About one-third of children in pediatric intensive care units experience delusions, and those delusional memories put youngsters at a higher risk of developing post-traumatic stress syndrome after their hospital stay.
 
Delusions were more common in children who had to be sedated for more than two days, and in youngsters who were admitted on an emergency basis, according to a study in the first May issue of the American Journal of Respiratory and Critical Care Medicine.
 
"In the majority of cases, these delusional memories consisted of one or more hallucinations which were often frightening and which the children could still recall vividly," said study author Gillian Colville, a consultant clinical psychologist and head of the pediatrics psychology service at St. George's Hospital in London. "[Children] reported seeing rats, cats, scorpions on the walls and, in some cases, crawling on the bed, and a couple of children were convinced that their parents had been replaced by imposters."
 
The timing of these hallucinations was usually around the time the children were being weaned off sedatives. Such medications are used to help control pain and anxiety in children, and in adults, who need intensive medical care.
 
"Sedatives, and benzodiazepines in particular, interfere with the ability to form new memories, and part of what they do is alter how you remember what's going on," said Dr. Scott Watson, a pediatric intensivist in the division of critical care medicine at Children's Hospital of Pittsburgh. "Sedating medications also interfere with normal sleep, so processing information and memory is more difficult."
 
However, because being in intensive care is a stressful experience itself, the authors aren't recommending that the use of sedatives be discontinued but suggest that additional studies be done in children to see if periods of interrupted sedation might lower rates of delirium.
 
HealthDay News

British research into Steno, one the most recent "superbugs" to claim lives, reveals that the bacterium has an incredible ability to resist antibiotics and other drugs, according to soon-to-be-published findings.
 
Steno, short for Stenotrophomonas maltophilia, thrives in moist environments, such as around taps and shower heads, and can be transmitted to people. It is responsible for roughly 1,000 cases of Steno blood poisoning in the U.K. annually. About 30 percent of these infections prove fatal.
 
"This is the latest in an ever-increasing list of antibiotic-resistant hospital superbugs. The degree of resistance it shows is very worrying," study senior author Dr. Matthew Avison, of the University of Bristol, said in a prepared statement. "Strains are now emerging that are resistant to all available antibiotics, and no new drugs capable of combating these pan-resistant strains are currently in development."
 
Pan-resistant Steno infections are extremely hard to treat but are rarer than similarly difficult MRSA and Clostridium difficile infections and are exclusively hospital-acquired.
 
The paper, to be published in Genome Biology, discusses the findings when researchers recently sequenced the Steno genome. This process, they hope, will help them learn how this bacterium works, so they can discover how to best combat it.
 
The organism, which is also found in the lungs of many adults with cystic fibrosis, can cause pneumonia and septicemia. Steno only enters the body through devices, such as catheters or ventilation tubes, which are left in place for long periods of time. It sticks to the catheter, grows into a 'biofilm,' and enters the patient's bloodstream when the catheter is next flushed.
 
Steno often affects the seriously ill, whose immune systems are already weakened. Since the new research shows Steno to be largely resistant to antibiotics, these patients face an extremely difficult situation.

HealthDay News

Many hospitals now investigate patient’s personal credit reports to figure out how likely they are to pay their bills.  By accessing these credit reports, hospitals are peering at personal lines of credit, payment histories and debts.
 
They say this helps identify which patients to pursue actively for payment because they can, in fact, afford to pay, which helps to minimize losses.  They also claim it allows them to quickly identify which patients are eligible for charity care or assistance programs.
 
If a hospital requests the information, be sure to ask them why and whether it’s absolutely necessary.  Also, if a problem arises, make sure you ask how the hospital came by the information.
 
By law, hospitals aren’t allowed to turn away patients in an emergency.  And public hospitals (as opposed to private hospitals) are often required to give non-emergency care if it is considered medically necessary.
 
David Horowitz
The Costco Connection
June 2008

Deloitte asked more than 3,000 Americans what they thought about their health care - their likes and dislikes, what they want and aren’t getting, their own prescriptions for system-wide improvement.  A glimpse of the consumer health care market, by the numbers:

• 93 percent of consumers say they’re not adequately prepared for future health care costs
• 79 percent say candidates’ positions on health care are likely to influence their presidential vote
• 46 percent place health care among their top three voting concerns
• 26 percent would pay more for online access to medical records and results
• 84 percent prefer generic drugs to name brands
• 39 percent say they'd go abroad for treatment if quality was comparable and the cost was cut in half
• 66 percent either strongly support (36 percent) or might support (30 percent) state-mandated health insurance
• 63 percent either strongly support a tax increase to provide coverage for the uninsured (29 percent), or are inclined to support one (34 percent)
• 52 percent understand their health insurance plans
• Only 8 percent understand their health insurance completely
• 18 might turn down a job to retain current health care coverage
• 34 percent would use a retail/walk-in clinic; 16 percent have already have
• 78 percent want to customize their insurance to include the features they value, with the cost changed accordingly

Health Care by the Numbers: 2008 Survey of Health Care Consumers

Here [is a snapshot of legislation about which we] should be aware … as we head into 2009 and beyond.

General health issues:

• H.R. 493: The Genetic Nondiscrimination Act of 2008
  The law, which was recently signed by President Bush, prohibits health plans from adjusting premiums on the basis of predictive genetic information and establishes new confidentiality protections for genetic information.
  
  The measure does, however, maintain plans' ability to use genetic information in the aggregate for the purposes of disease management and prevention.  It also prohibits employers and labor organizations from discriminating against employees on the basis of genetic information.
  
  
• S.334: Healthy Americans Act
  The Healthy Americans Act would eliminate employer-sponsored health insurance to guarantee universal health care coverage that is transportable, private and equal to the insurance that federal employees have today. It maintains a focus on prevention, wellness and disease management and encourages transparency across all health care offerings.
  
  The bill was introduced by Sen. Ron Wyden (D-Or.) in January 2007 and is continuing to gain bipartisan momentum in the Senate.

Health technology:

• S.1693: Wired for Health Care Quality Act
  Establishes a public-private partnership that would set guidelines for electronic health information exchanges.
  
  
• H.R.5442: TRUST in Health Information Act
  Creates a competitive grant program to encourage the implementation and use of health IT systems with a single organization to develop and enforce quality and performance measures.

Quality and price transparency:

• Over two-dozen states currently mandate that health care providers give report cards or other quality measures on their servicing organizations.
  

Employee Benefit Advisor

Researchers from the Harvard School of Public Health and other collaborative institutions studied county-level mortality rates between 1983 and 1999 to determine how life expectancy varied among U.S. counties. Ultimately, the results showed a steady increase in mortality inequality, resulting from stagnation or increase in mortality among the worst-off segment of the population, including rural and poor communities. Female mortality increased in a large number of counties, primarily because of chronic diseases related to smoking, being overweight and high blood pressure…
 
For poor Americans who live in rural areas, very limited access to health care and lack of insurance contribute to a decrease in overall health, quality of life and life expectancy. In addition, poor health habits lead to an increased incidence of obesity, high blood pressure, heart disease, stroke and cancer, all of which contributed to increased mortality rates.
 
Ultimately, this information about inequalities in life expectancy portrays a different picture than once thought. While life expectancy has been rising in general, this does not necessarily filter down to all Americans. Some citizens consistently get left behind.
 
When analyzing the data correlating a lower life expectancy with where you live, it is clear that the issue is complex. Beyond mere health habits and medical care, economics, culture and access to information also play a role in how well and how long you live. In a recent study published in the journal, Stroke, researchers found yet another link between income and health. The study showed that the poorest segment of the population is five times more likely to have a stroke than the wealthiest segment, who, despite being overweight and sedentary, have the lowest risk of stroke.
 
These studies should be a clarion call to everyone. Our broken health-care system must be reformed. The richest country in the world having a declining life expectancy is pure scandal. But we must stop turning to politicians, business and insurance companies for solutions.
 
The answer is more than just assuring that every American has health insurance. While this may help, it is only a small element of the solution. Health-care reform must be led by health-care professionals, by the people who work in the trenches, and by those who understand what it takes to solve our health crisis. We cannot leave it to politicians and lobbyists.
 
It is time to reform how we think about health care. First, we must only practice medicine based on sound scientific evidence of benefit. We must focus on prevention and health promotion; this strategy will have a far greater impact than spending millions of dollars on futile care performed at the end of life.
 
We must solve the problem of the disappearing primary care physician, who should assume a greater and more important role in coordinating all aspects of care. Physicians must be discerning in the tests they order, should use the most appropriate but least expensive medications and should assure that every procedure is clearly justified with proven evidence of tangible benefit. We must also take advantage of the tremendous technological resources, including telemedicine, that make it possible to monitor patients closely wherever they live.
 
The fact that mortality rates are rising in any American county is totally unacceptable and must be addressed immediately. Affordable, accessible and rational health care must be a right available to all Americans, no matter their social circumstance or where they live.
 
I AGREE!!!
 
ArcaMax Health & Fitness ezines@arcamax.com
May 24, 2008
Lifelong Health: Declining Life Expectancy Is An Inexcusable Scandal
Dr. David Lipschitz

The number of young adults without health insurance rose again in 2006, so 38 percent of high school graduates and 34 percent of college graduates will spend some time uninsured in the year after graduation, a new report shows.
 
"We've been tracking this since 2003, and every year we've done the study, the number of uninsured has grown," said report co-author Sara Collins, an assistant vice president at the Commonwealth Fund.
 
There were 13.7 million Americans aged 19 to 29 without health insurance in 2006, up from 13.3 million in 2005, according to the latest federal data, the report said.
 
"There are a couple of transition periods when you turn 19," Collins said. "Many health insurance programs won't cover you as a child, and also when you graduate from college."
 
Public programs such as Medicaid and the State Children's Health Insurance Program end coverage at the age of 19. "Voluntary employer-provided insurance is tied to the ability to get a job, and the jobs available to young people tend to be those that don't carry benefits," Collins said.
 
While young people are less likely to need health care, "they do use the health-care system," she said. "Losing coverage at this time can affect your ability to transition effectively into a situation of health care."
 
And when young people do require health care, it can be because of a major accident, in which costs can be "catastrophic," Collins said. "And it is never a good idea to be without health insurance, no matter what your age."
 
Two-thirds of the young adults who went without health insurance for some time went without needed care because of cost, the report said. Half reported problems paying medical bills or said they were paying off medical debts over time.
 
Some action is being taken to remedy the situation, Collins said. Twenty states have passed legislation requiring insurance companies to extend coverage of minors after age 18 or 19. The age limits in state laws range from 24 in Delaware, Indiana and South Dakota to 30 in New Jersey.
 
On the federal level, a law has been proposed that would have dependent children of government workers covered to age 25.
 
Extending the age limit for federal programs such as Medicaid would have the greatest impact, because such programs cover poorer people, Collins said. "This is a problem facing people at all income levels, but the largest number of uninsured are in lower income families," she said. Raising the age limit for those programs would cover up to 7.6 million uninsured young adults in families with incomes below 200 percent of poverty, the report said.
 
HealthDay News

A new study finds that senior citizens in Baltimore seem to avoid visiting the emergency room around the beginning of each month, possibly because they want to stay home and make sure no one steals their Social Security checks.

The findings could help doctors get a better handle on fluctuations in when the elderly seek medical care, said study author Dr. David Jerrard, an associate professor of emergency medicine at the University of Maryland. "We feel that this is a real phenomenon, a real trend."  Jerrard said he's noticed for some time that older patients were less likely to show up around the beginning of the month. "Our patient load would drop off precipitously," he said. "Some of the patients would tell us that they'd made a point of staying home when their checks were sent out. A lot of them were fearful that the checks would be stolen."

HealthDay News

There is strong evidence patients do not complete their medical regimen unless they are shown compassion, a U.S. expert said.

Karen Fox created and manages the Adventures in Caring Foundation, which in 1991 was recognized by former President George H. W. Bush for outstanding community service.

"The economic benefits of compassion are startling. It's not just the patients and their families who suffer from a lack of compassion," Fox said in a statement.  "It also harms staff retention and morale, and the culture and performance of a medical organization as a whole."

Tremendous time is wasted every day in high-tech healthcare units doing old-fashioned damage control for physicians and staff whose heartless communication has upset patients and families, Fox said.

Compassion can be taught, but not by lecture -- it just takes more than the traditional classroom setting -- it's more akin to coaching and apprenticeship, Fox said.

Fox said compassion involves:

• Attention to the signs and clues to what is important to the patient.

•  Acknowledgment the patient is a unique individual.

• Affection via the human touch of warmth, comfort, humor and kindness.

• Embracing people just as they are, without judgment.

ArcaMax Health & Fitness

Informed patients, often with high expectations, are causing doctors to adjust their bedside manner, a U.S. study found.
 
The study, published in Clinical Orthopaedics and Related Research, found changes in society and technology have resulted in patients who expect to be listened to and who want to be fully involved in clinical decision-making.
 
Education, affluence, information sources -- including the Internet -- direct-to-consumer marketing result in patients not merely requesting care but requesting a particular operation or even a particular implant. Patients no longer show their doctors absolute and unquestionable respect.
 
"Patients have come to expect miracles in medicine as the norm, yet these miracles are not without inherent risk," study author Dr. Bohannon Mason of the Orthocarolina Hip and Knee Center in Charlotte, N.C,, said in a statement.
 
However, Mason cautioned patients might not necessarily be motivated by evidence-based medicine and may be willing to adopt the promises of direct-to-consumer marketing.
 
Doctors need to, in Mason's view, "maintain control of validated information sources and of the exchange of information with the patient" as they serve "as the interpreters and balancers of scientific information to help guide patients through the maze of medical hyperbole."
 
“Picky Patients Making Doctors Scurry”
ArcaMax Publishing
http://www.arcamax.com/healthtips/s-302064-470444
 

(Although this article is about Cancer, the author/doctor mirrors many of the recommendations you will find in Hospital Stay Handbook)
 
…With the majority of health care costs spent in the final months of life, it's vital that Americans begin to understand the many challenges, dilemmas and options of treating a terminal illness.
 
First, it begins with the patient. Do your homework! (Recommendation 7 – Educate Yourself). Consult with a physician you trust, and find a strong patient advocate to help. (Recommendation 11 – Arrange for 24/7 Coverage) Get second opinions and be educated... The more you know, the easier it will be to make informed choices...
 
If therapy is selected, make sure that you communicate with the responsible physician and understand your choices, the details of the therapy, possible benefits, side effects and how success or failure of the planned treatment will be determined. (Recommendation 9 – Understand Every Procedure Used or Denied in Treatment) Know how long the therapy will take and the amount of time you will need to stay in the hospital. Understand how long care in the hospital will be covered by your insurance policy, and make sure there is a plan for what will happen once continued stay in the hospital is either no longer needed or insurance will no longer cover the cost of care…
 
This is an important warning -- you must understand and track the progress of the disease and the therapy. Is the patient improving and, if not, is there anything else that should be done? (Recommendation 11 – Arrange for 24/7 Coverage, Care Team Notebook)   
 
You cannot count on staying in the hospital indefinitely. Post-hospital treatment requires a completely different care plan. Where will you go? Who will provide care and treatment? Unfortunately, most care plans only account for the time spent in-hospital. Upon admission to the hospital, meet and develop a relationship with a hospital social worker, who is far and away the most knowledgeable about discharge planning, and the choices available to you once you leave the hospital. (Recommendation 2 – Choose Your Hospital with Awareness)
 
…You must take an active role in determining your path. Do not rely on your physician to create the best, most optimal treatment plan. As an empowered consumer of health care, you must learn to navigate our complex and dysfunctional health care system -- especially when battling terminal illness. (Recommendation 4 – Take Legal Steps to Ensure the Patients Wishes Are Honored).
 
Dr. David Lipschitz
Author of the book "Breaking the Rules of Aging."
www.drdavidhealth.com.
 
“Lifelong Health: If Cancer Treatments are Futile, It's OK to Say No”
ArcaMax Publishing
http://www.arcamax.com/healthtips/s-309881-912338
 

A U.S. non-profit group has announced a "call for action" in response to a study that says only 42 percent of healthcare personnel get a flu shot.
 
"Too many valuable healthcare personnel risk contracting influenza because they have not been vaccinated," said Dr. William Schaffner, vice president of the National Foundation for Infectious Diseases. "Even more troubling is the fact that these employees risk spreading the virus among the sick and often immunocompromised patients under their care."
 
Unvaccinated health facility employees can be a significant source of influenza virus transmission -- among each other and to patients, Schaffner said.
 
“Four in 10 Healthcare Staff Have Flu Shots”
ArcaMax Publishing
Health and Fitness
Thursday March 6, 2008
 

A surgeon's skills and preferences may dictate treatment choices for kidney cancer more than clinical factors such as tumor size or the patient's general health, a new study finds.
 
This means many patients who are candidates for less radical surgical procedures, such as a partial nephrectomy where only part of the kidney is removed, may not be getting them, the California researchers said.
 
"The world of medicine is slow to incorporate new technology," acknowledged Dr. Patrick Lowry, an assistant professor of surgery at Texas A&M Health Science Center College of Medicine. "It's kind of like a family tree. When more people are trained in it, they go out and spread it to others…"
 
Patients also have a role to play in guiding their care...
 
"Patient education and understanding and self-advocacy are important in discussing, with the primary doctor or urologist or surgeon…"
 
For instance, patients can ask questions like: "'What are the different treatment options available for this tumor? I've heard about partial nephrectomy. Is that a possibility in my case and, if it's not, why isn't it? If you think the whole kidney needs to be removed, what about the possibility of having it done with less invasive surgery?'"

HealthDay News

ACP Medicine provides physicians and other clinicians with the information they need to practice evidence-based and state-of-the art medicine. Even if this information were used in each patient encounter and with adherence to the highest principles of professionalism, however, that would not be sufficient to create a high-performing health care system. More is needed; the systems in which we work must be robust and responsive, too.
 
A paper in the January 1, 2008 issue of Annals of Internal Medicine addresses problems in the United States health care system. The article describes current health care in the United States in terms of its costs and who pays for it, the physician workforce, and the availability and application of technology and innovations. It then describes a set of criteria and 37 indicators of high performance developed by the independent, nonprofit Commonwealth Foundation; those criteria and indicators are used to compare health care in the United States with that in twelve other highly industrialized countries. The scoring sheet includes measures of living longer and healthier; the quality, access, efficiency, and equity of health services; and the system's capacity for innovation and improvement.
 
The report indicates that although the United States has many fine physicians, medical services, and heath care facilities, its health care does not compare favorably with that in the other industrialized countries. The United States spends far more—per capita or as a percentage of the gross domestic product—on health services, administration, and regulation and scores lower on quality of care, safe care, coordinated care, and patient-centered care. Access, efficiency, equity, infant mortality, and longevity scores for the United States are all the lowest or next to lowest, compared with those of Australia, Canada, Germany, New Zealand, and the United Kingdom. The study clearly delineates major gaps in the United States system and many opportunities for improvement.
 
This analysis led the ACP, through its Health and Public Policy Committee and the Board of Regents, to formulate new College policy to improve health care in the United States and begin advocating for this policy as strongly as possible. The ACP made eight specific recommendations:

Eight Ideas for a High-Performing Health Care System
David C. Dale, MD, FACP
President, American College of Physicians
ACP Medicine

Universal screening for a common antibiotic-resistant bacteria is no better than standard infection control at reducing the rate of hospital-acquired infections in surgical patients, new Swiss research shows.
 
The bacteria, methicillin-resistant Staphylococcus aureus (MRSA), is an increasing public health concern.
 
But there is still hope, said study author Dr. Stephan Harbarth, attending physician in infectious diseases and associate hospital epidemiologist at University of Geneva Hospitals and Medical School in Geneva, noting that there has been an "unprecedented" decline of MRSA rates in several European countries and a stable, relatively low rate in others.
 
"Clearly, these recent findings suggest that MRSA spread can be curbed in hospitals, provided that active control programs are implemented," he continued. "For instance, following the introduction of specific programs for limiting cross-transmission, first at regional level and subsequently at national level, MRSA infection rates decreased by almost 50 percent between 1993 and 2006 in hospitals of the Paris region, and by 20 percent since 2001 in more than 50 hospitals across France."
 
Still, Harbarth cautioned, "this needs strong public health action, something not to be expected under the current federal administration of the U.S."
 
The findings are in the March 12 issue of the Journal of the American Medical Association

HealthDay News

Taking care of someone with a serious heart problem may raise your own risk of cardiac disease, a new study finds.
 
The study of more than 500 family members and others caring for a heart patient showed that those who provided care all or most of the time were more likely to show psychological strain and less likely to eat heart-healthy diets.
 
Both of those factors upped their own cardiovascular risks.
 
"The added responsibility that someone has after a loved one leaves the hospital can lead to feelings of isolation, increase depression, and make them not eat as well as they should," explained lead researcher Dr. Lori Mosca, director of preventive cardiology at Columbia University Medical Center in New York City.
 
Exactly 50 percent of the study participants were caregivers -- 39 percent providing care most or all of the time and 11 percent part of the time. Almost two-thirds (63 percent) were women. Caregivers tended to be over 50, unemployed and not to have finished high school.
 
"The big lesson for physicians is the need to put on our radar screen the fact that caregivers may be at risk," Mosca said. "It is a missed opportunity in our practice than when someone comes in with a cardiac patient, we do not engage the caregiver in an educational process to the extent that it will help them as well as the patient."
 
Depression often helps boost the health risks associated with caregiving, Mosca noted. In fact, measures of psychological strain were significantly higher among study participants with depression and low social support, she said. "We don't know if high caregiving strain leads to depression, or if depression increases the sense of strain," Mosca said.
 
"Taking care of a person who has this kind of vascular disease is a burden," Daviglus said. "We see the same burden in caring for someone with any kind of serious disease."
 
Doctors should be continually aware of the burden borne by caretakers, she added. "We should intervene. When we see a patient with a partner, we should ask about the health of the caregiver and run continuing checks on them."

HealthDay News

People share their homes, their food and more with their pets, but one thing you probably never thought you could share with your animals is a drug-resistant staph infection.
 
However, according to a letter in the March 13 issue of the New England Journal of Medicine, a German family appears to have done just that. Doctors were puzzled when a woman was repeatedly treated for methicillin-resistant Staphylococcus aureus (MRSA), yet still kept coming back with the infection.
 
Eventually, they discovered that the family cat was harboring the dangerous bacteria, sometimes called a "super bug."
 
"Animals and especially pets or companion animals might serve as reservoirs for human-pathogenic bacteria," said Dr. Andreas Sing, head of the department of infectiology at the Bavarian Food and Health Safety Authority in Germany.
 
Before you give puss the boot, know that researchers believe it was the woman who probably initially transmitted the bacteria to the cat, not the other way around.
 
About 25 percent to 30 percent of Americans are colonized with staph bacteria, but only about 1 percent are colonized with MRSA, according to the U.S. Centers for Disease Control and Prevention. Most MRSA infections occur in health-care settings, such as hospitals or nursing homes, but the number of community-acquired infections is growing. According to the CDC, about 12 percent of all MRSA infections are now acquired in the community.
 
MRSA spreads through skin-to-skin contact with an infected person, but its transmission has also been associated with contaminated surfaces, crowded living conditions and poor hygiene, according to the CDC.

HealthDay News

Elderly Americans taking prescription medications face a lower risk for being given an inappropriate drug or dosage if they receive care from a geriatrician, new research reveals.
 
The finding is based on a large, national review of mostly male veterans who sought care at VA facilities across the United States.
 
The analysis indicates that roughly one in four vets were inappropriately prescribed medications, while those few who had visited with a geriatrician in the past year had reduced exposure to such critical mistakes.
 
"Geriatric care seems to help protect patients who are receiving prescription medications," said study author Mary Jo V. Pugh, a research health scientist with the South Texas Veterans Health Care System, and an assistant professor at the University of Texas Health Science Center at San Antonio.
 
"And we think this may be about more than just the individual's decision to see a geriatrician but also about the hospital culture regarding elderly care itself," she added.
 
The study, published in the February issue of Medical Care, is a review of data concerning more than 850,000 veterans over the age of 65 who had sought outpatient care at one of 124 VA facilities between 1999 and 2000.

HealthDay News

Dying patients need to be regularly monitored for pain, shortness of breath, and depression, say new American College of Physicians (ACP) guidelines to improve end-of-life care.
 
Published this week in the Annals of Internal Medicine, the guidelines state that doctors should use proven therapies to treat these three common symptoms among dying patients and should ensure there's advance care planning for all patients with serious illness.
 
"Many Americans will face a serious illness at the end of life, and their families will be involved in their care," Dr. Amir Qaseem, senior medical associate in the Clinical Programs and Quality of Care Department of the ACP's Medical Education and Publishing Division, said in a prepared statement.
 
"We wanted to pull together [the] best available evidence on improving care that relieves or soothes symptoms at the end of life. Evidence review showed that the three most common symptoms were pain, difficult breathing and depression, so our guidelines address these," he added.

HealthDay News

Individual surgeon characteristics, such as gender and medical training, may influence whether a women receives radiation after breast conservation cancer surgery, a U.S. study suggests.
 
Many breast cancer patients don't receive radiation therapy after breast conservation therapy, even though it's been shown to reduce breast cancer recurrence and is considered a standard of quality care, according to background information in the study.
 
Previous research has shown that certain patient characteristics, such as race and distance from a radiation therapy facility, influence the likelihood of receiving radiation after breast cancer surgery. But the effect of doctor characteristics has been unclear.
 
In this study, published in the Jan. 29 online issue of the Journal of the National Cancer Institute, researchers at the Herbert Irving Comprehensive Cancer Center at Columbia University in New York City analyzed data on about 30,000 women, 65 and older, who were diagnosed with breast cancer between 1991 and 2002 and received breast-conservation surgery. The researchers also looked at the 4,453 surgeons who operated on the women.
 
About 75 percent of the women in the study received radiation after surgery and, each year from 1991 to 2002, there was an increase in the percentage of women who received radiation. But older women, black women, unmarried women and those living outside urban areas were less likely to receive radiation.
 
After they adjusted for patient and tumor characteristics, the study authors concluded that women who received radiation were more likely to have a surgeon who was female, had an M.D. degree (compared to a D.O. degree), or was trained in the United States.
 
"Our study is one of the first to demonstrate associations between certain surgeon characteristics and quality of breast cancer care. If confirmed, more research is needed on whether they reflect surgeon behavior, patient response, or physician-patient interactions," the researchers wrote.

HealthDay News

Challenging a recent U.S. government decision to lower the benchmark for designation as a high-volume heart transplant hospital, a new Johns Hopkins Medical Institutions study reports the benchmark should instead increase, from 10 transplants to 14 transplants a year.
 
The Centers for Medicare and Medicaid Services, which qualifies medical centers for federal reimbursement, recently lowered the high-volume standard from 12 to 10 heart transplants per year.
 
"Our results clearly demonstrate that current standards have been arbitrarily set too low," senior investigator Dr. John Conte, director of heart and lung transplantation at The Johns Hopkins Hospital, said in a prepared statement. "There is a certain threshold, a minimum numbers of surgeries needed to maintain the expertise of the entire transplant team."
 
Each year, more than 2,000 people have a heart transplant in the United States.
 
In their study, the Hopkins team noted that high-volume centers consistently show higher survival and lower complication rates. They analyzed the records of 14,401 people who had heart transplants in the United States between 1999 and 2006, and found that death rates one month and one year after transplant increased steadily at hospitals that did fewer than 14 transplants per year.
 
The overall average death rate one year after heart transplant was 12.6 percent. But patients had a 16 percent greater risk of dying in a hospital that did fewer than five heart transplants per year. Patients who had a transplant at hospitals that did more than 40 heart transplants a year had the best chance of surviving.
 
Patients at hospitals that did less than 10 heart transplants a year had an 80 percent increased risk of dying within a month, compared to less than 1 percent for patients at hospitals that did more than 40 heart transplants per year.
 
Death rates flattened for the majority of patients in hospitals that did 14 or more heart transplants per year, the researchers found.
 
Roughly a dozen hospitals in the United States, including Johns Hopkins, perform at least 20 heart transplants a year, the researchers noted.

HealthDay News

Patients admitted to the top-rated hospitals in the United States have an average 27 percent lower risk of dying than patients admitted to other hospitals in the country, a new study shows.
 
Released Thursday by HealthGrades, an independent health-care ratings organization, the analysis of 27 procedures and diagnoses also found that patients who have surgery at the top-rated hospitals have an average 5 percent lower risk of complications during their hospital stay.
 
For this study, researchers analyzed nearly 41 million hospitalizations in 2004, 2005 and 2006 at all 4,971 of the nation's non-federal hospitals. If all hospitals had the quality of care of the top 5 percent of those hospitals, 171,424 lives may have been saved, and 9,671 major complications may have been avoided during the three years studied.
 
The study also found that the top 5 percent of hospitals lowered their in-hospital risk-adjusted death rates over those three years by an average of 15 percent.
 
The procedures and diagnoses included in the analysis included: cardiac surgery; angioplasty and stenting; heart attack; heart failure; atrial fibrillation; chronic obstructive pulmonary disease; community-acquired pneumonia; stroke; abdominal aortic aneurysm repair; bowel obstruction; gastrointestinal bleeding; pancreatitis; diabetic acidosis and coma; pulmonary embolism; and sepsis.
 
Dr. Samantha Collier, HealthGrades chief medical officer, said, "The data in this year's study clearly indicates that the gap between top-performing hospitals and others persists. This disparity in the quality of care at U.S. hospitals is disappointing."
 
The top-rated hospitals "have proven that consistently delivering top-notch medical care is possible, and it is time for the rest to follow suit," Collier said in a prepared statement.

HealthDay News

It's called the "widow" or "widower" effect, and doctors have long been familiar with this curious but very real phenomenon: When a husband or wife dies, there's a greater likelihood that the surviving spouse will pass soon afterward.
 
Now, researchers are gaining a better understanding of the forces at work, realizing problems often start with the hospitalization of a spouse.
 
New findings suggest that having a husband or wife who needs to be admitted to a hospital with a serious illness poses health risks for the partner. The culprit: The stress and upheaval the partner experiences while enduring the hospitalization of an ailing husband or wife.
 
"It's not like your spouse's sickness somehow magically makes you worse," said Dr. Nicholas A. Christakis, a professor of medical sociology at Harvard Medical School's Department of Health Care Policy. "We believe it works by imposing some kind of burden."
 
To unravel the connection, Christakis and co-researcher Paul D. Allison, a University of Pennsylvania statistician, examined records of more than a half million couples who were in enrolled in Medicare from 1993 through 2001. Their findings, published in the New England Journal of Medicine, demonstrate the ripple effect of a spouse's hospitalization -- across various illnesses -- on the partner's health.
 
"What this work shows is that illness in one person -- in a spouse -- can affect the health, the mortality, of another person," Christakis explained. "And this, in turn, means taking better care of someone who's sick not only benefits the sick person, but also benefits other people, such as their spouse."
 
In the United States, at least 44 million adults, including spouses, provide care for a loved one, the National Alliance for Caregiving estimates. Yet, few of these individuals are adequately prepared to cope with the rigors of caring for another person or the toll it can take on their health, according to the Family Caregiver Alliance.
 
Overall, Christakis' study found that a spouse's hospitalization boosted the risk of a man's death by 22 percent compared with the death of a spouse. A husband's hospitalization increased a woman's death risk by 16 percent.
 
Some diseases posed more of a burden than others. For example, a woman's hospitalization for stroke, congestive heart failure or hip fracture raised her husband's death risk by 6 percent, 12 percent and 15 percent, respectively. Similarly, a man's hospitalization for colon cancer did not significantly influence his wife's death risk, but other diseases did have a major impact.
 
A spouse's hospitalization for dementia proved most stressful, raising risk of death 22 percent for men and 28 percent for women, Christakis said. "In fact," he added, "we show that having a demented spouse is as bad for you as having a dead spouse."
 
Some diseases are deadly, but don't pose as much of a burden on the caregiver, be it physical, psychological, financial or some combination of these, he explained.
 
The study also identified certain time frames during which caregivers are particularly vulnerable, including immediately after a hospitalization and again three to six months into the illness.
 
Suzanne Mintz, president and co-founder of the National Family Caregivers Association, said the study offers additional proof that the stress of caring for a family member can have negative health consequences.
 
"The findings should frighten family caregivers," she said, "but more importantly, hopefully, help them give priority status to their own health needs."
 
Spousal family caregivers' risk of depression is six times greater than that of non-caregivers, Mintz noted. And, they are less likely to reach out for help, she said. To protect their health, Mintz urges family caregivers to spread the work load.
 
"Caregiving is much more than a one-person job, especially when both the family caregiver and the care recipient are elderly," she said. "Often, spousal caregivers do not want to ask for or take help from their grown children, but that really is the first place we should all turn."

HealthDay News

Hospital patients who have the misfortune of suffering cardiac arrest at night or on the weekend are less likely to survive than those who have a heart attack during weekdays or weekday evenings, new research finds.
 
Although the study was not set up to pinpoint exactly why this is happening, it's likely that different staffing patterns, access to procedures, and other systemic issues may explain the difference in outcomes.
 
"Hospitals simply don't work the same at night as they do during the day," explained study author Dr. Mary Ann Peberdy, an associate professor of internal medicine and emergency medicine at Virginia Commonwealth University in Richmond. "There is enough data out there to suggest that this may be a process issue that is at least contributing, and probably contributing substantially."
 
The immediate cause of poor survival on nights and weekends may be one of timing: either there is a delay getting critical procedures or a delay in diagnosing the cardiac arrest in the first place.
 
"We're literally talking about a difference in seconds, which makes a significant impact," said Beth Mancini, associate dean of Undergraduate Nursing Programs at the University of Texas at Arlington. "It's time for hospitals to look critically at their processes."
 
Mancini is one of the "mothers" of the database used in this study, which is published in the Feb. 20 issue of the Journal of the American Medical Association.
 
According to the Institute of Medicine, up to 98,000 preventable in-hospital deaths occur every year in the United States, and the rate of medical errors is higher at night).
 
Previous, smaller studies have reported that heart attacks treated on a Saturday or Sunday are more deadly than those attended to during the week. Most of those had less than 100 patients, Peberdy said.
 
Canadian researchers have also found that strokes treated on the weekend are deadlier than those that are treated on a weekday.
 
The current study, the most comprehensive of its kind, analyzed survival rates for 86,748 adults who had suffered cardiac arrest events in one of 507 hospitals participating in the American Heart Association's National Registry of Cardiopulmonary Resuscitation.
 
Survival was divided into hourly time segments, with day/evening specified as 7 a.m. to 10:59 p.m., night as 11 p.m. to 6:59 a.m., and weekends as 11 p.m. Friday to 6:59 a.m. Monday.
 
Overall survival was 14.7 percent for nights/weekends, and 19.8 percent for weekdays.
 
Although individuals do undergo physiological changes at different times of the day, most of these changes were ruled out by the authors. And there were no survival discrepancies in the emergency department and trauma services.
 
"Emergency departments are one of the only places in the hospital that are typically staffed the same 24 hours a day and also have attending senior-level physicians available 24 hours a day," Peberdy said. "[Other areas of] the hospital often have doctors-in-training who respond to the cardiac arrest. That suggests this may be a process issue."
 
Other process issues may also be at fault. In one hospital, Mancini said, certain doors are locked at night, taking it longer to get a patient to a defibrillator. Even physician fatigue at the end of a shift could play a role.
 
"This paper really needs to go to hospitals, and the people who run them," Peberdy said.

Hate to say, “I told you so,” but, I told you so…

HealthDay News

HealthGrades' 2008 Hospital Ratings Released

Tenth Annual Study Finds Mortality Rates 71% Lower at Top-Rated Hospitals

Patients have an average 71 percent lower chance of dying at the nation's top-rated hospitals compared with the lowest-rated hospitals across 18 procedures and conditions analyzed in the tenth annual HealthGrades Hospital Quality in America Study, now available on HealthGrades' Web site. The study also found that if all hospitals performed at the level of hospitals rated with five-stars by HealthGrades, 266,604 Medicare lives could potentially have been saved over the three years studied.

The study, which examined 41 million hospitalization records at 5,000 hospitals over a three-year period, is the nation's most comprehensive annual report on hospital quality in America.  The study accompanies HealthGrades' release of its hospital star ratings, viewed by an average of 3 million consumers each month on HealthGrades.com.

"Concentrating on emulating practices from exemplary hospitals can result in improvement," said Dr. Samantha Collier, HealthGrades' chief medical officer. "If this focus were targeted to four key quality areas -- heart failure, respiratory failure, sepsis, and pneumonia -- the nation could achieve up to a 50-percent reduction in potentially preventable deaths."

HealthGrades

Periodically stopping sedatives and allowing for spontaneous breathing -- the so-called "wake up-and-breathe" protocol -- improves results for patients on mechanical ventilators in intensive care units, a new study finds.

This practice helps wean patients from ventilators and should become common practice, the study authors said.

"Our results show that a paired sedation and ventilator weaning protocol resulted in patients spending more time off mechanical ventilation, less time in coma, and less time in intensive care and the hospital, and the protocol improved one-year survival compared with usual care," said lead researcher Dr. Timothy Girard, an instructor in medicine at Vanderbilt University School of Medicine.

About one-third of patients in intensive care are mechanically ventilated, in which a machine generates a controlled flow of air to the patient's respiratory system. Ventilation is often accompanied by large doses of sedatives. But the use of ventilators is associated with significant adverse effects, such as infection, collapsed lungs and lung damage. The sedatives can also produce unwanted side effects, including sleeping for days.

HealthDay News

The last thing you want to hear in the emergency room when you've got crushing chest pain or can't breathe is that you have to wait before you can get treatment.

Unfortunately, in too many instances, that's exactly what's happening. In fact, new research found that waiting times in emergency rooms have increased by 36 percent for all patients, to an average of 30 minutes per patient. And the sickest sometimes have to wait the longest: As many as one-quarter of all heart attack patients had to wait 50 minutes or longer before seeing a doctor.

Study author Dr. Andrew Wilper, a fellow in general internal medicine at Harvard Medical School and an internist with the Cambridge Health Alliance, reports in the Jan. 15 online issue of Health Affairs that the increasing wait times are the result of a "perfect storm" that has occurred as emergency room visits are on the rise while many ERs are closing their doors.

"It's hard to ignore the fact that several hundred ERs have closed their doors, and we've seen an increase in the number of patients using ERs. Plus, there are a number of internal factors contributing like bottlenecks because of a lack of inpatient bed space and a lack of specialists available to treat patients," Wilper explained.

"The real problem is that patients are backing up in the ER. If a patient is still in the ER six or even 12 hours later, it means that room, that nurse and that equipment just aren't available for the next patient that comes in the door," explained Dr. Art Kellermann, a spokesman for the American College of Emergency Physicians.

Kellermann said a good analogy to this situation would be if controllers at a busy airport started parking planes on the runways. "We'd think they'd lost their minds, but that's what hospital administrations are doing with ERs," said Kellermann. "We've taken the most time-critical portal of care and allowed it to become gridlocked."

HealthDay News

If you arrive in an emergency room in significant pain, you are less likely to be prescribed a narcotic to ease that pain if you are not white, new research shows.

The reasons for the disparity aren't clear, but there's no doubt that minorities don't get effective pain treatment in the ER as often as whites do, said study author Dr. Mark Pletcher, an assistant professor of epidemiology and biostatistics at the University of California, San Francisco. "There's no difference in the pain severity or types of pain that people are presenting with, but the difference is there consistently."

To come to this conclusion, Pletcher and his colleagues examined reports from a national survey about visits to emergency rooms between 1993 and 2005. Pain-related visits made up 156,729, or 42 percent, of 374,891 visits tracked by the survey.

The findings are reported in the Jan. 2 issue of the Journal of the American Medical Association.

HealthDay News

Urinary catheters may be one of the least pleasant parts of a hospital stay, but doctors, families and patients need to pay more attention to the risk of infection.

According to a new national study, fewer than one in three hospitals are using either bladder scanners or antimicrobial catheters to prevent urinary tract infection and less than one in 10 are using daily, automated reminders that prompt doctors to review the need for a catheter.

Researchers at the University of Michigan noted that one in four hospital patients has a urinary catheter, a tube inserted into the urinary tract to allow urine to flow out of the bladder and into a bag. One percent of these patients are at risk for a urinary tract infection, the most common kind of infection acquired while hospitalized.

To study policies and practices surrounding the prevention of urinary tract infections, the Michigan team sent a detailed survey to all 119 Veterans Administration hospitals in the United States, as well as 600 randomly selected non-federal hospitals with an intensive care unit over 50 hospital beds.

They inquired about a variety of techniques that can prevent urinary tract infections, including the use of infection-reducing catheters (antimicrobial, condom-style or suprapubic). They also asked about the use of bladder scanners, which are used to find out if bladders are completely emptied, or the use of antimicrobial agents in the bags themselves.

The research team also asked about other infection-control methods, such as automated reminders, stop orders, monitoring systems, evaluation of infections and urinary catheter teams.

When they analyzed the results, the group found no consistently applied strategy for preventing catheter-related infections. Furthermore, most hospitals were not using even basic, proven tactics that can prevent these infections.

The study, published in the January issue of Clinical Infectious Disease, is the first national survey of catheter-related urinary tract infection prevention, the researchers said.

HealthDay News

People over age 60 are twice as likely to lose memory and mental acuity after elective surgeries than younger adult patients, according to a new study.

These patients are also at higher risk of dying within one year of the surgery if they experience a related mental decline, a Duke University team reported.

However, higher education appeared to protect against the loss of mental ability after surgery, the team add.

"We have known that patients undergoing heart surgery are at risk for cognitive dysfunction -- problems with memory, concentration, processing of information -- but the effects of non-cardiac surgeries on brain function are not as well-understood," lead investigator Dr. Terri Monk, an anesthesiologist at Duke and the Durham Veterans Affairs Medical Center, in Durham, N.C., said in a prepared statement. "Our study found that increasing age put patients in this population at greater risk for cognitive problems. And this is significant, because the elderly are the fastest growing segment of the population. We know that half of all people 65 and older will have at least one surgery in their lifetime."

The researchers found that many of the adults experienced postoperative cognitive dysfunction (POCD) upon being discharged. However, when tested three months later, the patients who were over age 60 were twice as likely to still have POCD. People who had POCD when they left the hospital and still had it three months later were more likely to die within a year of surgery.

The study also found that POCD was more likely among less educated patients and people who had a history of stroke, even without symptoms of impaired brain function.

"Education protected against postoperative cognitive problems, likely because education may provide an opportunity to condition the brain and better equip it to withstand injury, much like physical exercise has a protective effect on the body," Monk said.

The researchers theorized that the loss of thought processes might increase the risk of death because of an interference with the ability to seek or follow medical care recommendations.

HealthDay News

Almost two-thirds of doctors say they are willing to report medical errors, but many of them just don't do it, a new study finds.

"The most important message seems to be that there is a gap between physicians' desire to report errors to improve performance over time and reporting of errors," said study author Dr. Lauris Kaldjian, an associate professor of medicine at the University of Iowa Carver College of Medicine. His study of 338 doctors from teaching hospitals across the country is published in the Jan. 14 issue of the Archives of Internal Medicine.

The study showed glaring differences between theory and practice. While 73 percent of the doctors said they would disclose any medical error that caused minor medical harm, and 92 percent said they would report an error that caused major damage, such as death or disability, only 18 percent said they had actually reported minor errors, while only 4 percent said they had made a major error and reported it.

Even more troubling, 17 percent acknowledged having made a minor error and not reporting it, while 4 percent indicated having made but not disclosed a major error.

The occurrence and reporting of medical errors became a big issue in 1999, when the U.S. Institute of Medicine issued a report, To Err Is Human, which estimated that the deaths of more than 100,000 Americans are tied to some form of medical mistake.

One big reason for the reporting gap appears to be that many physicians are unfamiliar with the reporting process, Kaldjian said. "We found that only about 55 percent of the respondents knew how to report errors," he said. "Only 40 percent knew what kind of errors should be reported."

The findings echo previous research on the issue, said Dr. Thomas Gallagher, an associate professor of medicine at the University of Washington who has conducted numerous studies on how errors are handled by the medical profession.

"The gap comes from a number of areas," Gallagher said. "Physicians are unfamiliar with the reporting process and their role in it. And a fair number of physicians are not certain how the process works. More important, physicians often are skeptical about whether reporting will have an impact on the quality of medical care that they would like it to."

More feedback from hospitals when an error is reported could improve the situation, Kaldjian said. "It is all the more important that hospitals be clear about why they have this reporting system and how the information from it will be used," he said.

The reporting situation is improving, but slowly, Gallagher said. "Physicians are more aware of the importance of reporting, but there is a long way to go," he said.

Federal regulations requiring that medical mistakes be reported to a central fact-gathering body is helping to actually improve medical practice, Gallagher said.

"It advances hospitals' ability to sort out which adverse events are more likely," he said. "But this is a slow process. Hospitals are slow to learn from one another. Still, physicians are deeply committed to improving the quality of care. As they learn they can report errors without punitive consequences, their reporting practices will improve."

The Kaldjian study did find evidence of positive feedback. Doctors who reported minor medical errors in the past said they were more likely to report any new errors.

HealthDay News

Parents who find themselves rushing a child to the nearest emergency room might want to keep a new finding in mind: Only 6 percent of emergency rooms in the United States have all the equipment they should have on hand to treat youngsters.

Many hospitals declined to respond to the survey, however, so the UCLA researchers suspect the true number of centers that don't meet recommendations might be even higher.

Among other deficiencies, hospitals failed to have a variety of devices geared toward infants and newborn babies, according to the survey, which is published in the December issue of Pediatrics.

The survey doesn't address the issue of whether hospitals with less appropriate equipment provide substandard services to kids, noted Dr. Karen Sheehan, medical director of Injury Prevention and Research at Children's Memorial Hospital in Chicago. "But if you don't have equipment small enough for a child, it is not a big leap to think this may affect a child's care."

Surveys were sent in 2003 to 5,144 emergency rooms around the United States, asking about what equipment was geared toward the proper treatment of children. The researchers wanted to know if the hospitals were following 2001 guidelines regarding pediatric care that were released by the American Academy of Pediatrics and the American College of Emergency Physicians.

According to the study, only 11 percent of emergency room visits by kids occur in hospitals specifically designed to treat children. The rest end up in regular emergency rooms.

HealthDay News

Side effects from just three drugs are responsible for a full third of all U.S. emergency room visits by senior citizens who had adverse reactions to medications, a new study found.

In 2004 and 2005, the blood thinner warfarin, the diabetes drug insulin and the heart drug digoxin caused about 58,000 emergency room visits a year in those 65 and older, the researchers found.

The major problem is that it's hard to determine the correct dose for each drug, said study lead author Dr. Daniel Budnitz, a medical officer with the U.S. Centers for Disease Control and Prevention (CDC).

"It's challenging," he said, "and it takes work between the patient and physician to get the dose just right."

Budnitz and his colleagues undertook the study to determine the danger posed to senor citizens by a long list of drugs that have been deemed "potentially inappropriate" for use in the elderly.

The researchers looked at several surveys of emergency room visits from 2004 and 2005. The study findings are published in the Dec. 4 issue of the Annals of Internal Medicine.

HealthDay News

Babies with congenital heart defects are more likely to survive if they're treated at a hospital with the most experience in treating such cases, U.S. researchers conclude.

Researchers at the University of Michigan analyzed figures from the 2003 Kids' Inpatient Database, which is sponsored by the U.S. Agency for Healthcare Research and Quality and includes information on children hospitalized in 36 states.

The study authors focused on two of the most severe congenital heart defects: transposition of the great arteries (TGA), in which major blood vessels leading between the heart and lungs are reversed; and hypoplastic left heart syndrome (HLHS), in which the left side of the heart does not develop properly.

If heart surgery isn't done within a few weeks of birth, both conditions are fatal. An arterial switch operation is used for TGA and an operation called the Norwood procedure is used to correct HLHS.

Reporting in the online edition of Pediatric Cardiology, the team found that the risk of an infant dying in a hospital during or after one of these operations varied greatly depending on the number of these procedures performed at a hospital. Death rates ranged from less than 1 percent to more than 10 percent for the arterial switch operation, and from around 10 percent to more than 35 percent for the Norwood procedure.

"The relationship between hospital volume and risk of dying was significant across the spectrum for both defects, though in the case of arterial switch operations, the difference dwindled among hospitals that performed about 15 or more in a year," study author Dr. Jennifer Hirsch, a pediatric cardiac surgeon, said in a prepared statement.

HealthDay News

A new breed of medical specialists, called hospitalists, can make a small but significant difference in shortening how long a patient needs to stay in the hospital, a new study shows.

The 2002-2005 study of almost 77,000 hospital stays at 45 centers showed that treatment by a hospitalist, rather than a general internist, resulted in about a half-day reduction in overall hospital stays on average, along with an average $268 drop in costs.

At the same time, researchers found no difference in the rate of either patient death or readmission when hospitalists were involved, according to the report in the Dec. 20 issue of the New England Journal of Medicine.

A hospitalist refers to a physician who cares solely for hospitalized patients.

HealthDay News

When thoughts of death intrude, the human mind isn't paralyzed with negativity or fear. Instead, the brain instinctively moves toward happier notions and images, a new study suggests.

The finding supports the notion that people are stronger, emotionally, when faced with their own or a loved one's death than they may have ever thought possible.

"It again speaks to how resilient humans are and how this tendency to cope with threats is some sort of indicator of mental health," said study co-author Nathan DeWall, assistant professor of psychology at the University of Kentucky.

DeWall and co-researcher Roy Baumeister, of Florida State University, published their findings in a recent issue of Psychological Science.

Humans are the only animal known to have a clear understanding that their life will end. On the surface, this knowledge could prove psychologically paralyzing -- why compete, learn and grow if these achievements will end?

However, DeWall and other scientists believe that as humans developed an awareness of death, they also evolved what's been called the "psychological immune system."

During crisis, this mechanism tilts thoughts and attitudes toward the positive -- even when the grimmest of events intervene. This mental shift is typically unconscious, DeWall said.

"That's why, when you ask people to predict how they'll respond to something negative, they usually say, 'Oh, it will be horrible, and it will last a long time,' " he said. However, studies don't bear that out -- research involving people stricken with disease or disability show that people tend to bounce back emotionally much more rapidly than they would have expected.

In evolutionary terms, "how and when this came about, we don't know for sure," DeWall said. "I suspect that this capacity to cope with potentially disastrous events in a relatively easy way really did aid our survival."

HealthDay News

When you experience an emotionally charged event, it's something that is etched into your memory, and now scientists think they know why. 

In experiments with mice, researchers found that powerful surges of the hormone norepinephrine -- surges that occur during emotional episodes -- cause a series of events that strengthen the connections between neurons, sealing these events into the memory.

"The question we are addressing is why is it that you can remember some trivial events that occur at a time when there is high emotional arousal," said lead researcher Dr. Roberto Malinow, of the Cold Spring Harbor Laboratory in New York. "For example, everyone remembers where they were when they heard about September 11, even though [they may have been] in some trivial place."

The researchers found that norepinephrine can modify brain cell receptors, making them easier to go into synapses -- the tiny spaces between brain cells -- making it easier to learn and form memories, Malinow said.

Maybe this is why those of us who have been through any traumatic hospitalization can’t forget anything…

HealthDay News
 

Geographic locale and language weigh heavily on U.S. Hispanics' ability to get good health care, a new study finds. 

Many of the nation's 44.3 million Hispanics have difficulty navigating the health care system, say researchers reporting in the journal Health Services Research.

In this study, a team led by Robert Weech-Maldonado, an associate professor at the University of Florida, Gainesville, analyzed 2002 data on more than 125,000 people enrolled in Medicare managed plans.

Seven percent of the study participants were Hispanic.

Compared to whites, Spanish-speaking Hispanics reported less favorable experiences when talking with health care providers or getting help from office staff, the study found. This suggests that these patients face more language barriers in doctor's offices, hospitals and other clinical settings, Weech-Maldonado said.

The study did find that Spanish-speaking Hispanics had an easier time than English-speaking Hispanics in dealing with the managed care aspects of the health care system, such as getting needed care and dealing with customer service.

It also found that Spanish-speaking Hispanics in Florida reported experiences similar to or better than English-speaking Hispanics in all aspects of care. This was not true among Spanish-speaking Hispanics in California or the New York/New Jersey region.

The study findings suggest that health care providers need to provide interpreter services to patients "not only because it's the right thing to do, but because it can impact patient reports of care and ultimately can influence quality of care," Weech-Maldonado said.

 HealthDay News
 

Potentially deadly, drug-resistant staph infections are more common, both in and out of hospitals, than experts once thought, a new study warns. 

Methicillin-resistant Staphylococcus aureus (MRSA) infections are the top cause of skin and soft tissue infections among people in hospitals and can result in severe and even fatal disease. In fact, MRSA infections account for almost 19,000 deaths and more than 94,000 life-threatening illnesses each year in the United States.

"Invasive MRSA is an important public health problem," said lead researcher Dr. R. Monina Klevens, an epidemiologist at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta. "We need to do a better job in preventing MRSA infections," she added. 

In the study, Klevens' group used data from the Active Bacterial Core surveillance/Emerging Infections Program Network from July 2004 through December 2005 to estimate the incidence of MRSA infection in the United States.

The report is published in the Oct. 17 issue of the Journal of the American Medical Association. 

The researchers uncovered 8,987 cases of invasive MRSA. Most of these (58.4 percent)) were found in community health care settings, 26.6 percent were in hospitals, 13.7 percent were infections not associated with health care facilities, and 1.3 percent could not be classified. 

Klevens' team estimated the rate of invasive MRSA in 2005 at 31.8 per 100,000 persons, but that rate was higher for certain populations. 

By age, rates of infection were highest for those 65 and older (almost 128 cases per 100,000). Blacks were much more likely than whites to become infected, at 66.5 cases per 100,000 versus about 28 per 100,000, respectively. Men had more cases (37.5 per 100,000) than women (26.3 per 100,000). The lowest rate was for children 5 to 17 years of age, at 1.4 cases per 100,000. 

Based on these data, the researchers estimated that there were 94,360 cases of invasive MRSA in the United States in 2005, and 18,650 deaths caused by these infections. 

Klevens believes more effort is needed, especially among health care providers, to reduce the number of infections. "This is really a call for action to health care settings that we need to do a better job at preventing MRSA," she said. 

HealthDay News
 

Infections with the drug-resistant staph germ called MRSA are approaching epidemic levels in some parts of the United States, a federal epidemiologist says. 

Methicillin-resistant Staphylococcus aureus infections, which are potentially deadly, are now responsible for an estimated 12 million outpatient visits each year for skin infections, said Jeff Hageman, of the U.S. Centers for Disease Control and Prevention. 

Hageman blamed the increase on rising numbers of infections -- a trend that has probably been under way for several years -- and greater awareness of the problem. 

"MRSA is epidemic in some regions of the country," he said. "The highest rates are in the southern parts of the U.S., including Atlanta, Los Angeles and Texas. We first began noticing MRSA in 1999 when there were four child deaths in Minnesota and North Dakota." 

"Most of these infections are minor and go away without any medical treatment," Hageman said. "It's not clear why some progress to life-threatening disease." 

While most MSRA infections occur in hospitals, the number and severity of infections in the community appears to be increasing. "Some 30 percent of people have staph bacteria on their skin," Hageman said. "The extent to which it is growing in the community is just being defined." 

HealthDay News
 

The quality of care received by vulnerable elderly Medicare, Medicaid patients is barely acceptable, a team of U.S. researchers report. 

Researchers at the University of California, Los Angeles, used quality of care measurements developed by the Assessing Care of Vulnerable Elders project to look at 43 specific types of care received by more than 100,000 community-dwelling people, average age 81, in 19 California counties between 1999 and 2000. 

The study found that vulnerable elderly patients -- those at risk of death or functional decline -- received only 65 percent of tests and other diagnostic evaluations and treatments recommended for a number of illnesses and conditions, including diabetes and heart disease. 

"Thirty-five percent of the medical care interventions they should have received were not provided, indicating significant room for improvement. We'd much rather have everything higher -- say, at least 90 percent," lead author Dr. David S. Zingmond, assistant professor of general internal medicine and health services research at UCLA's David Geffen School of Medicine, said in a prepared statement. 

HealthDay News
 

Providing physical therapy to respiratory patients in the intensive care unit can shorten the time they have to spend in the hospital, researchers report. 

Respiratory failure patients in the ICU who received mobility therapy within 48 hours after the insertion of a breathing tube stayed in the hospital an average of three days less than patients who didn't have the therapy, say researchers from Wake Forest University Baptist Medical Center, in Winston-Salem, N.C. 

The shorter hospital stay among patients who received therapy included a reduction of time in the ICU of more than a day, the researchers reported. 

A treatment called "initial passive range of motion" therapy was given to patients by nursing assistants who flexed the joints of the patients' upper and lower limbs three times a day, seven days a week. As the patients improved, they received more advanced therapy from a physical therapist. 

The therapy was safe for patients and didn't increase hospital costs because the salaries of the staffers who did the mobility therapy were offset by the shorter patient stays in the hospital, the researchers noted. 

"Although there are data for efficacy of exercise for emphysema patients and for congestive heart failure patients in the outpatient setting, this was the first time for ICU administration of exercise as a therapeutic agent," lead investigator Dr. Peter Morris, associate professor in the section on pulmonary, critical care, allergy and immunologic diseases, said in a prepared statement. 

HealthDay News
 

Spouses caring for partners with Alzheimer's disease report better physical health if they participate in individual or group counseling, new data shows.

"Preserving the health of spouse caregivers through counseling and support also benefits the person with Alzheimer's disease, as caregivers who are in poor health are more likely to have difficulty providing good care," Dr. Mary Mittelman, research professor in the department of psychiatry at the New York University School of Medicine noted in a prepared statement.

The results come from an ongoing 20-year study of 406 married couples in which one spouse is acting as a caregiver to a partner with Alzheimer's disease. Alzheimer's disease is the most common form of dementia and is characterized by gradual loss of memory and clarity of thought. Five million Americans live with the disease today, according to the Alzheimer's Association.

The couples were divided into two groups. Caregivers in one group received enhanced counseling and support, including six individual and family counseling sessions, support groups and telephone counseling. The second group received information and help upon request.

The researchers surveyed the caregivers about their physical health. Those who received the counseling reported better health than those who did not. The effect on caregivers' health typically began four months after beginning the intervention and lasted for more than a year.

Previous results from this study have shown that counseling for caregivers can delay the Alzheimer's-affected spouse's move to a nursing home for up to 18 months. Counseling also helps ease depression in caregivers.

New evidence suggests that a bit of theatrics can help doctors become better caregivers.

The finding is based on the experience of a small group of internal medicine residents who went through six hours of theater workshops and lectures led by university theater professors.

Focus was placed on the impact that body language, eye contact, verbal cues and attentiveness have on patient-doctor communications, and the skills taught appeared to significantly improve both a physician's bedside manner and patient trust.

"We're not trying to teach doctors to be actors," said Dr. Alan Dow, an associate director of residency training at the Virginia Commonwealth University VCU) Medical Center, in Richmond, Va. "But there are some valuable communication skills that doctors are just not learning and that the medical education system is just not thinking about right now. And we thought that a lot of the stuff that's being taught to theater students is very similar to what doctors could benefit from in terms of communicating with patients."

HealthDay News
 

Some American seniors stop taking medications for chronic health problems such as high blood pressure and diabetes when they exceed spending limits in their Medicare prescription drug plans, new research shows.

The study, by the nonprofit research organization the RAND Corporation, also found that many of those seniors do not resume taking their prescription drugs when their drug benefits kick in again at the start of a new health plan year.

The RAND team analyzed prescription drug use from 2003 to 2005 among 60,000 seniors enrolled in a health plan offered by a large national employer. The seniors were enrolled in one of three drug plans: one with a spending limit of $1,000; one with a spending limit of $2,500; and one with no spending limit. In each of the plans, enrollees had to pay a portion of their drug purchases.

The study looked at the use of drugs to treat high blood pressure, cardiac problems, diabetes, ulcers, depression, and prescription pain medications that have over-the-counter substitutes.

Reporting in the Sept./Oct. issue of the journal Health Affairs, the researchers found that 6 percent to 13 percent of seniors enrolled in drug plans with spending caps reached their spending limit in each of the years of the study. Of those who reached their spending limits, about half went without drug benefits for more than 90 days.

Seniors in capped plans who spent the most on drugs were more likely to discontinue their use of medications than those in plans with no cap.

Discontinuation of drugs varied from 15 percent for anti-cholesterol medications to 28 percent for cardiac drugs, the study found.

"Prescription use falls significantly as patients reach their benefit caps," lead author Geoffrey Joyce, a senior economist at RAND, said in a prepared statement. "Most of the drugs we studied help prevent long-term complications of chronic disease, so there are likely to be adverse health consequences for seniors who hit their caps."

"Drug caps are a cost-saving measure, but our findings raise the issue of whether in the long run they may lead to other medical cost such as increased hospitalizations," senior author Dana Goldman, director of health economics at RAND, said in a prepared statement.

HealthDay News