Saturday, October 29, 2011

Samsung to introduce flexible displays in devices next year

This can well be game changer. Think about an ereader or your medical record a flexible display. Go one step further. With imprinted circuitry think about a iPad on a flexible display.

Samsung to introduce flexible displays in devices next year | by Casey Johnston

Samsung’s 2012 lineup of gadgets will include ones with flexible screens, the company announced during an investor call today. The company’s smartphones will likely get them first, possibly in the first half of the year.

Samsung isn’t the first company to pursue flexible gadget parts, as Sony showed a flexible display in 2009 at the Consumer Electronics Show. But Samsung may be the first major device manufacturer to get them to market, and with its new dominant market position, flexible displays stand to get a wide release.

The company’s pursuit of flexing screens stems from its purchase of Liquivista, a company that uses electrowetting technology to make screens that flex, but are still bright and low power. During the call, Robert Yi, vice president of investor relations, said that the company plans to introduce the displays “sometime in 2012, hopefully the earlier part. The application will probably start from the handset side.” Tablets and other devices will get the technology later.

On the one hand, flexible displays mean that dropping your phone or tablet directly onto their screens may no longer be the disaster it currently is. However, Samsung has said little about how the quality of the displays will compare to the AMOLED screens the company usually favors in its higher-end devices, or even the oft-denigrated PenTile displays.The company also didn’t indicate whether the displays will only appear in all its devices, or only a subset.

- Posted from my iPad2

Thursday, October 27, 2011

Study Points to Potential Treatment for Sickle Cell Disease

Study Points to Potential Treatment for Sickle Cell Disease

Scientists corrected sickle cell disease in adult laboratory mice by activating production of a special blood protein normally produced only before birth. The approach may lead to new treatments for people with the blood disorder.

Sickle cell disease is caused by an abnormality in hemoglobin, the protein in red blood cells that carries oxygen throughout the body. About 100,000 Americans live with sickle cell disease. It is most prevalent in people of African, Hispanic, Mediterranean and Middle Eastern descent.

People with sickle cell disease have 2 copies of an altered hemoglobin gene. The defective protein that results changes shape after releasing its oxygen. This causes red blood cells to become stiff, misshapen and sticky. These sickle-shaped cells slow blood flow to tissues, resulting in organ damage.

There is no widely available cure for sickle cell disease. Bone marrow transplants have cured some patients. However, the treatment poses several risks, and most patients don’t have relatives who can donate compatible, healthy bone marrow.

Past studies have shown that an elevated level of a form of hemoglobin called fetal hemoglobin reduces the tendency of sickle hemoglobin to change the shape of red blood cells. Production of fetal hemoglobin normally predominates before birth but turns off as adult hemoglobin takes over. A drug called hydroxyurea can boost production of fetal hemoglobin and reduce the complications of sickle cell disease. However, not all patients respond well to this medication, and adverse side effects are a concern.

A research team led by Dr. Stuart Orkin set out to explore a more targeted approach to raising fetal hemoglobin by blocking production of a protein called BCL11A. The team—at Harvard Medical School, Children’s Hospital of Boston and the Howard Hughes Medical Institute, Boston—had previously demonstrated that BCL11A suppresses the production of fetal hemoglobin soon after birth. Their work was funded by NIH’s National Heart, Lung and Blood Institute (NHLBI), National Cancer Institute (NCI) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The study appeared in the October 13, 2011, online edition of Science.

The scientists used a genetic technique to inactivate the gene for BCL11A in mice with sickle cell disease. Without BCL11A, the mice continued to produce fetal hemoglobin. Sickled cells were absent in the mice, as were their disease symptoms. Other aspects of blood production appeared to be unaffected.

“This study provides the first proof of principle that BCL11A might serve as a target for treating sickle cell disease and related blood disorders such as the thalassemias,” Orkin says. More research is needed, however, before such therapies can be tested in people.

- Posted from my iPad2

Location:Georgetown,United States

Antibody offers hope for multiple sclerosis treatment

Antibody offers hope for multiple sclerosis treatment : Nature News

Promising phase III trial paves the way for alemtuzumab approval.

Duncan Graham-Rowe

ultiple sclerosis attacks the central nervous system, and there are few effective treatments.
The first drug to show signs of not just halting multiple sclerosis (MS), but actually reversing the nerve damage caused by the condition, has taken a significant step towards clinical approval.

The results of a phase III trial, presented on 22 October at the 5th Joint Triennial Congress of the European and Americas Committees for Treatment and Research in Multiple Sclerosis, in Amsterdam, found that 78% of patients treated with the monoclonal antibody alemtuzumab remained free from relapse after two years — and half the relapse rate of one of the standard therapies, interferon β-1a (marketed as Rebif, among other names).

However, alemtuzumab did not perform quite as well as it had in earlier trials. There was some evidence that it had reversed damage to nerves, but the result was not statistically significant, says Alasdair Coles, a neuroscientist at the University of Cambridge, UK, and the UK chief investigator of the Comparison ofAlemtuzumab and Rebif Efficacy in Multiple Sclerosis (CARE-MS) I trial.

Coles told the meeting that magnetic resonance imaging showed that subjects taking alemtuzumab had also lost less brain volume than those taking Rebif, a proxy measure for overall tissue damage. “Alemtuzumab has eliminated the loss of brain tissue,” he says.

Just 8% of patients taking alemtuzumab experienced a worsening in disability according to standard measures, in comparison with 11% taking Rebif. There was no statistical difference between the two groups, but Coles puts this down to Rebif performing better than expected. “The patients recruited in this trial showed very little worsening of disability,” he says.

Significant promise?

Ludwig Kappos, chair of neurology at the University Hospital of Basel in Switzerland, who has been involved in several MS drug trials, says he is disappointed that there was no significant effect on disability progression. “This is in contrast to what the phase II study has shown,” he says. But he expects this effect to show up in another ongoing phase III trial: CARE-MS II, the preliminary results of which should be available later this year.

There is no cure for MS, a condition caused by the body’s own immune system attacking the myelin sheath that normally protects the nerves and speeds up neurological signals in the brain and spinal cord. At the moment, the only treatments are drugs such as interferon β-1a and glatiramer acetate (Copaxone), both of which merely slow the progression of the disease.

But alemtuzumab has the potential to reverse it: the drug tackles the mechanisms that cause damage to cells by effectively resetting the immune system. It targets the CD52 glycoproteins on the surface of mature immune cells, or lymphocytes, depleting levels of the aggressive T and B cells without affecting other lymphocytes. For reasons still not quite understood, when the lymphocytes repopulate, those involved in attacking the myelin sheath seem less likely to recover.

Immune response

Although the efficacy of alemtuzumab is impressive, performance was never really the issue, says Les Funtleyder, a health-care strategist at trading firm Miller Tabak + Co in New York. “With alemtuzumab the issue is safety,” he says.

The drug brings an increased risk of autoimmune diseases. In the trial, 18.1% of people taking alemtuzumab experienced thyroid-related autoimmune responses, and 0.8% developed the potentially life-threatening condition immune thrombocytopenia. But, says Coles, these findings mirror those from earlier trials, and it is possible to identify those patients most at risk by screening for certain biomarkers. “What’s reassuring with this trial is that there are no new safety issues,” he says.

Some patients and clinicians who have already got wind of the alemtuzumab’s efficacy seem unwilling to wait for clinical approval, says Coles. The drug is already approved in many countries as a treatment for some forms of leukaemia and lymphoma, under the name Campath. In some countries, including the United Kingdom, it is legal to prescribe any drug for off-label use, and so patients have already started using it to treat MS, he says.

But it is not just MS patients who have been holding their breath over this drug, says Funtleyder. Earlier this year, Genzyme, a drug company based in Cambridge, Massachusetts, that makes alemtuzumab and a range of other therapies, was acquired by Paris-based drug-maker Sanofi. The value of the deal for Genzyme’s shareholders is contingent on the success of alemtuzumab in treating MS; the first milestone is for the drug to gain approval from the US Food and Drug Administration before the end of March 2014.

- Posted using my iPad2

Location:Georgetown,United States

Yoga May Help Low Back Pain

Yoga May Help Low Back Pain, Mental Effects? Not So Much -

Low back pain sufferers benefitted from taking yoga or stretching classes, a new study found.

A study believed to be the largest of its kind suggests that the physical aspects of yoga are effective at relieving low back pain, but it didn’t find any evidence that yoga provided broader mental benefits.

The study, funded by the National Institutes of Health’s National Center for Complementary and Alternative Medicine, was published online Monday in the Archives of Internal Medicine. It was lead by researchers at Seattle’s Group Health Research Institute.

Smaller studies in the past have suggested that yoga, which involves stretching exercises along with a mental component of deep breathing and other relaxation techniques, was moderately effective at easing symptoms of chronic lower back pain.

It was thought the combination of stretching and relaxation relieved back pain, according to previous studies.

But the current study found both yoga and stretching were equally as effective, suggesting the benefits of yoga are attributable to the physical benefits of stretching and not to its mental components, said the study’s lead author, Karen J. Sherman, senior investigator at Group Health Research Institute.

It involved 228 adults with chronic, low back pain that didn’t have a specific cause such as a spinal disc problem. They were divided into three groups to compare two types of classes with patients using a self-care book that provided instruction on exercises and stretches to help treat lower pain.

The people who took classes may have been more likely to complete the exercises. More than 80% of the participants in the self-care group reported reading some of the book and doing some exercises, but time spent on the exercises was typically less than the class groups. “They need that class format to get started,” Ms. Sherman said.

About 50% of patients in the yoga or stretching classes reported feeling much better or completely better in relation to their back pain and function compared to about 20% of patients in the self-care group, said Ms. Sherman.

Twice as many patients in the yoga and stretching groups reported decreased medication use during the study compared to the self-care group.

About 90 patients each were randomly assigned to attend 75-minute weekly yoga classes or weekly stretching classes for 12 weeks. The people who attended the classes were also instructed to practice for 20 minutes a day at home in between classes.

Another group involved 45 patients who were given a 200-page book with advice on exercising, lifestyle modifications and managing flare-ups.

The type of yoga used in the study was viniyoga, a style of hatha yoga, that adapts exercises for each person’s physical condition. The stretching classes involved 15 stretches targeting the lower back and legs were which held for a full minute repeated for a total of 52 minutes of stretching.

The study measured changes in back pain and functional status at the beginning of the study and at six weeks, 12 weeks and six months.

Write to Jennifer Corbett-Dooren at

- Posted using from my iPad2

Location:Klondike Dr,Georgetown,United States

Advance Directives Cut Unwanted Hospitalizations

Informed Patient: Advance Directives Cut Unwanted Hospitalizations - Health Blog - WSJ

Informed Patient: Advance Directives Cut Unwanted Hospitalizations

By Laura Landro

Frail elderly patients who have advance directives through a program to communicate treatment preferences have fewer unwanted hospitalizations, according to a new study published online in the Journal of the American Geriatrics Society.

The program uses a form known as POLST — Physician Orders for Life-Sustaining Treatment — which allows patients to document their preferences about certain treatments. Signed by both patient and doctor, the form spells out choices including whether a patient wants to be on a breathing machine or feeding tube.

The program launched in Oregon almost 20 years ago, but remains controversial to some groups that feel life-sustaining treatment should always be administered.

Efforts to expand use of the forms, currently in use in about 14 states, with about 20 programs in development, were the subject of an Informed Patient column earlier this year.

The new study was designed to assess whether treatments provided were consistent with what was documented on the POLST form. A review of the forms for 870 living and deceased patients found that orders about resuscitation were honored 98% of the time, and orders to limit medical interventions were honored 91.1% of the time.

When patients identify treatments they don’t want, the forms direct clinicians to focus on enhancing comfort if needed. Near the end of life, 24% of POLST orders were rewritten to reflect a change of preferences, primarily for comfort-focused care.

Susan Tolle, director of the Center for Ethics in Health Care at Oregon Health & Science University, and one of the study’s authors, tells the Health Blog that the study found that in cases where wishes were not respected, “there was a good reason most of the time.”

For example, patients were sent to the hospital if they fell and broke a hip because surgical procedures were required to control pain. “We of course would set a fracture or sew up a wound,” Tolle says. “The wonderful news is that there isn’t a sense of patients refusing care and so they are neglected,” she adds. “Instead they are getting appropriate comfort measures when that is what is indicated.”

Tolle says the next step is changing the culture of health care, where end-of-life decision making is still a fraught issue and interventions may be standard procedure even in the frail and elderly. “It’s one thing to change the law to make it possible to use POLST effectively and another to have it offered to every patient in a nursing home or hospice care,” she says.

The POLST study adds to the growing debate over end of life care. Another recent study published last month in the New England Journal of Medicine found that health-care transitions — such as a move from one nursing home to another — in the last months of life can be burdensome and potentially of limited benefit for patients with advanced cognitive and functional impairment.

The study of 474,829 nursing home residents identified close to 20% had at least one such transition, including multiple hospitalizations in the last 90 days of life. Blacks, Hispanics and those without advance directives were at increased risk.

Thursday, October 20, 2011

Physicians should embrace patient engagement

Physicians should embrace patient engagement Kent Bottles, MD The doctor/patient relationship is certainly changing and evolving. A term I hear a lot today is: “patient engagement/activation.” Why is this concept so important and what does it mean? What can physician executives do to make it easier for our patients to become engaged and activated? Judith Hibbard has pioneered the study of patient engagement, and she noted that one needs knowledge, skills, and emotional support to actively engage in one’s health care. She identified four behaviors associated with engagement and activation: 1. Self management 2. Collaboration with provider 3. Maintaining function/preventing declines 4. Access to appropriate and high quality care She also developed a Patient Activation Measure (PAM) tool to place individual patients on a 4 level scale of engagement and activation. The Center for Advancing Health defines engagement as “actions individuals must take to obtain the greatest benefit from health care services available to them,” and they expanded Hibbard’s work by identifying 43 engagement behaviors that can be grouped into ten categories. Patients who do not successfully engage in these behaviors will not receive optimal health care and will not realize all the benefits of the many scientific breakthroughs of 21st century medicine. Because of the economic environment, the increasing complexity of medical care, and health care reform, it is becoming more important for patients to take an active and knowledgeable role in their health care. The ten categories of the Engagement Behavior Framework are: 1. Find safe, decent care. 2. Communicate with health care professionals 3. Organize health care 4. Pay for health care 5. Make good treatment decisions 6. Participate in treatment 7. Promote health 8. Get preventive health care 9. Plan for the end of life 10. Seek health knowledge Recently Klick Pharma invited 19 health care activists from a wide variety of disease states to participate in a conversation about an ePatient Bill of Rights that would support patient engagement and activation. After four hours of conversation, this group reached consensus on the following key messages of such a bill of rights: 1. Shared access to my data 2. Attitude of collaboration and overall respect 3. The patient is the largest stakeholder 4. Transparency and authenticity across all areas 5. Voice of the patient is a legitimate (clinical) source 6. The right to efficient communication with providers who utilize the technology we need It is not easy for any one patient to follow all of the above suggestions from the three different groups advocating patient engagement/activation. The Medicare Current Beneficiary Survey reported that only 30% of older Americans possess the motivation and skills to actively engage in their health care. Hibbard found that 23% of those surveyed had embraced such behaviors in their health care, but they worried they would falter during a medical crisis. In her survey, 12% wanted to remain unengaged and 29% reported they did not have the knowledge to understand their treatment regimens. Researchers who have studied patient engagement/activation have found a positive relationship to health status outcomes. Beatrice Golomb and colleagues found patients on statin drugs were far more likely than doctors to initiate discussions of symptoms possibly related to the drugs. Annette O’Connor’s systematic review of the effects of shared decision-making technologies found a 23 percent reduction in surgical interventions among patients using them, with better functional status and satisfaction. David Mosen and colleagues documented that patients with high PAM scores were significantly more likely to perform self-management behaviors, use self-management services, and report high medication adherence. They were also ten times more likely to have high patient satisfaction scores and five times more likely to have high quality of life scores. Jessie Gruman has had cancer four times and is the founder and president of the Center for Advancing Health. Addressing an audience of health care providers, she recently said: As a savvy and confident patient who is flummoxed by so much of what takes place in health care, I am regularly surprised by how little you know about how little we patients know. You are immersed in the health culture. But we don’t live in your world. So we have no idea what you are talking about much of the time. One way to help us feel competent in such unfamiliar environments is to give us some guidance about what this place is and how it works. What are the rules? Experts in patient activation/engagement suggest that hospitals and medical practices provide each patient with a short guide that explains how best to be a patient in that unique setting. Such a handbook could be printed, a smartphone app, an email, on a website, or a poster prominently displayed in the waiting room. It is important that patients understand how to get after-hours and emergency care, how to make appointments, what accommodations (physical navigation, translation services) are available, what insurance documents should be brought to the office visit, how to get prescription refills, and many other basic kinds of information that often frustrate even motivated individuals. Another tool that can be individualized for each clinical setting is a written contract or pact that clearly sets out the roles and expectations of all involved in the doctor/patient relationship. Components of such a document might include that patients should tell their provider about all other visits to physicians and alternative healers and that providers will ask about such care and be willing to share information. Another part of such a contract might require the patient to prepare for each visit by writing down a list of concerns and questions and the provider to respond to the patient’s questions and answer questions in a manner that the patient can readily understand. Another suggestion is that hospitals and medical practices become much more open to new technologies. Many patients find patient social networking sites such as PatientsLikeMe, DiabetesMine, Inspire, Disaboom, and IMedix valuable sources of practical information about living with chronic disease. CureTogether is exploring ways that patients can conduct observational research about their condition that is quite helpful to newly diagnosed patients. Patients are going to continue to google their symptoms and try to diagnose themselves before visiting the physician. Smartphone apps like can help patients prepare for their visits by listening to actual patient/doctor conversations, recording their office visit so they can go back over instructions and physician advice, and sharing their audio health record of the visit with members of their care team who are unable to accompany the patient to the visit. By providing guides, compacts, and information about new technologies, physician executives can send a powerful, positive message to their patients. Gruman believes such support communicates that we want our patients to be comfortable, to receive the best possible care, and that we are accountable for our services because we clearly spell out our commitments. Physician executives should embrace patient engagement/activation because it will help our patients get better clinical outcomes and because it is the right thing to do.

Wednesday, October 19, 2011

Stem cells used in advanced heart disease

In a medical breakthrough a man’s heart was saved through the use of a breakthrough medical technology. The man, John Christy, is the first person in the United States to undergo this procedure. The new procedure utilizes stem cells in helping repair the arteries all throughout a person’s body. Christy was suffering from coronary artery disease at a very advanced stage. What was done to him was to insert his own specific stem cells into his body during a CABG surgery. The stem cells are used to grow new blood vessels in the heart. This is a revolutionary procedure that can save millions of lives when it is further developed and become widely available.

Great device for when you are in trouble

A Device for When You’re Hurt, Lost or Feeling Scared - Katherine Boehret - The Digital Solution - AllThingsD | by Katherine Boehret Two weeks ago, alone in a hotel room 3,000 miles from home, I suddenly felt an intense pain in my head, stronger than any headache I’ve ever experienced. Light was unbearable, I felt too dizzy to stand and the nausea was overwhelming. I called my husband in Washington, D.C., and whispered my symptoms, which I now know were most likely the signs of a migraine. This week, I tested a product I could have used during that scare: the 5Star Responder from GreatCall Inc., a sort of portable OnStar. It’s a 1.8-ounce gadget with a speaker and microphone that clips onto a keychain or shirt. One large center button calls an always on-duty concierge, who knows information about each caller—like medications, preferred hospitals, emergency contacts and the caller’s location (using built-in GPS). Once the situation is assessed, a nurse can speak with the caller, emergency services can be dispatched or, in less urgent scenarios, the agent can stay on the line with the caller. GreatCall’s 5Star Responder is one of the first truly portable emergency-call devices. It runs on Verizon’s network, giving it coverage anywhere a Verizon phone works. Other emergency-call devices like Medical Alert by LifeStation work in the home and are geared toward seniors who rarely go out. The 5Star Responder has a speaker, microphone and a button that calls an agent or 911. The 5Star Responder will be available Wednesday from and in stores like Wal-Mart and Sears on Oct. 23. It’s $50, plus a $35 activation fee—or $25 if you sign up online. A $15 monthly service fee is applied, with additional family members paying $9 monthly. Also on Wednesday, 5Star Urgent Response will become available as a $15 iPhone app in Apple’s App Store, though the monthly service fees still apply. The website,, where users set up their personal data, also launches. Still, the 5Star Responder is yet another thing people will need to remember to plug in and charge (one charge lasts roughly three days in standby, the company estimates). It also felt noticeably heavy on my keychain. Yet 5Star Responder could really make a difference in situations where people don’t call 911 because they don’t believe they have an emergency, like not taking the symptoms of a heart attack seriously. The 1.8 ounce device can fit in a small purse or clip onto a keychain. The device isn’t just for seniors with health problems. Take a child who is too young to have a cellphone and gets separated from his family at a festival. When he presses the 5Star button, an agent determines his location and gets parents on a conference call with the child via the device’s speaker. The device also could be good for a runner who doesn’t want to carry a heavy smartphone and collapses in pain during a run. Or a person walking in a sketchy neighborhood who wants the agent to talk to him until he gets to his car. The device will call 911 directly if you hold down the call button for five seconds. If the Responder’s center button is pressed and a caller can’t respond, the agent will try to call the device back and an alternative phone number, such as an emergency contact, before finally dispatching emergency personnel. To test the 5Star Responder and a prereleased version of the iPhone app, I “suffered” through a variety of pretend scenarios. These included revisiting my above-described migraine, walking alone at night in an unsafe neighborhood, heart-attack-like symptoms and reporting a break-in at my house in the middle of the night. I informed the agent on each call that this was a test case. They still acted like it was a real call, doing things like asking me to hold while they contacted paramedics, simulating the time it would take to dispatch emergency personnel. In one test, I told the call agent that I was walking in a neighborhood that didn’t feel safe, and he offered to call the police to come to my location. I told him I wanted to stay on the line with someone as I walked and he spoke with me for another five minutes until I got to my destination. Once, I pressed the call button but hung up in the middle of the first ring. Seconds later, the 5Star Responder device rang, and when I pressed the center button to answer, an agent told me he was calling back to make sure everything was safe and secure. When I called to report someone in my house, the agent asked me to hold while she sent police. When she got back on the line, I asked her to connect me with my emergency-contact person, and she initiated a call to my husband. When I called and described my migraine experience as if it was really happening, the agent suggested sending emergency-medical personnel, but I asked if I could speak to a nurse. My agent transferred me to GreatCall’s LiveNurse service, which took about 40 seconds before that service’s operator transferred my call to an actual nurse. Before talking with me about my situation, the nurse asked me to spell my name and give my birth date. This relatively lengthy process could be problematic in some scenarios. When I was suffering from my migraine, I could barely say a sentence on the phone with my husband because even the sound of his voice in my ear was excruciating. In the end, the nurse suggested sending paramedics because I reported shallow breathing and an irregularly fast heartbeat.

Tuesday, October 18, 2011

The virtual doctor visit

Welcome to Rite Aid, The Virtual Doctors Will See You Now Rite Aids in Detroit are getting chat rooms with which customers can video chat with doctors or nurses for medical advice. The doctors can even tele-prescribe over the Internet. You got your shopping list: coffee, toothpaste, Tums, and…a doctor’s consultation about your lower back pain? Rite Aid is now your one-stop-shop for everything pharmaceutical, including expert medical advice on prescriptions or any other health-related questions you might ask your primary doctor. Chat rooms are already being installed at Rite Aids Detroit in which you can connect with doctors and nurses through the Internet for one-on-one video consultations. Now the doctors themselves are over-the-counter, and you don’t even need health insurance, just a credit card. Technology continues to make health care more convenient and accessible, and to reshape the clinic as we know it. Inside the private chat rooms, customers will pay $45 to talk to a doctor for ten minutes. After describing symptoms they’ll receive feedback from the doctor and even a prescription if necessary, which they can then immediately fill. And they can choose to speak to a general practitioner or a specialist such as a psychologist or dermatologist. Nurses are also available for consultation free of charge. Staffed by OptumHealth, the company that also supplies the chat rooms, nurses can provide the customer with basic health information and assist them on appropriate care options. If they’re not comfortable with video chat, patients can choose to chat by typing or talk over the phone. The exchanges are automatically recorded and the recording can be sent off to the customer’s primary doctor to maintain continuity. The “virtual” clinics are part of the OptumHealth’s NowClinic Online Care services. Rite Aid and OptumHealth’s efforts make health care more convenient. And if the chat rooms are convenient enough customers can still use NowClinic 24/7 by going to Of course, it’s also very convenient for Rite Aid to have people in their store who have fresh prescriptions that need to be filled.. The virtual clinics are part of a growing trend to make healthcare more accessible through technology. Rite Aids in Detroit are the first to receive the NowClinics, but BlueCross BlueShield has a similar system in five different states through which patients are able to gain immediate online access to doctors within the company’s network. Additionally, there are a number of websites such as,, and that have doctors online, ready 24/7 to give advice to paying customers. And OptumHealth doesn’t want to stop there. Chuck Grothaus, Senior Director of Corporate Communications told Singularity Hub that there are plans to “include some remote diagnostic capabilities including the ability to measure and share blood pressure information, among other things. We are still researching and developing what these tools will entail.” It’s the next step, you know it! Some customers, however, might be resistant to this trend towards virtual care, or to taking advice from a doctor they’ve only “met’ ten minutes ago. But a study published earlier this year shows that virtual health care can be as good or even better than old fashioned visits to the doc’s office. The study compared traditional health care monitoring and total internet-based monitoring of a group of HIV positive patients. While neither the physical or psychological healths showed differences between the two groups, the patients monitored through the “Virtual Hospital” felt they had better access to clinical information. Virtual doctors are just the latest way technology is making it easier for us to stay healthy. We can track our calories and sleep with Fitbit, test our blood sugar levels with our smartphones, and soon we’ll be able to swallow a pill that monitors our internal physiology. But to be clear, virtual visits aren’t meant to replace face-to-face visits but to augment them. An at home, do-it-yourself stethoscope exam probably wouldn’t work. As medical records become increasingly digitized virtual doctors and virtual hospitals will draw closer to true doctors’ office visits, even if they are found at the end of aisle five, just past the toothpaste and hair gel.

Heart Failure Puts Fewer in Hospital

Heart Failure Puts Fewer in Hospital - By RON WINSLOW and SHIRLEY S. WANG Hospital admissions for elderly U.S. patients with heart failure fell by nearly 30% over a decade, an analysis of federal Medicare data shows, a surprising finding that offers fresh evidence of progress in the battle against cardiovascular disease. The report, being published Wednesday in the Journal of the American Medical Association, is the first to document a decline in admissions in the U.S. for the condition, an enormously costly problem and the most common reason for hospitalization among Medicare beneficiaries. Hospital admissions for elderly U.S. patients with heart failure fell by nearly 30% in the past decade, a surprising finding that offers fresh evidence of progress in the battle against heart disease. Stefanie Ilgenfritz has details on The News Hub. The finding is based on data from more than 55 million patients in Medicare’s conventional fee-for-service program who were hospitalized for heart failure between 1999 and 2008. Researchers estimated there were 229,000 fewer admissions for heart failure in 2008 than would have been expected had the rate of admissions remained at 1999 levels. The analyses were conducted on data collected from 1998 through 2008. As a result of the improvement, the Medicare program saved an estimated $4.1 billion in hospital costs related to heart failure, according to the report. Heart disease overall is still the leading cause of death in the U.S., and this latest research comes with caveats. For heart-failure patients who were hospitalized, death rates one year after that fell only slightly—to 29.6% in 2008 from 31.7% in 1999. Hospitalization rates also varied significantly by state, and the improvement for black men was smaller than that of other groups. But the gains, coming as the population ages and as obesity and diabetes—both risk factors for heart disease—are enormous public-health concerns, were a welcome surprise to some experts. Many attributed the improvements to better preventive measures and disease management, as well as a reduction in elderly rates of heart attack—a common cause of heart failure. “At a time when we bemoan a lot of things in health care, this is a remarkable success story,” says Harlan Krumholz, a Yale University cardiologist and senior author of the study. Heart failure is a progressive weakening of the heart’s ability to pump blood to the rest of body that in late stages typically results in accumulation of fluid in the lungs and lower extremities. It is often accompanied by poor kidney function and other problems. The American Heart Association estimates that total costs for treating patients with heart failure, including associated indirect costs, were $39.2 billion in 2010. Dr. Krumholz and his colleagues, including first author Jersey Chen, also a Yale cardiologist, said they couldn’t say with certainty what is behind the admissions decline. But Dr. Krumholz’s team in a separate analysis of Medicare data 18 months ago reported a 23% decline in admissions for heart attacks. Because they damage the heart muscle, heart attacks can lead to heart failure. Ralph Brindis, immediate past-president of the American College of Cardiology and a senior adviser for cardiovascular disease at Northern California Kaiser Permanente, said he was “moderately surprised and encouraged” by the finding in light of the aging of the population. The improvements likely reflect better prevention and early treatment of high blood pressure and coronary-artery disease, said Dr. Brindis, who wasn’t involved in the study. These factors include reductions in the smoking rate and lowering cholesterol levels using drugs known as statins, as well as diet. John Harold, a cardiologist at Cedars-Sinai Heart Institute in Los Angeles, said he has seen fewer patients admitted for heart failure and heart attacks. He and other doctors have a greater awareness of the risk factors for heart failure as well as a better arsenal of treatment. When a patient with heart failure comes in to see him—Dr. Harold was scheduled to see five such patients on Tuesday—he addresses their blood pressure and weight, as well as their smoking and control over their diabetes if applicable. He believes patients are generally more educated now about health, such as the consequences of smoking, compared with the 1990s, and are more willing to change their behavior. They are now recruited to participate in their care in a way they weren’t before, he says. He will ask patients to chart their weight daily and alert him if it fluctuates by two or three pounds in a short period, because fluid gain could be a sign that something is wrong. Guidelines for treating heart failure, which were issued for the first time by the American College of Cardiology and American Heart Association in 1998, also have helped doctors, according to Dr. Harold, who serves as vice president of the ACC. Though obesity continues to bedevil Americans, its rate has steadied in recent years. By 2008, nearly 70% of the U.S. adult population was considered overweight or obese, but that number hadn’t changed for women since 1999 and for men since 2003, according to the Centers for Disease Control and Prevention. Smoking rates, on the other hand, dropped to 20.8% in 2007 from 23.3% in 2000 of U.S. adults 18 and older, according to the CDC. “This is occurring in a period without a major game-changing breakthrough in treatment,” Dr. Krumholz said. He also noted that hospital readmissions for heart failure weren’t reduced during the study period. That suggests the benefit was significantly in patients who avoided the hospital to begin with. Drugs that reduce high cholesterol, which are largely statins, were the most popular class of medication in 2008, with 202 million prescriptions dispensed, up from 145 million in 2004, according to IMS Health, which tracks prescription drugs. Other drugs that treat heart failure or heart disease, including beta blockers and ACE inhibitors, were also among the top 10 classes of drug dispensed in 2008 and up from five years earlier. Beyond that, Dr. Krumholz, the study’s senior author, said a focus in the past decade on quality improvement and treating patients according to evidence-based guidelines—including better use of medications in people at risk for heart failure—may be paying dividends. Clyde Yancy, chief of cardiology at Northwestern University and a spokesman for the American Heart Association, noted that for patients who did wind up in the hospital, the death rates one year later didn’t decline dramatically over that same period—a finding that he said wasn’t surprising. Such patients usually have other medical conditions as well, and they may end up dying because of one of those other reasons, he said. Dr. Yancy, who wasn’t involved with the study, signaled some items of concern in the report. Some populations, such as black men and those in certain regions across the country, didn’t fare as well as others, prompting questions about whether differences in access to or quality in care might be responsible for the disparities, he said. Write to Ron Winslow at and Shirley S. Wang at

Abbott Labs develops an absorbable stent

As reported in the Wall Street Journal Abbott Labs has developed a coronary artery stent that is reabsorbded into the vessel once it is no longer needed. The intent is to return that vessel to its normal state and potentially reducing the risk of blood clots.

Monday, October 17, 2011

Medicare Releases Patient Safety Ratings For Hospitals - Kaiser Health News

Medicare has begun publishing patient safety ratings for thousands of hospitals as the first step toward paying less to institutions with high rates of surgical complications, infections, mishaps and potentially avoidable deaths.

The new data, available starting last week on Medicare’s Hospital Compare website, evaluate hospitals on how often their patients suffer complications such as a collapsed lung, a blood clot after surgery or an accidental cut or tear during treatment. The measures also include specific death rates for patients who had breathing problems after surgery, had an operation to repair a weakness in the abdominal aorta or had a treatable complication after an operation.

In addition, Hospital Compare is evaluating rates of some specific medical errors, such as giving patients the wrong type of blood, leaving surgical implements in patients’ bodies during surgery and falls that occur during their stay.

The evaluations are part of Medicare’s broad move from paying hospitals a set amount for each procedure. That change was directed by last year’s health care law, which set up new “value-based purchasing program” that will begin in October 2012. Over time, hospitals with the lowest quality—as judged by a variety of metrics, not just the new patient safety measures—will be at risk to lose up to 2 percent of their regular Medicare reimbursements under the health law.

The new data on patient safety moves Medicare further along toward its ultimate goal, which is to base payments on the actual medical outcomes for patients. To rate hospitals, Medicare is comparing them to the national rates for medical complications and hospital acquired conditions. For instance, on average, 2.1 out of every 1,000 patients discharged suffered an accidental cut and tear from medical treatment. Out of 100 patients, 4.4 on average died after surgery to repair a weakness in their abdominal aorta.

By looking at how a hospital compares to the national average on this and other complication statistics, Medicare has come up with overall evaluations of how good hospitals are at avoiding complications and hospital-acquired conditions. Medicare is aiming to incorporate the new patient safety data into payments in the second year of the program.

Making this information public has been long favored by patient safety advocates. “This is pulling the curtain back on preventable health care harm to older Americans,” said Rosemary Gibson, co-author of “The Treatment Trap” and editor of a series of articles on overtreatment in the Archives of Internal Medicine. “These are really good things to know. We are really getting into the meat of what can happen to patients in hospitals.”

But the latest data is intensifying objections from the hospital industry and some academic researchers that Medicare is using dubious and unfair measurements in ways that will hurt some hospitals, particularly those with sicker patients. The data is based on billing claims that hospitals submit to the government, not clinical medical records. One concern held by hospitals and researchers is that hospitals categorize the same things differently when billing Medicare, skewing comparisons.

“Medicare claims data is the thing a lot of people judge from, but it’s a large database and frankly I’ve always wondered if apples and oranges are being mixed,” said Dr. Gerald Healy, a senior fellow at the Institute for Healthcare Improvement, a Massachusetts nonprofit, and past president of the American College of Surgeons.

Hospital officials said their initial review of the new data has exacerbated their concerns that Medicare’s calculations do not fully take into account the fact that some hospitals do more surgeries or treat sicker patients.

“We believe the data is fairly seriously flawed in the way it’s calculated,” said Nancy Foster, a vice president at the American Hospital Association. “When inaccurate data is out there, it both misleads the public and generates a lot of activity that is unproductive in the hospital.”

Atul Grover, head of advocacy for the Association of American Medical Colleges that represents teaching hospitals, said some of Medicare’s measures also make teaching hospitals look worse. “If you’re not appropriately risk-adjusting on this, you’re already selecting a patient population that’s more likely to die,” he said. “That’s why they come to us, because other people are reluctant to operate on those complex cases.”

Officials at the Agency for Healthcare Research and Quality, which designed many of the measures, referred questions to Medicare. Officials there were not immediately available to discuss the new measures. Dr. Patrick Romano, a professor at the University of California, Davis School of Medicine who helped the government design the measures, said the measures do take the sickness levels of patients into account, although not as thoroughly as Hospital Compare’s existing evaluations of readmissions and hospital-wide mortality rates.

Still, he said the measures were a good addition to the overall view of how well hospitals are doing. “We’re trying to understand a large animal like an elephant or a whale,” he said. “To do that, we take pictures from a variety of perspectives, with different cameras and different techniques.”

Hospital Compare was originally designed to be a helpful consumer tool, but to date it has not been widely used by patients choosing hospitals. Experts caution about drawing dire conclusions from the raw rates of hospitals, as some of the measures are complex and differences not statistically significant. For some of the measures, Hospital Compare categorizes most hospitals simply as “average,” “above” or “below” the national norm, which experts say is a better way for consumers to know whether a hospital is an outlier.

To find a hospital on the site, type in the city and state, click on the hospital name and then select the “Patient Safety Measures” tab at the left. Hospital Compare also gives patients the option of choosing several hospitals at once. The new data covers the period between October 2008 and June 2010.

Medicare last week also announced 18 more measures it is considering for inclusion in the value-based purchasing program.  Many of these measures look at how hospitals handle stroke patients and what steps they take to protect patients from blood clots. Others are intended to address two bacterial infections that can spread through hospitals: Clostridium difficile and Methicillin-resistant Staphylococcus aureus.

Friday, October 14, 2011

So what is this blog?

Lest you think this blog is written by techo-nerds, it is not. My wife and I are both in our 70’s and do not come from technology based backgrounds. Having said that we both have and use IPads, our check book is a PDA, and we have a PC desktop that serves a data storage and controls our wireless home network. As unusual as this may sound we believe we are not outside the norm but rather represent a growing cohort of computer literate seniors.

On the more personal side, Barb and I have been in both the clinical and administrative venues of healthcare delivery for over 40 years. During this time we became increasingly aware of the symbiotic relationship between the healthcare provider and it's recipient, the patient. We also realized that the patient was ill informed of not only the business of healthcare but more importantly, their accountability in the delivery of quality healthcare.

To that end, we will attempt to give you a look into the world of personal technology and how it can impact your ability to be more accountable for your healthcare decisions. Secondly, we will cover the technological changes coming down the pike.

Now that I have given you "some insight", let me conclude by saying you will not find any silver bullets or magic potions on this Blog. What I hope you will find is ways to move yourself towards becoming an advocate in the furtherance of your own healthcare.