Monday, December 31, 2012

Focus on Unusual Illnesses? How Medicine Actually Helps

December 28, 2012

Surgery establishes penile sensation in men with spina bifida

By Chris Mc Cann
A procedure to establish feeling in the penis for men with spina bifida was performed for the first time in the United States in Seattle.
Anthony “Tony” Avellino, UW professor of neurological surgery, and Thomas Lendvay, a UW associate professor of pediatric urology who practices at Seattle Children’s Hospital, led the surgical team.
“This is truly an innovative procedure for either spina bifida patients or patients with lower-level spinal-cord injury who have sensation in the groin but not the penis,” said Avellino.
Lendvay noted that, “Based on the positive results of the first two patients, this new procedure has the potential to greatly improve the quality of life in our spina bifida adult and adolescent patients.”
Spina bifida can take several forms. This illustration shows a type in which the spinal cord protrudes from the infant’s back.
People with spinal bifida were born with an incomplete closure of their backbone, often because the neural tube didn’t form correctly during early embryonic development. Even when the spine is surgically closed after birth, the spinal cord in the affected section may not work properly in conducting nerve impulses. The patient may have a combination of nerve function and loss. They may have paralysis or numbness in only some parts of their body, for example.
The new operation is known as TOMAX (TO MAX-imize sensation, sexuality and quality of life). The procedure entails transferring a branch of the nerve supplying sensation from the thigh skin to the main skin sensation nerve to the penis. The successful completion of the procedure allows men with spinal cord impairment to feel sensation in a previously insensitive penis and improve sexual health.
Max Overgoor from the University of Utrecht in The Netherlands had performed 18 successful operations when David Shurtleff, UW professor of pediatrics, invited him to Seattle to observe the first U.S. operation of this nature.

From :

My opinion:
This certainly isn't something I knew existed and, as such, I would never have known that a number of doctors are working on treating it.  However, though the illness might seem odd or rare (it occurs in 7 out of 10,000 people), I believe that it is important that this treatment is now available.  For example, spinal bifida primarily affects sensation, but it also steals an important aspect of life from men - the ability to reproduce.  I'm glad that there are doctors who are willing to work on lesser known and/or bizarre diseases.  Though their work might not reach a great number of people, it is likely that their combined work does.  I hope it remains financially possible to research such illnesses in the future.

Sunday, December 30, 2012

Are Tattoos Any Good?


Design, placement
If you’re going to get a tattoo, remember it’s called “permanent ink” for a reason.
For many, it’s easier (and cheaper) to get a divorce than to remove a tattoo. So, when you think about design and placement — said both artists and the tattooed — think about the future.
“Not every employer is going to think ‘It’s no big deal,’” Pederson said. “Not every person you want to befriend is going to accept your tattoo. Think about what kind of first impression your tattoo will make on other people.”
Bryon Widner had tattooed brutish symbols including a blood-soaked razor, swastikas and the letters “HATE” on his face and body during his years in the white power movement.
After he left the movement, he found he was shunned on job sites, in stores and restaurants, according to a story published in 2011 by The Associated Press.
Widner considered using acid to remove his ink when a contact in an anti-hate group, called One People’s Project, hooked Widner up with Southern Poverty Law Center. The agency found him a benefactor who paid $35,000 to remove the tattoos.
The procedures — 25 surgeries in 16 months — were extremely painful, and after the first couple, a doctor at the Department of Plastic Surgery at Vanderbilt University Medical Center in Nashville decided Widner was suffering too much. The rest were performed under a general anesthetic. Widner’s story was the subject of a documentary called “Erasing Hate.”
Some tattoo artists will give their customers any kind of ink they want. Others, like Burdick and Arran Brown, another owner of Darkside Tattoos, said they wouldn’t give anyone a swastika. Even if it wasn’t offensive to them, Burdick said, it would reflect poorly on their business.

My opinion:
I'm not surprised that many tattoo parlors refuse to draw in hate symbols, but there probably are a lot of people, especially ones who are unlicensed to give tattoos, who would do so.  Choosing an "okay" tattoo may be difficult, because there is no telling how the person will change over time.  Not only may the symbol become obsolete, but due to changes in the skin, it might not look appealing anymore, either.  Although I do believe tattoo removals are becoming somewhat easier, many doctors are against tattoos because of this and for other reasons.  I remember when I was shadowing a doctor and a patient who had a history of hepatitis C.  The patient probably got the illness after a dirty needle was used to engrave a tattoo.  The patient turned to me and said, "Don't get a tattoo in Australia."  Then the doctor turned to me and said, "Don't get a tattoo ever!"  Interesting discussion, to say the least, but is it ever worth it to get a tattoo?  Sometimes there may be decent reasons, for example, if it is meant to pay tribute to a deceased spouse.  But are there other tributes that are just as meaningful, if not more so?  Feel free to comment.

Friday, December 28, 2012

Think Medical Syringes Should Once Be Used Once?

Dirty medical needles put tens of thousands at risk in USA

When seven people arrived at a Delaware hospital in March with drug-resistant MRSA infections, the similarities were alarming.
All of the patients had the same strain of MRSA, all had the infections in joints, and all had gotten injections in those joints at the same orthopedic clinic in a three-day span. State health officials found that the clinic had injected multiple patients with medication from a vial that was meant to be used only once, spreading the MRSA bacteria to a new patient with each shot.
A month later, three patients in Arizona were hospitalized with MRSA infections, also following shots at a pain clinic. Again, state and county health officials tied the cases to the injection of multiple patients from a single-dose vial. A fourth shot recipient died; investigators noted that MRSA "could not be ruled out" as a cause.
In July, more than 8,000 patients of an oral surgeon in Colorado were advised to get tested for HIV, the virus that causes AIDS, and hepatitis after state health investigators found that his office reused syringes to inject medication through patients' IV lines. Six patients have tested positive for one of the diseases.
As drug-resistant superbugs and increasingly virulent viruses menace the medical community, health officials still face a quiet threat that was supposed to die with the advent of the disposable syringe more than 50 years ago: dirty needles.
Since 2001, more than 150,000 patients nationwide have been victims of unsafe injection practices, and two-thirds of those risky shots were administered in just the past four years, according to data from the U.S. Centers for Disease Control and Prevention. The errors led to at least 49 disease outbreaks, a USA TODAY examination shows, and a trail of victims suffering with potentially life-threatening bacterial infections, such as MRSA, and sometimes fatal viruses, such as hepatitis.

My opinion:
Frankly, I don't think this should be an issue today.  When doctors use a needle or syringe on one patient, they should throw it away and use another one for another patient.  Simple as that.  I am a bit confused, though, about using a "single-dose vial."  Perhaps the vials had been contaminated if the needles or syringes were put in it after they were used to inject the patient with medication.  In my chemistry classes, the instructors emphasize the risks of contamination.  But the worst that could have happened in those cases was a faulty experiment.  In these cases, peoples' lives are at risk.  Are medical schools not emphasizing these issues enough, or are there other reasons that these mistakes occur?  I know that sometimes, doctors who work long shifts are very tired and cannot function.  Feel free to add your thoughts.

Thursday, December 27, 2012

Providing Health Care in Foreign Countries

OSU expands foreign medical work

By  Ben Sutherly
The Columbus Dispatch Friday November 30, 2012 6:38 AM
A local $5 million grant seeks to raise Ohio State University’s standing in global medicine and advance its humanitarian work overseas by cementing OSU Wexner Medical Center’s ties to the Global Health Delivery Partnership in Boston.
The corporate gift from the Greif Packaging Charitable Trust was announced yesterday at the McCoy Community Center for the Arts in New Albany.
OSU President E. Gordon Gee declared the partnership part of “the land-grant mission of the 21st century,” one that will bring opportunity to Third World residents through improved quality of life.
Dr. Steven Gabbe, CEO of Wexner Medical Center, said he thinks the alliance opens new doors for students and clinical faculty members and will spur “exponential” growth of the medical center’s global-health program.
“I think we are now partnering with the leading program in global health,” Gabbe said.
Half of the $5 million gift will go to Ohio State. The rest will go to the Global Health Delivery Partnership, which includes Brigham and Women’s Hospital in Boston, Harvard Medical School and Partners in Health, a Boston-based nonprofit that employs a variety of tactics to improve the health of the poor in the developing world.
Although Ohio State will use some of its share of the funding for part-time faculty hires, it plans to spend the bulk of it overseas, said Dr. Daniel Sedmak, director of Wexner Medical Center’s Office of Global Health.
Here’s how the initiative will work: Ohio State experts in maternal and neonatal care, and those adept at dealing with high-risk pregnancies, will travel to Haiti to learn low-cost, effective techniques of delivering health care from Partners in Health. They’ll then be deployed to Haiti and other parts of the world such as Ethiopia, Kenya and Rwanda to set up prenatal clinics and other limited-resource health centers, then train professionals to take over that work.

My opinion:
I certainly like this idea, although I can imagine that many others will not.  Whenever I read comments to articles describing our involvement with wars overseas, many people seem upset that we are not spending the money here in America.  Considering that we are emerging from a recession, and that spending cuts may be ahead, are our efforts in foreign countries still worthwhile?  Personally, I would rather spend the money on this than on the war in Iraq, but will we be able to afford either of these in the near future?  What if the grant money disappears after this one?  Can the program survive if it is put on hold?  Feel free to comment.

Identity Theft? How about Medical Data Theft?

December 26, 2012, 10:03PM

University of Michigan Health Systems Admits Patient Data Stolen

Some 4,000 University of Michigan Health Systems patients had their medical data compromised last month when hospital equipment was stolen from a vendor's vehicle.
That medication management provider, Mountain View, Calif.-based Omnicell, admits it violated both its own and UMHS hospitals' data storage policies when it left patients' demographics, medication regimes and admissions records on an unsecured device that was stolen from an Omnicell employee's car on Nov. 14.
The stolen data did not contain personal identification such as addresses, phone numbers, Social Security numbers or financial data, according to The Detroit Free Press.
Impacted patients were notified by letter beginning last week, the report said.
The UMHS theft is just one in a long line of hospital data security breaches this year, many the result of missing or stolen devices or discs that held patient data.
Yesterday, in an ongoing series, the Washington Post published a report, a year in the making, on the health care sector's vulnerability to hackers. One reason may be health care data security laws, such as security and privacy provisions in HIPAA, have not kept up with technology and (sometimes outdated) software is left unpatched.
"Security researchers are starting to turn up the same kinds of trivial-seeming flaws that earlier opened the way for hackers to penetrate financial services networks, Pentagon systems and computers at firms such as Google," the report said.
In one example of lax security practices, a University of Chicago medical center used an unsecured Dropbox account and single username and password (published in an online manual) to manage patient care via residents' iPads.
The risks go beyond identity theft and fraud. In recent years a security researcher known as Barnaby Jack has demonstrated how insulin pumps and pacemakers could be controlled wirelessly to remotely send lethal doses and voltage to patients.

My opinion:
I know HIPAA laws are a big deal, but I feel like thieves are not usually after a patient's confidential medical history.  Identity theft and fraud makes more sense to me, but I had no idea that people could be killed by means of wireless instruments!  It looks like the hospitals need to upgrade their technology and perhaps even their policies - I think this is the fourth or fifth time I've heard of records being stolen from somebody's car!  I've even heard that hospitals often stores one patient's records in the files of another patient!  Maybe computer engineers will be working more on enhancing the online record system in the future.  Feel free to comment.

Should Drug Companies Set More Limits?

Drug companies cashing in on human growth hormone abuse

Investigation shows record sales of human growth hormones

Gallery Image
Dr. Mark Molitch of Northwestern University, who helped write medical standards meant to limit HGH treatment to legitimate patients, holds an injector pen that contains approximately a weeks worth of doses for a patient in need of the drug. An Associated Press investigation shows that a federal crackdown on illicit foreign supplies of human growth hormone has failed to stop rampant misuse.

My opinion:
I understand how this container prevents the patient from accessing too much of the medication, but drug companies probably won't like this.  One of the biggest problems with "big pharma" is that it seems to sell medication that will obviously lead to dire consequences.  For example, drug companies could have made an alternative version of Sudafed that cannot be turned into meth, yet works just as well, if not better, than Sudafed at relieving symptoms.  Yet, since this cost more, the drug companies didn't make any changes, and the extraction of meth from Sudafed continued.  Should the government be cracking down on the drug companies, as well?  Also, I wonder if this is like the Prohibition, in some aspects.  After the Prohibition ended, and alcohol was once again legal, the amount of drinking actually decreased!  Do people tend to use steroids more when they are banned, too?   Feel free to comment.

Bringing Health Services Right To You!

A mobile health unit provides some wheels out of poverty

 By John Kelly

When she was a young mother — struggling with her finances, dependent on public assistance — Sheannea Bobbitt used to take her sick children to a free clinic that was two bus rides away from their home in far Southeast D.C. When Sheannea arrived, she couldn’t help but notice how sad and desperate the place was, how surly the employees were and how, in turn, that seemed to make everyone there sad and desperate and surly.
“I hated taking the girls there,” she said.
Sheannea had grown up poor, though she didn’t know it at first.
“You don’t really know that you’re poor until somebody tells you,” she said. “You grow up with family values, good character and integrity, and you don’t realize that money is missing.”
Thanks to her mother, Sheannea had those things. It was just the two of them living together in public housing in a neighborhood that Sheannea says was “infested” with crack. She wanted a path out.
“This is where I am,” she would tell herself. “It’s temporary. It’s not where I’m always going to be.”
But the clinic was a reminder how far she had to go. It was not a nice place. It seemed to reinforce the patients’ poverty. Then Sheannea learned about a mobile health unit that would come to her neighborhood. The unit — basically a fully appointed doctor’s office on a truck — was operated then by Georgetown Hospital. Since 2000, the program has been run by Children’s National Medical Center.
“Historically, transportation and geographical isolation have been barriers to access to primary medical care,” said Rhonique Harris, the medical director of mobile health programs for Children’s. “There are pockets of isolation in neighborhoods where there’s a lot of poverty, a lot of crime. But ultimately the families are just trying to make it. Families like my family, like your family.”

My opinion:
I think this is a great leap forward in patient access to health care, especially among the impoverished.  Usually, I imagine patient navigation as when patients are directed to their providers, but here, the providers are directed to the patient.  Given that the providers are trained, perhaps the latter method of patient navigation is in fact the easiest method.  For example, the poor might not be aware that they are ill, and/or lack the motivation to go see a doctor.  But bringing the doctor to the patient, even if the truck is just strolling around the neighborhood, might be a source of motivation on its own.  The next step in patient navigation may be to increase access to insurance, although I'm not quite sure how this could be done.  Though insurance policies are largely determined by politics, how does a patient know what insurance is best for him or her?  Do we need more people to explain insurance policies?  Feel free to comment.

Tuesday, December 25, 2012

Pharmacists Aiding Addicts

Rogue pharmacists fuel addiction

Joey Rovero’s quest for pills ended at Pacifica Pharmacy.
MCT Wire
Dec 25, 2012
All four were patients of a Rowland Heights physician who was a prolific prescriber of narcotic painkillers and other addictive drugs. To get their fix, they needed more than a piece of paper.
They needed a pharmacist willing to dispense the drugs, and at Pacifica they found one.
All four died of drug overdoses after filling prescriptions at the tiny pharmacy in Huntington Beach, Calif., court and coroners’ records show.
Pacifica’s owner, Thang Q. “Frank” Tran, sold pain medications in large quantities. Particularly popular with his customers were high-dose, 80-milligram tablets of OxyContin. Tran filled nearly twice as many of those prescriptions as did nearby Walgreens, CVS and Sav-On pharmacies combined, according to state records.
Many of his customers traveled long distances and paid cash. Rovero drove more than 350 miles from Arizona State University in Tempe to get his prescriptions in Rowland Heights and then 33 more miles to the pharmacy.
“I thought to myself, ‘Why in the world would these kids go that much farther out of their way?’ ” said April Rovero, whose son was 21 when he died. “Someone must have told them to go there.”
Pharmacists are supposed to be a last line of defense against misuse of prescription medications. By law, they are required to scrutinize prescriptions, size up customers and refuse to dispense a drug when they suspect the patient has no medical need for it.
Some, however, provide massive amounts of painkillers and anti-anxiety drugs to addicts and dealers with no questions asked, according to state records, regulators and law enforcement officials.
Rogue pharmacists are key enablers of drug abuse and an important source of supply for the illegal market.


My opinion:
I've heard of this happening, before.  I guess that one must consider all figures, even those in a position of authority, when investigating drug deals.  There are actually cases in which pharmacists can REFUSE to give patients prescriptions, for example, if it goes against the personal beliefs of the pharmacists.  Often, these prescriptions are for contraceptives.  So we have pharmacists giving medication that they aren't supposed to be giving, and pharmacists who aren't giving the medication that they are supposed to be giving.  Apparently, depending on the state, the latter isn't always illegal.  Should it always be illegal, though?  Feel free to comment.

Medical School in Three Years

Who Else Is Nervous About This Plan to Shave a Year Off of Medical School?

Scott Hales / Shutterstock
Adam Clark Estes 3,734 Views Dec 23, 2012
Of all the professions in which one might want to uphold the highest educational standards, medicine must be at the top of the list. When you go to the doctor, do you want your doctor to say, "I soaked up every ounce of knowledge possible during the fourteen years I spent learning how to save your life." Or would you rather hear, "How'd I like med school? I graduated early, breezed right through that business." If universities follow New York University's lead, the latter will become the reality. Starting next year, NYU and a handful of other medical schools will offer the option for students to enroll in an accelerated program that lets them finish in three years, instead of four. The motivation behind the change? It's cheaper.
In a way, shortening medical school makes solid sense. The four years a future doctor spends in medical school is just a fraction of her training. Usually, there are at least another six years after that: one year doing an internship, at least three years in residency and sometimes another two doing a fellowship. And only then do the new doctors start earning those awesome salaries that can pay back the $150,000 or so in student loans that they accumulated getting their degree.


My opinion:
While there may be good reason to shorten medical school into three years, I can't help but think that medical schools is already difficult enough as it is.  It seems as if everything in our country is being run based on financial reasons, these days.  Are there better ways to lighten the cost of medical school?  I've often wondered why financial aid is much more difficult to receive in medical school than in undergrad.  Should financial aid at both levels be alike?  Feel free to comment.

Triple Organ Transplant

Emory performs first triple organ transplant in Georgia

By Janet Christenbury | Woodruff Health Sciences Center | Dec. 19, 2012
Story image
38-year-old Stephanie Lindstrom received a new heart, liver and kidney in July 2012. She is the first triple organ transplant to be performed in Georgia. 

A 38-year-old mother of two is celebrating Christmas with a renewed spirit of hope and thankfulness this year. Just five months ago, Stephanie Lindstrom received a triple organ transplant at Emory University Hospital, the first triple organ transplant ever to be performed in the state of Georgia.

Following a lifetime battle of congenital heart complications, Lindstrom's condition turned critical this summer when she was told she would need more than a new heart; she would need a new liver and kidney, too. All other interventions to help her were not successful.
"A double transplant involving the heart and liver are extremely rare, with less than 60 of them ever performed in the U.S." says Stuart Knechtle, professor of surgery at Emory University School of Medicine and director of the Adult Liver Transplantation Program. "Because of Stephanie's heart failure, she developed liver failure. Then she became septic, which led to damage to kidney failure. So a triple organ transplant was our only hope to save her."

My opinion:
I almost can't believe that it is possible to do this, although I think this is actually extremely important.  All too often, the body reacts like a set of dominoes - one bad organ leads to the failure of even more organs, especially at old age.  Though the article says that double transplants are rare, I'm not sure if it's because people don't usually need them or if it isn't possible to perform them.  In order to increase our lifespans, however, I think doctors should focus on healing multiple issues at the same time.  Feel free to comment.

Doctor Shortage in Midwest

North Dakota faces medical crisis

One-third of North Dakota’s physicians are between 55 and 64, meaning a depletion of our medical ranks in the near future. By: Lloyd Omdahl, The Dickinson Press
One-third of North Dakota’s physicians are between 55 and 64, meaning a depletion of our medical ranks in the near future.
Our increasing population, particularly in the booming western part of the state, will require 500 more doctors by the time the state reaches 800,000.
As a major source of diabetes and heart disease, obesity is adding new pressure for medical care. Obesity increased by 80 percent in the last 15 years. About two-thirds of our citizens have already reached obesity.
The Affordable Care Act (Obamacare) will add the 60,000 uninsured North Dakotans to the medical load in the state.
North Dakota is the second-highest state in the number of people over 84 and we have plenty of folks between 75 and 84. The elderly require the lion’s share of medical time and expense. In fact, they are breaking Medicare.
The statistics tell us that we are approaching a medical crisis for which we do not have the infrastructure. Seventeen of North Dakota’s 53 counties do not have practicing physicians.
All of these factors will challenge the foresight of the 2013 legislative session because they call for investment in training more medical practitioners. Fortunately, the oil boom revenue has made it possible to consider options that would have been unthinkable 10 years ago.
In order to meet the shortage, the University of North Dakota Medical School will require expansion in facilities and students. Three proposals have been offered for consideration by the upcoming legislature session.
1. First, there is a bare bones $38 million addition to the present facility in Grand Forks. This is really a short-term stop-gap proposal that won’t stand the test of time.
2. A second option calls for a $68 million five-story addition to the present facility with 170,000 square feet of new space.
3. The third possibility is construction of a $134 million building with 370,000 square feet.
In his budget message to the Legislature, Gov. Jack Dalrymple endorsed the $68 million addition to the existing structure. The governor is to be commended for this step forward.
However, it should not preclude a careful analysis by the Legislature of the long term implications of adding to an old structure. Perhaps the proposal for a building would be a more plausible choice in the context of a 50-year perspective.
Another consideration in opting for the new building is recruitment of quality personnel to teach the enlarged student classes and to share in medical research. After all, North Dakota’s image is not the greatest in the outside world. That means working conditions become a major consideration for professionals looking to build a long-term career somewhere.
An expanded medical school will offer more opportunities for North Dakota young people to become professionals in their home communities. About 80 percent of the new classes are North Dakota students. And, according to the matriculation records, more qualified students are waiting in line.
As state policymakers consider their choices, it should be pointed out that this is not a UND institution even though it is located in Grand Forks.
The whole state is facing this medical challenge. Because the school is meeting a critical statewide need from east to west, it is a North Dakota medical school. Hopefully, legislators will recognize the statewide importance of the right decision.
 My opinion:
I think this article helps to justify some of my assumptions in the last one.  Considering that 17 counties in North Dakota don't have doctors, then yes, rural areas are really suffering from this problem.  I've also recently learned that public medical schools prefer to accept in-state applicants, as they need to increase the number of doctors right at home.  However, I also understand that these same applicants are usually sent away to different states for their residencies.  It is during this time that the students will make connections with doctors, and so perhaps they are more likely to stay away from home rather than in state.  Do medical schools realize this, or are there other factors that also need to be considered?  Feel free to comment.

Does U.S. Need General Practictioners and Specialists?

West Virginia needs medical specialists
Being No. 1 in diabetes deaths shows a need for endocrinologists

FOR years, West Virginians have been told that they need family doctors and not those expensive specialists. Marshall University has become a national leader in producing family physicians.
That is laudatory. Properly compensated, rural physicians can serve the state well.
But West Virginia must also have specialists. It leads the nation in cancer deaths and deaths from diabetes and is No. 2 in deaths from chronic lung diseases.
There are shortages in certain specialties, such as endocrinology, that the state needs to address.
West Virginia would be a natural for an endocrinologist because there are so many people with advanced diabetes and other diseases of the endocrine system.
But while demand for such specialists has increased, the compensation has not. Many if not most of the sickest people in the state are on Medicaid or Medicare, government-run health programs that do not adequately compensate specialists.
Also, endocrinologists have smaller patient loads because they must devote more time to treating individuals.
"You make less money as an endocrinologist than you would as a general practice physician," said Dr. Joseph Shapiro, dean of Marshall's medical school. "Why would you want to train more to make less?"
That is especially true given the expense of medical school, which often leaves new doctors with student loans of $100,000 or more.
Dermatologists also are in short supply for a different reason. The Accreditation Council for Graduate Medical Education allows West Virginia University's dermatology residency program to accept only one student each year.
"It's an underserved specialty that's fiercely protective of its domain," Shapiro told Zack Harold of the Daily Mail.
Reducing barriers to competition and increasing government compensation would go a long way toward improve medical care in West Virginia.
Discouraging specialists to save money would hurt West Virginia patients. That's not good medicine.

My opinion:
I guess this reveals all sides of the issue.  The bottom line is that, overall, we need more doctors of all specialties, and certain sections of the country may need certain types of doctors more than other sections.  Furthermore, I think the shortage is especially severe in rural areas.  I was not aware that some specialists don't make more than general practitioners - I thought endocrinologists made plenty.  Maybe only in certain areas.  I did understand, though, that dermatology is one of the most competitive specialties out there.  Is it time to approach the accreditation councils and ask them to accept more residents?  I believe they are already doing so, but frankly, I'm not so sure that we'll end up with enough doctors across ANY specialty.  Feel free to comment.

Monday, December 24, 2012

Smoking May Cause More Back Pain

Another Good Reason to Quit Smoking in New Year: Less Back Pain

December 06, 2012
A University of Rochester Medical Center analysis of more than 5,300 patients followed for eight months during treatment of spinal disorders showed that cigarette smokers reported far more pain than never-smokers or those who had quit.
Smoking cessation either prior to treatment or during the course of care was related to significant improvements in pain – a result that underlines the need for structured stop-smoking programs among the legions of patients who experience back pain due to degenerative disease, deformity, or musculoskeletal problems, said Caleb Behrend, M.D., chief resident in the Department of Orthopaedics and Rehabilitation at URMC.
Glenn R. Rechtine, M.D., a nationally recognized spinal surgeon and adjunct faculty at URMC, led the study, which was published in the Journal of Bone and Joint Surgery.
“We found that people who stopped smoking had meaningful benefit by reduction of their pain,” said Behrend. “The pain improvement is in addition to all the other benefits you gain from quitting.”
The relationship between pain and smoking is complex and full of contradictions. Nicotine has analgesic properties, for example, and yet clinical evidence shows that smokers are at higher risk for developing back pain and other chronic pain disorders, according to the American Society of Anesthesiologists.
Scientists already know that nicotine interacts with a family of proteins (nAChR), which have a key role in the central, and peripheral nervous system, and control anxiety and pain. Prolonged exposure to cigarettes upsets the function of these cells and eventually changes the way pain is processed, as well as impairing oxygen delivery to tissues, predisposing a person to bone and joint disorders such as osteoporosis, and inducing inflammation and depression. Smokers with spinal conditions also tend to have persistently more intense pain and more long-term disability.
The URMC study noted a daunting fact: Nearly all people will experience back pain at some point in their lives and many will seek medical care. And because the socioeconomic impact of spinal disorders (cost of care and lost productivity for patients) is so great, researchers wanted to find out if improvements in pain could be achieved with a cost-effective intervention such as smoking cessation.
Researchers reviewed a prospectively maintained database of 5,333 patients, who completed questionnaires about pain at the initial doctors’ visit and at the time of discharge from care. Patients were treated with surgery, or with physical therapy, injections, over-the-counter medications, and home exercise programs. Physicians counseled all smokers to quit, and patients were referred to a smoking cessation hotline.
Of the 5,333 people, those who had never smoked or had quit some time ago reported less pain than smokers or those who had just quit. By the end of the follow-up period, the people who had recently quit or who quit during treatment showed significant improvements in pain. People who continued to smoke during treatment had no improvement in pain on all scales.
Behrend noted that younger people tended to comprise the group of current smokers and those who only decided to quit during treatment; this is consistent with other studies showing that smoking is associated with degenerative spine disease at a younger age. Older patients tended to comprise the group who had never smoked or quit long ago.
The rate of smoking cessation was 22 percent, and research shows that up to 36 percent of patients with painful spinal disorders are able to quit with help from a structured program. A grant from the Southwestern Medical Foundation was used to create and maintain the patient database.

My opinion:
I am reminded of an old saying in the land of statistics - "Correlation DOES NOT imply causation."  In this research, smoking has many ways of relieving and causing pain, so it might be difficult to fully understand just how smoking affects spinal pain.  Smoking might not even directly cause these issues, but rather a side effect of smoking.  Frankly, I'm amazed by the methods in which some doctors think and figure all these things out.  For doctors, what kind of train of thought may be the best to have?  Also, I just realized something - I feel like the researchers in this project just looked at records.  Can research be done by looking at files?  Often, I think not - there might be other factors that researchers need that cannot be gained from looking at a piece of paper.  Feel free to comment.

Friday, December 21, 2012

Disappearing Stents?

City woman first to get dissolvable stent
HT Correspondent, Hindustan Time
In another advancement in angioplasty, Gurpreet Kaur (48) from Amritsar became first patient in Punjab to be fitted with dissolvable stents at local Fortis hospital.
Addressing a press conference on Friday, Dr Arun K Chopra, head, cardiology, Fortis hospital, said while in metallic stents patients have to take two blood thinning medicines for years, in case of dissolvable stents, Gurpreet will take just one medicine for a period of two years. "The work of the stent placed in the valve is roughly for one year. The new stent is called Bioresorbable Vascular Scaffold (BVS) and is made by Abbott Vascular, a material that remains firm for one year. In the next one to two years, it dissolves and turns into carbon dioxide and water," he said.
Chopra added that from using balloons in the 1970s, science has now evolved to using absorbable stents. "In metallic stents, which are foreign objects, artery often grows scar tissue to cover them. Since the stent is a mesh, scar tissue in the stent makes it impossible to remove and replace. White blood cells may also clog the artery and many metallic stents fail just a few months after implantation," he said.
"The soluble heart stent is designed to avoid all these problems. Dissolving into the wall of the artery, it is much less likely to cause clotting. Since it disappears in a year after it is implanted, it does not trigger the growth of scar tissue or activate the immune system," he said.
Chopra added that with this stent the patient can safely discontinue blood thinners after a certain period of time and that patient can undergo any surgery in future without any risk. 
The drug controller of India recently approved the bio-absorbable stent of multinational firm Abbott Vascular after a review of the results of a trial on 100 patients. A soluble stent will cost nearly Rs. 3 lakh while imported drug-coated permanent metallic stents cost Rs. 1.3 lakh, he added.
As of now, the facility is only available at Fortis hospitals in Amritsar and Mohali, but it will be soon be available at other hospitals. Dr Pinak Moudgil, director, and Dr HP Singh from Fortis hospital, Amritsar, were also present during the press conference.

My opinion:
I think this advancement is important for the biomedical engineering industry.  It represents that new ideas must undergo continuous improvements - everything can always be better.  Similarly, in the orthodontics industry, braces have become smaller and somewhat easier to wear over the years.  Many of these new technologies are often harmful to the patient, but I think, if proper advancements are achieved, then the patient will not only feel physically better, but psychologically, as well.  It would be easier to convince the patient to have the treatment, and he or she would worry less, afterward.  Feel free to comment.

Sunday, December 16, 2012

More Med. Schools in Other Countries

University of Cincinnati interested in opening medical school in China

CINCINNATI — The University of Cincinnati has been in talks with Chinese officials about adding a medical school campus in that country.
College of Medicine Dean Tom Boat recently updated university trustees about the discussions.
Tens of millions of dollars would be needed in donations to make the UC campus a reality, The Cincinnati Enquirer ( ) reported. But supporters point to the potential for new growth and revenue in the world's largest nation by population.
"It would allow us to have an international connection with China that would really push our globalization efforts forward," Boat told professors and students last week.
China is the leading source for international students for UC, with 962 Chinese students enrolled this year. The university already has a number of collaboration and project agreements in China.
Boat emphasized the plans are in very early stages with Chongqing Medical University, which has four hospitals with 5,000 beds and treats millions of outpatients annually.
"If the plan plays out, yes, it would be a UC-branded campus," Boat said.
Duke University, in Durham, N.C., has moved ahead with its plans for a China campus in partnership with Chinese educators. Duke Kunshan University operations are currently expected to begin in the 2013-14 academic year, pending final approval from Chinese officials.
UC's College of Medicine could use another source of revenue. The medical school lost $7 million on operating costs, while receiving a $10 million one-time payment from Cincinnati Children's Hospital and Medical Center.
UC gave out $2.66 million in institutional aid to medical students in the 2010-11 school year, compared to $5.8 million by Ohio State University, the Cincinnati newspaper reported.

My opinion:
 Additional questions for the previous article about medical schools overseas - are these schools mostly for students in those countries?  Can American students go there, too?  Considering the national doctor shortage, should the money be used to establish hospitals here, rather than in other countries?  Feel free to comment.

So Which State is the First One with no Abortions?

Mississippi May Become First Abortion-Free State as Hospitals Refuse Last Abortion Facility

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Mississippi is poised to become the first abortion-free state in the nation as the last remaining abortion facility within its borders reports that it is having difficulty complying with the law.
Earlier this year, lawmakers in Mississippi passed a regulation that requires abortion facilities in the state to have board certification and obtain admitting privileges. The latter requirement, which allows abortionists to send women that are injured during an abortion to local hospitals for further treatment, was said to serve as a safeguard to protect women that need critical medical care.
After the bill was signed into law, Jackson Women’s Health Organization, the last abortion facility in the state, filed a lawsuit in an attempt to block the requirements. During a hearing in July, the facility explained to the court that it had been unsuccessful in obtaining admitting privileges, and was granted six months of additional time to comply with the law under the direction of federal judge Daniel Jordan.
Jackson Women’s Health Organization now has until January 16th to find a hospital that will grant it admitting privileges, but with one month left to go, the facility says that it is still being refused by area hospitals.

My opinion:
Given that abortion is a ridiculously complicated issue, I'm not going to try to say whether this is right or wrong.  I do wonder, however, why Mississippi?  Why not other states?  I guess even in states that are relatively anti-abortion, some facilities try to stay open despite the fact that the laws are against them.  Additionally, though the recently made law here doesn't outlaw abortions, maybe it is just the government's sly way of getting rid of abortion clinics.  Feel free to comment.

Are Old Doctors Always Fit to Practice?

As doctors grow older, hospitals begin requiring them to prove they’re still fit

By Sandra G. Boodman | Kaiser Health News,December 10, 2012
  • Many doctors practice medicine into their 70s. But, how old is too old? Patient safety experts and hospital administrators worry about aging doctors.
A distinguished vascular specialist in his 80s performs surgery, then goes on vacation, forgetting he has patients in the hospital; one subsequently dies because no doctor was overseeing his care. An internist who suffered a stroke gets lost going from one exam room to another in his own office. A beloved general surgeon with Alzheimer’s disease continues to assist in operations because hospital officials don’t have the heart to tell him to retire.
These real-life examples, provided by an expert who evaluates impaired physicians, exemplify an emotionally charged issue that is attracting the attention of patient safety experts and hospital administrators: how to ensure that older doctors are competent to treat patients.
About 42 percent of the nation’s 1 million physicians are older than 55 and 21 percent are older than 65, according to the American Medical Association, up from 35 percent and 18 percent, respectively, in 2006. Their ranks are expected to increase as many work past the traditional retirement age of 65, for reasons both personal and financial.
Many older doctors remain sharp, their skills up-to-date and their judgment honed by years of experience. Peter Carmel, the AMA’s immediate past president, a 75-year-old pediatric neurosurgeon in New Jersey, recently wrote about “going full tilt.”
Unlike commercial airline pilots, who by law must undergo regular health screenings starting at age 40 and must retire at 65 — or FBI agents, whose mandatory retirement age is 57 — doctors are subject to no such rules. Nor are any formal evaluations required to ensure the continued competence of physicians, many of whom trained decades ago. Most states require continuing education credits to retain a medical license, but, as Ann Weinacker, chief of the medical staff at Stanford Hospital and Clinics in California, observed, “you can sleep through a session, and if you sign your name, you’ll get credit.”

My opinion:
It's a good thing someone finally brought this up.  I do agree that many old doctors may still be fit to practice, but it seems as if other employers are more likely to let their employees go if their age hinders their work.  Should hospitals start employing more stringent rules for doctors to stay in the business?  I also think this might be a reason why the nation will be so short on doctors in the future - I had no idea that 42% of physicians are older than 55.  If many of them die, and if hospitals start forcing more of them to retire, how do we replace them?  Feel free to comment.

Hospitals in Asia Lookng Toward Better Communication

Interoperability biggest challenge for Asia healthcare IT

Summary: Asian hospitals have different IT systems which makes an interoperable EMR system difficult to implement, and government support and impetus is needed for such initiatives to be successful.
SINGAPORE--Interoperability issues continue to bug hospitals in Asia-Pacific looking to have access to patients' medical records, and governments will have to take the lead to pave the way for nationwide electronic medical record (EMR) systems to take off.
Johnny Ma, Asia-Pacific general manager for health and life sciences at Hitachi Data Systems (HDS), said the best way for effective diagnosis is to have a single medical record for every individual, but the possibility for duplicate records is high as the person may visit more than one hospital.
In order to exchange and consolidate patient records, hospitals in the region need to be able to communicate across their different IT systems. But such interoperability remains a "quite a significant challenge", Ma noted.
"From a technical point of view, [the different hospitals] are using different IT systems. From the business point of view, it's about business benefits. While medical records belong to the patient, at the same time, it's also a business asset," he explained.
Furthermore, healthcare facilities in Asia do not follow the national healthcare insurance systems favored by the United States or certain European countries which provides an impetus to consolidate medical records. These countries are able to use the insurance system to stipulate industry standards for EMR, which means hospitals that do not comply to the rules risk not being paid for their medical services, the executive said.
As such, governments in this part of the world play an important role in driving interoperability between hospitals and they stand to benefit most, Ma stated. With interoperable records, governments are able to save on medical subsidies as patients will not need to conduct the same medical examination or X-ray scan twice when they seek a second opinion from different medical practitioners, he elaborated.
Governments will also have more medical data to allow them to conduct research on discover on issues such as why a particular illness is more widespread in different areas of the country, he said.
EMR efforts in Asia encouraging
Despite the challenges, some countries in Asia are already taking steps in setting up their EMR systems, Ma pointed out.
Singapore and Hong Kong, for example, are two markets that have started consolidating their citizens' medical records. These two nations are both compact, have good healthcare systems and medical staff with high standards, and these factors make it easier to implement an interoperable EMR system, he said.
In fact, both countries are ready to move on to the next step and use EMR for clinical decision support. This means medical staff can use the data to make decisions on how to treat patients, such as avoiding prescribing treatment and medicine that provokes a patient's allergies, the executive explained.
China, too, is moving fast in setting up its national health record system. Ma said China is trying to "squeeze" what took Singapore, Hong Kong and South Korea 10 years to achieve and reach it in 2 to 3 years. It is doing "very well" and is forward looking in that it plans to incorporate a DNA data bank to facilitate diagnostics and research work, he added.

My opinion:
I think that this is especially important for Asian countries, considering that there are many more people, and thus, adequate records are needed.  Not only this, but many Asians may not be able to afford multiple check-ups when looking for second opinions.  Furthermore, in America, I know that doctors can send prescriptions over the internet directly to the pharmacists.  Maybe if Asian countries had this kind of a system, too, patients would more easily access treatments, and pharmacies would better be able to keep track of their records.  Feel free to comment.

Should Hospitals be Privatized?

Protest over privatisation of public hospitals in Spain
Spain,Health/Medicine, Mon, 03 Dec 2012 IANS

Madrid, Dec 3 (IANS/EFE) Thousands of people, including health professionals, took to the streets of the Spanish capital Sunday to protest plans by the Madrid regional government to outsource management and some services provided by public hospitals.
The demonstrators, who included elderly people and children, showed up at all the hospitals in the capital as part of the "Abraza tu hospital" (Embrace Your Hospital) campaign.
Protesters chanted and held hands as they surrounded large hospitals like Gregorio Maranon Hospital.
The protest's goal is to pressure the regional government "to put in place the mechanisms needed to make it possible to have a more efficient public health system", union member Magdalena Salcedo told EFE.
About 3,000 protesters, according to organizers' estimates, held hands and surrounded La Princesa Hospital, forming a human chain around the medical facility.

My opinion:
I feel really bad that this is happening in Spain.  The issue is, though, that the country may be in very poor condition and the government actually has no money to sustain their hospitals.  Additionally, at least in America, many hospitals may be constrained by too much administration.  In Spain, however, I'm sure the situation is different, but I'm not sure if only 3,000 people protesting are actually able to put a halt to the government's actions.

Friday, December 14, 2012

Understand your prescription? It's not always easy.

Confused by medication guides? You're not alone

NEW YORK (Reuters Health) - The information sheets that come stapled to certain prescriptions picked up at the pharmacy are too complex and difficult for people to understand, according to a new study.

"Anyone who's seen these are not going to be surprised by the fact that they're difficult to read," said Michael Wolf, the study's lead author and an associate professor at Northwestern University's Feinberg School of Medicine in Chicago.

The U.S. Food and Drug Administration-approved medication guides are attached to drugs that the agency considers to have "serious and significant public health concerns," according to the report.

Patients are supposed to read the guides before taking the drugs to learn about risks, side effects, potential interactions with other drugs and why the medication should be taken as prescribed.

"You want to make sure that message is effective. Otherwise it can do major harm," Wolf told Reuters Health.

In previous studies, Wolf and his colleagues found several problems with the guides, including patients not understanding their content and - in many cases - not even receiving them along with their medication.

The number of drugs required to be accompanied by a so-called med guide increased from 40 in 2006 to 305 last year. That led the researchers to look into whether the guides had gotten easier to understand.

For the new study, the researchers first analyzed 185 medication guides in April 2010, which represented the majority of those available on the FDA's website at the time.

On average, the guides were about 2,000 words long, none of the guides had a review section or brief summary and only one met "suitability" guidelines frequently used as the standard for medical education materials.

Then, Wolf and his colleagues asked 449 adults at two Chicago clinics to read three medication guides then answer a series of questions about the drugs, including how they should be stored and their possible side effects. The participants were allowed to refer back to the guides during the test and were not rushed to answer the questions.

On average, the participants were only able to correctly answer half of the questions.

My opinion:
In my medical humanities class, I remember discussing that doctors need to convey information in everyday terms when speaking with patients.  This article just goes to show that this is a must, and not just for doctors, but for pharmacists, too.  The author later comments that, in general, all people had difficulty answering the questions, regardless of education level.  This, to me, indicates that the problem might be in the terminology, rather than the syntax or grammar.  Perhaps before drugs are introduced to the market, labs should test the instruction manuals as the researchers did in this scenario.  Feel free to comment.

Digging into the Logistics of the Primary Care Shortage

Newly insured patients may have trouble finding primary care physicians

Current safety-net providers are attentive to issues of quality but may be unable to care for more patients

Implementation of the Affordable Care Act – now assured by the re-election of President Obama – is expected to result in up to 50 million currently uninsured Americans acquiring some type of health insurance coverage. But a study by researchers at the Mongan Institute for Health Policy at Massachusetts General Hospital (MGH) finds that a significant percentage of the primary care physicians most likely to care for newly insured patients may be not be accepting new patients. The investigators note that strategies designed to increase and support these "safety-net" physicians could help ensure that newly covered patients have access to primary care.
"This study raises very serious concerns about the willingness and ability of primary care providers to cope with the increased demand for services that will result from the ACA," says Eric G. Campbell, PhD, of the Mongan Institute, senior author of the report to be published in the American Journal of Medical Quality. "Even with insurance, it appears that many patients may find it challenging to find a physician to provide them with primary care services."
In 2000 the Institute of Medicine published a report on the health care "safety net" – physicians and organizations caring for a significant proportion of uninsured or Medicaid-covered patients – that noted a lack of enough safety-net providers and the chronic underfunding of Medicaid. The Affordable Care Act was designed to ensure almost universal health insurance coverage, including expanding the number of individuals eligible for Medicaid. The authors of the current study note that many newly covered patients are likely to turn to physicians in the already-stressed health care safety net and that areas where such patients are likely to live often have limited primary care services. In addition, studies have suggested that physicians caring for disadvantaged groups of patients may provide lower-quality care.
The authors set out to better understand the physicians in the primary care safety net, to determine their willingness to accept new Medicaid patients and to assess their attitudes about and interest in quality improvement activities. As part of a 2009 survey of medical professionalism, physicians were asked to indicate the approximate percentage of their patients who were covered by Medicaid or were uninsured and unable to pay. They also were asked whether they were accepting new Medicaid or uninsured patients, along with several questions regarding services they provided to vulnerable populations and their attitudes towards and participation in quality improvement activities. Because of their focus on the primary care safety net, the investigators restricted their analysis to responses from internists, pediatricians and family practitioners.
Of 840 primary care physicians responding to the survey, 53 percent were safety-net providers, defined as having patient panels with more than 20 percent uninsured or Medicaid patients. Half of all responding primary care physicians indicated they were accepting new patients who either were covered by Medicaid or had no means of paying for their care. But safety-net physicians were considerably more likely to accept both patient groups, with 72 percent taking new Medicaid patients and 61 percent taking new patients with no medical coverage. There were no significant differences between the physician groups in reported attitudes about or participation in quality improvement efforts, and safety-net physicians reported greater awareness of and efforts to address disparities in health care than did non-safety-net physicians.

My opinion:
Another reason why more primary care doctors are needed!  Although, to make a point, perhaps new doctors should be provided training about these issues, at least to increase awareness.  I write this because many new physicians may elect not to participate in this "safety net" for the newly insured, and the problem would continue to spiral out of control.  I also know that current doctors may participate in something called "grand rounds," when speakers present on medical issues.  But, it would be interesting to see a grand rounds that focuses on the legal issues of medicine, as well.  Not only would this give doctors a chance to reconsider their values, but some might be interested in really furthering their efforts to fix the problem.  Arguably, they may have some (but not complete) control over the issue, and by increasing their awareness, they may be able to arrive at better solutions than others.  Feel free to comment.

Monday, December 10, 2012

Overseas Hospitals

Cleveland clinic to finish by end of 2013

on Nov 13, 2012

Abu Dhabi’s Cleveland Clinic, a world-class health facility for the region designed by HDR and Aedas, is reportedly on track for its projected completion at the end of 2013.
Located on Abu Dhabi’s Al Maryah Island, the $1.9bn project aims to extend the same level of medical care as the United States-based Cleveland clinic model.
This 364-bed facility is organised into five institutes each with their own design needs: Digestive Disease, Eye, Heart, and Vascular; Neurological; Respiratory; and Critical Care.
Mohammed Ayoub, HDR’s lead designer for the project, said the clinic is on track to be one of the most advanced and high-tech yet luxurious hospitals in the world.

“The term ‘hospital of the future’ is used quite often, but I can’t imagine another facility that reflects that phrase more than the Cleveland Clinic Abu Dhabi,” said Ayoub. “It’s a building that blends cutting-edge technology, evidence-based design, world-class care, and Arabic culture with elegant architecture—creating a facility that looks more like a seven-star hotel than a hospital.”
The overall campus incorporates unique design elements drawn from the local community from a Gulf inspired colour palette, to Arabesque patterns.
Facilities are clustered around a central reflecting pool, giving off an aquatic feel throughout. Glass walkways paired with a warm wood interior and a double glass curtain wall connect patient spaces and faculty offices. Windows reflect out to the on-site gardens and views of the Arabian Sea.
The overall effect is designed to promote wellness and serenity, blurring the lines of hospital and hospitality, claims Ayoub. Upon completion next year, the Cleveland Clinic aims to provide impeccable standards of care in an iconic setting.

My opinion:
I had no idea hospitals were building campuses in other countries.  It's like how some colleges maintain schools in different continents.  It's also interesting that many of these colleges, and now hospitals, choose to build in the Middle East.  Perhaps this is because the financial situation there, for some people, is very stable.  I'd like to see more of these in other places, too, but are they necessary for other reasons?  By appealing to other cultures, I believe this will increasingly help the clinic to get their name out into the open.  Feel free to comment.

Sunday, December 9, 2012

Restructure the Clinic?

Cleveland Clinic's 4 radical approaches to care integration, patient satisfaction

With a historical reputation for being the best, Cleveland Clinic has applied some unconventional methods to its care integration model that boosts patient satisfaction.

Both President Obama and Gov. Romney mentioned the Clinic as an exemplary innovator in the presidential debate.

"I really think our model is our secret sauce," Cleveland Clinic CEO Delos "Toby" Cosgrove said in a Business Insider interview about the recent shout-outs. Based on the idea of "Patients first"--the slogan the Clinic adopted since Cosgrove took the helm--the system has restructured the entire organization.

1. Get rid of departments
The Clinic restructured the entire system, eliminating the surgical department and the department of medicine, rethinking organization based on patient needs.

For example, if a patient has a headache, he can go to one neurologic institute, with the specialists physically located near each other. The institutes are more efficient and less costly, according to the CEO.

"In one year, we changed the whole organization," Cosgrove said. "It's all by institutes."
2. Evaluate everyone every year
No physician is tenured at the Clinic. All the employees are salaried and have one-year contracts, including Cosgrove, who has had 37 one-year contracts. The idea is modeled after every other industry, in which employees receive a performance evaluation every year--notably absent in healthcare.

"You got privileges at a hospital, and they were yours for life," Cosgrove noted. "In the annual professional review, we go over all individual contributions to the organization, and that contributes to our decisions about what we do about salary or whether we reappoint or don't."

 Such annual assessments mean physicians are not compelled to provide unnecessary services.
"We have no financial incentives to do more or less," the CEO told Business Insider.

Read more: Cleveland Clinic's 4 radical approaches to care integration, patient satisfaction - FierceHealthcare

 My Opinion:
I feel like the slogan "patients first" is rather cliched.  It's like how businesses always say they try to put "customers first."  Perhaps another, more catchy saying would help the clinic.  I also don't understand how eliminating departments becomes less costly.  Sure, maybe specialists are easier to seek out, but regardless of whether it's less costly or not, the patient is still probably paying lots of money to go see the same doctors.  The evaluations are interesting - but the CEO doesn't mention that any patients are allowed to have their say.  It would also be interesting to see the statistics for these reviews - are some doctors actually let go, and if not, are there any that have their salaries reduced?  Feel free to comment.

Tuesday, December 4, 2012

In-Vitro Video Cameras

Cleveland Clinic uses EmbryoScope technology to keep a close watch on developing embryos

Published: Tuesday, November 27, 2012, 8:15 AM     Updated: Tuesday, November 27, 2012, 8:16 AM
EMBRYO_13837691.JPG The photo of this embryo was taken by a camera built into an EmbryoScope, a specially made incubator that is in a dozen fertility centers across the United States. The Cleveland Clinic has two of the machines, which takes automated and continuous time-lapse video of fertilized embryos to track their development without having to move them.
CLEVELAND, Ohio -- Modern technology has given people with fertility problems hope that they can become parents.
Even so, less than 40 percent of in vitro fertilization and other assisted reproductive technology cycles result in a pregnancy.
The Cleveland Clinic Fertility Center in Beachwood is one of only 12 sites in the United States using new technology designed to help select embryos that have the best chance of developing into a successful pregnancy and birth. The EmbryoScope is an incubator with a built-in camera that takes automated and continuous time-lapse video of fertilized embryos stored there until they are transferred into a woman's uterus.
Massachusetts-based Unisense FertiliTech A/S, developed the technology, which has been used in the United States for research since 2009, and overseas even longer.
The Food and Drug Administration granted the EmbryoScope clearance in December 2011, opening the door for fertility centers to use it in their IVF labs.
DESAI_12539421.JPG Nina Desai
The Clinic jumped at the chance to buy the incubator, which Nina Desai, director of the Clinic's IVF laboratory, calls "revolutionary." Desai liked it so much that she bought another one three months later. The units cost $120,000 apiece, she said.
EmbryoScope shoots video at set time intervals of every 20 minutes so lab embryologists can go back and view the development of an embryo (an egg that has been fertilized by a sperm). The lab also can capture and review still photos of all of the images taken while the embryos are developing inside a special culture dish.
Time-lapse imaging is nothing new, but this is a significant advancement, Desai said.
In the past, video could capture the development of a single embryo in a culture dish, under a microscope.
"Initially the technology was very cumbersome," Desai said.
With the Clinic's two EmbryoScopes, up to 72 embryos from as many as a dozen patients can be monitored at once, and the embroyos never have to be moved out of the incubator.
The technology, Desai said, has made the process of selecting viable embryos for transfer much easier.
With one round of IVF costing as much as $12,000, picking a viable embryo the first time can result in a significant cost-savings. Having more data available to choose the best-developed embryos also will cut down the chances of extra ones being implanted as "insurance," resulting in multiple births.
That information includes cell division patterns and the characteristics that distinguish embryos that implant from those that don't.
"For patients with a lot of embryos, it gives us a little bit better ability to select," Desai said. "If you're imaging embryos every 20 minutes, you're getting a wealth of information."
An embryo is typically transferred on either Day 2 or Day 3 after fertilization, when it has reached up to the 8-cell stage, or at Day 5 or Day 6, when it is more developed.
More than 60 women at the Clinic have successfully gotten pregnant; the first birth (a set of twins) is due in January. And while they can't be in the lab to watch the embryos develop in real time, patients are given a DVD of the video (with either all of the embryos or just the ones selected) usually after a successful transfer.
Today, EmbryoScope is in use at more than 185 fertility clinics worldwide. Around 8,000 babies have been born from embryos that have been monitored in an EmbryoScope. But those numbers, based on a estimated 30 percent pregnancy rate, is a rough estimate at best, said FertiliTech's Marianne Vivian.
"We don't track miscarriages and we don't take into account medical tourism, [the practice of someone traveling to another country for medical care]" she said.
The Clinic is using EmbryoScope to monitor the embryos of women ages 38 and under with at least eight embryos from which to choose. Desai is collecting the data for a study on selection criteria that she hopes to publish in the future.

My opinion:  I think it's a bit much to pay $120,000 for a video camera.  I understand that this camera is sharp, and that it captures multiple embryos, but there is probably a less expensive way to do this.  Is medical technology one of the reasons why health care costs have skyrocketed?  I also believe that there is a question of ethics at hand.  In the movie Gattaca, parents may select the qualities of their future children by simply meeting with a geneticist.  Though this situation is far different, it does involve choosing one embryo over the others.  It will be interesting to see the guidelines are for selection - how much can one tell about the baby's genes from its embryo by the sixth day?