Saturday, August 30, 2008

Compare hospitals on heart attack, heart failure and pneumonia

Welcome to a new era of openness in medical care. In this interactive USA TODAY graphic, you'll find medicine's best-kept secret revealed: death rates for heart attack, heart failure and pneumonia for every hospital in the nation. USA TODAY created this graphic using data compiled by the federal government's Center for Medicare and Medicaid Services (CMS).

USA TODAY has used the information to create an easy-to-navigate database that allows you to compare the performance of the hospital next door with the hospital across town. Want to check the performance of every hospital in your state? See the 100 hospitals that performed the best? The worst? We've put the information at your fingertips.

You can view the hospitals on a map, chart or several lists. When you click on a hospital, you'll see an estimate of the hospital's average death rate for one of the three conditions, bracketed by a high-end estimate or a low-end estimate. By presenting the information in this way, we can say with 95% confidence that the hospital falls in that range.

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Wednesday, August 27, 2008

Scientists convert cells to different type in mice, may lead to therapies

Scientists have transformed one type of cell into another in living mice, a big step toward the goal of growing replacement tissues to treat a variety of diseases. The cell identity switch turned ordinary pancreas cells into the rarer type that churns out insulin, essential for preventing diabetes. But its implications go beyond diabetes to a host of possibilities, scientists said.

It's the second advance in about a year that suggests that someday doctors might be able to use a patient's own cells to treat disease or injury without turning to stem cells taken from embryos. The work is "a major leap" in reprogramming cells from one kind to another, said one expert not involved in the research, John Gearhart of the University of Pennsylvania.

That's because the feat was performed in living mice rather than a lab dish, the process was efficient and it was achieved directly without going through a middleman like embryonic stem cells, he said. The newly created cells made insulin in diabetic mice, though they were not cured. But if the experiment's approach proves viable, it might lead to treatments like growing new heart cells after a heart attack or nerve cells to treat disorders like ALS, also known as Lou Gehrig's disease.

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Ayurvedic medicines often contaminated by toxic metals, study says

Ayurvedic medicines -- herbal mixtures dating back thousands of years in India and increasingly popular in the West -- are frequently contaminated with lead, mercury or arsenic, according to a study published today. A fifth of the nearly 200 concoctions tested contained levels of the toxic metals that, if taken at the maximum recommended doses, would surpass California's safety guidelines.

Dr. Robert Saper, a Boston University professor of family medicine who led the study, said the findings should spur the Food and Drug Administration to start clamping down on the largely unregulated world of pills, herbs and powders classified as dietary supplements.

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Can a troubled economy actually improve public health?

AS MORE people watch their home equity erode, put off retirement because their nest eggs are taking a dive, and bike or bus to work to save gas money, many are thanking their lucky stars that they still have a job to commute to.

But strange as it may seem, bad times can also be good for health. Forget individual health for a minute. This is about the macro picture, the health of entire societies. And there statistics show that as economics worsen, traffic accidents go down, as do industrial accidents, obesity, alcohol consumption and smoking. Population-wide, even deaths from heart disease go down during recessions.

"Deaths go down when unemployment goes up," says Christopher J. Ruhm, professor of economics at the University of North Carolina at Greensboro, who for the last few years has been publishing counterintuitive and controversial papers on the economy and health. Put total mortality numbers on a spreadsheet, he's found, and the population's physical well-being improves as just about every measure of economic health dips.

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Wednesday, August 20, 2008

Hospital death rates unveiled

Motorists heading through the Lehigh Valley from Allentown, Pa., earlier this year passed two giant billboards proclaiming: "Fast Heart Attack Care Saved My Husband's Life." What the billboards didn't say was just how fast. It took 24 minutes for Richard Silverman's doctors at Lehigh Valley Hospital to clear a 100% blockage from his heart's most vital artery. That's a third of the 90-minute goal that hospitals strive for.

"Maybe five minutes more and I'd be gone," Silverman, 63, co-owner of Pro-dent, a dental laboratory in Allentown, says his doctor told him. Doctors at Lehigh Valley are proud of their speed. It's one reason the hospital boasts the lowest heart attack death rate in the country, 11.6%, in a new government analysis obtained by USA TODAY. Among those at the other end of the spectrum is Virginia's Danville Regional Medical Center with death rates for heart attack of 19.6% and for heart failure of 15.5%.


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New study backs angioplasty through the wrist

The best path to a clogged heart may be through the wrist. About a million artery-clearing angioplasties are performed in the United States each year, and the usual route is to thread a tube to the heart through an artery in the groin. Now a major study shows going through the wrist instead can significantly lower the risk of bleeding - without the discomfort of lying flat for hours while the incision site seals up.

Just one in 100 angioplasties is done via the wrist, and the approach isn't for everyone. But Monday's study promises to spur more specialists to use the method. "In experienced hands, it can be done more," said Dr. Sidney Smith, heart disease chief at the University of North Carolina at Chapel Hill and a past president of the American Heart Association, who wasn't part of the study.

Cardiologists have preferred working through the femoral artery in the groin because it is a larger blood vessel than the wrist's radial artery, easier to tug catheters through. Catheters have gradually gotten smaller and more flexible, and previous small studies had suggested the wrist approach could be safer because that puncture site can be bandaged. In one earlier study, the wrist method even trimmed hospital costs because patients were discharged sooner.

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Monday, August 18, 2008

The coming boom in medical travel could help both rich and poor

HEALTH care has long seemed one of the most local of all industries. Yet beneath the bandages, globalisation is thriving. The outsourcing of record keeping and the reading of X-rays is already a multi-billion-dollar business. The recruitment of doctors and nurses from the developing world by rich countries is also common, if controversial. The next growth area for the industry is the flow of patients in the other direction—known as “medical tourism”—which is on the threshold of a dramatic boom.

Tens of millions of middle-class Americans are uninsured or underinsured and soaring health costs are pushing them and cost-conscious employers and insurers to look abroad for savings . At the same time the best hospitals in Asia and Latin America now rival or surpass many hospitals in the rich world for safety and quality. On one estimate, Americans can save 85% by shopping around and the number who will travel for care is due to rocket from under 1m last year to 10m by 2012—by which time it will deprive American hospitals of some $160 billion of annual business.

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The Ups and Downs of Outpatient Procedures: What You Need to Know

How times have changed. Today, from 60 to 70 percent of surgeries are done on an outpatient basis—the patient heads home the same day, often within a few hours of surgery.

As surgeons demonstrate that a particular surgery can be done safely without an overnight stay, insurers may balk at paying for a hospitalization deemed “medically unnecessary.” And physicians have indeed introduced innovations that lead to quicker recovery. Arthroscopic and laparoscopic surgery, for example, use keyhole incisions to insert miniature instruments and a tiny camera or scope to visualize the body’s interior, while short-acting, local anesthetic techniques let patients bounce back to alert functioning more readily.

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Sunday, August 17, 2008

Medical marijuana: What does science say?

Regular user As the political debates over medical marijuana drag on, a small cadre of researchers continues to test inhaled marijuana for the treatment of pain, nausea and muscle spasms. Depending on whom you ask, marijuana is a dangerous drug that should be kept illegal alongside heroin and PCP, or it's a miracle herb with a trove of medical benefits that the government is seeking to deny the public -- or something in between: a plant with medical uses and drawbacks, worth exploring.

The truth, these researchers say, is that marijuana has medical benefits -- for chronic-pain syndromes, cancer pain, multiple sclerosis, AIDS wasting syndrome and the nausea that accompanies chemotherapy -- and attempts to understand and harness these are being hampered. Also, they add, science reveals that the risks of marijuana use, which have been thoroughly researched, are real but generally small.

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Thursday, August 14, 2008

Study finds exercise key to aging well, living long

The study started with around 1,000 people over the age of 50. Half of the participants were members of a runner’s club, and the other half were otherwise healthy people from Stanford, but not members of the running club.

However, we found that over time, the runners group had very low levels of disability that increased very slowly. The controls, on the other hand, had disability that increased much more quickly. At the end of the study, the difference between the disability levels was very dramatic.

Participants who were part of a runner’s club also enjoyed lower mortality rates — about half that of the non-participants. So not only were they less disabled, but they lived longer as well.

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Help Could Be On The Way For Alzheimer's

Help finally could be on the way for victims of Alzheimer's disease. After decades of arduous work, drug makers and academic researchers believe they've made considerable progress in bringing a new generation of treatments to market that may ease symptoms of the devastating brain disease and might even stop its progression.

Several compounds are in mid- and late-stage clinical trials, and the first new drugs could hit the market in as soon as three years. "The rate of Alzheimer's is going to explode as the baby boomers hit 65," said Dr. Sam Gandy, a leading researcher at Mount Sinai Medical Center and chairman of the Alzheimer's Association's medical board.

Today about 5.2 million Americans suffer from the neurological disease. About 13% of all people aged 65 and over are believed to be afflicted, with that number rocketing to about 50% at age 85. By 2030, an estimated 7.7 million will be living with the disease, according to the Alzheimer's Association.

That's grim news for American families. Because Alzheimer's patients eventually require some type of round-the-clock care, having a family member stricken with the disease can be a heavy burden, emotionally and financially. And although many patients do end up spending their final days in a nursing facility, an estimated 70% are cared for at home.

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Study Says Wide Waistlines Increase Risk of Strokes

We know that being overweight or obese can contribute to heart disease and heart attacks, but does extra weight around your belly increase your risk of stroke?

Of the stroke group, 301 had suffered a full-blown stroke, 37 had bleeding in the brain, and 41 experienced what is often called a "mini-stroke" or transient ischemic attack (TIA). A TIA occurs when blood flow to the brain is temporarily blocked and then is spontaneously restored. It's often a precursor to a full stroke and is considered a warning sign.

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Wednesday, August 13, 2008

Thousands whose health policies were canceled to be offered new coverage

About 3,400 Californians whose health insurance was canceled by Kaiser, Health Net and PacifiCare after they got sick will soon receive notification that they may be eligible for new coverage and for compensation for medical bills they paid while they were uninsured. The state's largest insurers have all been widely accused of looking for ways to drop individual policyholders who incur high costs. The insurers contend that members who are dropped have misrepresented their medical histories on their applications.

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Sunday, August 10, 2008

More options available to help stop snoring

YOU'RE ON the verge of falling asleep, and then it starts. The snorting. The choking sounds. Sometimes there's even a little whistle to it. A family member or roommate sleeping nearby has launched into an all-night bout of snoring, and you're the one who is going to lie awake all night listening to it. If simple lifestyle changes and over-the-counter remedies can't control chronic snoring, more sophisticated surgical and nonsurgical treatments are another option.

According to the American Academy of Otolaryngology-Head and Neck Surgery, 45% of normal adults snore at least occasionally, and 25% are habitual snorers. Of the habitual snorers, about 10% have obstructive sleep apnea, a serious medical problem in which people stop breathing completely, multiple times per night, for at least 10 seconds at a time. Apnea raises the risk for dangerous daytime drowsiness and a range of ills, including elevated blood pressure, heart attacks and strokes.

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FDA: Some cholesterol and heart drugs don't mix

Patients taking some common medications for high cholesterol and irregular heart beats can suffer severe muscle damage because of a problem in the way the drugs interact, the government warned on Friday.

The Food and Drug Administration said doctors should use extra care when prescribing Zocor, generic Zocor, or Vytorin to patients who are also taking amiodarone, a heart rhythm drug marketed as Cordarone or Pacerone. The danger is higher for patients taking more than 20 milligrams a day of the cholesterol drugs, the agency said. The generic name for the cholesterol medications is simvastatin.

Muscle injury is a risk with any of the cholesterol drugs known as statins, including Lipitor, particularly for the elderly. Although the risk of such injuries is low overall, they can be serious because they can lead to kidney failure and even death.

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The FDA urged doctors to consider switching patients who are taking the heart rhythm drug to other statins for controlling cholesterol. The heart medication is mainly used to treat irregular rhythms in the ventricles, the heart chambers that pump blood to the lungs and body.

Friday, August 8, 2008

Scientists create stem cells for 10 disorders

Harvard scientists say they have created stems cells for 10 genetic disorders, which will allow researchers to watch the diseases develop in a lab dish. This early step, using a new technique, could help speed up efforts to find treatments for some of the most confounding ailments, the scientists said.

Dr. George Daley and his colleagues at the Harvard Stem Cell Institute used ordinary skin cells and bone marrow from people with a variety of diseases, including Parkinson's, Huntington's and Down syndrome to produce the stem cells. The new technique reprograms cells, giving them the chameleon-like qualities of embryonic stem cells, which can morph into all kinds of tissue, such as heart, nerve and brain. As with embryonic stem cells, the hope is to speed medical research.

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Medical blogs for doctors and patients alike

Here's a roundup of some of the best-known medblogs. Go to the sites, however, and these doctors might introduce you to even more.
The world of medical blogs is crowded, colorful and as diverse as the nation's population of doctors and nurses. Following are a few of the best-known. But virtually all med bloggers provide their own "blog rolls," which link to the fellow bloggers they like to read. And most will reveal a bit about themselves under FAQs or in their "About" section.

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Thursday, August 7, 2008

3 Southern California hospitals accused of using homeless for fraud

Clarence Lavan watches as authorities raid City of Angels Medical Center near downtown L.A. Lavan, who has Graves' disease, said he's a patient of the one of the doctors named in a lawsuit but has never even met the doctor. He holds a bag of empty medicine bottles.
Clarence Lavan watches as authorities raid City of Angels Medical Center near downtown L.A. Lavan, who has Graves' disease, said he's a patient of the one of the doctors named in a lawsuit but has never even met the doctor. He holds a bag of empty medicine bottles.
The elaborate enterprise churned thousands of indigents through hospitals over the last four years and billed Medicare and Medi-Cal for costly and unjustified medical procedures, federal, state and local investigators said Wednesday. After raids on three hospitals in Los Angeles and Orange counties Wednesday, one hospital chief executive faces criminal charges and executives at two other facilities were accused of fraudulent business practices in a related civil lawsuit filed by Los Angeles City Atty. Rocky Delgadillo.

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Wednesday, August 6, 2008

As numbers of the uninsured go up, so do ER visits

Hospital emergency departments, typically the medical providers of last resort, are becoming the only option for insured as well as uninsured people who are unable to get care elsewhere, leading to a record rise in emergency room visits over the past decade, a federal government report found.

ER visits jumped more than 32 percent from 90.3 million in 1996 to 119 million in 2006, the most recent year statistics are available, according to the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention.

"The uninsured have long been more frequent users of (emergency rooms). That's not new. What's new is the rise ... in frequency in visits, and that's occurring in the insured," said Dr. Stephen Pitts, author of the report and a CDC fellow, who teaches emergency medicine at Emory University's School of Medicine.

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ER visits are also the most expensive and for the uninsured, usually costs are not recovered by the hospital. This cost is spread to the insured patients raising the cost of their insurance. - Bill

Growth hormone cuts abnormal fat in patients with HIV

But the treatment may produce an unnecessary risk for those who have early stages of diabetes, researchers say. Low doses of human growth hormone can reverse some of the abnormal fat distribution caused by HIV therapy, lowering the risk of cardiovascular disease, but the treatment may produce an unnecessary risk for those who have early stages of diabetes, researchers said Sunday. The hormone produced good results but would have to be used carefully to avoid inducing diabetes, said Dr. Steven Grinspoon of the Harvard Medical School, lead author of the paper.

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Stop prostate exams at age 75, federal panel recommends

Side effects of cancer treatments and stress from false positives outweigh any potential benefits, the group says. There's a backlash to the recommendation among some experts. Men over the age of 75 should no longer be screened for prostate cancer because the potential harm from the test results -- both physical and psychological -- outweighs any potential benefit from treatment, a federal panel said Monday.

Most oncologists already argue against treating most men in that age group for prostate cancer because they are more likely to die from some other cause than from their tumor. The new guidelines go one step further, saying, in effect, why test if the patient is unlikely to be treated?

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I am a general internist, and, in the past three years, I have known two men (not my patients), one in his 80s, the other in his 90s, who were not screened and who developed florid prostate cancer with multiple painful metastases to their bones. The younger man had other health problems, but his cancer responded to hormone treatment that significantly improved the quality of his remaining years. The older man, otherwise perfectly healthy and in full possession of his faculties, died a painful and almost certainly premature death.

Defending the Prostate Cancer Blood Test

The U.S. Preventive Services Task Force, a panel of experts who guide national health care, issued its report Monday based on a review of past research. The task force found that screening can detect some cases of prostate cancer, but the benefits of treatment in men over 75 "are small to none." Treatment often causes "moderate-to-substantial harms," including impotence and bladder control and bowel problems, the task force said, without evidence it saves the lives of these elderly men.

The panel did not recommend for or against prostate screening of men under 75 but suggested that doctors discuss the potential benefits and harms of the test with their patients. "I think it's a very well done and justifiable recommendation," said Dr. Barnett Kramer, associate director of disease prevention at the National Institutes of Health. "They continue to say the jury is still out for men under 75."

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Monday, August 4, 2008

Health insurance ambition narrows

Schwarzenegger seeks a deal to cap profits, set minimum benefits and limit cancellations on individual policies. Seeking to salvage two years of efforts to completely remake California's health insurance system, Gov. Arnold Schwarzenegger and Democratic legislators are nearing deals intended to rein in costly, meager medical insurance policies sold directly to individuals.

Three million Californians buy health insurance on their own rather than through employers. Insurers keep premiums low -- and profits high, their critics say -- on some individual policies by limiting the services they cover. Many of the policies have big deductibles and require patients to pay large portions of their expenses, costing them much more than coverage obtained at workplaces.

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