Wednesday, October 31, 2012
Atlas of Health Care Charts Performance
Quality of Care Varies by Area by Jayne O'Donnell. USA Today. October 31, 2012.
The Dartmouth Atlas of Health Care can be found here.
While this document is designed to help medical students find appropriate and attractive residencies, the article points out that it can also be used to help consumers determine how their local hospital differs from the norm. Using 2010 Medicare data, the report documents variations of treatment of patients at the end of life, as well as surgical procedures, and patient experiences.
Trends in Birth Control
IUDs and Implants are Changing Birth Control Landscape by Kim Painter. USA Today. October 30, 2012.
LARCs or "long lasting reversible contraceptives" are growing in popularity for a variety of reasons: (1) Under the Affordable Care Act insurers will be required to cover the up-front costs. (2) The American College of Obstetricians and Gynecologists has started recommending LARCs. (3) The failure rate for LARCs is a fraction of that for hormonal pills. Some IUDs last up to 10 years.
LARCs or "long lasting reversible contraceptives" are growing in popularity for a variety of reasons: (1) Under the Affordable Care Act insurers will be required to cover the up-front costs. (2) The American College of Obstetricians and Gynecologists has started recommending LARCs. (3) The failure rate for LARCs is a fraction of that for hormonal pills. Some IUDs last up to 10 years.
Tuesday, October 30, 2012
Hidden Dangers of Obesity
Revealing the Unexpected Dangers of Obesity by Shirley S. Wang. The Wall Street Journal. October 29, 2012.
Obesity is a complex condition involving hormones, inflammatory molecules and chemicals that can have wide impact. Just how wide is only now beginning to be understood. For example, the olfactory bulb contains one of the densest collection of insulin receptors outside the pancreas. In mice research, there are indications that the change in the sense of smell is related to obesity, either as a effect or as a cause. Sleepiness, apart from sleep apnea, could also be related to obesity as perhaps is fertility and cancer.
Obesity is a complex condition involving hormones, inflammatory molecules and chemicals that can have wide impact. Just how wide is only now beginning to be understood. For example, the olfactory bulb contains one of the densest collection of insulin receptors outside the pancreas. In mice research, there are indications that the change in the sense of smell is related to obesity, either as a effect or as a cause. Sleepiness, apart from sleep apnea, could also be related to obesity as perhaps is fertility and cancer.
A Lasting Flu Virus Vaccine?
Scientists Move Closer to a Lasting Flu Vaccine by Carl Zimmer. The New York Times. October 30, 2012.
The basic obstacle to a lasting flu vaccine is that immune system's B and T cells must learn how to develop a specific response to the unique characteristics of the flu prevalent for the season. To circumvent that problem scientists at Oxford University are developing a T cell-based flu vaccine that targets parts of the virus that change little from year to year. Other researchers are focusing on antibody-based broad-spectrum flu vaccine. They have discovered that certain antibodies can attach to the flu virus protein in a variety of locations thus facilitating the search for a long-lasting flu vaccine.
The basic obstacle to a lasting flu vaccine is that immune system's B and T cells must learn how to develop a specific response to the unique characteristics of the flu prevalent for the season. To circumvent that problem scientists at Oxford University are developing a T cell-based flu vaccine that targets parts of the virus that change little from year to year. Other researchers are focusing on antibody-based broad-spectrum flu vaccine. They have discovered that certain antibodies can attach to the flu virus protein in a variety of locations thus facilitating the search for a long-lasting flu vaccine.
Confronting Mental Health Issues in Sports
With No One Looking, A Hurt Stays Hidden by William C. Rhoden. The New York Times. October 29, 2012.
Athletic gladiators often do not want to admit mental health problems. To do so increases the risk of the stigma of weakness, the perception that the athlete cannot overcome the problem alone. There is also the issues of confidentiality and fear that mental health issues will prevent advancement. This article discusses the roles of coaches (Is training in mental health needed?), club owners, and public attitudes toward mental health.
Athletic gladiators often do not want to admit mental health problems. To do so increases the risk of the stigma of weakness, the perception that the athlete cannot overcome the problem alone. There is also the issues of confidentiality and fear that mental health issues will prevent advancement. This article discusses the roles of coaches (Is training in mental health needed?), club owners, and public attitudes toward mental health.
Monday, October 29, 2012
Georgia Researchers Find Magnetic Stimulation Treats Depression
Magnetic Brain Stimulation Helps Treat Depression by Urvaksh Karkarla. Atlanta Business Chronicle. October 26, 2012.
Major Depressive Disorder is the leading cause of disability for ages 15 to 44, affecting 14.8 million American adults in a given year.
Georgia Health Science University researchers have found that powerful magnetic stimulation of the frontal lobe of the brain can alleviate symptoms of depression. The Neuronetics Transcranial Magnetic Stimulation (TMS Therapy System has been approved by the Food and Drug Administration for the treatment of depression. The therapy did not contribute to insomnia or oversleeping, a problem for those with depressive disorder.
Major Depressive Disorder is the leading cause of disability for ages 15 to 44, affecting 14.8 million American adults in a given year.
Georgia Health Science University researchers have found that powerful magnetic stimulation of the frontal lobe of the brain can alleviate symptoms of depression. The Neuronetics Transcranial Magnetic Stimulation (TMS Therapy System has been approved by the Food and Drug Administration for the treatment of depression. The therapy did not contribute to insomnia or oversleeping, a problem for those with depressive disorder.
New Atlas Charts Relationship of Climate and Disease
U.N. 'Atlas of Health and Climate" Offers Leaders Tool For Early Warning of Disease Outbreaks. Associated Press. October 29, 2012.
This volume relates, as an example, the number of cases of meningitis in sub-Saharan Africa with the dry season, a relationship which has resulted in approximately 25,000 deaths over the past 10 years.
It was created with the cooperation of the World Health Organization and World Meteorological Association and was designed to assist leaders and policymakers.
The atlas can be found here.
This volume relates, as an example, the number of cases of meningitis in sub-Saharan Africa with the dry season, a relationship which has resulted in approximately 25,000 deaths over the past 10 years.
It was created with the cooperation of the World Health Organization and World Meteorological Association and was designed to assist leaders and policymakers.
The atlas can be found here.
Sunday, October 28, 2012
Nationwide Health Insurance Plans Under New Health Care Law
U.S. Set to Sponsor Health Insurance by Robert Pear. The New York Times. October 26, 2012.
Two nationwide insurance plans operated under contract with and under the sponsorship of the federal government will be offered to consumers in every state. These multistate plans are established under the provisions of the President Obama's health care law and will compete directly with private insurers. Premiums and benefits are to be negotiated by the US Office of Personnel Management which establishes benefits for federal employees. The plans would be offered through state insurance exchanges. Issues in underwriting, licensing, abortion services, and state regulation are discussed in the article.
Materials Innovation Addresses Infection Risk
New Materials May Help Prevent Infection by Blocking Initial Bacterial Attachment. Science Daily. October 26, 2012.
British researchers have discovered a new class of materials that resist bacterial attachment. If bacterial attachment can be thwarted, the formation of biofilm and hence antibiotic resistance can perhaps be overcome. The hope is that clinical trials will show that this source of infection, and therefore increased hospital cost, can be lessened or eliminated.
British researchers have discovered a new class of materials that resist bacterial attachment. If bacterial attachment can be thwarted, the formation of biofilm and hence antibiotic resistance can perhaps be overcome. The hope is that clinical trials will show that this source of infection, and therefore increased hospital cost, can be lessened or eliminated.
Massive Study of Women Smokers Demonstrates the Value of Quitting, No Matter the Age
Women Who Quit Smoking Do Live Longer by John Gever. MedPage Today. October 26, 2012.
A massive study involving 1.3 million women in the UK has confirmed what has been known about men: That quitting smoking, no matter when, has mortality benefits. While the women who quit smoking at age 50 had higher mortality than those who had never smoked, the rate of those who quit was much lower than current smokers. The study was significant because it measured the first generation of UK women who smoked early in life.
A massive study involving 1.3 million women in the UK has confirmed what has been known about men: That quitting smoking, no matter when, has mortality benefits. While the women who quit smoking at age 50 had higher mortality than those who had never smoked, the rate of those who quit was much lower than current smokers. The study was significant because it measured the first generation of UK women who smoked early in life.
Innovator with Interest in Health
Simplicity and Order for All by Seth Stevenson. WSJ Magazine. October 26, 2012.
This article focuses on Jack Dorsey, the Winner of the WSJ Innovator of the Year 2012: Technology. While the emphasis of this article is not medicine, it does mention the possibl next frontier for Jack Dorsey, founder of Twitter and Square, an application that lets anyone use a cell phone to accept credit card payments. The article cites Dorsey's ability to "create streamlined beauty out of giant ungainly systems that at first glance appear to be irredeemably chaotic." Dorsey mentions that he is interested in applying his ability to health. "We need new tools" he says in order deal with the overwhelming complexity that faces individuals with health insurance, the health industry, and diagnoses. Obviously, Dorsey views medicine and health as ripe fields for innovation.
This article focuses on Jack Dorsey, the Winner of the WSJ Innovator of the Year 2012: Technology. While the emphasis of this article is not medicine, it does mention the possibl next frontier for Jack Dorsey, founder of Twitter and Square, an application that lets anyone use a cell phone to accept credit card payments. The article cites Dorsey's ability to "create streamlined beauty out of giant ungainly systems that at first glance appear to be irredeemably chaotic." Dorsey mentions that he is interested in applying his ability to health. "We need new tools" he says in order deal with the overwhelming complexity that faces individuals with health insurance, the health industry, and diagnoses. Obviously, Dorsey views medicine and health as ripe fields for innovation.
The Body Issue
The Body Issue. The New York Times Magazine. October 28, 2012.
A marvelous and eclectic collection of essays on massage, gerontology, yoga, and mortality. The emphasis here moves away from the "hard science" of medicine toward more emphasis on the intangible, cultural, intuitive, psychological, as well as the use of data to shape the behavioral and physical environment.
In The Island Where People Forget to Die Dan Buettner focuses on the social, cultural, and dietary features of the Greek island of Ikaria to determine why so many of its residents live so long.
In Naked With Strangers by John Jeremiah Sullivan recounts his personal experience and reactions to receiving a series of massages and body treatments.
In Safety Lessons from the Morgue by Robert Stook explores the work of Susan P. Baker of the Johns Hopkins Bloomberg School of Public Health as uses data about causes of deaths to work for policies and environments that promote safety.
A marvelous and eclectic collection of essays on massage, gerontology, yoga, and mortality. The emphasis here moves away from the "hard science" of medicine toward more emphasis on the intangible, cultural, intuitive, psychological, as well as the use of data to shape the behavioral and physical environment.
In The Island Where People Forget to Die Dan Buettner focuses on the social, cultural, and dietary features of the Greek island of Ikaria to determine why so many of its residents live so long.
In Naked With Strangers by John Jeremiah Sullivan recounts his personal experience and reactions to receiving a series of massages and body treatments.
In Safety Lessons from the Morgue by Robert Stook explores the work of Susan P. Baker of the Johns Hopkins Bloomberg School of Public Health as uses data about causes of deaths to work for policies and environments that promote safety.
Thursday, October 25, 2012
Greek Doctors Aid Victims of Austerity
Amid Cutbacks, Greek Doctors Offer Message to Poor You Are Not Alone by Liz Alderman. The New York Times. October 24, 2012.
Now about one half of the 1.2 million long term Greek unemployed lack health insurance, a number that is certain to rise with an unemployment rate of 25 percent. Before the agreement with international lenders to stave off financial collapse Greeks had access to universal care. This article puts a human face on these figures with doctors forming an underground movement to take care of the uninsured. A doctor emphasized the crisis: "In Greece now, to be unemployed means death." This is especially the case with cancer care, a major emphasis of this article.
Now about one half of the 1.2 million long term Greek unemployed lack health insurance, a number that is certain to rise with an unemployment rate of 25 percent. Before the agreement with international lenders to stave off financial collapse Greeks had access to universal care. This article puts a human face on these figures with doctors forming an underground movement to take care of the uninsured. A doctor emphasized the crisis: "In Greece now, to be unemployed means death." This is especially the case with cancer care, a major emphasis of this article.
Prospect for Improvement Delinked from Medicare Payment for Certain Services
Settlement Eases Some Rules for Medicare Patients by Robert Pear. The New York Times. October 23, 2012.
In a settlement of a class-action lawsuit the administration has agreed to pay skilled nursing and therapy services based upon need not potential for improvement. The impact of this settlement could be substantial for people with Alzheimer's , multiple sclerosis, Parkinsons disease, stroke, spinal cord injuries, etc. While costs to the Medicare program could increase, the new rules could also save money by helping individuals avoid more expense care in hospitals or nursing homes.
In a settlement of a class-action lawsuit the administration has agreed to pay skilled nursing and therapy services based upon need not potential for improvement. The impact of this settlement could be substantial for people with Alzheimer's , multiple sclerosis, Parkinsons disease, stroke, spinal cord injuries, etc. While costs to the Medicare program could increase, the new rules could also save money by helping individuals avoid more expense care in hospitals or nursing homes.
Developmental Stability the Key to Intelligence?
If Smart is the Norm, Stupidity Gets More Interesting by David Dobbs. The New York Times. October 23, 2012.
Since scientists are having difficulty in finding the specific genetic keys to intelligence, they are looking elsewhere. By looking at the mutations we carry and their relationship to developmental stability, the accuracy with which the genetic design is built, they are beginning to discern an association between bodily symmetry and intelligence. This article is largely based upon the ideas of Kevin Mitchell, a developmental neurogeneticists at Trinity College Dublin.
Since scientists are having difficulty in finding the specific genetic keys to intelligence, they are looking elsewhere. By looking at the mutations we carry and their relationship to developmental stability, the accuracy with which the genetic design is built, they are beginning to discern an association between bodily symmetry and intelligence. This article is largely based upon the ideas of Kevin Mitchell, a developmental neurogeneticists at Trinity College Dublin.
IBM's Watson Harnesses Big Data for Medicine
IBM's Watson is Learning Its Way to Save Lives by John Gertner. Fast Company. October 15, 2012
While IBM's computer Watson is best known for willing on Jeopardy! it is this fall being tested on real patients at Memorial Sloan-Kettering Cancer in New York. Building upon its ability to grasp the complexities of human language and answer difficult questions, IBM researchers are applying Watson to complex decision trees in diagnoses and cancer treatment. Watson is being used by Wellpoint, the big insurer, to evaluate medical procedures for payment. However, the article focuses on the role of Watson at providing "second opinions" to any doctor anywhere. In an environment where 90% of the world's information was created in the last two years, the role of computers such as Watson is seen as certain to expand. Key is also Watson's ability to interpret unstructured or semistructured information such as doctor's notes. The article also reviews IBM's approach to innovation.
While IBM's computer Watson is best known for willing on Jeopardy! it is this fall being tested on real patients at Memorial Sloan-Kettering Cancer in New York. Building upon its ability to grasp the complexities of human language and answer difficult questions, IBM researchers are applying Watson to complex decision trees in diagnoses and cancer treatment. Watson is being used by Wellpoint, the big insurer, to evaluate medical procedures for payment. However, the article focuses on the role of Watson at providing "second opinions" to any doctor anywhere. In an environment where 90% of the world's information was created in the last two years, the role of computers such as Watson is seen as certain to expand. Key is also Watson's ability to interpret unstructured or semistructured information such as doctor's notes. The article also reviews IBM's approach to innovation.
Wednesday, October 24, 2012
A Model for the Future of Medicine
Kaiser Permanente CEO on Saving Lives, Money. USA Today. October 24, 2012.
In this interview with George Halvorson, chief executive of Kaiser Permanente, the largest managed care company and hospital in the nation, he offers his many interesting observations including:
*Because we are prepaid, we don't make our money by having care go wrong.
*Most of (our competitors)...don't get paid for prevention.
*We buy our surgeons by the month, not by the cut. (Physicians at KP are on salary eliminating any possible incentive for unnecessary surgery).
*We need to stop rewarding the infrastructure of American health care for making mistakes.
Fascinating article about a firm that many view as a model for the future of U.S. medicine.
In this interview with George Halvorson, chief executive of Kaiser Permanente, the largest managed care company and hospital in the nation, he offers his many interesting observations including:
*Because we are prepaid, we don't make our money by having care go wrong.
*Most of (our competitors)...don't get paid for prevention.
*We buy our surgeons by the month, not by the cut. (Physicians at KP are on salary eliminating any possible incentive for unnecessary surgery).
*We need to stop rewarding the infrastructure of American health care for making mistakes.
Fascinating article about a firm that many view as a model for the future of U.S. medicine.
Stress and Burnout in the Workplace
Burnout Up Among Employees by Sharon Jayson. USA Today. October 24, 2012.
Based upon a national survey of 1,880 workers, ComPsych, a provider of employee assistance, found that 63% had high levels of stress at work, along with extreme fatigue and feeling out of control. The Conference Board in another survey found just one-third of workers were satisfied with their workload. This article addresses the implications of such findings.
Based upon a national survey of 1,880 workers, ComPsych, a provider of employee assistance, found that 63% had high levels of stress at work, along with extreme fatigue and feeling out of control. The Conference Board in another survey found just one-third of workers were satisfied with their workload. This article addresses the implications of such findings.
Sunday, October 21, 2012
Doctor Supply: The States Compared
10 States With the Most and Fewest Doctors by 24/7 Wall St. October 19, 2012.
On page 2 of this examination is an examination of Georgia with the 22nd lowest number of medical students per 100,000, the 5th highest percentage of residents without health insurance, and the 10th lowest life expectancy. This article is based upon information from the American Association of Medical Colleges, the U.S. Census Bureau, and the Kaiser Family Foundation
On page 2 of this examination is an examination of Georgia with the 22nd lowest number of medical students per 100,000, the 5th highest percentage of residents without health insurance, and the 10th lowest life expectancy. This article is based upon information from the American Association of Medical Colleges, the U.S. Census Bureau, and the Kaiser Family Foundation
Quality Control Issues and Drugs Manufacturers
Lapses at Big Drug Factories Add to Shortages and Danger by Katie Thomas. The New York Times. October 17, 2012.
This article puts forward the idea that drug safety issues extend far beyond the compounding pharmacy involved in the current outbreak of meningitis. While manufacturers reject the notion that production quality is deteriorating, there are areas of concern cited by the article. For example a congressional report claims that a third of the pharmaceutical manufacturing capacity is off line due to quality issues. Industry spokesmen cite continuing efforts to improve operations and safety in response to FDA concerns.
This article puts forward the idea that drug safety issues extend far beyond the compounding pharmacy involved in the current outbreak of meningitis. While manufacturers reject the notion that production quality is deteriorating, there are areas of concern cited by the article. For example a congressional report claims that a third of the pharmaceutical manufacturing capacity is off line due to quality issues. Industry spokesmen cite continuing efforts to improve operations and safety in response to FDA concerns.
Saturday, October 20, 2012
Weight Loss and Exercise and Cardiovascular Event Prevention
Weight Loss No Help for Diabetic Heart by Chris Kaiser. MedPage Today. October 19, 2012.
The National Heart, Lung, and Blood Institute pulled the plug on the study when it was found that there was no sign that diet and exercised lessened the risk of myocardial infarction, stroke, hospitalizations for angina, and death. While no improvements in cardiovascular events were noted, researcher subjects noted improvements in sleep apnea, mobility, and quality of life.
The National Heart, Lung, and Blood Institute pulled the plug on the study when it was found that there was no sign that diet and exercised lessened the risk of myocardial infarction, stroke, hospitalizations for angina, and death. While no improvements in cardiovascular events were noted, researcher subjects noted improvements in sleep apnea, mobility, and quality of life.
Synthetic Biology: Future Tool Against Viral Disease?
Repelling Viruses, Reviving Mammoths by George M. Church and Ed Regis. The Wall Street Journal October 20-21, 2012.
In this article featuring several potential uses of synthetic biology, the authors cite current clinical tests of manipulating human immune cells so that they become invulnerable to HIV and AIDS.
In this article featuring several potential uses of synthetic biology, the authors cite current clinical tests of manipulating human immune cells so that they become invulnerable to HIV and AIDS.
Boys Hit Puberty Sooner Now, Study Finds by Alan Mozes. U.S. News and World Report. October 20, 2012.
Building upon research from the 1990's which showed that girls are entering puberty at an earlier age, University of North Carolina public health researchers have found that boys are also entering puberty earlier. They have found that black boys are entering puberty at 9, whites at 10, and Hispanics at 10-11. The researchers were surprised at this result since the factors that sped the process in girls should have slowed the process in boys. Of concerns was the growing gap between physical and social maturation.
Bacteria as Friends
Bacteria in Balance by Karen Weintraub. boston.com. The Boston Globe. October 14, 2012.
Medicine is posed for a revolution in bacterial control. This revolution is based upon the evolving research which shows that not all bacteria are bad. Indeed, it is now known that some bacteria protect against disease. In that light, new emphasis is placed on balance in the internal bodily environment. This lack of balance may explain the rise of inflammatory diseases and autoimmune disorders such as type 1 diabetes, asthma, and allergies. Research has pointed to the possibility that restoring bacterial diversity may be a better way to fight sinus infection than antibiotics. Also, learning to use bacteria as a way to stimulate the immune system for therapeutic goals could be a productive goal. A diet rooted in human evolutionary history could also contribute to bacteria in balance.
Medicine is posed for a revolution in bacterial control. This revolution is based upon the evolving research which shows that not all bacteria are bad. Indeed, it is now known that some bacteria protect against disease. In that light, new emphasis is placed on balance in the internal bodily environment. This lack of balance may explain the rise of inflammatory diseases and autoimmune disorders such as type 1 diabetes, asthma, and allergies. Research has pointed to the possibility that restoring bacterial diversity may be a better way to fight sinus infection than antibiotics. Also, learning to use bacteria as a way to stimulate the immune system for therapeutic goals could be a productive goal. A diet rooted in human evolutionary history could also contribute to bacteria in balance.
Thursday, October 18, 2012
Value of Annual Medical Exam Questioned
Study Questions the Value of Annual Physical Exams by Brenda Goodman. WebMD. October 16, 2012.
The study was created at the Nordic Cochrane Center in Copenhagen, Denmark. and combined data from 14 studies of over 180,000 people. Patients were followed from four to 22 years. It was found that there was no difference in the death rates (7%) of those who had annual exams and those who did not.
Those who question the conclusions of this study point to the fact that most of the studies were done during the 60's and 70's during a time when tests now shown to have little value for general screening were performed routinely. Also during those periods there was limited emphasis on quitting smoking. For those who question the report, the problem is not the exam but what is addressed in the exam.
Others point to more current research which point to limited value of annual physical for otherwise healthy adults. They emphasis a focus on areas of demonstrated health benefit and prompt to attention to abnormal signs and symptoms.
The study was created at the Nordic Cochrane Center in Copenhagen, Denmark. and combined data from 14 studies of over 180,000 people. Patients were followed from four to 22 years. It was found that there was no difference in the death rates (7%) of those who had annual exams and those who did not.
Those who question the conclusions of this study point to the fact that most of the studies were done during the 60's and 70's during a time when tests now shown to have little value for general screening were performed routinely. Also during those periods there was limited emphasis on quitting smoking. For those who question the report, the problem is not the exam but what is addressed in the exam.
Others point to more current research which point to limited value of annual physical for otherwise healthy adults. They emphasis a focus on areas of demonstrated health benefit and prompt to attention to abnormal signs and symptoms.
Study: Modest Cancer Benefit in Multivitamins for Men Over 50
A Daily Multivitamin Reduces Cancer Risk in Older Men by Olivia B. Waxman. Time. October 18, 2012.
The study followed over 14,000 physicians over the age of 50 for 11 years. An 8% reduction in cancer rate, the study indicates, seems to be associated with taking a daily multivitamin. The study's lead author stated that skipping the vitamins and eating a healthy and varied diet could also keep the tumors at bay. This study contrasts with recent studies finding little benefit (omega 3, vitamin D) or harm (increased death rate for Vitamin B, folic acid, iron, copper, etc) for vitamin supplements.
The study followed over 14,000 physicians over the age of 50 for 11 years. An 8% reduction in cancer rate, the study indicates, seems to be associated with taking a daily multivitamin. The study's lead author stated that skipping the vitamins and eating a healthy and varied diet could also keep the tumors at bay. This study contrasts with recent studies finding little benefit (omega 3, vitamin D) or harm (increased death rate for Vitamin B, folic acid, iron, copper, etc) for vitamin supplements.
Sickness Transmission Pathways in a Hospital Graphed
Tag--You're Sick: Patterns of personal contact in a hospital reveal true pathways of transmission. Scientific American November 2012.
European researchers tagged 119 individuals in a pediatric ward to record face-to-face interactions and the attendant potential for spreading airborne pathogens. The graphs presented here record the interactions of nurses, physicians, caregivers, ward assistants, and patients. Important is the fact that nurses interact with the widest variety of people and therefore should focus on disease/sickness transmission.
European researchers tagged 119 individuals in a pediatric ward to record face-to-face interactions and the attendant potential for spreading airborne pathogens. The graphs presented here record the interactions of nurses, physicians, caregivers, ward assistants, and patients. Important is the fact that nurses interact with the widest variety of people and therefore should focus on disease/sickness transmission.
Wednesday, October 17, 2012
Fingerprint Technology to Increase Adherence to Drug Regimes
Health-Care IT. The Wall Street Journal. October 16, 2012.
A finger print technology to deal with the tremendous problem of tuberculosis drug adherence in India was the winner in the Health-Care IT category of the WSJ Technology Innovation Award. Combined with changes in drug accessibility and distribution, Operation ASHA, uses fingerprints to record the patients who picked up their medicines. Counselors are notified when patients did not pick up their medicines. Fingerprinting increased adherence to the complete drug program.
A finger print technology to deal with the tremendous problem of tuberculosis drug adherence in India was the winner in the Health-Care IT category of the WSJ Technology Innovation Award. Combined with changes in drug accessibility and distribution, Operation ASHA, uses fingerprints to record the patients who picked up their medicines. Counselors are notified when patients did not pick up their medicines. Fingerprinting increased adherence to the complete drug program.
Biopsies and Marrow Donations Facilitated by Innovation
Less-Painful Biopsies by Shirley Wang. The Wall Street Journal. October 16, 2012.
The OnControl Bone Marrow Systems by Vidacare Corp. was the winner of the Wall Street Journal's Innovation Award in the category of Medical Devices. The device which bores like a drill is designed to lessen the pain, quickens the process, lessens the need for more than one puncture. This technology will perhaps lower the barrier to marrow donations.
The OnControl Bone Marrow Systems by Vidacare Corp. was the winner of the Wall Street Journal's Innovation Award in the category of Medical Devices. The device which bores like a drill is designed to lessen the pain, quickens the process, lessens the need for more than one puncture. This technology will perhaps lower the barrier to marrow donations.
New Tactics for Peripheral Artery Disease
New Tactics to Treat Artery Disease by Ron Winslow. The Wall Street Journal. October 15, 2012.
Peripheral artery disease (PAD) is increasingly common with an aging population and the prevalence of diabetes. This article explores treatment alternatives such as supervised exercise and less conservative treatments such as stents and balloons to clear arteries. Sometimes treatments associated with the heart are effective in dealing with this leg ailment.
Peripheral artery disease (PAD) is increasingly common with an aging population and the prevalence of diabetes. This article explores treatment alternatives such as supervised exercise and less conservative treatments such as stents and balloons to clear arteries. Sometimes treatments associated with the heart are effective in dealing with this leg ailment.
The Blind Connect Through Technology
New Gadgets Assist the Blind by Te-Ping Chen. The Wall Street Journal. October 14, 2012.
There are 285 million visually impaired individuals worldwide according to the World Health Organization. Increasingly technologies are addressing the problem of keeping these individuals connected and participating in society. This article relates the efforts of companies like Ocean Blue Software which speaks TV menu listings, on-screen prompts, and schedule listings. Also important has been the proliferation of smartphones which has been a boon to assistive technology. An example is an app that will snap photos of menus or box labels and read them aloud. This relatively new industry has growth potential as the population ages and new uses for unimpaired individuals are developed.
There are 285 million visually impaired individuals worldwide according to the World Health Organization. Increasingly technologies are addressing the problem of keeping these individuals connected and participating in society. This article relates the efforts of companies like Ocean Blue Software which speaks TV menu listings, on-screen prompts, and schedule listings. Also important has been the proliferation of smartphones which has been a boon to assistive technology. An example is an app that will snap photos of menus or box labels and read them aloud. This relatively new industry has growth potential as the population ages and new uses for unimpaired individuals are developed.
Monday, October 15, 2012
Patient Happiness Tied to Medicare Reimbursement
U.S. Ties Hospital Payments to Making Patients Happy by Janet Adams. The Wall Street Journal. October 14, 2012.
Over the next year $1 billion in government payments to hospitals will be based in part on patient satisfaction as determined by a 27-question government survey administered to patients. This new emphasis on patient satisfaction tied to funding has had broad impact. Some medical professionals view this approach as unfair with those at hospitals serving the poor are especially concerned. Long waits in the emergency room may leave low-income patients grumpy and less likely to respond favorably to surveys. The article focuses on the experience of Grady Memorial Hospital in Atlanta, GA as it seeks to adapt to those incentives. Sometimes surprising discoveries and relationships were uncovered. For example, when ESPN was added to the television offerings to increase satisfaction, it was also discovered that pain medication requests declined during afternoon football games.
Over the next year $1 billion in government payments to hospitals will be based in part on patient satisfaction as determined by a 27-question government survey administered to patients. This new emphasis on patient satisfaction tied to funding has had broad impact. Some medical professionals view this approach as unfair with those at hospitals serving the poor are especially concerned. Long waits in the emergency room may leave low-income patients grumpy and less likely to respond favorably to surveys. The article focuses on the experience of Grady Memorial Hospital in Atlanta, GA as it seeks to adapt to those incentives. Sometimes surprising discoveries and relationships were uncovered. For example, when ESPN was added to the television offerings to increase satisfaction, it was also discovered that pain medication requests declined during afternoon football games.
Sunday, October 14, 2012
Avon Franchise Model Applied to Healthcare in Africa
The Avon Ladies of Africa by Tina Rosenberg. The New York Times. October 10, 2012.
A key problem in the third world is effective distribution of helpful goods and services resulting from lack of an effective business model. The firm, Living Goods, which operates in Uganda applies the franchise model to health goods. This model has proven its worth in the United States where it supports one in eight jobs and is beginning to show effective elsewhere. In Africa, Living Goods uses the Avon lady model to sell items such as sanitary pads, soap, and deworming pills, and other health related products.
A key problem in the third world is effective distribution of helpful goods and services resulting from lack of an effective business model. The firm, Living Goods, which operates in Uganda applies the franchise model to health goods. This model has proven its worth in the United States where it supports one in eight jobs and is beginning to show effective elsewhere. In Africa, Living Goods uses the Avon lady model to sell items such as sanitary pads, soap, and deworming pills, and other health related products.
An Answer to Georgia's Physician Shortage
Burns: An Answer to Georgia's Doctor Shortage by Dr. John M. Burns and Doris Parrish. Savannahnow/Savannah Morning News. October 14, 2012. Opinion Piece.
Dr. John Burns is the Director of the Master of Science in Physician Assistant Studies at South University's Savannah Ga. campus. Doris Parrish directs the Master of Science in Nursing at South.
The article argues that nurses and PA's could be part of the answer to the 5,000 doctor shortage in Georgia physicians projected for 2030. Burns points out a little-noted contributor to the doctor shortage: According to the AMA doctors are cutting back their hours and seeing fewer patients.
Dr. John Burns is the Director of the Master of Science in Physician Assistant Studies at South University's Savannah Ga. campus. Doris Parrish directs the Master of Science in Nursing at South.
The article argues that nurses and PA's could be part of the answer to the 5,000 doctor shortage in Georgia physicians projected for 2030. Burns points out a little-noted contributor to the doctor shortage: According to the AMA doctors are cutting back their hours and seeing fewer patients.
Wired Health Conference: Living By Numbers
Wired Health Conference: Living by Numbers. Wired Magazine in Partnership with Robert Wood. Johnson Foundation. October 15-16.
This is a conference that can be viewed online when you enter your email address. The conference will focus on opportunities to bring data into real-time decision-making for doctors, researchers, hospitals, and individuals. It will span the gap between healthcare and technology connecting pioneering researchers with entrepreneurs.
This is a conference that can be viewed online when you enter your email address. The conference will focus on opportunities to bring data into real-time decision-making for doctors, researchers, hospitals, and individuals. It will span the gap between healthcare and technology connecting pioneering researchers with entrepreneurs.
Secret DNA Testing the Focus of U.S. Panel
Citing Privacy Concerns, U.S, Panel Urges End to Secret DNA Testing by Sharon Begley. Reuters. October 11, 2012.
Since DNA samples can be obtained from many sources, the potential for abuse is clear. For example toothpicks, licked stamps, hair, nail clippings, and dental floss can be used to obtain health information relevant to employment, insurance and paternity, the Presidential Commission for the Study of Biomedical Issues has focused on the issues raised by secret DNA testing. While a three-year-old law prevents genetic discrimination in employment, other uses, such as in divorce proceedings, are not prohibited by federal law. Among the recommendations of the panel is that surreptitious commercial testing be banned.
Since DNA samples can be obtained from many sources, the potential for abuse is clear. For example toothpicks, licked stamps, hair, nail clippings, and dental floss can be used to obtain health information relevant to employment, insurance and paternity, the Presidential Commission for the Study of Biomedical Issues has focused on the issues raised by secret DNA testing. While a three-year-old law prevents genetic discrimination in employment, other uses, such as in divorce proceedings, are not prohibited by federal law. Among the recommendations of the panel is that surreptitious commercial testing be banned.
Walmart Institutes No Cost Heart and Spine Surgeries for Its Associates
Walmart Expands Health Benefits To Cover Heart and Spinal Surgeries At No Cost To Associates. Bloomberg Businessweek. October 11, 2012.
Six leading hospital and health systems in the U.S. will participate in the program that is called by Walmart officials the "first time a retailer has offered a comprehensive, nationwide program for heart, spine and transplant surgery.
Six leading hospital and health systems in the U.S. will participate in the program that is called by Walmart officials the "first time a retailer has offered a comprehensive, nationwide program for heart, spine and transplant surgery.
Conductor Slated to Return to Podium After Medical Leave
Saying "It's Miraculous for Me," Levine will Conduct Again at the Met by Daniel J. Wakin. The New York Times. October 11, 2012.
James Levine, the principal conductor of the Metropolitan Opera, is scheduled to return to the Met podium in May. Most recently he suffered from severe spinal damage from a fall from which he unable to walk. He expects to regain some mobility soon. He also suffers from a nonprogressive condition related to Parkinson's as well as lengthy list of other maladies. Maestro Levine's doctors said that he would likely benefit from a return to his beloved Met. The article recounts the adaptations that will facilitate his return. It also provides a story of determination and desire to continue to contribute even in the face of sickness and injury.
James Levine, the principal conductor of the Metropolitan Opera, is scheduled to return to the Met podium in May. Most recently he suffered from severe spinal damage from a fall from which he unable to walk. He expects to regain some mobility soon. He also suffers from a nonprogressive condition related to Parkinson's as well as lengthy list of other maladies. Maestro Levine's doctors said that he would likely benefit from a return to his beloved Met. The article recounts the adaptations that will facilitate his return. It also provides a story of determination and desire to continue to contribute even in the face of sickness and injury.
Technology and the Future of Medicine
The Digital Doctor. The New York Times. Science Times. October 11, 2012.
In this special edition of the Science Times, writers explore technological issues in medicines including apps and iPads, electronic medical records, computer-aided design and manufacture in dentistry, telemedicine, the new doctor's bag, accessibility in therapy, and other issues.
In this special edition of the Science Times, writers explore technological issues in medicines including apps and iPads, electronic medical records, computer-aided design and manufacture in dentistry, telemedicine, the new doctor's bag, accessibility in therapy, and other issues.
Five Promising Approaches to Ending Cancer
The Five Most Promising Approaches to Ending Cancer. The New Scientist. October 13-19. This article is at the moment available only to subscribers and on the newsstand.
(1) RNA Interference involves temporarily turning genes on or off.
(2) Nanoparticles can permit the precise targeting of cancer cells.
(3) Super-bugs can be used to produce anti-cancer drugs inside tumors.
(4) Immunotherapy harnesses the body's own immune system to fight cancer.
(5) Virotherapy involves using genetically modified viruses to eat their way through tumors.
(1) RNA Interference involves temporarily turning genes on or off.
(2) Nanoparticles can permit the precise targeting of cancer cells.
(3) Super-bugs can be used to produce anti-cancer drugs inside tumors.
(4) Immunotherapy harnesses the body's own immune system to fight cancer.
(5) Virotherapy involves using genetically modified viruses to eat their way through tumors.
Thursday, October 11, 2012
Strokes Increase Among the Young
Strokes Increasing in Younger Patients, Study Suggests by Janice Lloyd. USA Today. October 11, 2012.
Stroke, the fourth leading cause of death in the United States, is increasing at a faster rate in young people. Early strokes are serious because they can lead to a greater lifetime disability. Diabetes and obesity are thought to be related to the increase. However better detection among young people may also be a contributing factor. The American Stroke Association indicate that 80% of strokes are preventable, leading to hope that diet and exercise might be effective in dealing with this trend.
Stroke, the fourth leading cause of death in the United States, is increasing at a faster rate in young people. Early strokes are serious because they can lead to a greater lifetime disability. Diabetes and obesity are thought to be related to the increase. However better detection among young people may also be a contributing factor. The American Stroke Association indicate that 80% of strokes are preventable, leading to hope that diet and exercise might be effective in dealing with this trend.
CDC Lead Fight Against Meningitis
CDC Leads Fight Against Meningitis Outbreak by Craig Schneider. The Atlanta Journal-Constitution. October 11, 2012.
This article summarizes the efforts the CDC in Atlanta are taking to counteract the outbreak which has now claimed 12 lives. These efforts have recently resulted in the discovery that the there are two fungi involved in the tainted steroid used in pain injections. Also treatment protocols have been refined as the nature of the fungi has become clearer. Also, extensive efforts are ongoing to contact individuals who possibly received the steroid pain injections.
This article summarizes the efforts the CDC in Atlanta are taking to counteract the outbreak which has now claimed 12 lives. These efforts have recently resulted in the discovery that the there are two fungi involved in the tainted steroid used in pain injections. Also treatment protocols have been refined as the nature of the fungi has become clearer. Also, extensive efforts are ongoing to contact individuals who possibly received the steroid pain injections.
Election Poses Stark Choice in Health Care
This Election, A Stark Choice in Health Care by Abby Goodnough and Robert Pear. The New York Times. October 10, 2012.
The most obvious choice is between a move toward universal coverage (Obama) or an emphasis cost reduction (Romney). However significant choices face Medicaid and Medicare. With Medicaid President Obama would expand the program as part of his move toward universal coverage. Governor Romney would effectively shrink Medicaid by giving the states a fixed amount to cover the disadvantaged along with more control. Under Obama Medicare would retain its basic current structure along with more efforts to reign in costs, often with cuts to providers. Under Romney, Medicare would eventually evolve into giving each beneficiary a fixed amount to purchase coverage under Medicare or from private insurance. The article fills in details of the competing approaches.
The most obvious choice is between a move toward universal coverage (Obama) or an emphasis cost reduction (Romney). However significant choices face Medicaid and Medicare. With Medicaid President Obama would expand the program as part of his move toward universal coverage. Governor Romney would effectively shrink Medicaid by giving the states a fixed amount to cover the disadvantaged along with more control. Under Obama Medicare would retain its basic current structure along with more efforts to reign in costs, often with cuts to providers. Under Romney, Medicare would eventually evolve into giving each beneficiary a fixed amount to purchase coverage under Medicare or from private insurance. The article fills in details of the competing approaches.
Wednesday, October 10, 2012
HHS Recognizes Physician Assistant Week
Statement From HHS Secretary Kathleen Sebelius On National Physician Assistant Week. ENEWSPF. October 5, 2012.
The Secretary marked Physician Assistant Week from October 6 through October 12. This week marks the anniversary of the graduation of first class of PA students from the Duke University Medical Center in 1967. There are now more than 84,000 certified PAs across the country with growth expected to over 100,000 to meet shortages in primary care.
The Secretary marked Physician Assistant Week from October 6 through October 12. This week marks the anniversary of the graduation of first class of PA students from the Duke University Medical Center in 1967. There are now more than 84,000 certified PAs across the country with growth expected to over 100,000 to meet shortages in primary care.
Nobel Prize for Stem Cell Pioneers
Nobel Prize Goes to SF Scientist by Ellen Alday. San Francisco Chronicle. October 8, 2012.
The 2012 Nobel Prize for physiology or medicine was awarded to Shinya Yamanaka and John Gurdon. Gurdon showed that it was possible to take any body cell, transplant it into a stem cell, and then reprogram it to become any other type of body cell. Yamanaka developed techniques to regress an adult cell back to its immature stem cell state. Among the many possible uses of these discovery is developing cardiac cells from skin to replace those damaged in a heart attack.
The 2012 Nobel Prize for physiology or medicine was awarded to Shinya Yamanaka and John Gurdon. Gurdon showed that it was possible to take any body cell, transplant it into a stem cell, and then reprogram it to become any other type of body cell. Yamanaka developed techniques to regress an adult cell back to its immature stem cell state. Among the many possible uses of these discovery is developing cardiac cells from skin to replace those damaged in a heart attack.
Georgia Doctor's Prescription for Student Performance
Attention Disorder or Not, Pills to Help in School by Alan Schwarz. The New York Times. October 9, 2012.
Dr. Michael Anderson of Canton Ga. deals in a unique way with what he sees as society's failure to improve school performance by improving a child's environment. He writes prescriptions for stimulants, often used to treat ADHD, to give low income students a level playing field with their more affluent classmates. While some authorities see no problem with such prescriptions, others are concerned with physical and psychological risks.
Dr. Michael Anderson of Canton Ga. deals in a unique way with what he sees as society's failure to improve school performance by improving a child's environment. He writes prescriptions for stimulants, often used to treat ADHD, to give low income students a level playing field with their more affluent classmates. While some authorities see no problem with such prescriptions, others are concerned with physical and psychological risks.
Sunday, October 7, 2012
The Dementia Plague
The Dementia Plague by Stephen S. Hall. Technology Review--Published by MIT. October 5, 2012.
Alzheimer's and other forms of dementia threaten to become a healthcare disaster. At present, estimates hold that 36 million people worldwide suffer from dementia and by 2030 the figure will be 70 million. By 2050 the total world population at risk for dementia is estimated to be two billion. Costs to U.S. society in 2050 is estimated to be $1 trillion dollars.
The emerging picture of dementia is much broader than Alzheimer's including "mixed dementias" which includes mini-strokes as well Alzheimer's associated with amyloid plaque. This complex picture has resulted in frustratingly slow scientific and clinical progress which is traced in this article.
Alzheimer's and other forms of dementia threaten to become a healthcare disaster. At present, estimates hold that 36 million people worldwide suffer from dementia and by 2030 the figure will be 70 million. By 2050 the total world population at risk for dementia is estimated to be two billion. Costs to U.S. society in 2050 is estimated to be $1 trillion dollars.
The emerging picture of dementia is much broader than Alzheimer's including "mixed dementias" which includes mini-strokes as well Alzheimer's associated with amyloid plaque. This complex picture has resulted in frustratingly slow scientific and clinical progress which is traced in this article.
Healthy Living and Breast Cancer: Athens Resources
Healthy Living Can Prevent Breast Cancer: Athens Resources. Athens Patch. October 6, 2012.
The article cites the research of Dr. Marian Neuhouse of the Fred Hutchinson Cancer Research Center in Seattle. Among her findings is that especially in postmenopausal women, being overweight is linked with breast cancer. After menopause, estrogens are synthesized by adipose tissues increasing inflammatory factors, which are linked to breast cancer. Athens resources such as Workout Warriors, Athens YMCA and The Classic City Tri Club are listed with links.
The article cites the research of Dr. Marian Neuhouse of the Fred Hutchinson Cancer Research Center in Seattle. Among her findings is that especially in postmenopausal women, being overweight is linked with breast cancer. After menopause, estrogens are synthesized by adipose tissues increasing inflammatory factors, which are linked to breast cancer. Athens resources such as Workout Warriors, Athens YMCA and The Classic City Tri Club are listed with links.
Anti-Tax Advocate Enters GA. Hospital Tax Controversy
Hospitals Respond to Norquist Letter on Provider Tax by Andy Miller. Georgia Health News. October 2, 2012.
Renewal of a hospital fee aimed at raising money for Georgia's Medicaid program has come under fire from GOP anti-tax leader Grover Norquist. In a letter to state legislators he stated that the fee would kill jobs and raise health costs. Norquist has enlisted Republican legislators across the nation in an anti-tax pledge. This tax, he maintains, violates the pledge. Hospitals across Georgia have delivered letters to legislators stating that failing to renew the fee could double Medicaid shortfall and limit care of Georgia's most vulnerable. In Georgia the fee generates more than $200 million a year. A fight over the hospital assessment will probably be a highlight of the 2013 General Assembly session
Renewal of a hospital fee aimed at raising money for Georgia's Medicaid program has come under fire from GOP anti-tax leader Grover Norquist. In a letter to state legislators he stated that the fee would kill jobs and raise health costs. Norquist has enlisted Republican legislators across the nation in an anti-tax pledge. This tax, he maintains, violates the pledge. Hospitals across Georgia have delivered letters to legislators stating that failing to renew the fee could double Medicaid shortfall and limit care of Georgia's most vulnerable. In Georgia the fee generates more than $200 million a year. A fight over the hospital assessment will probably be a highlight of the 2013 General Assembly session
Romney Claim Corrected by Romney Staff
Romney Health Care Debate Claim Gets Corrected by His Own Staff by Julie Rovner. NPR. October 6, 2012.
In the debate on Wednesday Republican presidential candidate Mitt Romney asserted that preexisting conditions were covered under his plan. In fact, only the Affordable Care Act (Obamacare) allows those without insurance who currently have preexisting medical conditions to be protected from discrimination by insurance companies. Current law allows those who currently have coverage to continue to pay premiums and continue receiving insurance coverage. Only those who currently covered by current law will be covered by the Romney proposal as acknowledged by a top Romney aid.
In the debate on Wednesday Republican presidential candidate Mitt Romney asserted that preexisting conditions were covered under his plan. In fact, only the Affordable Care Act (Obamacare) allows those without insurance who currently have preexisting medical conditions to be protected from discrimination by insurance companies. Current law allows those who currently have coverage to continue to pay premiums and continue receiving insurance coverage. Only those who currently covered by current law will be covered by the Romney proposal as acknowledged by a top Romney aid.
Viable Eggs Created From Normal Cells
Japan Team Offers Fertility Hope with Stem Cell Eggs. New York Daily News. October 5, 2012.
Using mice, Japanese researchers have created viable eggs from normal cell. Mice stem cells were harvested and genetically altered to create the primordial germ cells that create sperm and eggs. The cells were extracted, fertilized, and implanted into surrogate mother mice. The mice pups born were healthy and able to reproduce. With further research this type of approach could be beneficial for reproductive medicine in humans.
Using mice, Japanese researchers have created viable eggs from normal cell. Mice stem cells were harvested and genetically altered to create the primordial germ cells that create sperm and eggs. The cells were extracted, fertilized, and implanted into surrogate mother mice. The mice pups born were healthy and able to reproduce. With further research this type of approach could be beneficial for reproductive medicine in humans.
Medicare Fraud Crackdown
Authorities Charge 91 in 430 million Medicare Fraud by David Ingram and David Morgan. Reuters. October 4, 2012.
Unnecessary ambulance rides, prescriptions for unqualified patients, unnecessary ambulance rides, kickbacks, identity theft, and money laundering were some of the fraudulent practices charged. Doctors, nurses, and other medical professionals were among the 91 charged.
Unnecessary ambulance rides, prescriptions for unqualified patients, unnecessary ambulance rides, kickbacks, identity theft, and money laundering were some of the fraudulent practices charged. Doctors, nurses, and other medical professionals were among the 91 charged.
Institutes of Medicine Identifies Sources of Excess Costs
Best Care At Lower Costs: The Path to Continuous Learning Health Care in America by Mark Smith, Robert Saunders, Leigh Stuckhardt, J. Michael McGinnis, Editors; Committee on the Learning Health Care System in America; Institute of Medicine.
The Institute of Medicine examines policy matters pertaining to the health of the public and was established by the National Academy of Sciences. This 381 page report contains a wide-ranging discussion of healthcare costs. It categorizes excess healthcare costs in 6 broad categories for the year 2009.
1. Unnecessary services resulting from overuse, discretionary use beyond established benchmarks, and unnecessary choice of higher costs services. 210 billion
2. Inefficiently Delivered Services resulting from mistakes, care fragmentation (lack of coordination, use of unnecessary high cost providers, operational inefficiencies. 130 billion
3. Excess Administrative Costs resulting from insurance paperwork, insurance administrative inefficiency, inefficiency of care documentation. 190 billion.
4. Prices That are two high resulting from service and product prices beyond benchmarks. 105 billion.
5. Missed prevention opportunities. 55 billion
6. Fraud from all sources. 75 billion.
The Institute of Medicine examines policy matters pertaining to the health of the public and was established by the National Academy of Sciences. This 381 page report contains a wide-ranging discussion of healthcare costs. It categorizes excess healthcare costs in 6 broad categories for the year 2009.
1. Unnecessary services resulting from overuse, discretionary use beyond established benchmarks, and unnecessary choice of higher costs services. 210 billion
2. Inefficiently Delivered Services resulting from mistakes, care fragmentation (lack of coordination, use of unnecessary high cost providers, operational inefficiencies. 130 billion
3. Excess Administrative Costs resulting from insurance paperwork, insurance administrative inefficiency, inefficiency of care documentation. 190 billion.
4. Prices That are two high resulting from service and product prices beyond benchmarks. 105 billion.
5. Missed prevention opportunities. 55 billion
6. Fraud from all sources. 75 billion.
Contaminated Drugs Lead to 7 Meningitis Deaths
Death Toll From Meningitis Outbreak Now Stands at 7 by Steven Reinberg and Margaret Steele. U.S. News and World Report. October 7, 2012.
The rare type of meningitis, which is not contagious, seems to be associated with a steroid procedure called lumbar epidural steroid injection. The steroids used are suspected of contamination with a fungus usually found in a leaf mold. The compounding pharmacy in Framingham, Mass. which manufactured the steroid has shut down and ceased distributing the steroid. 75 health care facilities apparently received shipments from the firm. There may be more victims since it takes a month or more for the symptoms to appear. Compounding pharmacists make speciality drugs not made by large drug companies but are not subject to the same rigorous oversight such as the FDA.
The rare type of meningitis, which is not contagious, seems to be associated with a steroid procedure called lumbar epidural steroid injection. The steroids used are suspected of contamination with a fungus usually found in a leaf mold. The compounding pharmacy in Framingham, Mass. which manufactured the steroid has shut down and ceased distributing the steroid. 75 health care facilities apparently received shipments from the firm. There may be more victims since it takes a month or more for the symptoms to appear. Compounding pharmacists make speciality drugs not made by large drug companies but are not subject to the same rigorous oversight such as the FDA.
Friday, October 5, 2012
Doctor Shortage in Georgia
Georgia Faces Major Doctor Shortage by Carrie Teegardin and Misty Williams. The Atlanta Journal-Constitution. October 5, 2012
Faced with retirements and a new federal health care law, Georgia faces a doctor shortage in the face of a surge in demand. The key issue is the bottleneck in Georgia residencies that force many medical students to leave the state for training.
Faced with retirements and a new federal health care law, Georgia faces a doctor shortage in the face of a surge in demand. The key issue is the bottleneck in Georgia residencies that force many medical students to leave the state for training.
The Aging Voice
Listening Carefully to Voice Changes by Judith Graham. The New York Times. September 26, 2012.
In a unique study, Eric Hunter of the National Center for Voice and Speech at the University of Utah traced the voice changes in Gordon B. Hinckley, president of the Church of Jesus Christ of Latter-day Saints in annual speeches he gave to the faculty of Brigham Young University. Since Mr. Hinckley didn't smoke or drink, he would have as "normal" a voice as one would expect.
Using computer analysis of pitch, the research team compared his voice over time. Dr. Hunter discovered that Hinckley's voice dropped markedly between ages 50 and 60, continued to drop from ages 60 to 68, flattened out, and then began to climb. At 74 his pitch began to rise perhaps as a result of muscle-related deterioration in the voice box, causing him to apply more vocal force to stretch the cords.
Vocal changes in the aged can have important consequences. If vocal changes are accompanied by hearing loss, communications can be more difficult. Also changes in voice can signify changes in swallowing to come.
In a unique study, Eric Hunter of the National Center for Voice and Speech at the University of Utah traced the voice changes in Gordon B. Hinckley, president of the Church of Jesus Christ of Latter-day Saints in annual speeches he gave to the faculty of Brigham Young University. Since Mr. Hinckley didn't smoke or drink, he would have as "normal" a voice as one would expect.
Using computer analysis of pitch, the research team compared his voice over time. Dr. Hunter discovered that Hinckley's voice dropped markedly between ages 50 and 60, continued to drop from ages 60 to 68, flattened out, and then began to climb. At 74 his pitch began to rise perhaps as a result of muscle-related deterioration in the voice box, causing him to apply more vocal force to stretch the cords.
Vocal changes in the aged can have important consequences. If vocal changes are accompanied by hearing loss, communications can be more difficult. Also changes in voice can signify changes in swallowing to come.
Thursday, October 4, 2012
Open Doctor's Notes
Letting Patients Read the Doctor's Notes by Pauline W. Chen. M.D. The New York Times. October 4, 2012.
In 1996, the Health Insurance Portability and Accountability Act (Hippa) has allowed patients to access and amend their own medical records. In fact, access is controlled by delays, administrative regulations, and permission forms.
For one year, three medical centers allowed and encouraged over 13,000 patients to have complete access to doctor's notes without any restrictions or delay in a study call OpenNotes. Almost all the patients and a majority of doctors were enthusiastic about the results. Patients felt more control over their own care, took medications more regularly, and followed their doctor's recommendations. Doctors experienced none of the expected negative consequences. None of the doctor's opted to stop sharing their notes with patients after the experiment ended.
The American Medical Association and the American Hospital Association are evaluating more open access to records at more institutions.
In 1996, the Health Insurance Portability and Accountability Act (Hippa) has allowed patients to access and amend their own medical records. In fact, access is controlled by delays, administrative regulations, and permission forms.
For one year, three medical centers allowed and encouraged over 13,000 patients to have complete access to doctor's notes without any restrictions or delay in a study call OpenNotes. Almost all the patients and a majority of doctors were enthusiastic about the results. Patients felt more control over their own care, took medications more regularly, and followed their doctor's recommendations. Doctors experienced none of the expected negative consequences. None of the doctor's opted to stop sharing their notes with patients after the experiment ended.
The American Medical Association and the American Hospital Association are evaluating more open access to records at more institutions.
Quick DNA Analysis For Infants
Infant DNA Tests Speed Diagnosis of Rare Diseases by Gina Kolata. The New York Times. October 3, 2012.
An article in Science Translation Medicine outlined a new approach to quickly analyzing a baby's entire DNA to pinpoint mutations in two days instead of weeks or months. Disease symptoms are used to narrow the search for genetic aberrations. A computer program searches for genes based on those symptoms. In narrowing the search for mutations the new method avoids ethical problems that arise when genes are discovered which can lead to adult disease.
An article in Science Translation Medicine outlined a new approach to quickly analyzing a baby's entire DNA to pinpoint mutations in two days instead of weeks or months. Disease symptoms are used to narrow the search for genetic aberrations. A computer program searches for genes based on those symptoms. In narrowing the search for mutations the new method avoids ethical problems that arise when genes are discovered which can lead to adult disease.
Wednesday, October 3, 2012
Nurse Anesthetists' Role to Expand?
Nurses Seek Expanded Role by Timothy W. Martin. The Wall Street Journal. October 3, 2012.
The Centers for Medicare and Medicaid will decide by November if Nurse Anesthetists should be directly reimbursed by Medicare for pain treatment services including epidurals and writing prescriptions for painkillers called opioids.
This proposed decision is sharply opposed by doctor's groups who assert that it could lead to increases in painkiller prescriptions, increased costs, and looser control of painkillers. The AARP, the Rural Health Association, and the American Association of Nurse Anesthetists support the proposed decision stating that there are not enough pain doctors to meet demand.
In light of state pressure to crack down on writing pain killer prescriptions, there is pressure to ramp up training requirements for physicians writing those prescriptions. The AANA does not have specific training requirements. Doctors who are not pain specialists may receive only a few weeks relevant training in residency or in medical school.
The Centers for Medicare and Medicaid will decide by November if Nurse Anesthetists should be directly reimbursed by Medicare for pain treatment services including epidurals and writing prescriptions for painkillers called opioids.
This proposed decision is sharply opposed by doctor's groups who assert that it could lead to increases in painkiller prescriptions, increased costs, and looser control of painkillers. The AARP, the Rural Health Association, and the American Association of Nurse Anesthetists support the proposed decision stating that there are not enough pain doctors to meet demand.
In light of state pressure to crack down on writing pain killer prescriptions, there is pressure to ramp up training requirements for physicians writing those prescriptions. The AANA does not have specific training requirements. Doctors who are not pain specialists may receive only a few weeks relevant training in residency or in medical school.
Tuesday, October 2, 2012
Live-Tweeted Surgery: Instagram Style
Instagram in the O.R.: Hearing Restoration surgery Live-Tweeted by Lindsay Abrams. The Atlantic. October 2, 2012.
The Swedish Medical Center in Seattle, WA live tweeted a cochlear implant surgery with Instagram.
There is an increasing movement toward transparency including providing patients with video recordings of their procedures. This article includes photos from the operating theatre.
The Swedish Medical Center in Seattle, WA live tweeted a cochlear implant surgery with Instagram.
There is an increasing movement toward transparency including providing patients with video recordings of their procedures. This article includes photos from the operating theatre.
Omega 3 Effectiveness and Research Methodology
Questioning The Superpowers of Omega-3 in Diets by Melinda Beck. The Wall Street Journal. October 1, 2012.
The Journal of the American Medical Association last month published a meta-analysis of 20 clinical trials, finding that omega 3 fatty acids did not prevent strokes, heart attacks, or death from heart disease. If these results are true, they will impact the 21% of Americans who take omega 3 supplements.
However, the American Heart Association will continue to recommend omega 3 by diet and especially for those with heart disease or high triglycerides.
Among the reasons the Association will continue to recommend omega 3 is that the JAMA study used a unusually strict standard of statistical significance. A more traditional measure would show an association of omega 3 and a 9 percent reduction in cardiac deaths.
The article provides a summary of other omega 3 research for Alzheimer's, macular degeneration, ADHD, depression, cancer, rheumatoid arthritis, and fetal development. This summary provide a picture of the uses and limitations of omega 3. For example, while omega 3 seems to reduce the levels of the protein associated with Alzheimer's, it does not seem to ward off cognitive decline.
The Journal of the American Medical Association last month published a meta-analysis of 20 clinical trials, finding that omega 3 fatty acids did not prevent strokes, heart attacks, or death from heart disease. If these results are true, they will impact the 21% of Americans who take omega 3 supplements.
However, the American Heart Association will continue to recommend omega 3 by diet and especially for those with heart disease or high triglycerides.
Among the reasons the Association will continue to recommend omega 3 is that the JAMA study used a unusually strict standard of statistical significance. A more traditional measure would show an association of omega 3 and a 9 percent reduction in cardiac deaths.
The article provides a summary of other omega 3 research for Alzheimer's, macular degeneration, ADHD, depression, cancer, rheumatoid arthritis, and fetal development. This summary provide a picture of the uses and limitations of omega 3. For example, while omega 3 seems to reduce the levels of the protein associated with Alzheimer's, it does not seem to ward off cognitive decline.
PA Studies Ranks #1 for Graduate Study for Jobs
The Best and Worst Master's Degrees for Jobs by Jacquelyn Smith. Forbes. June 8, 2012.
Mid-career median earnings for Physician Assistants is $97,000. The field is expected to grow by 30% by 2020 as a result of demographics and a doctor shortage. Physician Assistant beat out computer science, the number two graduate degree for jobs according to Forbes magazine.
Mid-career median earnings for Physician Assistants is $97,000. The field is expected to grow by 30% by 2020 as a result of demographics and a doctor shortage. Physician Assistant beat out computer science, the number two graduate degree for jobs according to Forbes magazine.
Non-Profit Hospitals Turn to Risk to Maximize Return
Riskier Investment Strategies For Hospitals Could Be Slippery Slope by Mark Reiboldt. The Atlanta Journal Constitution. September 19, 2012.
In order to compensate for cuts to government hospital reimbursement rates, non-profit hospitals are turning to riskier investments such as real estate, hedge funds, private equity, and venture capital.
The report from Commonfund pointing out this trend can be found here.
In order to compensate for cuts to government hospital reimbursement rates, non-profit hospitals are turning to riskier investments such as real estate, hedge funds, private equity, and venture capital.
The report from Commonfund pointing out this trend can be found here.
Retracted Papers Reveal Abuse
Misconduct Widespread in Retracted Science Papers, Study Finds by Carl Zimmer. The New York Times. October 1, 2012.
In a study looking at over 2,000 articles retracted by scientific journals, researchers found misconduct evident in three-quarters of the retractions for which a reason could be determined. Fraud and misconduct may be more of a problem than previously thought, a author of the study indicated. Previously, simple error was blamed for the retractions. However a more in-depth review revealed more serious concerns. One academic authority disagreed citing the small number of articles compared with the total number of articles published. An author of the report responded that perverse incentives may be creating overwhelming and harmful incentives.
In a study looking at over 2,000 articles retracted by scientific journals, researchers found misconduct evident in three-quarters of the retractions for which a reason could be determined. Fraud and misconduct may be more of a problem than previously thought, a author of the study indicated. Previously, simple error was blamed for the retractions. However a more in-depth review revealed more serious concerns. One academic authority disagreed citing the small number of articles compared with the total number of articles published. An author of the report responded that perverse incentives may be creating overwhelming and harmful incentives.
Alternative Treatments for Veterans Trauma
For Veterans, A Surge of New Treatments for Trauma by Tina Rosenburg. The New York Times. September 26, 2012
Suicide is the leading cause of death in the army. With rate rising and with 38 suicides in July 2012, officials are identifying causal factors and implementing new approaches.
The most prominent factor is post-traumatic stress disorder. In Afghanistan, with repeated tours and improvised explosive devices, experts believe that there will be more PTSD. Treatments include cognitive therapy and prolonged exposure which helps the soldier view the trauma differently. These approaches work with about 40% of the service members.
To deal with the rest mental health is being integrated into primary care with screening to identify suffers of PTSD, depression, sleep disorders, and substance abuse. With this effort is a program to deal with the stigma of of therapy. Staffs are being expanded and outreach programs are being implemented. Group sessions are helpful for some. Alternative therapies are being tried.
Among those alternative therapies include yoga, acupuncture, and Buddhist meditation. In one integrated program guided visual imagery, biofeedback, self-awareness, dance, self-expression, and drawing has shown results and promise. Drop-out rates for alternative therapy programs are virtually zero.
Suicide is the leading cause of death in the army. With rate rising and with 38 suicides in July 2012, officials are identifying causal factors and implementing new approaches.
The most prominent factor is post-traumatic stress disorder. In Afghanistan, with repeated tours and improvised explosive devices, experts believe that there will be more PTSD. Treatments include cognitive therapy and prolonged exposure which helps the soldier view the trauma differently. These approaches work with about 40% of the service members.
To deal with the rest mental health is being integrated into primary care with screening to identify suffers of PTSD, depression, sleep disorders, and substance abuse. With this effort is a program to deal with the stigma of of therapy. Staffs are being expanded and outreach programs are being implemented. Group sessions are helpful for some. Alternative therapies are being tried.
Among those alternative therapies include yoga, acupuncture, and Buddhist meditation. In one integrated program guided visual imagery, biofeedback, self-awareness, dance, self-expression, and drawing has shown results and promise. Drop-out rates for alternative therapy programs are virtually zero.
Monday, October 1, 2012
Georgia, Nation Impacted by National Medical Trends
National Trend Bodes Ill for U.S. Medicine by Kevin Hall. The Moultrie Observer. June 4, 2011.
While Colquitt County in south Georgia has a grip on short-term physician supply, it, along with the rest of the nation have not confronted the looming physician shortages over the next 10 years. This shortage results from
(1) Increasing population up to 357 million by 2025.
(2) Aging population which uses physicians at a much higher rate than younger individuals
(3) Increased coverage under health reform
(4) Retirement of doctors: 250,000 or the nation's 800,000 doctors will retire in the next 10 years
In Georgia the critical issue is residency opportunities. In 2007 70% of Medical College of Georgia graduates did their residency out of state. In 2010 the figure had risen to 80%. Graduate medical education is generally funded under the Medicaid program and limited to 100,000 slots in which Georgia is underrepresented. To deal with this issue in South Georgia, four hospitals are creating a consortium to eventually provide residencies to 160 a year by 2020.
The Board for Physician Workforce is the organization charged with advising the Georgia Governor and General Assembly or physician workforce and medical policy issues.
While Colquitt County in south Georgia has a grip on short-term physician supply, it, along with the rest of the nation have not confronted the looming physician shortages over the next 10 years. This shortage results from
(1) Increasing population up to 357 million by 2025.
(2) Aging population which uses physicians at a much higher rate than younger individuals
(3) Increased coverage under health reform
(4) Retirement of doctors: 250,000 or the nation's 800,000 doctors will retire in the next 10 years
In Georgia the critical issue is residency opportunities. In 2007 70% of Medical College of Georgia graduates did their residency out of state. In 2010 the figure had risen to 80%. Graduate medical education is generally funded under the Medicaid program and limited to 100,000 slots in which Georgia is underrepresented. To deal with this issue in South Georgia, four hospitals are creating a consortium to eventually provide residencies to 160 a year by 2020.
The Board for Physician Workforce is the organization charged with advising the Georgia Governor and General Assembly or physician workforce and medical policy issues.
Controversial Advocate of Weight Gain Theory
Reubin Andres, An Advocate of Weight Gain, Dies at 89 by Leslie Kaufman. The New York Times. October 1, 2012.
Dr. Andres was an advocate of the belief that weight gain in older people increases longevity. While serving as clinical director of the National Institute on Aging. Using date from the Society of Actuaries and Association of Life Insurance Directors of American, he compared weight data with those who lived longest. He found that the group with the smallest percentages of deaths was 10 to 20 percent over the recommended weights and increased with age. He believed that the desirable range of weights rises with ages. His fews were challenged by some health officials. The National Institutes of Health does not recommend age-specific weight gain. In addition to his work on weight, Dr. Andres developed a method to quantify insulin sensitivity and insulin secretion. Dr. Andres died on September 23 at his home in Baltimore.
Dr. Andres was an advocate of the belief that weight gain in older people increases longevity. While serving as clinical director of the National Institute on Aging. Using date from the Society of Actuaries and Association of Life Insurance Directors of American, he compared weight data with those who lived longest. He found that the group with the smallest percentages of deaths was 10 to 20 percent over the recommended weights and increased with age. He believed that the desirable range of weights rises with ages. His fews were challenged by some health officials. The National Institutes of Health does not recommend age-specific weight gain. In addition to his work on weight, Dr. Andres developed a method to quantify insulin sensitivity and insulin secretion. Dr. Andres died on September 23 at his home in Baltimore.
Insurers and Health Care Cost--NY Times Opinion
How Insurers Can Help Unsigned Editorial. New York Times. October 1, 2012.
In this opinion piece, the editors of The New York Times cites an innovative program by Blue Cross and Blue Shield of Massachusetts aimed at reducing health care costs. Under this program many of the states largest hospitals and physician groups are placed on fixed budgets with incentives, both positive and negative, to meet budget targets in care. This contrasts with a fee-for-service approach which compensates doctors for each service they provide. Fee-for-service is often criticized for encouraging doctors to do more rather than less. Under the new approach insurers do not dictate what procedures or tests that are to be performed. These decisions are left to doctors to work within the resources provided. To prevent doctors from denying care to meet budget targets, bonuses are provided patient achievements in areas such as blood pressure control. Costs thus far have been controlled by using low-cost hospitals and non-hospital laboratories which are often cheaper.
In this opinion piece, the editors of The New York Times cites an innovative program by Blue Cross and Blue Shield of Massachusetts aimed at reducing health care costs. Under this program many of the states largest hospitals and physician groups are placed on fixed budgets with incentives, both positive and negative, to meet budget targets in care. This contrasts with a fee-for-service approach which compensates doctors for each service they provide. Fee-for-service is often criticized for encouraging doctors to do more rather than less. Under the new approach insurers do not dictate what procedures or tests that are to be performed. These decisions are left to doctors to work within the resources provided. To prevent doctors from denying care to meet budget targets, bonuses are provided patient achievements in areas such as blood pressure control. Costs thus far have been controlled by using low-cost hospitals and non-hospital laboratories which are often cheaper.
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