Archive for April, 2011

Actemra

http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm251572.htm

FDA NEWS RELEASE

For Immediate Release: April 15, 2011

FDA approves Actemra to treat rare form of juvenile arthritis

The U.S. Food and Drug Administration today approved Actemra (tocilizumab), given alone or in combination with methotrexate, for the treatment of active systemic juvenile idiopathic arthritis (SJIA) in children ages 2 years and older.

SJIA, or Still’s disease, is a rare, potentially life-threatening disorder in children that causes severe inflammation throughout the body. SJIA is distinguished from other forms of juvenile idiopathic arthritis (JIA) by the prominence of systemic and inflammatory features, including spiking fevers; rash; swelling and inflammation of lymph nodes, liver, and spleen; and high white blood cell and platelet counts. The prevalence of JIA is an estimated 1 to 2 per 1,000 children, and SJIA affects about 10 percent of all JIA patients.

Actemra is an interleukin-6 receptor blocker approved by the FDA on Jan. 8, 2010, for treatment of adults with moderately to severely active rheumatoid arthritis who have had an inadequate response to other approved therapies.

“This new indication of Actemra provides the first approved therapy for children with this rare disease,” said Badrul Chowdhury, M.D., Ph.D., director of the Division of Pulmonary, Allergy, and Rheumatology Products in the FDA’s Center for Drug Evaluation and Research.

An international, multicenter controlled trial demonstrated the safety and effectiveness of Actemra, in which 112 patients received either Actemra infusions or placebo infusions every two weeks. Study participants included patients with SJIA aged 2 to 17 years old who had inadequate response to or who were unable to take nonsteroidal anti-inflammatory drugs and corticosteroids.

Eighty-five percent of those receiving Actemra responded to treatment, compared with 24 percent of patients receiving placebo. Response was defined as at least 30 percent improvement in the American College of Rheumatology’s JIA efficacy variables, along with absence of fever in the preceding seven days. In the long-term, follow-up period of the trial there were three cases of macrophage activation syndrome (MAS) among SJIA patients receiving Actemra. MAS is a potentially fatal complication of childhood systemic inflammatory disorders, thought to be caused by excessive activation and proliferation of certain immune cells.

Actemra carries a Boxed Warning for serious infections. Patients treated with Actemra who develop a serious infection should stop Actemra treatment until the infection is controlled. A Boxed Warning is a brief, concise summary of the information that is critical for a prescriber to be aware of, including any restriction on distribution or use, which is included in a black box at the beginning of the drug label.

Changes in certain laboratory test results such as liver tests, blood counts, and cholesterol are not uncommon with Actemra and should be monitored with regular blood tests. The most common side effects in trial participants with SJIA included upper respiratory tract infection, headache, sore throat, and diarrhea.

The ER & The Mentally Ill

http://www.npr.org/2011/04/13/135351760/mentally-ill-languish-in-hospital-emergency-rooms

Mentally Ill Languish In Hospital Emergency Rooms

by Jenny Gold

“……Mentally ill patients often languish in hospital emergency rooms for several days, sometimes longer, before they can be moved to a psychiatric unit or hospital. At most, they get drugs but little counseling, and the environment is often harsh……”

Check out “2010 Survey of Hospital ED Administrators:  ED Challenges and Trends”

http://schumachergroup.com/_uploads/news/pdfs/ED%20Challenges%20and%20Trends%2012.14.10.pdf

The MRSA Bundle & The Drop in Deadly V.A. Hospital Infections

http://www.nytimes.com/2011/04/14/health/14infections.html?_r=1&nl=todaysheadlines&emc=tha23

NY Times

April 13, 2011
Study Finds Drop in Deadly V.A. Hospital Infections
By KEVIN SACK

ATLANTA — “An aggressive four-year effort to reduce the spread of deadly bacterial infections at veterans’ hospitals is showing impressive results and may have broad implications at medical centers across the country………

The study of 153 Veterans Affairs hospitals nationwide found a 62 percent drop in the rate of infections caused by methicillin-resistant Staphylococcus aureus, or MRSA, in intensive care units over a 32-month period. There was a 45 percent drop in MRSA prevalence in other hospital wards, like surgical and rehabilitation units……”

NEJM (http://www.nejm.org/doi/full/10.1056/NEJMoa1007474)

Veterans Affairs Initiative to Prevent Methicillin-Resistant Staphylococcus aureus Infections

Rajiv Jain, M.D., Stephen M. Kralovic, M.D., M.P.H., Martin E. Evans, M.D., Meredith Ambrose, M.H.A., Loretta A. Simbartl, M.S., D. Scott Obrosky, M.S., Marta L. Render, M.D., Ron W. Freyberg, M.S., John A. Jernigan, M.D., Robert R. Muder, M.D., LaToya J. Miller, M.P.H., and Gary A. Roselle, M.D.

N Engl J Med 2011; 364:1419-1430;  April 14, 2011

The “MRSA Bundle”: 

1)  Universal nasal surveillance for MRSA,

2) Contact precautions for patients colonized or infected with MRSA,

3)  Hand hygiene, and

4)  A change in the institutional culture whereby infection control would become the responsibility of everyone who had contact with patients.

“……The rates of health care–associated MRSA infections in ICUs had not changed in the 2 years before October 2007 (P=0.50 for trend) but declined with implementation of the bundle, from 1.64 infections per 1000 patient-days in October 2007 to 0.62 per 1000 patient-days in June 2010, a decrease of 62% (P<0.001 for trend). During this same period, the rates of health care–associated MRSA infections in non-ICUs fell from 0.47 per 1000 patient-days to 0.26 per 1000 patient-days, a decrease of 45% (P<0.001 for trend)…..”

Kids & Football Injuries

http://www.medicalnewstoday.com/articles/222023.php

Medical News Today, 4/12/11

“A new study conducted by researchers in the Center for Injury Research and Policy of The Research Institute at Nationwide Children’s Hospital found that an estimated 5.25 million football-related injuries among children and adolescents between 6 and 17 years of age were treated in U.S. emergency departments between 1990 and 2007. The annual number of football-related injuries increased 27 percent during the 18-year study period, jumping from 274,094 in 1990 to 346,772 in 2007. …..”

EM Excellence Award Recipients

http://www.healthgrades.com/%2fcms%2fratings-and-awards%2f2011-Emergency-Medicine-Excellence-Award-Recipients.aspx

http://www.healthgrades.com/cms/ratings-and-awards/2011-Emergency-Medicine-Excellence-Award-Announcement.aspx

Tuesday, April 12, 2011
2011 Emergency Medicine Excellence Award™

 Patients Treated at Top Hospitals for Emergency Medicine have 40% Lower Death Rate

Knowing which hospitals in your area perform best when it comes to treating patients who arrive through the emergency room can greatly increase your chances of survival.

A study released today by HealthGrades found large differences in the quality of emergency care, both by hospital and by market area. 
 
The findings are based on an analysis of more than seven million Medicare patient records from 2007 to 2009. HealthGrades Emergency Medicine in American Hospitals study focused on 12 of the most common and life-threatening medical emergencies among that patient population, including heart attack, stroke, pneumonia and chronic obstructive pulmonary disease, or COPD. The HealthGrades study included only those cases admitted to the hospital from the emergency room for further medical treatment, representing the full continuum of a patient’s care. Those hospitals performing in the top 5% in the nation were designated as Emergency Medicine Excellence Award™ hospitals. View a full listing of these hospitals, by city.

Top 10 Cities for Emergency Medicine

  1. Cincinnati, OH
  2. Phoenix, AZ
  3. Milwaukee, WI
  4. Dayton, OH
  5. Cleveland, OH
  6. W. Palm Beach, FL
  7. Tucson, AZ
  8. Baltimore, MD
  9. Houston, TX
  10. Detroit, MI

2010 Survey of Hospital ED Administrators

 ”2010 Survey of Hospital ED Administrators:  ED Challenges and Trends”

http://schumachergroup.com/_uploads/news/pdfs/ED%20Challenges%20and%20Trends%2012.14.10.pdf

KEY FINDINGS OF THE SURVEY

 

The majority of hospital emergency department (ED) administrators (66%) believe health reform will cause patient volume at their EDs to increase, while only 5% believe ED patient volume will decrease because of health reform.
 

64% of ED administrators said that due to health reform their EDs will see more patients who cannot access primary care doctors in a timely manner. Only 7% said their EDs will see fewer patients who cannot access a primary care physician in a timely manner due to health reform.

 

55% of ED administrators said that due to health reform their EDs will see more patients who cannot access specialist physicians in a timely manner. Only 3% said their EDs will see fewer patients who cannot access a specialist physician in a timely manner due to health reform.

 

Close to three-fourths of ED administrators (74%) indicated that lack of specialist physicians available to cover the ED posed at least a moderate risk to patients at their facilities. 38% indicated that lack of specialist coverage posed either a significant risk to patients or a very significant risk.

 

ED administrators cited orthopedic surgeons and neurosurgeons as the types of specialists providing coverage in their facilities in shortest supply, followed by neurologists, cardiologists, general surgeons, otolaryngologists and cardiovascular surgeons.

 

About one-third of ED administrators (36%) pay specialists to provide coverage to their EDs.

 

The majority of ED administrators (at least 70%) believe reimbursement from Medicaid, Medicare and commercial insurance to their EDs will decrease under health reform.

 

The great majority of ED administrators (86%) indicated they are often or sometimes unable to transfer mental/behavioral patients to inpatient facilities in a timely manner.

 

Over 70% of ED administrators report mental/behavioral patients boarding for 24 hours or longer. 10% said they have boarding times for mental/behavioral patients as long as one week or more.

 

60% of ED administrators believe patient care at their EDs has been compromised due to delays in transferring mental/behavioral patients to inpatient facilities.

 

While 73% of ED administrators said their hospital has invested in electronic medical records in the ED, 56% said that to date the investment has not been worth the cost. However, 76% said that eventually the investment would justify the cost.

 

Uncompensated care and reimbursement for services rank as the two issues of most importance to ED administrators over the next 12 months, followed by health reform.

 

 

Partnership for better and cheaper patient care: Give me details and more details…..

http://www.hhs.gov/news/press/2011pres/04/20110412a.html

FOR IMMEDIATE RELEASE
Tuesday, April 12, 2011
Contact: HHS Press Office
(202) 690-6343

Partnership for patients to improve care and lower costs for Americans

New partnership between Administration, the private sector, hospitals and doctors to
make care safer, potentially save up to $50 billion

Health and Human Services Secretary Kathleen Sebelius, joined by leaders of major hospitals, employers, health plans, physicians, nurses, and patient advocates, today announced the Partnership for Patients, a new national partnership that will help save 60,000 lives by stopping millions of preventable injuries and complications in patient care over the next three years.  The Partnership for Patients also has the potential to save up to $35 billion in health care costs, including up to $10 billion for Medicare.  Over the next ten years, the Partnership for Patients could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings.  Already, more than 500 hospitals, as well as physicians and nurses groups, consumer groups, and employers have pledged their commitment to the new initiative.

“Americans go the hospital to get well, but millions of patients are injured because of preventable complications and accidents,” said Secretary Sebelius.  “Working closely with hospitals, doctors, nurses, patients, families and employers, we will support efforts to help keep patients safe, improve care, and reduce costs. Working together, we can help eliminate preventable harm to patients.”

Today, leaders from across the nation pledged their commitment to this new initiative.  To launch this initiative, HHS announced it would invest up to $1 billion in federal funding, made available under the Affordable Care Act.  Today, $500 million of that funding was made available through the Community-based Care Transitions Program.  Up to $500 million more will be dedicated from the Centers for Medicare & Medicaid Services (CMS) Innovation Center to support new demonstrations related to reducing hospital-acquired conditions.  The funding will be invested in reforms that help achieve two shared goals:

  • Keep hospital patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40-percent compared to 2010.  Achieving this goal would mean approximately 1.8 million fewer injuries to patients, with more than 60,000 lives saved over the next three years. 
  • Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20-percent compared to 2010.  Achieving this goal would mean more than 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

The Partnership will target all forms of harm to patients but will start by asking hospitals to focus on nine types of medical errors and complications where the potential for dramatic reductions in harm rates has been demonstrated by pioneering hospitals and systems across the country.  Examples include preventing adverse drug reactions, pressure ulcers, childbirth complications and surgical site infections. The CMS Innovation Center will help hospitals adapt effective, evidence-based care improvements to target preventable patient injuries on a local level, developing innovative approaches to spreading and sharing strategies among public and private partners in all states.  Members of the partnership will identify specific steps they will take to reduce preventable injuries and complications in patient care. 

“With new tools provided by the Affordable Care Act, we can aggressively implement programs that will help hospitals reduce preventable errors,” said CMS Administrator Donald Berwick, M.D.  “We will provide hospitals with incentives to improve the quality of health care, and provide real assistance to medical professionals and hospitals to support their efforts to reduce harm.” 

HHS has committed $500 million to community-based organizations partnering with eligible hospitals to help patients safely transition between settings of care.  Today, community-based organizations and acute care hospitals that partner with community-based organizations can begin submitting applications for this funding.  Applications are being accepted on a rolling basis.  Awards will be made on an ongoing basis as funding permits.

In coordination with stakeholders from across the health care system, the CMS Innovation Center is planning to use up to $500 million in additional funding to test different models of improving patient care and patient engagement and collaboration in order to reduce hospital-acquired conditions and improve care transitions nationwide.   These collaborative models will help hospitals adopt effective interventions for improving patient safety in their facilities. 

The programs announced today are just two of the many ways the Affordable Care Act is helping improve the health care system.  Last month, HHS announced the first-ever National Quality Strategy, which will serve as a tool to help coordinate quality initiatives between public and private partners as well as to leverage and coordinate existing efforts by federal agencies and departments to improve patient care.  HHS also announced new rules to help doctors, hospitals, and other providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs).  By 2015, a portion of Medicare payments to the majority of hospitals will be linked to whether hospitals are delivering safer care, using information technology effectively and meeting patient needs.  Payment incentives and supports to improve quality and lower costs will also be available to state Medicaid programs.

“No single entity can improve care for millions of hospital patients alone,” said Berwick.  “Through strong partnerships at national, regional, state and local levels – including the public sector and some of the nation’s largest companies – we are supporting the hospital community to significantly reduce harm to patients.”

For more information about the Partnership for Patients, visit www.HealthCare.gov/center/programs/partnership.  For a fact sheet on today’s announcement, visit www.HealthCare.gov/news/factsheets/partnership04122011a.html.  For more information about the Community-based Care Transitions Program funding opportunity, visit www.cms.gov/DemoProjectsEvalRpts/MD/itemdetail.asp?itemID=CMS1239313.

A BUN can help in the early assessment of acute pancreatitis

http://archinte.ama-assn.org/cgi/content/abstract/171/7/669

Blood Urea Nitrogen in the Early Assessment of Acute Pancreatitis

An International Validation Study

Bechien U. Wu, MD, MPH; Olaf J. Bakker, MD; Georgios I. Papachristou, MD; Marc G. Besselink, MD; Kathryn Repas, BA; Hjalmar C. van Santvoort, MD; Venkata Muddana, MD; Vikesh K. Singh, MD; David C. Whitcomb, MD, PhD; Hein G. Gooszen, MD; Peter A. Banks, MD

Arch Intern Med. 2011;171(7):669-676. doi:10.1001/archinternmed.2011.126

Hospital Preparedness Program cut by $185 million

http://www.propublica.org/article/house-calls-for-drastic-cuts-in-hospital-preparedness-funding

ProPublica

by Sasha Chavkin
ProPublica, April 8, 2011, 3:39 p.m.

“…..the House of Representatives passed a budget measure that would cut the federal Hospital Preparedness Program by $185 million, a 44 percent reduction from last year’s budget…….”

Stuck on you…

http://www.ems1.com/ems-oddities/articles/1005725-Md-man-found-glued-to-a-toilet-seat/

Maryland man found glued to a toilet seat

By EMS1 Staff

CECIL COUNTY, Md. — “Medics were called to the scene of a Maryland Walmart bathroom to find a man apparently glued to the toilet in what appeared to be an April Fool’s joke.

It took responders 15 minutes to remove the man from the bathroom stall, but they were unable to remove the toilet seat from his body, according to CNN……”

Virginia: “You touch me and it’s jail time, me buck-o.”

http://www.nbc29.com/story/14371499/new-law-protects-doctors-in-the-er

WNBC 29

New Law Protects Doctors in the ER

“Emergency room doctors across the commonwealth are cheering a new law that offers them additional on-the-job protections. The law, which will take effect July 1 calls for up to 15 days in jail for anyone who knowingly assaults an emergency room doctor or nurse…..”

Salmonella & Water Frogs

http://www.cdc.gov/salmonella/water-frogs-0411/040711/index.html

  • As of April 5, 2011, a total of 217 individuals infected with the outbreak strain of Salmonella Typhimurium have been reported from 41 states since April 1, 2009. These infections are associated with contact with water frogs, specifically, African dwarf frogs.
  • A single water frog breeder in California has been identified as the source of African dwarf frogs associated with human infections. This breeding facility was first identified as the source of African dwarf frogs associated with human infections in 2010. Past information about this investigation in 2009-2010 can be found on the CDC Salmonella page.
  • In late March 2011, local health department staff visited the frog breeder and collected environmental samples. These samples were tested in CDC laboratories and were found to be positive for Salmonella bacteria; additional testing is ongoing to determine if this Salmonella strain is the outbreak strain.

Persons infected with the outbreak strain of Salmonella Typhimurium, by state

Infected individuals range in age from less than 1 year old to 73 years old. Seventy-one percent of patients are younger than 10 years old, and the median age is 5 years old. Fifty-one percent of patients are female. Among ill persons, 34% were hospitalized. No deaths have been reported.

Clinical Features/Signs and Symptoms

Most persons infected with Salmonella bacteria develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most persons recover without treatment. However, in some persons, the diarrhea may be so severe that the patient needs to be hospitalized. Salmonella infection may spread from the intestines to the bloodstream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics. The elderly, infants, and those with impaired immune systems are more likely to have a severe illness from Salmonella infection.

 

Persons infected with the outbreak strain of Salmonella Typhimurium, by month of illness onset

Kava ingestion & Rhabdomyolysis

Rhabdomyolysis associated with kava ingestion
Published online: 04 April 2011
Ryan Bodkin, Sandra Schneider, Donna Rekkerth, Linda Spillane, Michael Kamali
DOI: 10.1016/j.ajem.2011.01.030
American Journal of Emergency Medicine

http://www.ajemjournal.com/article/S0735-6757%2811%2900061-1/abstract

Residents’ hours….

http://well.blogs.nytimes.com/2011/04/07/is-a-well-rested-doctor-a-better-doctor/?ref=health

http://www.bmj.com/content/342/bmj.d1580.full.pdf

NYT

April 7, 2011, 7:00 am

Is a Well-Rested Doctor a Better Doctor?

By PAULINE W. CHEN, M.D.

“…..While work-hour guidelines have been around since 1989, it wasn’t until 2003 that the organization responsible for accrediting American medical residency programs issued the first national guidelines limiting residents to no more than 80 hours of work per week…….

Junior doctors in the European Union have faced even tighter regulations. Since 2009, doctors-in-training have been restricted to working no more than 52 hours per week; beginning in 2012, the limit will be 48 hours…….

[A]ccording to a new report in the British medical journal BMJ that reviewed all the published data on the effects of restricting resident work hours in the United States and Europe……. [t]he researchers found that while all the punch-clock sturm und drang has improved the lifestyle of junior doctors, decreasing their fatigue seems to have had little if any effect on how patients actually do……..”

Adverse events in hospitals: We can detect it better than you…..

http://content.healthaffairs.org/content/30/4/581.abstract

‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured

David C. Classen, Roger Resar, Frances Griffin, et al

10.1377/hlthaff.2011.0190 Health Aff April 2011 vol. 30 no. 4 581-589

“Identification and measurement of adverse medical events is central to patient safety…. We found that…..voluntary reporting and the Agency for Healthcare Research and Quality’s Patient Safety Indicators……missed 90 percent of the adverse events. The Institute for Healthcare Improvement’s Global Trigger Tool found at least ten times more confirmed, serious events than these other methods. Overall, adverse events occurred in one-third of hospital admissions. Reliance on voluntary reporting and the Patient Safety Indicators could produce misleading conclusions about the current safety of care in the US health care system and misdirect efforts to improve patient safety.”