Story first appeared in the Associated Press
Medical procedures and surgeries on the wrong patient and wrong body part have declined substantially at Veterans Affairs hospitals nationwide, while reports of close calls have increased, according to a study that credits ongoing quality improvement efforts. A Michigan Spinal Cord Injury Lawyer has seen a decrease in calls.
These efforts include a VA requirement for doctors, nurses and other hospital workers to report medical errors and near-misses to their bosses. The study is based on reports from mid-2006 to 2009; they were compared with data from the previous five years.
The per-month rate of reported errors declined to about two from about three at the VA's 153 centers that do surgery or other major medical procedures. Reported monthly close calls increased to about three from almost two.
Skeptics might wonder if a decline in reported errors means hospital workers are clamming up, but co-author Julia Neily, a nurse and associate director with the VA's National Center for Patient Safety, said, care is becoming safer. She said the increase in close-call reports suggests doctors, nurses and their co-workers are becoming more willing to speak up when something goes wrong or looks like it's about to.
The VA's quality improvement efforts encourage that kind of openness. Veterans facilities also are among hospitals that have adopted pilot-style checklists, where a member of the operating team reads off things like the patient's name, the type of procedure, anesthesia and tools needed. Body parts to be operated on are marked, and team members are supposed to speak up if something doesn't sound right. Patients, too, are sometimes involved before being wheeled into the operating room.
The study was published online Monday in the Archives of Surgery.
During the 42 months studied, there were 101 medical errors and 136 close calls, out of more than half a million procedures.
The researchers and patient safety experts not involved in the study said the results show a promising trend, including a decline in the severity of medical errors at VA hospitals.
Still, there were troubling signs - 30 procedures or surgeries on the wrong patient and 48 on the wrong body part or wrong side of the body.
Most "wrong patient" events involved CT scans, MRIs and other radiology procedures. "Wrong" surgeries included implanting the wrong size eye lens and the wrong type of knee joint.
Why these major errors continued to happen despite a big focus on improving safety is the question, Neily acknowledged.
Sometimes patients have the same or similar names, she said.
Sometimes patients speak different languages or otherwise have difficulty communicating with their doctors, said Dr. Allan Frankel of the Institute for Healthcare Improvement, who stressed that non-VA hospitals are also struggling to get those numbers down to zero after adopting similar systems.
Dr. David Mayer, co-director of the Institute for Patient Safety Excellence at the University of Illinois at Chicago, said sometimes surgeons and other OR team members are distracted during "time-outs" and checklist-reading before surgeries, thinking ahead to the operation.
At UIC's medical center, surgeons are encouraged to have these sessions outside the operating room, in a quiet setting around patients' beds, to make it easier to focus, Mayer said. Some VA hospitals also use that approach, Neily said.
The study lacked data on deaths related to surgery mistakes during the study, although the authors said there were no deaths in 2009, the most recent year examined.
A 2006-08 study published last year reported an 18 percent decline in deaths at 74 Veterans hospitals that had adopted the surgery checklist approach.
26 July 2011
FLYING HOSPITALS HELP THOSE IN THE SERVICE
Story first appeared on the Associated Press.
A light rain fell on a runway in the early morning darkness as vans pulled up to what one officer calls the "Cadillac" of medical evacuation aircraft.
Dozens of service members began loading wounded comrades onto a huge C-17 military transport plane in a carefully choreographed process. As many as eight people carry a single patient, who often is connected to more than 100 pounds of advanced medical equipment.
The giant plane had been converted into a flying intensive care unit to evacuate the war zones' most seriously wounded for advanced care in Germany and the U.S. The wounded travel under the watchful eye of Air National Guard Critical Care Air Transport Teams.
Army Spc. Adam Castagna was on one of those flights after suffering serious injuries in a roadside bombing in Afghanistan a week before Easter. The 37-year-old, whom younger comrades call "Pops," had been evacuated to Germany. His family rushed to his bedside from New Jersey.
He was on life support, he had internal bleeding; and family wasn’t sure if he was going to make it.
But Adam Castagna was on his way back to the U.S. less than two weeks later, aboard a plane with all of the equipment, the bells and whistles that you would expect to find in a civilian facility back in the United States, said Col. Charles Chappuis, the physician on the critical care team that treated Castagna.
The critical care flights are part of a big evolution in getting wounded troops back to the U.S., which took about three weeks on average during the Vietnam War. That process can now take as little as three days, depending on the patient's needs.
Castagna's trip began at Bagram, a sprawling U.S. base north of Kabul. More than 2,300 patients were brought into the post hospital's bustling trauma center in the first three months of this year, according to Air Force Col. Guillermo Tellez, the hospital's commander.
The wounded stay in Afghanistan as long as needed to be stabilized before being flown to Ramstein Air Base in Germany for the next level of care. The emphasis is not necessarily on moving them quickly, but when they're ready.
Chappuis, the flight doctor, said the critical care teams get as much advanced treatment done on the ground as possible. The goal is to be able to spend the flight monitoring vital signs and keeping the patients comfortable instead of having to do something more complicated like putting in an intravenous tube. Once airborne, there's no consultant to call, Chappuis observed.
The four critical care teams based at Ramstein fly about a dozen missions each week into Iraq and Afghanistan.
Air Force Lt. David Worley, who was the critical care nurse on Chappuis' team, and Tech. Sgt. Chris Howard, the respiratory therapist, watched over Castagna and two other patients on their eight-hour flight across the Atlantic Ocean.
They communicated over headsets with Chappuis, who said the three patients were given continuous infusions of painkillers and sedatives.
Castagna spent some of the flight whispering to his younger brother, who stood watch over his bed, sometimes stroking his brother's forehead.
As Chappuis stood nearby in an Air Force flight suit and a Nike baseball cap, Michael Castagna raved about the care his brother was receiving en route. Chappuis said there is no better mission, as he glanced back to check on the three patients.
A light rain fell on a runway in the early morning darkness as vans pulled up to what one officer calls the "Cadillac" of medical evacuation aircraft.
Dozens of service members began loading wounded comrades onto a huge C-17 military transport plane in a carefully choreographed process. As many as eight people carry a single patient, who often is connected to more than 100 pounds of advanced medical equipment.
The giant plane had been converted into a flying intensive care unit to evacuate the war zones' most seriously wounded for advanced care in Germany and the U.S. The wounded travel under the watchful eye of Air National Guard Critical Care Air Transport Teams.
Army Spc. Adam Castagna was on one of those flights after suffering serious injuries in a roadside bombing in Afghanistan a week before Easter. The 37-year-old, whom younger comrades call "Pops," had been evacuated to Germany. His family rushed to his bedside from New Jersey.
He was on life support, he had internal bleeding; and family wasn’t sure if he was going to make it.
But Adam Castagna was on his way back to the U.S. less than two weeks later, aboard a plane with all of the equipment, the bells and whistles that you would expect to find in a civilian facility back in the United States, said Col. Charles Chappuis, the physician on the critical care team that treated Castagna.
The critical care flights are part of a big evolution in getting wounded troops back to the U.S., which took about three weeks on average during the Vietnam War. That process can now take as little as three days, depending on the patient's needs.
Castagna's trip began at Bagram, a sprawling U.S. base north of Kabul. More than 2,300 patients were brought into the post hospital's bustling trauma center in the first three months of this year, according to Air Force Col. Guillermo Tellez, the hospital's commander.
The wounded stay in Afghanistan as long as needed to be stabilized before being flown to Ramstein Air Base in Germany for the next level of care. The emphasis is not necessarily on moving them quickly, but when they're ready.
Chappuis, the flight doctor, said the critical care teams get as much advanced treatment done on the ground as possible. The goal is to be able to spend the flight monitoring vital signs and keeping the patients comfortable instead of having to do something more complicated like putting in an intravenous tube. Once airborne, there's no consultant to call, Chappuis observed.
The four critical care teams based at Ramstein fly about a dozen missions each week into Iraq and Afghanistan.
Air Force Lt. David Worley, who was the critical care nurse on Chappuis' team, and Tech. Sgt. Chris Howard, the respiratory therapist, watched over Castagna and two other patients on their eight-hour flight across the Atlantic Ocean.
They communicated over headsets with Chappuis, who said the three patients were given continuous infusions of painkillers and sedatives.
Castagna spent some of the flight whispering to his younger brother, who stood watch over his bed, sometimes stroking his brother's forehead.
As Chappuis stood nearby in an Air Force flight suit and a Nike baseball cap, Michael Castagna raved about the care his brother was receiving en route. Chappuis said there is no better mission, as he glanced back to check on the three patients.
MEDCO PURCHASED
Story first appeared in Bloomberg News.
Express Scripts Inc. agreed to buy Medco Health Solutions Inc. for $29.1 billion to become the largest pharmacy-benefits manager in the U.S.
The $71.36-a-share offer in cash and stock is 28 percent more than Medco’s recent closing price of $55.78.
Medco stockholders will receive $28.80 in cash and 0.81 of an Express Scripts share for each Medco share, according to a statement from the companies.
Buying larger Medco would give Express Scripts the scale to dominate the market for contracts to manage drug benefits for corporate and government clients. Medco also said today that it lost its $11 billion contract with UnitedHealth Group Inc., which accounts for 17 percent of its business. The loss would have thrown Medco to the No. 3 rank in the industry, trailing Express Scripts and CVS CareMark.
The takeover would be the largest in pharmacy services in at least a decade, surpassing the $21.7 billion deal that formed CVS Caremark Corp. in 2007. The companies negotiate drug prices for employer and government insurance plans and manage pharmacy claims. Franklin Lakes, New Jersey-based Medco is the largest by revenue, followed by Woonsocket, Rhode Island-based CVS Caremark and Express Scripts, run by Chairman and CEO George Paz.
Lost Contracts
Medco, led by Chairman and Chief Executive Officer David Snow, has lost $3.5 billion in contracts. The loss of additional business would have increased the pressure on Medco executives to fill in the revenue gap, because scale matters so much in the industry.
Express Scripts is reported to be paying 9.1 times Medco’s 2012 estimated earnings before interest, taxes, depreciation and amortization, excluding the UnitedHealth contract.
About $1 billion in cost savings has been identified to date and the deal is expected to be slightly accretive in the first year after the deal close and moderately accretive once fully integrated. CVS Corp. paid 12.2 times Ebitda for Caremark Rx Inc. in 2007.
Intense Competition
Medco shares have declined 13 percent since May of 2011, after the company announced the loss of a $3 billion contract covering 9.8 million mail-order prescriptions. Medco in March of 2011 lost the renewal of a $500 million contract with the California Public Employees Retirement System.
Competition intensified among pharmacy-benefits managers after Express Scripts moved forward with integrating Indianapolis-based WellPoint Inc.’s pharmacy-benefits unit with 25 million members. CVS, in the past year, grabbed a contract with Capital Blue Cross of Pennsylvania from Express Scripts and the federal workers plan from Medco.
The number of potential targets dwindled after Hartford, Connecticut- based Aetna Inc. gave a 12-year, $9.5 billion contract to CVS in July of 2010 and UnitedHealth began investing in its pharmacy benefits unit.
Financial Advisers
Credit Suisse AG and Citigroup Inc. provided financial advice to Express Scripts, while Skadden, Arps, Slate, Meagher & Flom, LLP gave legal counsel. Medco’s co-lead financial advisers were JPMorgan Chase & Co. and Lazard, with Sullivan & Cromwell LLP as legal adviser and Dechert LLP as regulatory counsel.
The deal for Medco would be the second-largest this year, after AT&T Inc.’s $39 billion planned acquisition of T-Mobile USA Inc.
Both companies also reported second-quarter earnings. Express Scripts earned 71 cents a share, excluding some items, matching the average analyst estimate.
Medco posted second-quarter profit excluding some costs of 96 cents a share, beating the average analyst estimate of 94 cents.
Express Scripts Inc. agreed to buy Medco Health Solutions Inc. for $29.1 billion to become the largest pharmacy-benefits manager in the U.S.
The $71.36-a-share offer in cash and stock is 28 percent more than Medco’s recent closing price of $55.78.
Medco stockholders will receive $28.80 in cash and 0.81 of an Express Scripts share for each Medco share, according to a statement from the companies.
Buying larger Medco would give Express Scripts the scale to dominate the market for contracts to manage drug benefits for corporate and government clients. Medco also said today that it lost its $11 billion contract with UnitedHealth Group Inc., which accounts for 17 percent of its business. The loss would have thrown Medco to the No. 3 rank in the industry, trailing Express Scripts and CVS CareMark.
The takeover would be the largest in pharmacy services in at least a decade, surpassing the $21.7 billion deal that formed CVS Caremark Corp. in 2007. The companies negotiate drug prices for employer and government insurance plans and manage pharmacy claims. Franklin Lakes, New Jersey-based Medco is the largest by revenue, followed by Woonsocket, Rhode Island-based CVS Caremark and Express Scripts, run by Chairman and CEO George Paz.
Lost Contracts
Medco, led by Chairman and Chief Executive Officer David Snow, has lost $3.5 billion in contracts. The loss of additional business would have increased the pressure on Medco executives to fill in the revenue gap, because scale matters so much in the industry.
Express Scripts is reported to be paying 9.1 times Medco’s 2012 estimated earnings before interest, taxes, depreciation and amortization, excluding the UnitedHealth contract.
About $1 billion in cost savings has been identified to date and the deal is expected to be slightly accretive in the first year after the deal close and moderately accretive once fully integrated. CVS Corp. paid 12.2 times Ebitda for Caremark Rx Inc. in 2007.
Intense Competition
Medco shares have declined 13 percent since May of 2011, after the company announced the loss of a $3 billion contract covering 9.8 million mail-order prescriptions. Medco in March of 2011 lost the renewal of a $500 million contract with the California Public Employees Retirement System.
Competition intensified among pharmacy-benefits managers after Express Scripts moved forward with integrating Indianapolis-based WellPoint Inc.’s pharmacy-benefits unit with 25 million members. CVS, in the past year, grabbed a contract with Capital Blue Cross of Pennsylvania from Express Scripts and the federal workers plan from Medco.
The number of potential targets dwindled after Hartford, Connecticut- based Aetna Inc. gave a 12-year, $9.5 billion contract to CVS in July of 2010 and UnitedHealth began investing in its pharmacy benefits unit.
Financial Advisers
Credit Suisse AG and Citigroup Inc. provided financial advice to Express Scripts, while Skadden, Arps, Slate, Meagher & Flom, LLP gave legal counsel. Medco’s co-lead financial advisers were JPMorgan Chase & Co. and Lazard, with Sullivan & Cromwell LLP as legal adviser and Dechert LLP as regulatory counsel.
The deal for Medco would be the second-largest this year, after AT&T Inc.’s $39 billion planned acquisition of T-Mobile USA Inc.
Both companies also reported second-quarter earnings. Express Scripts earned 71 cents a share, excluding some items, matching the average analyst estimate.
Medco posted second-quarter profit excluding some costs of 96 cents a share, beating the average analyst estimate of 94 cents.
GENOME MACHINE FOR $1000
Story first appeared in USA TODAY.
Personal genomics, medicine tailored to patient's particular genes, may have come a step closer to the $1,000 genome.
And it is starting with Intel co-founder, Gordon Moore, the man behind the famed "Moore’s Law" prediction of exponentially growing computer power.
News of a low-cost semiconductor-based gene sequencing machine comes Wednesday in the jounal Nature, reported by a team led by Jonathan Rothberg of Ion Torrent by Life Technologies in Guilford, Conn.
DNA sequencing and, more recently, massively parallel DNA sequencing has had a profound impact on research and medicine. The reductions in cost and time for generating DNA sequence have resulted in a range of new sequencing applications in cancer, human genetics, infectious diseases, and the study of personal genomes, as well as in fields as diverse as ecology, and the study of ancient DNA,. Although de novo (new) sequencing costs have dropped substantially, there is a desire to continue to drop the cost of sequencing at an exponential rate consistent with the semiconductor industry's Moore’s Law as well as to provide lower cost, faster and more portable devices. This has been operationalized by the desire to reach the $1,000 genome.
The team reports the complementary metal-oxide semiconductor (CMOS) "ion chip" based sequencing machine unraveled the genomes of both bacteria and a person, identified as "G. Moore" of European ancestry, better known as Gordon Moore, the man behind "Moore's Law."
Intel: Moore’s Law
The study states they have demonstrated the ability to produce and use a disposable integrated circuit fabricated in standard CMOS foundries to perform, for the first time, 'post-light' genome sequencing of bacterial and human genomes. With fifty billion dollars spent per year on CMOS semiconductor fabrication and packaging technologies, their goal was to leverage that investment to make a highly scalable sequencing technology. Using the G. Moore genome we demonstrated the feasibility of sequencing a human genome.
Most genome sequencers rely on expensive fluorescent dyes. Moving genome sequencing into semiconductor technology promises to speed genomics, the researchers conclude, saying, their work suggests that readily available CMOS nodes should enable the production of one-billion sensor ion chips and low-cost routine human genome sequencing.
Geneticist Daniel MacArthur of Wired's Genetic Future blog, however, is critical of the report, saying, Ion Torrent is not yet a remotely competitive technology for affordable whole human genome sequencing. He criticized the study for statistics that he says obscure the reality of a relatively low-quality genome produced at a high cost.
Rothberg confirms his team has sequenced Moore's genes stating, yes it is THE Gordon Moore the father of Moore's law and co-founder of Intel.
A little more reason why: The development of ion semiconductor sequencing will have as profound and effect on sequencing as the introduction of CMOS imagers had on the development of digital photography - it will make sequencing ubiquitous, fast, and low cost.
The ability to leverage Moore's law, enabling more and more sensors and sequencing reactions per chip, makes the $1,000 genome not only inevitable but just the start.
Much like computing, sequencing directly on a ion chip enables the rapid and continual increase in speed and reduction in cost. At the rate of Ion's current technology improvements we will reach the $1,000 human genome in 2013 and continue to drop the cost from there.
Personal genomics, medicine tailored to patient's particular genes, may have come a step closer to the $1,000 genome.
And it is starting with Intel co-founder, Gordon Moore, the man behind the famed "Moore’s Law" prediction of exponentially growing computer power.
News of a low-cost semiconductor-based gene sequencing machine comes Wednesday in the jounal Nature, reported by a team led by Jonathan Rothberg of Ion Torrent by Life Technologies in Guilford, Conn.
DNA sequencing and, more recently, massively parallel DNA sequencing has had a profound impact on research and medicine. The reductions in cost and time for generating DNA sequence have resulted in a range of new sequencing applications in cancer, human genetics, infectious diseases, and the study of personal genomes, as well as in fields as diverse as ecology, and the study of ancient DNA,. Although de novo (new) sequencing costs have dropped substantially, there is a desire to continue to drop the cost of sequencing at an exponential rate consistent with the semiconductor industry's Moore’s Law as well as to provide lower cost, faster and more portable devices. This has been operationalized by the desire to reach the $1,000 genome.
The team reports the complementary metal-oxide semiconductor (CMOS) "ion chip" based sequencing machine unraveled the genomes of both bacteria and a person, identified as "G. Moore" of European ancestry, better known as Gordon Moore, the man behind "Moore's Law."
Intel: Moore’s Law
The study states they have demonstrated the ability to produce and use a disposable integrated circuit fabricated in standard CMOS foundries to perform, for the first time, 'post-light' genome sequencing of bacterial and human genomes. With fifty billion dollars spent per year on CMOS semiconductor fabrication and packaging technologies, their goal was to leverage that investment to make a highly scalable sequencing technology. Using the G. Moore genome we demonstrated the feasibility of sequencing a human genome.
Most genome sequencers rely on expensive fluorescent dyes. Moving genome sequencing into semiconductor technology promises to speed genomics, the researchers conclude, saying, their work suggests that readily available CMOS nodes should enable the production of one-billion sensor ion chips and low-cost routine human genome sequencing.
Geneticist Daniel MacArthur of Wired's Genetic Future blog, however, is critical of the report, saying, Ion Torrent is not yet a remotely competitive technology for affordable whole human genome sequencing. He criticized the study for statistics that he says obscure the reality of a relatively low-quality genome produced at a high cost.
Rothberg confirms his team has sequenced Moore's genes stating, yes it is THE Gordon Moore the father of Moore's law and co-founder of Intel.
A little more reason why: The development of ion semiconductor sequencing will have as profound and effect on sequencing as the introduction of CMOS imagers had on the development of digital photography - it will make sequencing ubiquitous, fast, and low cost.
The ability to leverage Moore's law, enabling more and more sensors and sequencing reactions per chip, makes the $1,000 genome not only inevitable but just the start.
Much like computing, sequencing directly on a ion chip enables the rapid and continual increase in speed and reduction in cost. At the rate of Ion's current technology improvements we will reach the $1,000 human genome in 2013 and continue to drop the cost from there.
WALTER REED CLOSES ITS DOOR
Story first appeared on the Associated Press.
Walter Reed Army Medical Center, the Army's flagship hospital where privates to presidents have gone for care, is closing its doors after more than a century.
Hundreds of thousands of the nation's war wounded from World War I to today have received treatment at Walter Reed, including 18,000 troops who served in Iraq and Afghanistan.
President Dwight Eisenhower died there. So did Gens. John J. Pershing and Douglas MacArthur.
It's where countless celebrities, from Bob Hope to quarterback Tom Brady, have stopped to show their respect to the wounded. Through the use of medical diplomacy, the center also has tended to foreign leaders.
The storied hospital, which opened in 1909, was scarred by a 2007 scandal about substandard living conditions on its grounds for wounded troops in outpatient care and the red tape they faced. It led to improved care for the wounded, at Walter Reed and throughout the military. By then, however, plans were moving forward to close Walter Reed's campus.
Two years earlier, a government commission, noting that Walter Reed was showing its age, voted to close the facility and consolidate its operations with the National Naval Medical Center in Bethesda, Md., and a hospital at Fort Belvoir, Va., to save money.
Former and current patients and staff members will say goodbye at a ceremony Wednesday on the parade grounds in front of the main concrete and glass hospital complex. Most of the moving will occur in August. On Sept. 15, the Army hands over the campus to the new tenants: the State Department and the District of Columbia. The buildings on campus deemed national historic landmarks will be preserved; others probably will be torn down. The city is expected to develop its section for retail and other uses.
The new facility will be called the Walter Reed National Military Medical Center. It will consolidate many of Walter Reed's current offerings with the Navy hospital.
Susan Eisenhower, granddaughter of the former president , said frankly, she will say it's with a heavy heart that Walter Reed closes. She knows that there was a process for that decision, but she feels we have lost a great, important part of history.
She recalled bringing to the hospital a birthday cake she had baked for her grandfather, who spent the last several months before his death in 1969 in a special suite where politicians and foreign leaders visited him.
There are countless pieces of history throughout the campus.
At the rose garden, some nurses from the Vietnam War era were said to have married their patients. The memorial chapel is where President Harry S. Truman went for his first church service after taking office, following a visit with Pershing, who lived in a suite at Walter Reed for several years, said John Pierce, historian for the Walter Reed Society.
A marker identifies the spot on the hospital grounds where, long before the hospital was built, Confederate sharpshooters fired near President Abraham Lincoln, leading an officer to call Lincoln a "damned fool" and order him to the ground, according a brochure produced by Walter Reed about its history.
President Calvin Coolidge's teenage son died in the hospital from an infected blister he received while playing tennis at the White House, Pierce said. A black and white photo from 1960 shows then-Sen. Lyndon Johnson, a vice presidential candidate at the time, visiting the bedside of Vice President Richard Nixon, who was being treated for a staph infection.
Presidents now are sent to Bethesda for treatment because it's considered more secure, said Sanders Marble, senior historian with the Office of Medical History at Fort Sam Houston, Texas.
The hospital was named to honor Maj. Walter Reed, an Army physician who treated troops and American Indians on the frontier. Among his medical achievements was life-saving research that proved that yellow fever was spread by mosquito. He died in 1902 at age 51 of complications related to appendicitis with a friend and colleague, Lt. Col. William C. Borden, treating him.
Pierce said he was sure (Borden) felt very guilty about that, and over the course of the next several years, he campaigned to get money for a new hospital and of course, wanted to name it for his good friend Walter Reed.
The original redbrick hospital had about 80 beds, but inpatient capacity grew by the thousands during the wars of the last century. Today, it treats about 775,000 outpatients annually, and has an inpatient load of about 150. It wasn't just service members and military retirees treated at the hospital over the decades, but their families, too. Countless babies were born at the hospital into the 1990s.
Rehabilitation for the wounded, including care for amputees, has been an important part of the mission since it opened. The wounded commonly spend a year or longer at the hospital now, although they are more quickly moved to outpatient care.
Photos from World War I show troops at Walter Reed learning skills such as typing and knitting. During World War II, brochures distributed to the war amputees featured pictures of amputees smoking and shaving. Marble said the message was that your life isn't over, don't get down.
Laura Lehigh's late husband, Michael Schmidt, was a lieutenant when he proposed to her during his stay at Walter Reed. He was recovering from a gunshot wound he received in Vietnam in 1968.
In letters to her, he described stinky bedpans, a "new inmate" moving into his ward, a "celebrity of the week" visit from "Tricky Dick Nixon," practical jokes played on student nurses, a champagne party for a triple amputee's 26th birthday, and how the orderlies turned patients' beds near a window around so they could watch Johnson enter the hospital to visit Eisenhower.
Despite all the warm feelings, a Washington Post investigation in 2007 uncovered shoddy living conditions in an outpatient ward known as Building 18. Troops were living among black mold and mouse droppings while trying to fend for themselves as they battled a complex bureaucracy of paperwork related to the disability evaluation system.
The report drew scrutiny of all aspects of care offered to the nation's wounded. The scandal embarrassed the Army and the Bush administration, and led to the firings of some military leaders.
Afterward, some in Congress pushed for the Pentagon to change course and keep Walter Reed open, but an independent group reviewed the idea and recommended moving forward with Walter Reed's closure plans.
It concluded that the Defense Department was or should have been aware of the widespread problems but neglected them because they knew Walter Reed was scheduled to be closed. Then-Defense Secretary Robert Gates agreed, and said there was little wisdom in pouring money into Walter Reed to keep it open indefinitely.
Gates said that is was far better to make an investment in brand-new, 21st-century facilities.
Pierce said the quality of medical care at Walter Reed didn't suffer, even leading up to the scandal.
He added that it was administrative issues and housing issues, and the housing issues were significant. He didn’t think anyone would want to say they weren't and it shouldn't have happened, but it was not a quality of care situation.
In addition to improved living conditions, one of the other upgrades after the scandal was the opening of an advanced rehabilitation center for troops with amputations. On a recent day, several amputees, including some who had lost three limbs, were exercising in the room, one even on a skateboard.
Marine Sgt. Rob Jones, 25, is a double amputee from the Afghanistan war who spends much of his days rowing. His goal is to become an FBI agent or make the U.S. Adaptive Rowing Team.
One of more than 440 troops from the recent wars getting outpatient care, he sat on a bench outside the center reading a book. His prosthetics were visible below his shorts.
Walter Reed Army Medical Center, the Army's flagship hospital where privates to presidents have gone for care, is closing its doors after more than a century.
Hundreds of thousands of the nation's war wounded from World War I to today have received treatment at Walter Reed, including 18,000 troops who served in Iraq and Afghanistan.
President Dwight Eisenhower died there. So did Gens. John J. Pershing and Douglas MacArthur.
It's where countless celebrities, from Bob Hope to quarterback Tom Brady, have stopped to show their respect to the wounded. Through the use of medical diplomacy, the center also has tended to foreign leaders.
The storied hospital, which opened in 1909, was scarred by a 2007 scandal about substandard living conditions on its grounds for wounded troops in outpatient care and the red tape they faced. It led to improved care for the wounded, at Walter Reed and throughout the military. By then, however, plans were moving forward to close Walter Reed's campus.
Two years earlier, a government commission, noting that Walter Reed was showing its age, voted to close the facility and consolidate its operations with the National Naval Medical Center in Bethesda, Md., and a hospital at Fort Belvoir, Va., to save money.
Former and current patients and staff members will say goodbye at a ceremony Wednesday on the parade grounds in front of the main concrete and glass hospital complex. Most of the moving will occur in August. On Sept. 15, the Army hands over the campus to the new tenants: the State Department and the District of Columbia. The buildings on campus deemed national historic landmarks will be preserved; others probably will be torn down. The city is expected to develop its section for retail and other uses.
The new facility will be called the Walter Reed National Military Medical Center. It will consolidate many of Walter Reed's current offerings with the Navy hospital.
Susan Eisenhower, granddaughter of the former president , said frankly, she will say it's with a heavy heart that Walter Reed closes. She knows that there was a process for that decision, but she feels we have lost a great, important part of history.
She recalled bringing to the hospital a birthday cake she had baked for her grandfather, who spent the last several months before his death in 1969 in a special suite where politicians and foreign leaders visited him.
There are countless pieces of history throughout the campus.
At the rose garden, some nurses from the Vietnam War era were said to have married their patients. The memorial chapel is where President Harry S. Truman went for his first church service after taking office, following a visit with Pershing, who lived in a suite at Walter Reed for several years, said John Pierce, historian for the Walter Reed Society.
A marker identifies the spot on the hospital grounds where, long before the hospital was built, Confederate sharpshooters fired near President Abraham Lincoln, leading an officer to call Lincoln a "damned fool" and order him to the ground, according a brochure produced by Walter Reed about its history.
President Calvin Coolidge's teenage son died in the hospital from an infected blister he received while playing tennis at the White House, Pierce said. A black and white photo from 1960 shows then-Sen. Lyndon Johnson, a vice presidential candidate at the time, visiting the bedside of Vice President Richard Nixon, who was being treated for a staph infection.
Presidents now are sent to Bethesda for treatment because it's considered more secure, said Sanders Marble, senior historian with the Office of Medical History at Fort Sam Houston, Texas.
The hospital was named to honor Maj. Walter Reed, an Army physician who treated troops and American Indians on the frontier. Among his medical achievements was life-saving research that proved that yellow fever was spread by mosquito. He died in 1902 at age 51 of complications related to appendicitis with a friend and colleague, Lt. Col. William C. Borden, treating him.
Pierce said he was sure (Borden) felt very guilty about that, and over the course of the next several years, he campaigned to get money for a new hospital and of course, wanted to name it for his good friend Walter Reed.
The original redbrick hospital had about 80 beds, but inpatient capacity grew by the thousands during the wars of the last century. Today, it treats about 775,000 outpatients annually, and has an inpatient load of about 150. It wasn't just service members and military retirees treated at the hospital over the decades, but their families, too. Countless babies were born at the hospital into the 1990s.
Rehabilitation for the wounded, including care for amputees, has been an important part of the mission since it opened. The wounded commonly spend a year or longer at the hospital now, although they are more quickly moved to outpatient care.
Photos from World War I show troops at Walter Reed learning skills such as typing and knitting. During World War II, brochures distributed to the war amputees featured pictures of amputees smoking and shaving. Marble said the message was that your life isn't over, don't get down.
Laura Lehigh's late husband, Michael Schmidt, was a lieutenant when he proposed to her during his stay at Walter Reed. He was recovering from a gunshot wound he received in Vietnam in 1968.
In letters to her, he described stinky bedpans, a "new inmate" moving into his ward, a "celebrity of the week" visit from "Tricky Dick Nixon," practical jokes played on student nurses, a champagne party for a triple amputee's 26th birthday, and how the orderlies turned patients' beds near a window around so they could watch Johnson enter the hospital to visit Eisenhower.
Despite all the warm feelings, a Washington Post investigation in 2007 uncovered shoddy living conditions in an outpatient ward known as Building 18. Troops were living among black mold and mouse droppings while trying to fend for themselves as they battled a complex bureaucracy of paperwork related to the disability evaluation system.
The report drew scrutiny of all aspects of care offered to the nation's wounded. The scandal embarrassed the Army and the Bush administration, and led to the firings of some military leaders.
Afterward, some in Congress pushed for the Pentagon to change course and keep Walter Reed open, but an independent group reviewed the idea and recommended moving forward with Walter Reed's closure plans.
It concluded that the Defense Department was or should have been aware of the widespread problems but neglected them because they knew Walter Reed was scheduled to be closed. Then-Defense Secretary Robert Gates agreed, and said there was little wisdom in pouring money into Walter Reed to keep it open indefinitely.
Gates said that is was far better to make an investment in brand-new, 21st-century facilities.
Pierce said the quality of medical care at Walter Reed didn't suffer, even leading up to the scandal.
He added that it was administrative issues and housing issues, and the housing issues were significant. He didn’t think anyone would want to say they weren't and it shouldn't have happened, but it was not a quality of care situation.
In addition to improved living conditions, one of the other upgrades after the scandal was the opening of an advanced rehabilitation center for troops with amputations. On a recent day, several amputees, including some who had lost three limbs, were exercising in the room, one even on a skateboard.
Marine Sgt. Rob Jones, 25, is a double amputee from the Afghanistan war who spends much of his days rowing. His goal is to become an FBI agent or make the U.S. Adaptive Rowing Team.
One of more than 440 troops from the recent wars getting outpatient care, he sat on a bench outside the center reading a book. His prosthetics were visible below his shorts.
MEDICAL CAMPS ATTEMPT TO LURE IN FUTURE DOCTORS
Story first appeared on the Associated Press.
Lark Nash, 14, holds up a donated human eye so her lab partner can take a picture during a medical camp session on removing corneas from eyes at Fauquier Hospital in Warrenton, Va. Dissecting human eyes isn't the normal fare of summer camp. It's part of an unusual program at a small Virginia hospital that aims to hook kids as early as middle school on the possibilities of a medical career. It's not for the squeamish. But no one's ever fainted over the eyes.
Again and again, 12-year-old Brianna Bowens cautiously pokes the human eyeball. On purpose.
The donated eye is tougher than you'd think. It takes a few slices with a sharp scalpel to pierce the white part - the sclera, she learns - and eventually remove the cornea in front.
Dissecting a human eye isn't the normal fare of summer camp. It's part of an unusual program at a small northern Virginia hospital that aims to hook kids as early as middle school on the possibilities of a medical career.
It's not for the squeamish. But no one's ever fainted over the eyes.
Brianna says she has got a strong stomach. She wants to be a pediatric surgeon or maybe a nurse.
She betrays her excitement when she's done, the twig-like optic nerve, magnifying lens and clear cornea carefully laid out. She whipped out her cellphone to take a picture.
Tom Gaile of the Old Dominion Eye Foundation teaches the crash course at Fauquier Hospital's medical camp, using eyes donated for education, to explain the importance of organ and tissue donation.
Programs to entice budding scientists, from building robots to measuring pollution, increasingly are becoming part of the summer ritual. On the health side, it can be harder to find hospitals that free up space and staff to give youngsters a taste of what beginning medical students learn - how to suture skin, take blood pressure, put on a cast, insert an IV, type blood - much less handle precious donated eyes.
But more medical camps are cropping up, although no one keeps a count. And if 12 sounds young, well, Virginia in particular is targeting middle-school students so they line up enough science courses for the best shot at increasingly competitive college training programs.
Barbara Brown, vice president of the Virginia Hospital & Healthcare Association which helps to fund the camp, says you can't wait 'til you're a senior and decide 'I want to go into health care.
She counts 760 mostly middle-school students going through one- to five-day medical camps at 26 hospitals this summer.
The idea is to show kids a wide variety of critical health careers, from nurse-anesthetists to pharmacists to physical therapists.
Julie Fainter of Fauquier Health, who coordinates the medical camp in this town west of Washington, D.C states that nobody ever says, 'I want to be an organ recovery technician.
Judging from the questions that pepper Gaile, maybe some will. Does removing the eye affect funeral viewing? No, the lids are closed. People can donate only the cornea or the entire eye, important as the sclera is transplanted in some eye surgeries and the rest is used for research. Does an eye's color change after it's out of the body? Yes, all irises turn brown after a while.
Marquesia Atwater, 14, came from suburban Atlanta after her mother did a Google search for medical camps.
She says that she has wanted to be a doctor her whole life, a decision the camp cemented.
During July and August, 92 kids will spend two days each in Fauquier's camps designed for either beginners or returning students. Funded mostly through a $15,000 hospital association grant and staff contributions, kids pay $50 to attend.
Eyes aren't the only hands-on experience.
How do you learn to stitch up a cut when you can't practice on people? They use pigs' feet, but nurse Wendy Greenwood makes sure the kids keep things sterile just like as if it was a person.
Gloves on. Swab the wound with iodine. No scratching your nose, Greenwood tells one student - and watch where you lay the curved needle so no one gets stuck.
Will Merriken, 12, of Warrenton, Va., finishes seven stitches, each a little faster as he gets more comfortable with the painstaking knots.
On to the hospital's lab. If a kid's going to get lightheaded, this is where it happens, Fainter says, maybe because of the faint chemical odor or the warmth necessary for culturing bacteria. She arms them with peppermints to ward off wooziness.
Inside, Will volunteers first to prick his finger and test his blood type. He drips blood onto a slide and medical technologist Suzie Capron explains how different antibodies make one type clump but not another. He's a B-positive.
Down in the emergency room on a quiet Wednesday morning, Dr. Greg Wagner gathers a dozen of the students for what's called a mock code, a resuscitation drill that doctors and nurses perform to fine-tune their own skills.
Paramedics race in a mannequin: A 45-year-old woman in cardiac arrest.
The kids, each assigned an ER job, spring into action under Wagner's direction. One pumps air into the "patient's" lungs. One inserts a tube to open the windpipe. Three trade off CPR. Another sets up the defibrillator, calling "Clear!" before each of three shocks. Others give injections of heart-stimulating drugs.
Ten minutes later, they abruptly fall quiet as Wagner asks how long they should keep trying before declaring death. No one volunteers.
14-year-old Lark Nash of Warrenton finally asked how often patients pass away.
Probably once a week, Wagner responds, describing the hardest part of his job. Nurses reveal a body bag lining the bed, and the students zip it over the mannequin.
Lark Nash, 14, holds up a donated human eye so her lab partner can take a picture during a medical camp session on removing corneas from eyes at Fauquier Hospital in Warrenton, Va. Dissecting human eyes isn't the normal fare of summer camp. It's part of an unusual program at a small Virginia hospital that aims to hook kids as early as middle school on the possibilities of a medical career. It's not for the squeamish. But no one's ever fainted over the eyes.
Again and again, 12-year-old Brianna Bowens cautiously pokes the human eyeball. On purpose.
The donated eye is tougher than you'd think. It takes a few slices with a sharp scalpel to pierce the white part - the sclera, she learns - and eventually remove the cornea in front.
Dissecting a human eye isn't the normal fare of summer camp. It's part of an unusual program at a small northern Virginia hospital that aims to hook kids as early as middle school on the possibilities of a medical career.
It's not for the squeamish. But no one's ever fainted over the eyes.
Brianna says she has got a strong stomach. She wants to be a pediatric surgeon or maybe a nurse.
She betrays her excitement when she's done, the twig-like optic nerve, magnifying lens and clear cornea carefully laid out. She whipped out her cellphone to take a picture.
Tom Gaile of the Old Dominion Eye Foundation teaches the crash course at Fauquier Hospital's medical camp, using eyes donated for education, to explain the importance of organ and tissue donation.
Programs to entice budding scientists, from building robots to measuring pollution, increasingly are becoming part of the summer ritual. On the health side, it can be harder to find hospitals that free up space and staff to give youngsters a taste of what beginning medical students learn - how to suture skin, take blood pressure, put on a cast, insert an IV, type blood - much less handle precious donated eyes.
But more medical camps are cropping up, although no one keeps a count. And if 12 sounds young, well, Virginia in particular is targeting middle-school students so they line up enough science courses for the best shot at increasingly competitive college training programs.
Barbara Brown, vice president of the Virginia Hospital & Healthcare Association which helps to fund the camp, says you can't wait 'til you're a senior and decide 'I want to go into health care.
She counts 760 mostly middle-school students going through one- to five-day medical camps at 26 hospitals this summer.
The idea is to show kids a wide variety of critical health careers, from nurse-anesthetists to pharmacists to physical therapists.
Julie Fainter of Fauquier Health, who coordinates the medical camp in this town west of Washington, D.C states that nobody ever says, 'I want to be an organ recovery technician.
Judging from the questions that pepper Gaile, maybe some will. Does removing the eye affect funeral viewing? No, the lids are closed. People can donate only the cornea or the entire eye, important as the sclera is transplanted in some eye surgeries and the rest is used for research. Does an eye's color change after it's out of the body? Yes, all irises turn brown after a while.
Marquesia Atwater, 14, came from suburban Atlanta after her mother did a Google search for medical camps.
She says that she has wanted to be a doctor her whole life, a decision the camp cemented.
During July and August, 92 kids will spend two days each in Fauquier's camps designed for either beginners or returning students. Funded mostly through a $15,000 hospital association grant and staff contributions, kids pay $50 to attend.
Eyes aren't the only hands-on experience.
How do you learn to stitch up a cut when you can't practice on people? They use pigs' feet, but nurse Wendy Greenwood makes sure the kids keep things sterile just like as if it was a person.
Gloves on. Swab the wound with iodine. No scratching your nose, Greenwood tells one student - and watch where you lay the curved needle so no one gets stuck.
Will Merriken, 12, of Warrenton, Va., finishes seven stitches, each a little faster as he gets more comfortable with the painstaking knots.
On to the hospital's lab. If a kid's going to get lightheaded, this is where it happens, Fainter says, maybe because of the faint chemical odor or the warmth necessary for culturing bacteria. She arms them with peppermints to ward off wooziness.
Inside, Will volunteers first to prick his finger and test his blood type. He drips blood onto a slide and medical technologist Suzie Capron explains how different antibodies make one type clump but not another. He's a B-positive.
Down in the emergency room on a quiet Wednesday morning, Dr. Greg Wagner gathers a dozen of the students for what's called a mock code, a resuscitation drill that doctors and nurses perform to fine-tune their own skills.
Paramedics race in a mannequin: A 45-year-old woman in cardiac arrest.
The kids, each assigned an ER job, spring into action under Wagner's direction. One pumps air into the "patient's" lungs. One inserts a tube to open the windpipe. Three trade off CPR. Another sets up the defibrillator, calling "Clear!" before each of three shocks. Others give injections of heart-stimulating drugs.
Ten minutes later, they abruptly fall quiet as Wagner asks how long they should keep trying before declaring death. No one volunteers.
14-year-old Lark Nash of Warrenton finally asked how often patients pass away.
Probably once a week, Wagner responds, describing the hardest part of his job. Nurses reveal a body bag lining the bed, and the students zip it over the mannequin.
19 July 2011
SAMSUNG SEEKS TO EXPAND IN MEDICAL EQUIPMENT FIELD
SAMSUNG SEEKS TO EXPAND IN MEDICAL EQUIPMENT FIELD
Samsung Electronics Co., whose empire ranges from memory chips to televisions, is in talks to buy makers of MRI scanners and X-ray machines to challenge General Electric Co. and Siemens AG in medical equipment.
Samsung is in contact with some companies, Senior Vice President Jo Jae Moon, who leads a team of medical-equipment developers, said in an interview in Seoul on July 15, without elaborating on the potential targets. The company has said it plans to spend 1.2 trillion won ($1.1billion) in the medical- equipment business by 2020.
Any purchases would build on Chairman Lee Kun Hee’s plans to build the medical-equipment operations into one that generates 10 trillion won in annual sales. Lee is counting on demand for health-care gear to spur sales of scanners as the proportion of elderly residents in markets from the U.S. to Europe and Japan climb to records each year.
Samsung fell 2.3 percent to 813,000 won at the 3:00 p.m. close of trading in Seoul, while the benchmark Kospi index lost 0.7 percent.
Value Added Technologies Co., which supplies parts for X-ray machines, jumped 8.3 percent to 10,500 won, the biggest daily gain since Feb.
24. Medical-gear maker Vieworks Co. surged 15 percent to 16,250 won, the most since April, 2009.
No. 1 Target
The maker of Galaxy phones and tablet computers, with a plan to invest
23.3 trillion won in new businesses by 2020, made its biggest acquisitions in the health-care industry last year when it bought a controlling 43.5 percent stake in diagnostic ultrasound devices maker Medison Co., as well as 100 percent of Prosonic from Consus Asset Management Co. for 331.3 billion won. Samsung increased its stake in Medison to 65.8 percent in April.
They have a lot of companies on their list, and they have been contacting most of them. Samsung prefers to acquire small companies overseas with niche technology. They stated they will continue to meet them and negotiate, adding that they have a target to be the No. 1 across ultrasound devices, X-rays and MRIs.
Samsung is making a push into an industry led by General Electric, which had $16.9 billion of revenue from health care last year, a growth of 5.6 percent.
Siemens had 12.3 billion euros ($17.4 billion) in revenue from medical solutions, a 3.4 percent increase.
Aging Population
Royal Philips Electronics NV grew its medical systems business 10 percent to 8.6 billion euros. By comparison, 24.3 percent of Samsung’s revenue last year was from semiconductors and 26.6 percent from telecommunications equipment. The company’s total revenue is expected to grow 7.9 percent to 167 trillion won this year.
Samsung is expanding into health care as its overall revenue grows at the slowest pace in five years and as populations worldwide get older.
The number of people aged 65 and above will account for 8.3 percent of the world’s population by 2014, compared with 7.9 percent this year. Japan may be the oldest society, with the portion of elderly projected to account for 25 percent of the population in three years.
Medison
Besides takeovers, Samsung will also invest to boost hiring as well as research and development at its own medical-equipment business, where the number of staff grew from less than 10 people in 2009 to more than 200 now, Jo said.
Medison aims to increase sales by more than fivefold to $1.6 billion by 2020 from last year, he said. The company had a 5 percent share in the global market for diagnostic ultrasound devices last year and targets to increase that to 24 percent within a decade, Jo said.
The company may roll out its first products with the new Medison brand in the second half. Closely-held Medison, which currently has more than 1,000 employees globally with 12 overseas branches, may set up a research base in Seattle. The company will also seek more patents.
Medison was set up in 1985 and went bankrupt in 2002 because of excessive expansion. The company was taken over by Consus in 2006.
Samsung Electronics Co., whose empire ranges from memory chips to televisions, is in talks to buy makers of MRI scanners and X-ray machines to challenge General Electric Co. and Siemens AG in medical equipment.
Samsung is in contact with some companies, Senior Vice President Jo Jae Moon, who leads a team of medical-equipment developers, said in an interview in Seoul on July 15, without elaborating on the potential targets. The company has said it plans to spend 1.2 trillion won ($1.1billion) in the medical- equipment business by 2020.
Any purchases would build on Chairman Lee Kun Hee’s plans to build the medical-equipment operations into one that generates 10 trillion won in annual sales. Lee is counting on demand for health-care gear to spur sales of scanners as the proportion of elderly residents in markets from the U.S. to Europe and Japan climb to records each year.
Samsung fell 2.3 percent to 813,000 won at the 3:00 p.m. close of trading in Seoul, while the benchmark Kospi index lost 0.7 percent.
Value Added Technologies Co., which supplies parts for X-ray machines, jumped 8.3 percent to 10,500 won, the biggest daily gain since Feb.
24. Medical-gear maker Vieworks Co. surged 15 percent to 16,250 won, the most since April, 2009.
No. 1 Target
The maker of Galaxy phones and tablet computers, with a plan to invest
23.3 trillion won in new businesses by 2020, made its biggest acquisitions in the health-care industry last year when it bought a controlling 43.5 percent stake in diagnostic ultrasound devices maker Medison Co., as well as 100 percent of Prosonic from Consus Asset Management Co. for 331.3 billion won. Samsung increased its stake in Medison to 65.8 percent in April.
They have a lot of companies on their list, and they have been contacting most of them. Samsung prefers to acquire small companies overseas with niche technology. They stated they will continue to meet them and negotiate, adding that they have a target to be the No. 1 across ultrasound devices, X-rays and MRIs.
Samsung is making a push into an industry led by General Electric, which had $16.9 billion of revenue from health care last year, a growth of 5.6 percent.
Siemens had 12.3 billion euros ($17.4 billion) in revenue from medical solutions, a 3.4 percent increase.
Aging Population
Royal Philips Electronics NV grew its medical systems business 10 percent to 8.6 billion euros. By comparison, 24.3 percent of Samsung’s revenue last year was from semiconductors and 26.6 percent from telecommunications equipment. The company’s total revenue is expected to grow 7.9 percent to 167 trillion won this year.
Samsung is expanding into health care as its overall revenue grows at the slowest pace in five years and as populations worldwide get older.
The number of people aged 65 and above will account for 8.3 percent of the world’s population by 2014, compared with 7.9 percent this year. Japan may be the oldest society, with the portion of elderly projected to account for 25 percent of the population in three years.
Medison
Besides takeovers, Samsung will also invest to boost hiring as well as research and development at its own medical-equipment business, where the number of staff grew from less than 10 people in 2009 to more than 200 now, Jo said.
Medison aims to increase sales by more than fivefold to $1.6 billion by 2020 from last year, he said. The company had a 5 percent share in the global market for diagnostic ultrasound devices last year and targets to increase that to 24 percent within a decade, Jo said.
The company may roll out its first products with the new Medison brand in the second half. Closely-held Medison, which currently has more than 1,000 employees globally with 12 overseas branches, may set up a research base in Seattle. The company will also seek more patents.
Medison was set up in 1985 and went bankrupt in 2002 because of excessive expansion. The company was taken over by Consus in 2006.
CAN DANDRUFF PREDICT DISEASE
Researchers are hoping a new analytic technique can someday help detect major diseases like cancer and Alzheimer's disease. In the meantime, the approach is proving useful at telling how bad a case of dandruff a person has.
The technique, known as metabolomics, enables scientists to track the metabolic processes in cells by identifying the chemicals, or metabolites, left behind from these processes. Procter & Gamble Co. says it has used metabolomics to find chemical markers on the scalp of dandruff-sufferers that indicate the severity of the condition. Researchers at the big consumer-products company say the discovery may help them develop better dandruff treatments, by monitoring changes in the scalp chemicals in the test lab. Currently, assessing the effectiveness of new treatments requires using employees known as "dandruff graders" who comb through people's scalps and rate the level of dandruff, a highly unreliable process.
Doctors routinely measure chemicals in the body to get health information, such as cholesterol and triglycerides. Metabolomics, however, involves measuring hundreds or thousands of chemical processes, such as the breakdown of nutrients from the diet, going on in the body at the same time, which could yield a lot more information. It can also account for environmental factors, such as how well a patient is absorbing medications. Since metabolism—energy generation or breakdown—gets disrupted in many diseases, figuring out how these metabolic pathways change could potentially yield better ways of diagnosing or treating a wide range of diseases.
One needs a composite picture of how the body works because multiple processes are going on at the same time and often interact with each other. By understanding, for example, that three or four pathways are disrupted in a disease, one can develop more effective treatments that target all, not just one, of those pathways.
One challenge in metabolomics is being able to sift through and identify all the chemicals in a sample. Often a tool called mass spectrometry is used, which delivers a print-out showing the chemical signatures as jagged lines of peaks and valleys. Each peak represents a metabolite present in the sample, which is typically taken from blood or urine. Researchers figure out what chemicals the peaks correspond to by analyzing its molecular weight. Sometimes additional chemical analyses are performed to confirm the initial tests.
Dandruff: Myth or Fact
Myth: Dandruff is just due to a dry scalp.
Fact: It's not. Dandruff is a complex inflammatory response.
Myth: Dandruff is always visible.
Fact: Flakes are only one sign of an unhealthy scalp.
Myth: Dandruff is contagious.
Fact: Dandruff may be a response to fungus, but it doesn't appear to be transmittable between people.
Myth: Dandruff is due to not washing enough.
Fact: Not so. Dandruff appears to be a reaction to a fungus that is on everyone's scalp.
Metabolomics is well suited to analyzing dandruff, which isn't just skin flaking as a result of a dry scalp. Dandruff is thought to be a complex inflammatory response to a common fungus on the scalp that disrupts the normal process of shedding skin cells. When people with a healthy scalp shed dead skin cells, enzymes digest the connections between the cells so the cells slough off individually, and invisibly. In some people, however, the immune system, for reasons that remain unknown, reacts to the fungus in a way that disrupts the typical enzyme process. This causes clusters of thousands of dead cells to be shed at the same time, resulting in visible flakes and itch. Dandruff affects millions of people in the U.S.
At Procter & Gamble, researchers hunted for molecules signaling inflammation of the outermost layer of scalp skin. The aim was to identify biological markers that indicate deeper changes going on within the skin tissue. Samples of skin cells were taken from the scalps of several hundred participants, some with dandruff and others with healthy skin. Researchers analyzed the chemicals that the cells from healthy scalps had produced and compared them to the dandruff sufferers. They eventually identified several markers of inflammation that differed between the groups. The markers can now be used to monitor participants in trials of new dandruff products to determine whether someone's condition is improving.
Another P&G dandruff study used similar methods to look for chemical markers that were related to itching, a symptom that dandruff sufferers often complain about. They identified elevated histamine markers in dandruff sufferers, confirming the idea that histamine is involved in itch and could be targeted in future treatments. The findings could help advance research in skin conditions, including psoriasis and eczema.
Extensive metabolomics research is being conducted in other medical conditions as well. At the Lombardi Cancer Center at Georgetown University, researchers are looking at the metabolites of smokers to understand why some get cancer and some don't.
In a small study presented at the American Association for Cancer Research this year, scientists examined hundreds of chemicals in the blood and urine from nine smokers and 10 nonsmokers. They found varying levels of nicotine-related metabolites in the smokers, which suggests that some smokers process nicotine differently than others. The goal is to figure out if these nicotine-related metabolites can be used to predict which individuals will get cancer.
Understanding how metabolism gets disrupted in Alzheimer's disease also is being investigated.
One doctor assessed more than 800 types of fats found in blood samples from 26 Alzheimer's patients and 26 cognitive normal adults. The study found for the first time an elevation of a particular type called sphingolipids in those with Alzheimer's.
The finding is important because lipids help make up brain cells, and may one day be used to help identify people with the memory-robbing disease.
The technique, known as metabolomics, enables scientists to track the metabolic processes in cells by identifying the chemicals, or metabolites, left behind from these processes. Procter & Gamble Co. says it has used metabolomics to find chemical markers on the scalp of dandruff-sufferers that indicate the severity of the condition. Researchers at the big consumer-products company say the discovery may help them develop better dandruff treatments, by monitoring changes in the scalp chemicals in the test lab. Currently, assessing the effectiveness of new treatments requires using employees known as "dandruff graders" who comb through people's scalps and rate the level of dandruff, a highly unreliable process.
Doctors routinely measure chemicals in the body to get health information, such as cholesterol and triglycerides. Metabolomics, however, involves measuring hundreds or thousands of chemical processes, such as the breakdown of nutrients from the diet, going on in the body at the same time, which could yield a lot more information. It can also account for environmental factors, such as how well a patient is absorbing medications. Since metabolism—energy generation or breakdown—gets disrupted in many diseases, figuring out how these metabolic pathways change could potentially yield better ways of diagnosing or treating a wide range of diseases.
One needs a composite picture of how the body works because multiple processes are going on at the same time and often interact with each other. By understanding, for example, that three or four pathways are disrupted in a disease, one can develop more effective treatments that target all, not just one, of those pathways.
One challenge in metabolomics is being able to sift through and identify all the chemicals in a sample. Often a tool called mass spectrometry is used, which delivers a print-out showing the chemical signatures as jagged lines of peaks and valleys. Each peak represents a metabolite present in the sample, which is typically taken from blood or urine. Researchers figure out what chemicals the peaks correspond to by analyzing its molecular weight. Sometimes additional chemical analyses are performed to confirm the initial tests.
Dandruff: Myth or Fact
Myth: Dandruff is just due to a dry scalp.
Fact: It's not. Dandruff is a complex inflammatory response.
Myth: Dandruff is always visible.
Fact: Flakes are only one sign of an unhealthy scalp.
Myth: Dandruff is contagious.
Fact: Dandruff may be a response to fungus, but it doesn't appear to be transmittable between people.
Myth: Dandruff is due to not washing enough.
Fact: Not so. Dandruff appears to be a reaction to a fungus that is on everyone's scalp.
Metabolomics is well suited to analyzing dandruff, which isn't just skin flaking as a result of a dry scalp. Dandruff is thought to be a complex inflammatory response to a common fungus on the scalp that disrupts the normal process of shedding skin cells. When people with a healthy scalp shed dead skin cells, enzymes digest the connections between the cells so the cells slough off individually, and invisibly. In some people, however, the immune system, for reasons that remain unknown, reacts to the fungus in a way that disrupts the typical enzyme process. This causes clusters of thousands of dead cells to be shed at the same time, resulting in visible flakes and itch. Dandruff affects millions of people in the U.S.
At Procter & Gamble, researchers hunted for molecules signaling inflammation of the outermost layer of scalp skin. The aim was to identify biological markers that indicate deeper changes going on within the skin tissue. Samples of skin cells were taken from the scalps of several hundred participants, some with dandruff and others with healthy skin. Researchers analyzed the chemicals that the cells from healthy scalps had produced and compared them to the dandruff sufferers. They eventually identified several markers of inflammation that differed between the groups. The markers can now be used to monitor participants in trials of new dandruff products to determine whether someone's condition is improving.
Another P&G dandruff study used similar methods to look for chemical markers that were related to itching, a symptom that dandruff sufferers often complain about. They identified elevated histamine markers in dandruff sufferers, confirming the idea that histamine is involved in itch and could be targeted in future treatments. The findings could help advance research in skin conditions, including psoriasis and eczema.
Extensive metabolomics research is being conducted in other medical conditions as well. At the Lombardi Cancer Center at Georgetown University, researchers are looking at the metabolites of smokers to understand why some get cancer and some don't.
In a small study presented at the American Association for Cancer Research this year, scientists examined hundreds of chemicals in the blood and urine from nine smokers and 10 nonsmokers. They found varying levels of nicotine-related metabolites in the smokers, which suggests that some smokers process nicotine differently than others. The goal is to figure out if these nicotine-related metabolites can be used to predict which individuals will get cancer.
Understanding how metabolism gets disrupted in Alzheimer's disease also is being investigated.
One doctor assessed more than 800 types of fats found in blood samples from 26 Alzheimer's patients and 26 cognitive normal adults. The study found for the first time an elevation of a particular type called sphingolipids in those with Alzheimer's.
The finding is important because lipids help make up brain cells, and may one day be used to help identify people with the memory-robbing disease.
MEDICAID IN NEED OF REFORM
Medicaid spending has risen so dramatically over the past two-and-a-half decades that the program has become part of the entitlement spending crisis threatening both state and federal budgets.
From 1999 to 2009, total federal and state spending on Kentucky's Medicaid program rose from $3.3 billion to $5.1 billion — a 54 percent increase. Kentucky's General Fund spending on Medicaid increased by 37 percent, from $802 million to $1.1 billion. Enrollment expanded by 39 percent, from about 664,000 to roughly 824,000.
These increases occurred during a time where Kentucky's real GDP grew only 8 percent and followed a decade of even more dramatic increases in the Medicaid program. Without significant changes, Kentucky's General Fund spending on Medicaid could easily be 70 percent higher in 2020 than in 2009, even without the expansions built into the recent federal health care reform bill. With reform bill provisions, Medicaid spending is projected to be 80 percent higher.
The numbers alone, however, fail to express the depth of the problem.
Medicaid is rife with incentives that thwart budgetary control and good health-care practices by consumers and providers. These include: under reimbursement that penalizes providers for accepting Medicaid patients; insufficient co-pays and deductibles that lead to misuse of services; one-size-fits-all coverage that does not allow shopping for insurance; matching federal funds that reward states for growing their programs; incentives to limit work to avoid crossing the income threshold where benefits are lost; and poorly targeting the population of the truly needy by making the middle class eligible for benefits.
The problem of under reimbursement of providers is perhaps especially misguided. With low reimbursement rates, providers are reluctant to take on Medicaid patients. This problem is highlighted by a recent study indicating appointment requests for those who claimed Medicaid coverage were denied 66 percent of the time, compared to 11 percent for those stating they had private insurance.
Thus, Medicaid simultaneously encourages enrollees to visit providers and discourages providers from accepting them as patients.
While this is not to say that no one has been helped by Medicaid, it does speak to the flawed design and implementation of the program that leads to more taxpayer dollars being spent while failing to target assistance to the truly needy.
While some piecemeal reforms of Medicaid may be useful, such as more use of managed care and co-pays, fundamental reform is superior. It would integrate the low-income into the mainstream of health insurance and medical care. This is done with three steps:
mainstream of health insurance and medical care. This is done with three steps:
■ Medicaid can be transitioned to a health-insurance voucher program, with the voucher amount determined by income and health condition. Recipients purchase the health insurance of their choice with the aid of the voucher.
■ The state should seek to remove any impediments that may exist to competition among insurers and providers. Competitive health insurance and health care markets work hand-in-glove with vouchers to bring the benefits of choice and competition to Kentucky's poorest.
Recipients have incentives to shop for their care and health insurance while providers are rewarded, not penalized, for accepting them as patients.
■ The program should be converted to one where federal funding is in the form of a block grant and flexibility is allowed for each state. This removes incentives for states to game the system to receive more federal matching money as well as enabling states to design programs that suit them best.
The growth of Medicaid has contributed heavily to the fiscal crisis that threatens the solvency of the federal and state governments while failing to fulfill the goal of improved health for a large share of its recipients.
This is clearly seen in the effects of the large expansions of the program from the late 1980s through the 2000s. Careful studies indicate that for every 10 new enrollees on Medicaid during this time, five to six would otherwise have had private insurance. Other studies find minimal improvement in access to care and in health status for new enrollees, with the exception of those who are very poor.
Kentucky and the nation deserve a program that better serves taxpayers and the truly needy.
From 1999 to 2009, total federal and state spending on Kentucky's Medicaid program rose from $3.3 billion to $5.1 billion — a 54 percent increase. Kentucky's General Fund spending on Medicaid increased by 37 percent, from $802 million to $1.1 billion. Enrollment expanded by 39 percent, from about 664,000 to roughly 824,000.
These increases occurred during a time where Kentucky's real GDP grew only 8 percent and followed a decade of even more dramatic increases in the Medicaid program. Without significant changes, Kentucky's General Fund spending on Medicaid could easily be 70 percent higher in 2020 than in 2009, even without the expansions built into the recent federal health care reform bill. With reform bill provisions, Medicaid spending is projected to be 80 percent higher.
The numbers alone, however, fail to express the depth of the problem.
Medicaid is rife with incentives that thwart budgetary control and good health-care practices by consumers and providers. These include: under reimbursement that penalizes providers for accepting Medicaid patients; insufficient co-pays and deductibles that lead to misuse of services; one-size-fits-all coverage that does not allow shopping for insurance; matching federal funds that reward states for growing their programs; incentives to limit work to avoid crossing the income threshold where benefits are lost; and poorly targeting the population of the truly needy by making the middle class eligible for benefits.
The problem of under reimbursement of providers is perhaps especially misguided. With low reimbursement rates, providers are reluctant to take on Medicaid patients. This problem is highlighted by a recent study indicating appointment requests for those who claimed Medicaid coverage were denied 66 percent of the time, compared to 11 percent for those stating they had private insurance.
Thus, Medicaid simultaneously encourages enrollees to visit providers and discourages providers from accepting them as patients.
While this is not to say that no one has been helped by Medicaid, it does speak to the flawed design and implementation of the program that leads to more taxpayer dollars being spent while failing to target assistance to the truly needy.
While some piecemeal reforms of Medicaid may be useful, such as more use of managed care and co-pays, fundamental reform is superior. It would integrate the low-income into the mainstream of health insurance and medical care. This is done with three steps:
mainstream of health insurance and medical care. This is done with three steps:
■ Medicaid can be transitioned to a health-insurance voucher program, with the voucher amount determined by income and health condition. Recipients purchase the health insurance of their choice with the aid of the voucher.
■ The state should seek to remove any impediments that may exist to competition among insurers and providers. Competitive health insurance and health care markets work hand-in-glove with vouchers to bring the benefits of choice and competition to Kentucky's poorest.
Recipients have incentives to shop for their care and health insurance while providers are rewarded, not penalized, for accepting them as patients.
■ The program should be converted to one where federal funding is in the form of a block grant and flexibility is allowed for each state. This removes incentives for states to game the system to receive more federal matching money as well as enabling states to design programs that suit them best.
The growth of Medicaid has contributed heavily to the fiscal crisis that threatens the solvency of the federal and state governments while failing to fulfill the goal of improved health for a large share of its recipients.
This is clearly seen in the effects of the large expansions of the program from the late 1980s through the 2000s. Careful studies indicate that for every 10 new enrollees on Medicaid during this time, five to six would otherwise have had private insurance. Other studies find minimal improvement in access to care and in health status for new enrollees, with the exception of those who are very poor.
Kentucky and the nation deserve a program that better serves taxpayers and the truly needy.
DANGEROUS BATH SALTS INCREASE AS A RECREATIONAL DRUGS
Hospitals throughout the USA are having to cope with a growing number of people coming in high on bath salts, which can be used as recreational drugs. These substances can be smoked, injected or snorted and may have dangerous long-term harmful effects. According to the American Association of Poison Control Centers (AAPCC), American poison centers have receives 2,237 calls related to toxic substances that are marketed as "bath salts" this year so far, compared to 302 calls in 2010. A Michigan Brain Injury Lawyer stated that the increase of drug use has an impact brain injury resulting from accidents caused by intoxicated drivers.
The AAPCC says the problem is expected to continue to grow. It adds that the toxic products can cause accelerated heart rate, hallucinations, agitation, hypertension (raised blood pressure), delusions and extreme paranoia.
Emergency department staff say that people who come in under the influence of these substances are usually high and violent and need to be hospitalized overnight. In some cases they require psychiatric help because they are so disconnected from reality.
One poison center director says the products are the worst he has seen during his two decades at the poison center. He also stated that these products create a very severe paranoia that they believe could cause users to harm themselves or others.
The products are sold through various outlets, including gas stations and online. They are sold under several names, including:
• Bloom
• Blue Silk
• Cloud Nine
• Hurricane Charlie
• Ivory Wave
• Lunar Wave
• Ocean Snow
• Red Dove
• Scarface
• Vanilla Sky
• White Lightning
• Zoom
Experts have observed that these substances trigger intense craving, similar to those found among methamphetamine users.
AAPCC scientists believe the "bath salts" contain MDPV (Methylenedioxypyrovalerone). MDPV is not approved in the USA for medical use.
Reports have also come in of insect repellants and plant fertilizers containing MDPV being marketed.
Even though the products, which usually come in powdered form and have "not for human consumption" written on their packaging, the majority of emergency center cases are of people who have snorted it. There is one reported case of a male who injected himself.
28 US states, mainly in the South and Midwest, as well as New York, New Jersey, and Maine have banned bath salts. An outbreak of bath salt usage as a recreational drug resulted in a ban in the United Kingdom.
Anecdotal cases of people high on bath salts in US media include a man who climbed a flagpole and then jumped into moving traffic. In another case, a woman scratched herself to death. One man went into a monastery and killed a priest with a knife.
The AAPCC says the problem is expected to continue to grow. It adds that the toxic products can cause accelerated heart rate, hallucinations, agitation, hypertension (raised blood pressure), delusions and extreme paranoia.
Emergency department staff say that people who come in under the influence of these substances are usually high and violent and need to be hospitalized overnight. In some cases they require psychiatric help because they are so disconnected from reality.
One poison center director says the products are the worst he has seen during his two decades at the poison center. He also stated that these products create a very severe paranoia that they believe could cause users to harm themselves or others.
The products are sold through various outlets, including gas stations and online. They are sold under several names, including:
• Bloom
• Blue Silk
• Cloud Nine
• Hurricane Charlie
• Ivory Wave
• Lunar Wave
• Ocean Snow
• Red Dove
• Scarface
• Vanilla Sky
• White Lightning
• Zoom
Experts have observed that these substances trigger intense craving, similar to those found among methamphetamine users.
AAPCC scientists believe the "bath salts" contain MDPV (Methylenedioxypyrovalerone). MDPV is not approved in the USA for medical use.
Reports have also come in of insect repellants and plant fertilizers containing MDPV being marketed.
Even though the products, which usually come in powdered form and have "not for human consumption" written on their packaging, the majority of emergency center cases are of people who have snorted it. There is one reported case of a male who injected himself.
28 US states, mainly in the South and Midwest, as well as New York, New Jersey, and Maine have banned bath salts. An outbreak of bath salt usage as a recreational drug resulted in a ban in the United Kingdom.
Anecdotal cases of people high on bath salts in US media include a man who climbed a flagpole and then jumped into moving traffic. In another case, a woman scratched herself to death. One man went into a monastery and killed a priest with a knife.
DEMENTIA RISKS DOUBLE AFTER A TRAUMATIC BRAIN INJURY
A brain injury more than doubles the risk of dementia, according to new research.
A large study of older war veterans suggests those who experienced traumatic brain injury (TBI) during their lives had more than two times the risk of developing dementia, according to scientists.
The researchers presented their findings stating that they are now getting a much better understanding that head injury is an important risk factor for developing dementia down the road.
Researchers looked at medical records of nearly 300,000 veterans, all 55 or older. None had dementia at the study's start. About 2% had had a TBI. All had at least one inpatient or outpatient visit between 1997 and 2000 and a follow-up sometime between 2001 and 2007.
A diagnosis of a concussion, post-concussion syndrome, a skull fracture or some non-specific head injuries are considered TBIs.
The risk of dementia was 15% in those with a TBI diagnosis, compared with almost 7% in those who had never had a TBI.
Other studies have shown that TBI can increase the risk of dementia: It might hit earlier, and symptoms could worsen.
About 1.7 million people experience a TBI each year, mostly because of falls and car accidents. TBI also is referred to as the "signature wound" of the wars in Iraq and Afghanistan, where TBI accounts for 22% of casualties overall and 59% of blast-related injuries.
With so many soldiers returning from war affected by blasts, the relationship between TBI and dementia needs to be sorted out.
It's unknown at this point how many soldiers have a history of brain injury
More research is needed to explore whether early rehabilitation can help reduce the risk for dementia. One researcher stated that if you know you've had a head injury and you are approaching older age, one has to be carefully monitored and screened for cognitive dementia.
A large study of older war veterans suggests those who experienced traumatic brain injury (TBI) during their lives had more than two times the risk of developing dementia, according to scientists.
The researchers presented their findings stating that they are now getting a much better understanding that head injury is an important risk factor for developing dementia down the road.
Researchers looked at medical records of nearly 300,000 veterans, all 55 or older. None had dementia at the study's start. About 2% had had a TBI. All had at least one inpatient or outpatient visit between 1997 and 2000 and a follow-up sometime between 2001 and 2007.
A diagnosis of a concussion, post-concussion syndrome, a skull fracture or some non-specific head injuries are considered TBIs.
The risk of dementia was 15% in those with a TBI diagnosis, compared with almost 7% in those who had never had a TBI.
Other studies have shown that TBI can increase the risk of dementia: It might hit earlier, and symptoms could worsen.
About 1.7 million people experience a TBI each year, mostly because of falls and car accidents. TBI also is referred to as the "signature wound" of the wars in Iraq and Afghanistan, where TBI accounts for 22% of casualties overall and 59% of blast-related injuries.
With so many soldiers returning from war affected by blasts, the relationship between TBI and dementia needs to be sorted out.
It's unknown at this point how many soldiers have a history of brain injury
More research is needed to explore whether early rehabilitation can help reduce the risk for dementia. One researcher stated that if you know you've had a head injury and you are approaching older age, one has to be carefully monitored and screened for cognitive dementia.
12 July 2011
NEW CIGARETTE WARNING LABELS JOLT USERS
Graphic new cigarette warning labels may already be having the desired effect: Calls to a national smoker's quit line more than doubled the day they hit the media.
The warning labels won't appear on cigarettes until next year, but were unveiled to the media last week.
Calls to the national 1-800-QUIT-NOW smoking cessation line surpassed 4,800 that Tuesday and 3,200 the next day. A typical Tuesday or Wednesday in June sees about 2,000 calls.
The new labels replace the traditional small, white "Surgeon General's Warning" text strips with graphic photograph warnings that cover the entire top half of each cigarette pack.
Versions of the new labels include depictions of diseased lungs and rotting teeth and gums. They also carry the 1-800-QUIT-NOW number, which the old labels did not.
The warning labels won't appear on cigarettes until next year, but were unveiled to the media last week.
Calls to the national 1-800-QUIT-NOW smoking cessation line surpassed 4,800 that Tuesday and 3,200 the next day. A typical Tuesday or Wednesday in June sees about 2,000 calls.
The new labels replace the traditional small, white "Surgeon General's Warning" text strips with graphic photograph warnings that cover the entire top half of each cigarette pack.
Versions of the new labels include depictions of diseased lungs and rotting teeth and gums. They also carry the 1-800-QUIT-NOW number, which the old labels did not.
STUDY OF CT SCANS FOR LUNG CANCER HAS MIXED REVIEWS
Full results of a big study that showed some smokers' lives could be saved by screening with lung scans now reveal more clearly what the risks are: There's a good chance of a false alarm.
Of those who got the recommended annual scans for three years, 4 out of 10 had a suspicious finding on at least one scan and were advised to have a follow-up test or biopsy. And more than 95 percent of them turned out to have nothing wrong.
The results out Wednesday give the first detailed look at the benefits and risks of screening longtime current or former smokers with special X-rays called CT scans. The government stopped the study last fall after seeing the scans were saving lives.
Most insurers don't cover the scans because no major groups currently recommend them.
The study’s sponsor said that no one should rush off and get one of these scans for screening until they had thought more about it. But guidance on smoker screening is likely to change with the study's results, which may help the nation's 94 million current and former smokers decide whether to be screened.
The study tested CT scans versus ordinary chest X-rays in 53,454 people over 55 with more than 30 pack-years of smoking: a pack a day for 30 years or two packs for 15 years. No one knows if younger or less frequent smokers would benefit from screening.
The study used top medical centers around the nation and low-radiation-dose machines. It involved skilled doctors who did less invasive tests in place of many biopsies and had far lower death rates when they did operate for lung cancer than is usual. The lower risk of death among those screened with scans in the study reflects all these things.
Numbers to know:
-Three. The number of scans, one each year, that showed benefit in this study. No one knows if a single scan or testing less often would help.
-Twenty percent. The reduction in the risk of dying from lung cancer among those given CT scans (356 deaths versus 443 in the X-ray group).
-Seven percent. The reduction in the risk of dying from any cause during the study (1,877 deaths in the CT group versus 2,000 in X-ray group).
-About 320. The number of people who would have to be scanned for three years to prevent a single death from lung cancer. That's impressive when compared to the 1,339 women in their 50s who would need to have mammograms for several years to avoid one breast cancer death. However, mammograms are cheaper and involve less radiation so the risks and benefits aren't quite the same.
-One percent. The odds of dying from surgery for lung cancer among those in the study. In general practice, it's 4 percent.
-$300 to $1,200. The average range of charges for a scan. At some private practices it's up to $2,500 and there's a group in Hollywood that's charging more than that.
Researchers plan a cost-effectiveness study and may compare the benefit from scans to smoking cessation efforts.
People should not take this positive study as 'now it is safe to smoke, because it isn't, and quitting remains the best way to lower cancer risk.
The cancer society and other medical groups expect to have screening advice for the public in a matter of months.
Of those who got the recommended annual scans for three years, 4 out of 10 had a suspicious finding on at least one scan and were advised to have a follow-up test or biopsy. And more than 95 percent of them turned out to have nothing wrong.
The results out Wednesday give the first detailed look at the benefits and risks of screening longtime current or former smokers with special X-rays called CT scans. The government stopped the study last fall after seeing the scans were saving lives.
Most insurers don't cover the scans because no major groups currently recommend them.
The study’s sponsor said that no one should rush off and get one of these scans for screening until they had thought more about it. But guidance on smoker screening is likely to change with the study's results, which may help the nation's 94 million current and former smokers decide whether to be screened.
The study tested CT scans versus ordinary chest X-rays in 53,454 people over 55 with more than 30 pack-years of smoking: a pack a day for 30 years or two packs for 15 years. No one knows if younger or less frequent smokers would benefit from screening.
The study used top medical centers around the nation and low-radiation-dose machines. It involved skilled doctors who did less invasive tests in place of many biopsies and had far lower death rates when they did operate for lung cancer than is usual. The lower risk of death among those screened with scans in the study reflects all these things.
Numbers to know:
-Three. The number of scans, one each year, that showed benefit in this study. No one knows if a single scan or testing less often would help.
-Twenty percent. The reduction in the risk of dying from lung cancer among those given CT scans (356 deaths versus 443 in the X-ray group).
-Seven percent. The reduction in the risk of dying from any cause during the study (1,877 deaths in the CT group versus 2,000 in X-ray group).
-About 320. The number of people who would have to be scanned for three years to prevent a single death from lung cancer. That's impressive when compared to the 1,339 women in their 50s who would need to have mammograms for several years to avoid one breast cancer death. However, mammograms are cheaper and involve less radiation so the risks and benefits aren't quite the same.
-One percent. The odds of dying from surgery for lung cancer among those in the study. In general practice, it's 4 percent.
-$300 to $1,200. The average range of charges for a scan. At some private practices it's up to $2,500 and there's a group in Hollywood that's charging more than that.
Researchers plan a cost-effectiveness study and may compare the benefit from scans to smoking cessation efforts.
People should not take this positive study as 'now it is safe to smoke, because it isn't, and quitting remains the best way to lower cancer risk.
The cancer society and other medical groups expect to have screening advice for the public in a matter of months.
THOSE WHO DIET AS TEENS ARE MORE LIKELY TO CONTINUE INTO ADULTHOOD
Dieting and disordered eating that begin in adolescence often continue into young adulthood.
Disordered eating includes unhealthy and extreme weight-control behaviors, such as fasting or skipping meals and binge eating.
Researchers analyzed data from 1,030 males and 1,257 females who were followed for 10 years beginning in either early adolescence (about 13 years old) or middle adolescence (about 16 years old).
About half of the teen girls and about one-quarter of the teen boys reported dieting during the previous year. Among females in both age groups, the prevalence of dieting remained constant from adolescence through young adulthood. For males, dieting remained constant in the younger age group, but increased among the older age group as they progressed to their mid 20s (rising from 22 percent to 28 percent).
The prevalence of unhealthy weight-control behaviors remained constant among the younger girls during the study period. It decreased as the girls aged, but remained very high (61 percent to 54 percent).
For males in both age groups, the prevalence of unhealthy weight-control behaviors remained constant, the study authors noted.
Extreme weight-control behaviors increased significantly in both female age groups, from 8 percent to 20 percent in the younger group of girls and from 13 percent to 21 percent in the older group.
Among the older males, extreme weight-control behaviors increased from 2 percent to 7 percent, the investigators found.
The findings from the current study argue for early and ongoing efforts aimed at the prevention, early identification and treatment of disordered eating behaviors in young people.
Dietitians and other health care providers should ask patients about their dieting behavior in childhood and through young adulthood.
Given the growing concern about obesity, it is important to let young people know that dieting and disordered eating behaviors can be counterproductive to weight management. Young people concerned about their weight should be provided with support for healthful eating and physical activity behaviors that can be implemented on a long-term basis, and should be steered away from the use of unhealthy weight-control practices.
Disordered eating includes unhealthy and extreme weight-control behaviors, such as fasting or skipping meals and binge eating.
Researchers analyzed data from 1,030 males and 1,257 females who were followed for 10 years beginning in either early adolescence (about 13 years old) or middle adolescence (about 16 years old).
About half of the teen girls and about one-quarter of the teen boys reported dieting during the previous year. Among females in both age groups, the prevalence of dieting remained constant from adolescence through young adulthood. For males, dieting remained constant in the younger age group, but increased among the older age group as they progressed to their mid 20s (rising from 22 percent to 28 percent).
The prevalence of unhealthy weight-control behaviors remained constant among the younger girls during the study period. It decreased as the girls aged, but remained very high (61 percent to 54 percent).
For males in both age groups, the prevalence of unhealthy weight-control behaviors remained constant, the study authors noted.
Extreme weight-control behaviors increased significantly in both female age groups, from 8 percent to 20 percent in the younger group of girls and from 13 percent to 21 percent in the older group.
Among the older males, extreme weight-control behaviors increased from 2 percent to 7 percent, the investigators found.
The findings from the current study argue for early and ongoing efforts aimed at the prevention, early identification and treatment of disordered eating behaviors in young people.
Dietitians and other health care providers should ask patients about their dieting behavior in childhood and through young adulthood.
Given the growing concern about obesity, it is important to let young people know that dieting and disordered eating behaviors can be counterproductive to weight management. Young people concerned about their weight should be provided with support for healthful eating and physical activity behaviors that can be implemented on a long-term basis, and should be steered away from the use of unhealthy weight-control practices.
08 July 2011
THE NUMBER ONE KILLER FOR WOMEN IS HEART DISEASE
Heart disease can sneak up on women in ways that standard cardiac tests can miss.
It's part of a puzzling gender gap: Women tend to have different heart attack symptoms than men. They're more likely to die in the year after a first heart attack.
In fact, more than 40 percent of women still don't realize that heart disease is the No. 1 female killer. One in 30 women's deaths in 2007 was from breast cancer, compared to about 1 in 3 from cardiovascular disease.
A new report says there's been too little progress in tackling the sex differences in heart disease. It outlines the top questions scientists must answer to find the best ways to treat women's hearts - and protect them in the first place.
Make no mistake: Heart disease is the leading killer of men, too. The illness is more prevalent in men, and tends to hit them about a decade earlier than is usual for women.
But while overall deaths have been dropping in recent years, that improvement has been slower for women who face some unique issues.
Sure, being a couch potato and eating a lot of junk food is bad for a woman's heart just like a man's. High cholesterol will clog arteries. High blood pressure can cause a stroke, say specialists at an Ecorse Stroke Care center.
But here's one problem: Even if a test of major heart arteries finds no blockages, at-risk women still can have a serious problem - something called coronary microvascular disease that's less common in men. Small blood vessels that feed the heart become damaged so that they spasm or squeeze shut.
Specialists who suspect microvascular disease prescribe medications designed to make blood vessels relax and blood flow a bit better, while also intensively treating the woman's other cardiac risk factors. But it's not clear what the best treatments are.
The report says part of the lack of understanding about such gender issues is because heart-related studies still don't focus enough on women, especially minority women. Only a third of cardiovascular treatment studies include information on how each gender responds even though federal policy says they should. Some Lincoln Park Heart Doctors urge direct comparisons of which treatments work best in women, and improved diagnostic tests.
Another issue: Even young women sometimes have a heart attack, and there are troubling hints that their risks are rising. There's been a small uptick in deaths among women younger than 45. Plus, high blood pressure, diabetes or related complications during pregnancy - a growing worry as more women start their pregnancies already overweight - aren't just a temporary problem but increase those mothers' risk of heart disease once they reach middle age. The report says too few doctors are aware they should consider that.
Then there are the questions of how best to tell which women are at high risk. Nearly two-thirds of women who die suddenly of heart disease report no previous symptoms, for example, compared with half of men. As for heart attacks, chest pain is the most common symptom but women are more likely than men to experience other symptoms such as shortness of breath, nausea and pain in the back or jaw.
Legislation pending in Congress would require better study of gender differences, and would expand a government program that currently screens poor women in 20 states for high cholesterol and other heart risks, offering smoking cessation and nutrition education to help lower those risks. Groups, which receive some funding from drug companies, and the heart association support the bill.
One young patient says women need to know more about heart disease - and to get pushy about any symptoms.
One woman of New Orleans was just 30 and seemingly healthy when she started getting short of breath and feeling a flutter in her chest during her daily workouts. Her primary care doctor thought it was panic attacks. Garden City Cardiologists found no obvious risk either - her cholesterol and blood pressure were normal - but ordered a stress test that signaled her heart fears were right. A further exam found severe blockages in two arteries that required stents to prop open.
Now 37, she says doctors' best guess is that a stressful lifestyle - a single mother, a full-time job, a part-time personal trainer, and studying for an advanced degree all at the same time - left her vulnerable even without obvious risk factors. Had she not been so fit, they said, her heart might not have held out as long before symptoms appeared. She's learned to be more laid-back, along with a healthier diet and keeping up that exercise.
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