The authors note that ESBLEC was found in nearly all the samples and that ESBLEC accounted for about 0.3% of the total E. coli found in untreated water headed to the plant for treatment.

Treatment at the plant did eliminate most of the E. coli and ESBLEC, but not all. After treatment, 2% of the E. coli remained, and 6% of ESBLEC survived treatment. In other words, after treatment, ESBLEC accounted for 0.6% of the remaining E. coli.

In addition, the concentration of ESBLEC in sludge destined for farmland was also high.

When the investigators tested isolates for antibiotic susceptibility, they found that the ESBLEC in the hospital wastewater were more resistant to antibiotics than those in the urban wastewater, particularly to ceftazidime (P < .001) and ofloxacin (P < .001).

"Our results suggest that there is a need for improvements in the monitoring of antibiotic-resistant microorganisms of human origin in effluent," they conclude.

Visit Medscape for the article.



Fixing HealthCare.gov would be top priority, HHS nominee Sylvia Mathews Burwell says

Sylvia Mathews Burwell emerged mostly unscathed Thursday from the first of two hearings on her nomination to head the Health and Human Services Department, even though her chief role will be to continue implementing the president’s controversial healthcare law.

Burwell, whose confirmation is likely, did not get much of a grilling and even received strong vows of support from two influential Republicans: Sen. John McCain (AZ), who introduced her warmly to the committee, and Sen. Richard Burr (NC), who promised to vote to confirm her at her next hearing before the Senate Finance Committee.

But the wide-ranging hearing also touched on some of the more contentious aspects of the law that she would be mired in: the technical problems that continue to plague the federal health insurance Web site, the unfinished job of expanding Medicaid and the president’s broken promise that people who liked their old plans could keep them.

Burwell also would inherit an agency that underwent major turmoil because of the rocky rollout of the healthcare law last year.

The gentle treatment underscored the broad support Burwell enjoys in her current role as head of the Office of Management and Budget, where she is viewed as a competent leader. It marked a contrast with HHS Secretary Kathleen Sebelius, who clashed often with Republicans prior to announcing last month that she would resign.

Because of a change in Senate rules last year, Burwell only needs 51 votes to be confirmed, a hurdle she could clear without the support of any Republicans. Still, Burwell steered a cautious path at the Thursday hearing, emphasizing her collaborative and leadership credentials and detailing her management philosophies, rather than straying into controversial territory.

Burwell called the technical problems that initially plagued the Web site “unacceptable.” But she said the Affordable Care Act is “making a difference in the lives of our families and our communities while strengthening the economy,” and said addressing the problems that still plague HealthCare.gov would be a top priority. Visit Washington Post for the article.



Hospital CEOs predict more states will expand Medicaid

Executives with some of the nation’s largest hospital companies predict that Medicaid expansion is on the horizon for more states, including Tennessee. Three for-profit hospital giants based in Middle Tennessee — HCA, Community Health Systems and LifePoint Hospitals — all reported earnings recently, and all were positive about the impact of health care reform on first-quarter earnings, although HCA was the most cautiously optimistic of the three.

Executives at LifePoint and CHS, which both reported a notable positive effect from Medicaid expansion, predict more states will follow suit. Though these companies are based in Tennessee, they have facilities across the country, and they say an increase in insured customers at hospitals anywhere could help their bottom lines.

“Seven of our 20 states had expanded Medicaid,” LifePoint CFO Leif Murphy said in the company’s recent earnings call. “(In the remaining states), we are working hard ... to help foster a better understanding of participation, and we believe that other states will ultimately expand coverage.”

CHS was also bullish on Medicaid expansion. “Three states of ours are trying to expand Medicaid,” said CFO Larry Cash on the recent conference call. “Hopefully, we’ll get that done.”

CHS CEO Wayne Smith connected the potential for Medicaid expansion with political elections. “Most Republicans, in my understanding, are concerned about the tea party knocking them off in this early (in the 2014 mid-term elections).” But after that period is over, he added, states including Pennsylvania, Missouri and Utah could potentially expand the program.

“And then, I think, as this continues to develop and people begin to get an understanding of what it’s doing for the uninsured population, not only in terms of coverage but in terms of improving their health, — [it’s] hard to improve your health if you don’t have access to healthcare. I think you’ll see those states come around.”

Visit the Tennessean for the story.



VA hospitals to undergo nationwide audit

A House committee voted Thursday to subpoena records relating to a waiting list at the Phoenix veterans hospital, and officials said Veterans Affairs Secretary Eric Shinseki had ordered a nationwide audit of access to care that the agency provides.

Meanwhile, Shinseki brushed aside calls for his resignation and got an unexpected political lifeline from House Speaker John Boehner following reports that 40 patients died because of delayed treatment at an agency hospital.

The American Legion and some in Congress have called for Shinseki's ouster following allegations of patient deaths at the Phoenix VA hospital due to delays in care and of a secret list the hospital kept of patients waiting for appointments to hide the delays.

The House Veterans Affairs Committee voted unanimously to subpoena all emails and other records in which Shinseki and other VA officials may have discussed destruction of what the committee called "an alternate or interim waitlist" for veterans seeking care in Phoenix.

A top VA official had told congressional staff last month that the "secret list" referred to in news reports may have been an "interim list" created by the hospital. And the committee had asked the VA on May 1 to answer why it was created, when it was destroyed, who authorized destruction and under what authority.

Shinseki answered in a letter Wednesday that VA employees used "transitory or interim notes ... for reference purposes" as they were moving information to the new electronic waitlist system. Regulations of the National Archives and Records Administration require that such notes be destroyed when they are no longer needed for reference, the VA says.

Dissatisfied with that response, the committee subpoenaed all documents relating to the destruction and gave Shinseki until 9 a.m. May 19 to produce them. The VA said in a statement that it will review the subpoena and respond.

Earlier Thursday, Shinseki told CBS that he sent inspectors to Phoenix immediately after he learned of reports about the deaths. "I take every one of these incidents and allegations seriously, and we're going to go and investigate," he said.

The VA also announced Thursday that Shinseki in recent days had ordered the Veterans Health Administration to do a "a face-to-face" audit over the next several weeks at all clinics at VA medical centers to make sure employees understand VA's policy and the need for continued integrity in managing patient access to care.

And at a Capitol Hill news conference, Boehner, R-Ohio, said: "I'm not ready to join the chorus of people calling on him to step down." He added that there is a "systemic management issue throughout the VA that needs to be addressed."

Shinseki announced last week that three officials at the Phoenix facility have been placed on leave while the VA inspector general investigates.

The Department of Veterans Affairs has long had a seemingly endless backlog and exceedingly long delays for treatment.

White House spokesman Josh Earnest said President Barack Obama has full confidence in Shinseki. He said Shinseki shares the president's passion for living up to the commitment that the U.S. has made to its veterans.

Earnest told reporters traveling with Obama in California that the VA has made tremendous progress in reducing the case backlog. He said while the backlog is moving in the right direction, the White House won't be satisfied until it is eliminated.

The VA has acknowledged that 23 patients have died as a result of delayed care in recent years. The VA's Office of Medical Inspector said clerks at a Fort Collins, CO, clinic were instructed last year on how to falsify appointment records. Other problems have occurred in Pittsburgh, Atlanta and Augusta, GA. Visit the Clarion-Ledger for the story.



Deadly illness in Nicaragua baffles experts

CHICHIGALPA, Nicaragua — During the harvest season, when exhausted workers spend seven days a week cutting sugar cane, the signs of illness were hard to spot at first. It was in the off-season, out on the baseball field, that some residents noticed a change. Base-stealers were lethargic. Pitchers were losing their aim. In the evening, outfielders were burning up as if standing under the scorching sun of the day.

Across Central America, a painful disease that affects the kidneys has killed at least 20,000 people over the past decade and has become the leading cause of deaths in hospitals among men in El Salvador. But the illness, often called chronic kidney disease of unknown causes, or CKDu, is so poorly understood that it still does not have a universally agreed-upon name.

Theories vary drastically, citing a combination of possible factors, including heat stress, chronic dehydration, toxic chemicals, painkillers, sugar consumption and even volcanic ash.

But there is a rare point of consensus, many researchers say: Nicaragua’s sugar cane heartland — in particular Chichigalpa, the town that is home to the country’s largest sugar mill — has been one of the hardest hit places in the world. Cane-cutting fathers and sons in the same family have died, and seemingly healthy young men are quickly wasting away.

The Nicaraguan government, the country’s sugar mills, even the World Bank, which has poured tens of millions of dollars into the sugar industry here, all say that until the mystery of the disease is solved, there is little they can do to prevent it. Now, after years of inconclusive research, the Centers for Disease Control and Prevention is stepping in to help with some of the most ambitious studies of the illness yet. But the sick former sugar cane workers here have little faith that more studies will bring improvements anytime soon. The fact that the research will be funded entirely by the sugar industry is only fueling the distrust.

“I don’t think anybody has clean hands,” said Kristen Genovese, a lawyer who helped sick former workers file a complaint against the World Bank’s lending arm in 2008 for lending $55 million to the sugar mill here, called San Antonio, without looking into the disease or the possibility that it might be connected to the industry.

“The government of Nicaragua has done nothing to help these people,” said Genovese, who was with the Center for International Environmental Law in Washington when she filed the complaint. And the World Bank, she argued, “should have spotted this problem, and didn’t do anything about it, and continued to invest in sugar in the region.”

Before each harvest, workers must take blood or urine tests that measure kidney function to determine whether they will be allowed to return to the fields. In preparation, some ingest concoctions of fresh tamarind juice and linseed oil, avoid the sun and force themselves to rest. Others simply pray.

The complete dependence on the industry, whatever the risks may be, is stark. Glassy-eyed men are convinced that something in the water or the fields made them sick. Yet they are desperate to return to work, borrowing their wives’ and sisters’ identity numbers in a furtive attempt to stay employed. In one neighborhood, even conservative studies show that one in three men have the illness.

Radically different perceptions of the cause have stirred debate over who should cover the enormous costs of treating patients with the disease.

Mario Amador, general manager of Nicaragua’s National Committee of Sugar Producers, one of the groups financing the C.D.C. studies, said the sugar cane business in Nicaragua had quadrupled over the past 10 years into a $500-million-a-year industry, supplying everything from Coca-Cola to rum makers. But he said the annual kidney exams, which he called necessary to avoid putting sick workers at additional risk, had created the false impression that the mills were linked to the disease.

Lawmakers in El Salvador and Sri Lanka, where similar kidney problems have emerged, have moved to ban certain herbicides. But few of the researchers who are focusing on Nicaragua — the country with the highest death rate from the disease, according to the Pan American Health Organization — are willing to say the answer is that simple.

Agricultural chemicals alone, they say, do not explain why the disease has been detected in some Nicaraguan miners at similar rates, why women who grew up on the sugar mill’s grounds have generally been unscathed, or why workers here are affected at much higher rates than people exposed to the same chemicals elsewhere. Perhaps extreme heat, dehydration, the intensity of the labor or other factors play a role, the researchers say.

Residents say they began noticing the sickness shortly after the Nicaraguan government, which had nationalized the sugar industry, returned the mills to private owners in 1992. As the operations at San Antonio rapidly expanded, driven partly by American and European appetites for sugar and a move into ethanol production, families say the cane cutters — many of whom had been born in a hospital on the mill grounds and went to a school there — grew sick in larger numbers.

“CKD is not a common disease in the sugar sector worldwide, so I.F.C. did not look into this issue at appraisal,” said the spokesman, Aaron Rosenberg, based in Washington. The institution has lent more than $100 million to Nicaraguan sugar mills over the past decade.

After the complaint, the mill agreed to provide food and other assistance to widows and sick workers. It also agreed to open its door to a team of outside researchers.

Yet “nature can be very reluctant to give up its secrets,” said Daniel Brooks, a researcher from Boston University, which was selected to investigate the disease by a committee that included mill executives and sick workers. Five years later, Dr. Brooks has as many questions about the disease as answers. His report published in 2012 neither entirely ruled out nor formally endorsed any theory. Now, Dr. Brooks and his team from Boston University will be leading the charge in three C.D.C. Foundation studies, which he believes could have implications far beyond Nicaragua.

“We don’t know if this is the tip of the iceberg yet,” he said. “If this is heat stress and the climate is changing in the direction of getting hotter over time, are we seeing something that will happen much more in the future and maybe extend its geographic range?”

For now his team is more focused on two other areas: whether the disease has a genetic component and its presence in children. Research into work-related risk factors is also planned, but sugar industry funding so far covers only preliminary work. The C.D.C. says that numerous measures are in place to protect the research from undue influence. Some others are suspicious. Visit the New York Times for the article.



Georgia hospitals a focus of project to reduce maternal deaths

ATLANTA -- Twenty-two Georgia hospitals have joined a project to reduce maternal death rates in the United States, a nursing group announced. The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) has launched an initiative to improve the treatment of pregnancy-related complications, and is focusing on birthing hospitals in Georgia and New Jersey.

Georgia ranks 50th among states in maternal deaths. That’s a prime reason why the state was one of the two selected for the project. Gwinnett Medical Center in Lawrenceville was one of four hospitals studied in a care transitions project. Another reason is Georgia’s large number of delivery hospitals, said Lashea Wattie, the Georgia section chair for AWHONN.

The 22 hospitals selected range from such large urban/suburban facilities as Grady Memorial Hospital in downtown Atlanta, Gwinnett Medical Center in suburban Atlanta and Memorial Health University Medical Center in Savannah to such small-town/rural facilities as Stephens County Hospital in Toccoa and Colquitt Regional Medical Center in Moultrie. The goal was to have a variety of hospitals throughout the state, AWHONN said.

The Washington-based organization points out that U.S. women experience a greater risk of maternal death than women in 46 other countries.

The Georgia estimate of 35 maternal deaths per 100,000 live births in 2011 reflected a rise. The estimate was 20.5 for the period from 2001 to 2006. That increase has kept the state “at the bottom of the pile when it comes to maternal mortality,’’ Dr. Seema Csukas, director of the Maternal and Child Health Section for the state Department of Public Health, told GHN in December.

The Georgia General Assembly, citing that ranking, passed legislation earlier this year that requires that Public Health establish a committee to review maternal deaths and to report on their causes.

The nation as a whole has seen its maternal mortality rate rise from 13.3 deaths per 100,000 live births in 2006 to a currently estimated mortality rate of about 21 per 100,000 live births in 2010.

AWHONN’s Postpartum Hemorrhage (PPH) Project has brought together 54 birthing hospitals in Georgia and New Jersey to improve clinical practices. Their kickoff meeting will be held in June, Wattie said, with the 18-month project starting in August.

The first initiative focuses on improving the treatment of obstetric hemorrhage — bleeding too much during childbirth — a leading cause of death during labor and delivery. While two to three women die every day in the U.S. from pregnancy-related complications, more than half of those deaths are preventable. Incidents of obstetric hemorrhage have increased in recent years along with an overuse of induced labor, AWHONN says.

Research suggests that women who have these inductions have a greater risk of postpartum hemorrhage. And African-American women are disproportionately affected by birthing complications, with three to four times more deaths than women of all other racial and ethnic groups, according to AWHONN.

Participating hospitals will work with national experts to identify the best practices for treatment.

The project is supported by a grant from Merck for Mothers, a 10-year, $500 million initiative created by the pharmaceutical giant to improve maternal health in more than 30 countries. Visit the Rome News-Tribune for the article.



Hospital pricing initiative dead with new agreement

A pair of ballot propositions that targeted hospital pricing and CEO pay in California have been dropped as part of an agreement between the California Hospital Association (CHA), some of its member hospitals and the Service Employees International Union-Healthcare Workers West (SEIU-UHW).

SEIU-UHW hosted a Fresno event in February to collect signatures for the Fair Healthcare Pricing Act of 2014, which would have prevented hospitals from charging more than 25 percent above the actual cost of providing patient care.

The other proposition, the Charitable Hospital Executive Compensation Act of 2014, would prohibit nonprofit charitable hospital executives in the state from receiving more than $450,000 in annual compensation.

C. Duane Dauner, CHA president and CEO, held up last night's agreement as "visionary."

"This moves us forward in new and bold ways to improve healthcare in a responsible way," Dauner said in a teleconference with reporters.

The centerpiece of the agreement, which runs through 2017, is the establishment of a $100 million joint advocacy fund to reform the state's medical programs, with a specific goal of increasing reimbursements through Medi-Cal.

Dave Regan, president of SEIU-UHW, said the money would help fund educational, legislative and regulatory fixes to the problem, which could lead up to a possible ballot initiative in 2016.

Not all member hospitals and organizations in the CHA have signed the agreement, though Regan said of his 85,000-90,000 SEIH-UHW members, the "overwhelming majority" of workers in institutions would be covered by the agreement. In addition, the parties have agreed to a code of conduct in their interactions, attempting to add an air of positivity and problem-solving to what has been at times a contentious relationship.

Regan said the code of conduct would remove "lowest-common denominatorism and negativity" from the relationship between union and employer. It wasn't clear how the agreement, which is not being made public, affects ongoing union organization efforts.

SEIU-UHW made quite a splash earlier this year with its propositions, hosting press conferences around the state denouncing hospitals for overcharging patients for services and products. State statistics showed markups of 143-321 percent for services at Central Valley hospitals.

At the time Tim Joslin, CEO of Community Medical Centers, said the SEIU pricing initiative would be "highly disruptive to the delicate financial balance" hospitals currently face. He estimates if it was approved, the proposition would cost Community Medical Centers tens of millions of dollars in lost revenue annually. "And anyone can see what that would mean — decreasing reinvestment, scaling down services, and limiting patient access," Joslin wrote in a memo. "In that scenario, patients, healthcare professionals, and the community at large would all be losers."

Regan and Dauner insisted that hospital price controls are still part of the discussion between the parties, and that reforming Medi-Cal reimbursement could go a long way in improving revenue streams. Visit the Business Journal for the story.



HPN invites you to experience the Critical Care Exposition in Denver, May 20-22, 2014

Supply Chain/Materials/Purchasing Managers and their staff are cordially invited to attend the 2014 Critical Care Exposition at the Colorado Convention Center in Denver, CO, May 20 - May 22, 2014 on a complimentary (fee-waived) admission basis.

The Critical Care Exposition is the largest tradeshow featuring healthcare equipment and supplies for acute and critical care nurses in the U.S. The three-day show features more than 200 exhibitors of products, devices, technology and pharmaceuticals used or administered by nurses who care for critically ill patients. The Critical Care Exposition is produced by the American Association of Critical-Care Nurses (AACN) as part of their annual conference, which attracts more than 6,000 nurses each year.

Healthcare Purchasing News, in conjunction with AACN, hosts its 10th annual pair of panel discussions that explore how supply chain professionals collaborate with critical care nurses to facilitate buying decisions, inventory levels, customer service and patient care. Critical care nursing and supply chain management panelists discuss the good, the bad and the ugly experiences they shared in ordering and using the right products when and where they needed them.

They’ll also examine some of the challenges critical care nurses and supply chain professionals face when communications break down between the two areas, demand for products spike and supplies run low, if not out. From those discussions and an active question-and-answer time, attendees learn tips and tricks for success, as well as what went right during the successes and what went wrong during the failures. Listening to “real world” case studies help you apply the lessons learned to your own situations. The session will be held on the Purchasing Stage on Tuesday, May 20 (11:15 AM - 11:45 AM) and Wednesday, May 21 (2:15 PM - 2:45 PM) in Booth 1025.

To request the "HPN Registration Special" (fee-waived registration information) send an email with your name, title and employer’s name to exhibits@aacn.org or call the AACN Exhibits Director Randy Bauler at (800) 394-5995, ext. 366.

When you request the HPN Registration Special by email or phone, you’ll receive a complimentary registration certificate (good for free admission), plus a list of the participating exhibitors and access to the NTI 2014 exhibits floor plan. You and your staff may visit the show May 20-22, using the show’s generic "Exhibits Only" badges for relative anonymity on the show floor.  We look forward to seeing you in Denver. For more information about the conference visit here.


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