• Help your loved one with activities of daily living. This includes bathing, toileting, dressing, eating and exercising.
• Provide company to your loved one and supervise his or her activities.
• Remind your loved one to take medications.
• Help with laundry, light housework, errands, food shopping and meal preparation.

1. Is the agency licensed by your state? To find out if your state requires licensing, contact your state's Department of Health.
2. Is the agency accredited? Has a monitoring organization approved its work?
3. Is the agency an approved Medicare provider?
4. How long has the agency been in business in this location? Look for several years or more.
5. Are home health workers supervised by an agency employee (often a nurse)?
6. I s there a written care plan for each patient's treatment? How often is it updated? Will you be given a copy of the care plan?
7. Do home health workers document their treatment of patients, especially if more than one worker cares for the patient?
8. Are home health workers available 24 hours a day, seven days a week, on various shifts?
9. Is a nursing supervisor on-call 24 hours a day?
10. Do health workers teach family members how to care for their loved one?
11. Does the agency have a Patients' Bill of Rights? It should discuss the rights and responsibilities of the agency, the caregiver and the patient.
12. How are employees recruited and trained?
13. Does the agency do background checks? Are employees screened for contagious diseases?
14. What does the agency do to protect a patient's confidentiality?
15. How does the agency work out disputes between workers and patients or their families?
16. Does the agency have a contact number for families with questions or complaints?
17. If a home health worker doesn't show up for work, who is responsible for finding a substitute?

• The U.S. Department of Labor's Bureau of Labor Statistics. Nursing, Psychiatric, and Home Health Aides.
• Medicare. Home Health Compare.
• The U.S. Department of Labor's Bureau of Labor Statistics. Personal and home care aides.
• The National Association for Home Care and Hospice. Who provides home care?
• The Visiting Nurses Association of America. Questions to ask a home health care agency.

Preparing for Vaccination with Novel H1N1 Vaccine

July 31, 2009

Epidemiology

In the Northern Hemisphere, novel H1N1 influenza virus is persisting, and is continuing to cause outbreaks and sporadic cases in numerous locales despite the onset of summer. Evidence to date suggests that population immunity to this virus is low, particularly among the young. Thus far, most cases of illness, hospitalization and death associated with novel H1N1 infection have occurred among persons less than 65 years of age. Groups at increased risk of influenza-related complications include pregnant women, those with asthma, COPD, diabetes, chronic cardiovascular disease, and immuno-compromised persons. These are the same groups as previously recognized to increase the risk of severe illness from seasonal influenza. In addition, morbid obesity may represent an additional risk factor for severe illness. Unlike seasonal influenza where persons 65 years and older are most likely to be hospitalized or die from influenza-related complications, this age group has been substantially less affected by novel H1N1 virus than younger age groups.

Widespread susceptibility to this virus among young persons and the potential for large numbers of cases raises the possibility of more hospitalizations and deaths especially among younger age groups than would be expected for a typical routine seasonal influenza virus. The virus has also caused numerous outbreaks in schools and summer, institutions such as camps and correctional facilities, and led to disruptive interventions such as school dismissals that have substantial societal impact.

Vaccine Manufacturing

Novel H1N1 vaccine is being procured by the U.S. government from five (5) vaccine manufacturers of currently U.S.-licensed seasonal influenza vaccines – inactivated subunit (4) and live, attenuated vaccines (1). Inactivated licensed novel H1N1 vaccine will be available in single-dose syringes, or in multi-dose vials. Live attenuated vaccine will be available in limited number in inhaler sprayers. Single-dose syringes will be thimerosal-free, which will address concerns about this additive, especially regarding pediatric and pregnant vaccine recipients (inhaler sprayer vaccine products will also be thimerosal-free). The availability of novel H1N1 vaccine is dependent on multiple factors including virus growth at commercial scale, regulatory review, availability of calibrated vaccine product potency assay reagents, overall production capacity, and availability to U.S. through HHS contracts.

Vaccine Purchase and Allocation

Novel H1N1 vaccine is being purchased by the U.S. government and will be made available for vaccinators at no cost. Syringes, needles, sharps containers and alcohol swabs will also be provided. Vaccine will be allocated across states proportional to population. State health departments (and a few separately funded cities) will direct their allocation to local health departments and other vaccination partners.

Planning Assumptions

Given uncertainty around the amount and timing of vaccine availability, state and local public health planners have been asked to plan for vaccine becoming available mid-October under the following scenarios: 40, 80, or 160 million doses becoming available from the 5 manufacturers (total) over approximately a one month period, followed by weekly amounts of 10, 20 or 30 million doses. At this point, the planning assumption is that the vaccine will require 15 µg of antigen for an immunizing dose, and that two doses spanning over 21 or more days will be needed for efficacy for most persons. Clinical trials will be conducted to determine which age groups, if any, require only one dose. The majority of vaccine will be packaged in multidose vials but enough preloaded syringes will be manufactured for young children and pregnant women.

In addition, based on best available information to date, planners have been provided scenarios to serve as a basis for making venue-based plans to vaccinate specific populations. These populations include students and staff (all ages) associated with schools (K-12th grade) and children (age ≥6 months) and staff (all ages) in child care centers; pregnant women, children 6 months – 4 years of age, new parents and household contacts of children <6 months of age, and non-elderly adults with medical conditions that increase the risk of complications of influenza, and health care workers and emergency services personnel. Formal recommendations for the use of novel H1N1 vaccine will be made by the ACIP in August 2009 based on all available epidemiologic data to date.

Vaccine Delivery System

Many state health departments are partnering with private sector partners to ensure the novel H1N1 vaccine is delivered to as many recommended persons as rapidly as possible. Vaccine will thus be available in a combination of settings including public health organized vaccination clinics, and in private sector settings such as provider offices (e.g. pediatricians, family physicians, obstetricians, internists), retail settings, pharmacies, workplaces, and through community vaccinators. Private providers who wish to administer the novel H1N1 vaccine will need to enter into relationships with their public health department so that vaccine can be directed to them.

While providers will receive the vaccine at no charge, information on reimbursement for administration is needed. CDC asked AHIP (America’s Health Insurance Plans) whether insurance plans would reimburse private providers for administration and received the following answer: “Every year health plans contribute to the seasonal flu vaccination campaign in several ways: a) Health plans communicate directly with plan sponsors and members on the current ACIP recommendations and encourage immunization; they also provide information on where to get vaccinations, and who to contact with any questions; b) Just as health plans have provided extensive coverage for the administration of seasonal flu vaccines in the past, public health planners can make the assumption that health plans will provide reimbursement for the administration of a novel (A) H1N1 vaccine to their members by private sector providers in both traditional settings e.g., doctor’s office, ambulatory clinics, health care facilities, and in non-traditional settings, where contracts with insurers have been established.”

Providers participating in novel H1N1 vaccination will be expected to administer vaccine in accordance with national recommendations for use of the vaccine. In addition, if administering vaccine during the early weeks, they will be expected to report weekly on the number of doses administered and the ages of persons who were vaccinated. Such data are critical for assessing early uptake and for adverse event monitoring as they provide a means of calculating adverse events rates.

Monitoring Coverage, Safety, and Effectiveness

Vaccine coverage will be monitored initially through weekly reports of doses administered, based on requirements set forth by CDC. Once the number of vaccinated persons is large enough to be detectable through population surveys, this information will be collected on an ongoing basis providing for monthly coverage estimates.

The Vaccine Adverse Event Reporting System (VAERS), a national vaccine safety surveillance program co-sponsored by the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration (FDA) collects an analyzes information from reports of adverse events following immunization and will serve as the foundation for safety monitoring. VAERS accepts reports from patients, providers, public health officials and others (1-800-822-7967, http://vaers.hhs.gov/contact.htm ). Signals that are detected through VAERS will be tested using a network of managed care organizations representing approximately 3% of the U.S. population, the Vaccine Safety Datalink (VSD). Vaccination information as well as individual outcome data are available though this network both to test signals on an ongoing basis and to monitor pre-specified adverse events. Additional strategies are being developed to actively monitor Guillain Barre Syndrome (GBS) incidence during the novel HINI influenza vaccination season with networks of providers set up for active case-finding.

CDC will utilize at least two primary means to assess vaccine effectiveness: the first will assess vaccine effectiveness for prevention of laboratory confirmed medically attended influenza at 4 community based sites; the second will assess vaccine effectiveness for prevention of influenza hospitalizations diagnosed by provider-ordered clinically available tests at 10 sites nationwide through the Emerging Infections Program. Additional assessments of influenza vaccine effectiveness will be conducted by the US Department of Defense which has the ability to conduct timely assessments of vaccine effectiveness in their active duty populations.

Seasonal Vaccination

Seasonal vaccine will be available beginning in August or September 2009. The seasonal influenza vaccine is expected to be available earlier than the novel H1N1 vaccine, but the availability of the two vaccines is expected to overlap. The process for ordering seasonal vaccine is unchanged from previous years.

Most Appropriate Treatment Strategy: Extension Of Vaccination Policy Or Prescription Of Anti-Influenza For Healthy Adults?

08 Aug 2009   

The use of antiviral drugs for the treatment of people presenting with symptoms is unlikely to be the most suitable approach during a seasonal outbreak. This is the conclusion of a study published Online First and in an upcoming edition of The Lancet Infectious Diseases. The review is the work of Dr Jane Burch and Professor Lesley Stewart, Centre for Reviews and Dissemination, University of York, UK, and collaborators. It reports that the amplification of the vaccination policy could result in a more clinically efficient and cost-effective strategy. But the cost-effectiveness of this is yet to be proven.

The authors mention that the findings could have significance for the current H1N1 pandemic, although the review used data for seasonal flu. They worked on a meta-analysis of the efficacy of the antiviral treatments: oseltamivir (tamiflu) and zanamivir (relenza). Healthy adults without known underlying health problems were included in the study. They also assessed individuals at risk of flu related complications, such as people with lung or heart disease, diabetes, or other health problems. In healthy adults, tamiflu reduced the median time to symptom alleviation by 0.55 days and relenza by 0.57 days. For at-risk groups, the corresponding reductions were 0.74 days (tamiflu) and 0.98 days (relenza). These reductions in symptoms are somewhat small in the perspective of the whole length of symptoms for most patients. Also, there was little information available on the occurrence of complications.

Instead of treating individuals when they present influenza symptoms, some different strategies might be more clinically efficient and cost effective. These include:

• Vaccination.
• Post-exposure prophylaxis: treating people with antiviral drugs after they have been in contact with flu.
• Expectant treatment: people that have been in contact with influenza are prescribed antiviral drugs to be taken as and when symptoms present.
• Making the drugs available over the counter for purchase.
• Introduction of rapid testing in the family doctor's consulting room before prescription, in order to allow the treatment only of people who have flu.

Each of these options has advantages and disadvantages. However, the authors explain: "Any strategy that increases the availability of the drugs to the general public, consequently increasing the rates of inappropriate use, could increase the chances of viral strains developing resistance."

They write in conclusion: "Although the evidence for clinical effectiveness in healthy and at-risk populations is similar, and the data relating to complications is lacking in both groups, it is reasonable to recommend precautionary treatment to people who are at an increased risk of suffering influenza-related complications. Even if active management of seasonal influenza in healthy adults is deemed a public health priority, recommending the use of antiviral drugs for the treatment of people presenting with symptoms is unlikely to be the most appropriate course of action, given the high specificity of zanamivir and oseltamivir to the influenza virus, and the debatable clinical importance of their affect on symptom duration. Extension of the vaccination policy might be a more appropriate choice for healthy adults, and an assessment of cost-effectiveness that includes societal costs of extending the UK vaccination policy to all working-age adults seems desirable."

"Prescription of anti-influenza drugs for healthy adults: a systematic review and meta-analysis"
Jane Burch, Mark Corbett, Christian Stock, Karl Nicholson, Alex J Elliot, Steven Duffy, Marie Westwood, Stephen Palmer, Lesley Stewart
DOI: 10.1016/S1473-3099(09)70199-9
The Lancet Infectious Diseases

Written by Stephanie Brunner (B.A.)
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Article URL: http://www.medicalnewstoday.com/articles/160188.php

New Survey Results Show Most Moms Are Aware Their Pre-teens And Teens Need Vaccines

08 Aug 2009   

A new survey reports that most moms know their children need additional vaccines beyond those received when they were infants or small children. But according to Centers for Disease Control and Prevention (CDC) estimates, most pre-teens and teens do not have all the vaccinations that it recommends. As children approach adolescence they can develop risks for certain diseases and protection from some childhood vaccines can wear off over time.

The survey, conducted by Harris Interactive, with support from Merck & Co., Inc., found that 4 out of 5 moms of pre-teens and teenagers agree that pre-teens and teenagers need additional vaccines beyond those they received when they were younger. However, although coverage rates for pre-teens and teens are increasing for most routine vaccines, a recent CDC report shows that most still do not have all of the recommended vaccinations.

"These results mirror what I see in my own practice - a lot of adolescents not up to date on their vaccines, in spite of their parents awareness of the need for them," said Dr. Lolita McDavid, Board-Certified Pediatrician practicing at Rainbow Babies and Children's Hospital in Cleveland, Ohio. "Taking your kids - including pre-teens and teens - for an annual check-up should be as routine as buying them school supplies.

About Dr. Lolita M. McDavid

Lolita M. McDavid is Medical Director of Child Advocacy and Protection at Rainbow Babies and Children's Hospital, the pediatric hospital of University Hospitals Case Medical Center. She is responsible for community outreach and programming as well as coordinating the medical services for the Child Protection Unit, serving at-risk children and families in Northeast Ohio. She is an Associate Professor of Pediatrics at Case Western Reserve University (CWRU).

Dr. McDavid serves on the committee of several national organizations including the Grant Review Committee and Peer Review Group at the U.S. Department of Health and Human Services and the National Advisory Committee of the Robert Wood Johnson Foundation, among others.

About the Survey

This survey was conducted online within the United States by Harris Interactive, with support from Merck & Co., Inc., between June 2-8, 2009 among 424 18+ female parent/legal guardian who have one or more children between the ages of 11 and 18. A full survey methodology is available upon request.

About Merck & Co., Inc.

Merck & Co., Inc. is a global research-driven pharmaceutical company dedicated to putting patients first. Established in 1891, Merck currently discovers, develops, manufactures and markets vaccines and medicines to address unmet medical needs. The Company devotes extensive efforts to increase access to medicines through far-reaching programs that not only donate Merck medicines but help deliver them to the people who need them. Merck also publishes unbiased health information as a not-for-profit service.

Source: Merck & Co., Inc

Article URL: http://www.medicalnewstoday.com/articles/160173.php

Provided by the NIH News in Health

Because it tastes so good, you may assume coffee is bad for you. Maybe you've heard rumors that your morning brew causes everything from heart disease to cancer. But researchers are finding that coffee poses little to no health risk for most people. Not only that, coffee drinking might have some health benefits.

Early research hinted that coffee might have some harmful effects. But most of those studies searched for links between people's habits and their overall health. In such studies, it's hard to know which effects come from coffee and which just show up by coincidence. Heavy coffee drinking sometimes goes hand in hand with unhealthy habits, like smoking and a less active lifestyle.

If you're sensitive to caffeine, Willett says, simply drink less of it. If you have trouble falling asleep at night, make sure to avoid it later in the day.

Caffeine is mildly addictive, so you might get headaches, drowsiness, irritability, nausea and other symptoms if you suddenly cut back. You can avoid these effects, though, by gradually reducing your caffeine intake.

"There's some evidence that high amounts of caffeine during pregnancy may cause problems with the pregnancy," says Dr. Jared Reis of NIH's National Heart, Lung and Blood Institute. That's why doctors recommend that pregnant women cut back on coffee and other caffeinated beverages.

Studies also suggest that caffeine may interfere with calcium absorption. Calcium is an important nutrient for growing and maintaining strong bones. Make sure you get enough calcium in your diet to help reverse this effect.

Overall, says Dr. Rob M. van Dam of Brigham and Women's Hospital and Harvard Medical School, "Caffeine doesn't seem to have the wide array of detrimental health effects we first thought it had."

At one time, many doctors worried that coffee might cause cancer. That's largely because caffeine damages DNA in the test tube, Willett explains, and DNA damage is linked to cancer. However, that doesn't mean that coffee causes cancer in people. Coffee also has high levels of compounds, called antioxidants, that protect DNA.

"Coffee's been looked at in detail in relation to many cancers, and there's really not been any good evidence that any type of cancer is increased by coffee consumption," Willett says. "I think we can say quite confidently that there's no increased risk of cancer with coffee consumption."

Some evidence even suggests that coffee may help reduce the risk of liver cancer, Willett says. NIH's National Cancer Institute is now organizing a new effort to put together data from many studies and look into this question, among many others.

Some doctors thought coffee might cause heart attacks or strokes, because caffeine can raise blood pressure. But Reis says that a cup of coffee won't lead to a dramatic increase in blood pressure for regular coffee drinkers. "In long-term studies, higher levels of caffeine have not led to a higher risk of cardiovascular disease," he says.

Some types of coffee can cause cardiovascular problems for another reason, however. Coffee can contain compounds that lead to a rise in LDL cholesterol. That's the "bad" kind of cholesterol that's been linked to cardiovascular disease.

"A lot depends on the way in which coffee is brewed," Reis explains. "When coffee is brewed with a paper filter, it removes a lot of the components that lead to higher LDL." So it's a good idea to drink filtered coffee to avoid this problem.

Perhaps the strongest research showing a health benefit from coffee relates to type 2 diabetes. In a 2002 study, van Dam's team reported that people drinking 7 or more cups per day had a 50% lower risk of type 2 diabetes than those drinking 2 or less cups. About 20 studies have now looked into the effect in various populations. "The great majority of studies confirm that coffee is associated with a lower risk for type 2 diabetes," van Dam says.

Researchers aren't sure why coffee has this effect, but some compound other than caffeine is responsible. "We did a study of decaffeinated coffee and essentially found the same association as caffeinated coffee," van Dam says.

Another potential benefit from coffee is that it can keep you from drinking less healthy things. "We think that coffee is actually quite a good beverage compared to other beverages," van Dam says. "It can be a reasonable beverage choice if you don't add a lot of cream and sugar."

Coffee can also help your social life, if you meet good friends to talk over coffee. Studies have clearly shown that people who have more social relationships have less stress and live longer. Research also suggests they're less likely to show mental declines as they age.

So go enjoy that cup of coffee. It's not the guilty pleasure you may have thought.

Experts say parents and kids need to act early and vigorously to reduce their risk of contracting the H1N1 virus.

"We do know that [the virus] is going to strike the school-age child and it's primarily because they're in crowded classrooms with lots of other children and have a better chance of spreading germs," said Sharon A. Wilkerson, dean and professor of the Texas A and amp;M Health Science Center College of Nursing in College Station. "Parents need to pay attention earlier and more urgently. We're still seeing cases of swine flu and I think we're going to see an increase with the start of the school year."

"We're giving advice with a new conviction," added Dr. Michael Spigarelli, assistant professor of pediatrics and internal medicine at Cincinnati Children's Hospital Medical Center. "The common perception is that kids are going to get sick and a certain amount of getting sick is how the immune system builds itself up. We're saying that this flu season may be potentially worse."

If soap and water aren't readily available, make sure your child has hand sanitizers in their backpack, along with other school supplies. Washing or sanitizing should take place before every meal and every snack, even if it's just cookies in the classroom. "We've just got to drill that into children," Wilkerson said.

Finally, "if you cough, cough into your arm or use tissues," Beeber stressed.

Children who are sick should be kept home, especially if they're running flu-like symptoms such as high fever, vomiting or diarrhea, Wilkerson said. They should also be kept away from other children. In back-to-school recommendations issued Aug. 7, the CDC advised that schools set aside a room for people developing flu-like symptoms while they wait to go home and that surgical masks be used for ill students or staff and those caring for them.

Any child who has been sick should be fever-free for at least 24 hours (without the aid of medications) before returning to school, Beeber added.

But the CDC guidelines noted that everything could change if the outbreak suddenly turns severe. In those cases, the agency said, some schools may need to be closed, and certain precautions -- for example, spacing school desks farther apart -- might need to be imposed.

Immunization could also be of great help, the experts noted. Children should be vaccinated for the regular, seasonal flu as soon as a vaccine is available, which hopefully will be earlier than the usual October-November time frame.

Trials involving about 2,800 people are also underway for an H1N1 flu vaccine, with officials hoping to have 160 million doses available starting in mid-October. "The vaccine will most likely, at least for children, require two doses separated by about three weeks or more," CDC director Dr. Thomas R. Frieden told reporters last Friday.

"We haven't seen the evidence that it's the most lethal thing we've seen since 1918 [the Spanish flu pandemic]," said Spigarelli. "We haven't seen it get terribly bad in the Southern Hemisphere. We're not seeing elementary schools being wiped out because of the swine flu."

More information

There's more on the H1N1 flu at the U.S. Centers for Disease Control and Prevention.

SOURCES: Stuart E. Beeber, M.D., attending pediatrician, Northern Westchester Hospital, Mt. Kisco, N.Y.; Sharon A. Wilkerson, Ph.D., R.N., dean and professor, Texas A&M Health Science Center College of Nursing, College Station, Texas; Michael Spigarelli, M.D., Ph.D., assistant professor, pediatrics and internal medicine, Cincinnati Children's Hospital Medical Center; Aug. 7, 2009, news telebriefing, with Thomas R. Frieden, M.D., director, U.S. Centers for Disease Control and Prevention

Copyright © 2009 ScoutNews, LLC. All rights reserved.

'Explosion' of Swine Flu Cases Predicted

BEIJING (Aug. 21) — The global spread of swine flu will endanger more lives as it speeds up in the coming months and governments must boost preparations for a swift response to a coming "explosion" of cases, the World Health Organization said Friday.

Many countries could see swine flu cases double every three to four days for several months until peak transmission is reached, once cold weather returns to the northern hemisphere, said WHO's Western Pacific director, Shin Young-soo.

The WHO says the swine flu virus — also known as H1N1 — has killed almost 1,800 people worldwide, and has declared a pandemic.

International attention has focused on how the pandemic is progressing in southern hemisphere countries such as Australia where winter — and the flu season — has started.

WHO earlier estimated that as many as 2 billion people could become infected over the next two years — nearly one-third of the world's population.

Others said Shin's cautionary comments were needed but that they were optimistic the spread would not be that serious.

Ann Moen, an influenza expert with the U.S. Centers for Disease Control and Prevention, said that if current trends continue it is possible that the swine flu pandemic will not be worse than a severe flu season.

"I think the world was preparing for an H5N1 (bird flu) pandemic and we didn't get that. So maybe this is our supreme tabletop exercise, a global sort of practice for something bigger," Moen told The Associated Press.

Health officials and drug makers are considering how to speed up production of a vaccine before the northern hemisphere enters its flu season in coming months. Estimates for when a vaccine will be available range from September to December.

"Developing countries like us, we have to fight this war without vaccines," said Mya Oo, deputy health minister of Myanmar. He urged pharmaceutical companies to consider selling the vaccines to developing countries at just above cost.

"Among the many pandemic response issues, this is probably the most critical issue: how we mobilize the vaccines, how we get them to developing countries," Fukuda said.

WHO has stressed that most cases of swine flu are mild and require no treatment, but the fear is that a rash of new infections could overwhelm hospitals and health authorities, especially in poorer countries.

"We only have a short time period to reach the state of preparedness deemed necessary," Shin said. "Communities must be aware before a pandemic strikes as to what they can do to reduce the spread of the virus, and how to obtain early treatment of severe cases."

The last pandemic — the Hong Kong flu of 1968 — killed about 1 million people. Ordinary flu kills about 250,000 to 500,000 people each year.

Swine flu is also continuing to spread during summer in the northern hemisphere. Normally, flu viruses disappear with warm weather, but swine flu is proving to be resilient.

Copyright 2009 The Associated Press.   

Surgical Scrub Solution: It's Good For Patients, Too

05 Sep 2009    

Giving critically ill hospital patients a daily bath with a mild, soapy solution of the same antibacterial agent used by surgeons to "scrub in" before an operation can dramatically cut down, by as much as 73 percent, the number of patients who develop potentially deadly bloodstream infections, according to a new study by patient safety experts at The Johns Hopkins Hospital and five other institutions.

Bloodstream infections, they say, strike as many as one in five patients in hospital intensive care units and up their chances of dying by as much 25 percent. Even when they are not fatal, such infections have been reported to lengthen hospital stays by an average of a full week and add as much as $40,000 in costs.

The new study, described this summer in the June issue of the journal Critical Care Medicine, tracked daily neck-to-toe sponge baths with a mild, 4 percent solution of chlorhexidine glutonate, given to 2,650 ICU patients at six different U.S. hospitals. Chlorhexidine glutonate is the same antibacterial agent used by surgeons while scrubbing in for an operation and by dentists as a potent mouthwash to guard against gum disease. Weekly swab testing found 32 percent fewer patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) and 50 percent fewer cases of vancomycin-resistant Enterococci (VRE), when compared to a similar number of ICU patients (2,670) at the same hospitals who were washed with just plain soap and water. MRSA and VRE are the two most common so-called hospital superbugs.

"Doing everything possible to ward of bloodstream infections and halt the spread of these dangerous bacteria is essential to safeguarding our patients' well-being, encouraging their speedy recovery and sparing valuable hospital resources," says study co-investigator Trish Perl, M.D., director of hospital epidemiology and infection control at Johns Hopkins.

"It's just as important to find the right soap to prevent infection as it is to find the right drug to treat patients who develop an infection," says Perl, a professor of medicine and pathology at the Johns Hopkins University School of Medicine.

"Our results show that using chlorhexidine [glutonate] as a daily washing agent is a simple, effective and relatively cheap way to protect the health of our most vulnerable patients," she adds, noting that various products cost very little. A 320-ounce bottle of the scrub solution costs as little as $6 a bottle, while 15 milliliter packets cost 33 cents each. It is also available as either a solid reddish-colored bar or an even milder baby-wipe type cloth containing a 2 percent chlorhexidine glutonate solution (at a cost of $2.57 for a pack of two.)

Perl says the goal is to "actively remove" bacteria that may be harmful to the patient or other patients in the hospital, people at greater risk of infection because of a weakened immune system or from use of medical devices that may offer a route for bacteria to enter the body.

"Because these bacteria have built up resistance to many of the most common antibiotic drugs used to kill them, our goal is to stop them from infecting patients or from spreading from patient to patient, as we are left with few options for treatment after they colonize and then infect a patient," says Perl, who points out that the chemical's antibacterial effects can last from six to 48 hours, depending on the strength of the solution.

"And altering the daily bathing routine is a simple and effective means of doing so because it involves no additional workload for nurses," she says.

The study showed no skin rashes or adverse events during the test period, between December 2004 and January 2006. Each critically ill patient was tested for infectious bacteria within 48 hours of admission and then weekly thereafter with either nasal or buttock swabs, and for the remainder of their hospital stay.

Among some 500 patients whose stay in hospital was long (at least 10 days), 11 who were washed with chlorhexidine had MRSA and five developed bloodstream infections. By contrast, MRSA was detected in 27 of a similar group who were bathed with plain soap, with eight developing bloodstream infections. Similarly, with VRE, nine patients in the chlorhexidine group had bloodstream infections, while 33 were infected in the plain-soap group.

As part of routine hospital procedures, any patients found to be infected or to be a carrier before infection has set in are placed in isolation for the remainder of their stay. Wound care is done only in designated, confined treatment spaces or separate rooms, and hospital staff must take special precautions between treatments, such as cleaning equipment and furniture with strong disinfectants and wearing disposable gloves, masks and gowns.

Perl says chlorhexidine has been in use since the 1950s, but its practical value had "not been appreciated" until now, citing the chemical's occasional use as a treatment for recurrent pimples as the main reason why the multicenter research team conducted the latest study.

"Our research is particularly important for preventing MRSA and other drug-resistant infections in children," she adds. Her team's previous research in 2007 showed that children admitted to Hopkins are increasingly identified as harboring MRSA or VRE, with four times as many children admitted to the pediatric ICU with MRSA and twice as many with VRE than five years ago.

In 2006, the Joint Commission estimated that 70 percent of the bacteria that cause infections for 2 million hospitalized Americans each year are resistant to at least one of the drugs most commonly used to treat them.

Perl's only caution is the need for long-term monitoring to make sure that hampering the growth of one kind of bacteria -- both S. aureus and Enterococci or so-called gram-positive bacteria -- does not promote the growth of other kinds, specifically, gram-negative bacteria.

Funding for the study was provided by the U.S. Centers for Disease Control and Prevention (CDC). Besides Perl, another Hopkins researcher involved in this survey was Kathleen Speck. Investigators elsewhere included lead investigator Michael Climo, M.D., Jaime Robles, Ph.D., and Edward Wong, M.D., all at the Commonwealth University Medical Center, in Richmond, Va., with Climo and Wong also based at the Hunter Holmes McGuire Veteran Affairs Medical Center, also in Richmond; Kent Sepkowitz, M.D., and Gianna Zuccotti, M.P.H., at Memorial Sloan-Kettering Cancer Center in New York; Victoria Fraser, M.D., and David Warren, M.D., at Washington University School of Medicine in St. Louis, Mo.; and John Jernigan, M.D., at the CDC.

Source: Johns Hopkins Medicine

Day Care Centers Urged To Be Vigilant Against Flu

By LAURAN NEERGAARD, AP Medical Writer Lauran Neergaard, Ap Medical Writer

Fri Sep 4 , 2009

WASHINGTON – Will you start seeing thermometers at day care centers? The government is urging the nation's 360,000 child care providers to be vigilant about sending home children who may have the flu — and the main symptom to check for is a fever.

The Centers for Disease Control and Prevention issued guidelines Friday for day care programs that echo the advice for schools: Kids need vaccine — against both regular flu and the new swine flu — and they should stay home when they're sick. Don't return until 24 hours after a fever naturally subsides.

"If your child comes down with the flu, we hope you plan to keep them home and not share this with their playmates," Health and Human Services Secretary Kathleen Sebelius said.

The guidelines urge day care providers to do a quick health check every day, looking for children with flu-like symptoms or other signs that they might be getting ill, such as not playing normally. Centers should separate the sick child from others until he or she can be taken home.

"There are many, many different kinds of respiratory illnesses that children get, and we don't want to be sending children home unnecessarily," said Dr. Beth Bell, a CDC epidemiologist.

So checking for a fever is what Bell called a "reasonable indicator" of flu, either the regular winter strains or the swine flu that scientists call the 2009 H1N1 flu.

While not everyone with swine flu has a fever, the CDC has said such cases are rare.

Regular winter flu kills 80 to 100 U.S. youngsters every year, so children are supposed to get vaccinated against it each fall. But swine flu is putting new emphasis on flu and kids: At least 40 children have died of it since spring, accounting for about one in 13 U.S. swine flu deaths, the CDC said this week — and it spreads very easily among children.

One puzzle: While regular winter flu is most dangerous to children 4 and under, most children who have died of swine flu so far are age 5 to 17. It's possible that that's because school-age children are the group most infected so far, but scientists aren't sure.

Regardless, children of all ages are supposed to be among the first in line to get swine flu vaccine when it arrives in mid-October.

Vaccine against both types is a good idea for day care workers, too, Sebelius said. It could mean the difference between a center staying open or having to close because of absent staff. Any child care workers that care for infants, or who themselves have high-risk conditions, will be among priority groups for swine flu vaccine.

Meanwhile, day care centers also should stress commonsense flu-fighters: Wash hands often, and teach children to cough and sneeze into their elbow, not the hand they'll immediately stick onto a toy or a neighbor. A key way that flu spreads is for someone to touch a germy surface and then touch their nose mouth.

Nine months after taking office, President Obama outlined his plan for overhauling the nation's health care system in a speech before Congress on Wednesday. It was long overdue.

Sixty-seven percent of respondents to a CBS News poll released last week said they didn't have a clear understanding of health care reform ideas because they found them too confusing. One of the reasons Americans are so puzzled is that President Obama hasn't done a good job explaining why we need reform or how his strategy will help fix the problem. His message got lost in translation.

Meanwhile, opponents have spelled out succinctly and effectively the failings of the Democrats' proposed plan -- and they've thrown in a few fabrications to boot. By using misleading words and phrases like "rationing," "government takeover" and "socialized medicine," and some truly ludicrous ones like "death panels" and "killing grandma," opponents of the president's plan have convinced many Americans that the health care reforms under consideration are indefensible. As New York Times columnist Charles Blow put it, "Conservatives speak in bumper stickers. Obama speaks in thesis statements."

That changed on Wednesday night when the president finally addressed critics head on, countering fallacies with facts. He spoke clearly, plainly and with authority about what's wrong with our nation's health care system and what needs to be done to fix it, and he defined the broad goals of his plan. "It will provide more security to those who have health insurance," he said. "It will provide insurance to those who don't, and it will slow the growth of health care costs for our families, our businesses and our government."

Some of this is quite complicated, and the president put it in the simplest terms possible. He probably didn't change many Republican congressmen's minds, but he may have gotten the attention of some citizens on the fence and those who were not sure what to think, in part by acknowledging valid ideas put forth by Republican lawmakers.

As a physician, I am particularly encouraged by the possibility that medical malpractice reform might be included in the legislation, since this has been sorely missing from the debate.

At the same time, the president stuck to his core message that we need to provide quality health care to all Americans. He said that one in three Americans have gone without health insurance at some time in the past two years. That seems about right based on anecdotal evidence in my practice. But the president pointed out that reforms are also necessary for the people with insurance. "Those who do have insurance have never had less security than they do today," he said.

It's now incredibly common to see patients who have either lost their jobs or are about to -- and they risk losing their health insurance as well. All President Obama or any politician needs to do is spend one week in my office or that of any doctor in America to see first hand how inefficient and unfair the health insurance industry is, and how frustrated both doctors and patients are as a result.

I saw a patient this week who was about to pay $1,500 out of pocket for a battery of lab tests (a Pap test, HPV test, STD screening and a cholesterol test) because her insurance company denied coverage. The first few tests are routine screenings for cervical cancer and the cholesterol test is obviously a preventive screening tool. The patient said she couldn't afford to have a colposcopy, a diagnostic test for cervical cancer even though the procedure was clearly necessary in her case. Fortunately, after the patient and my office staff spent two hours on the phone, the insurance company reprocessed the first panel of tests and covered them. Let me point out that the patient was a bright, educated woman; those without her persistence might not know to push back and challenge a denial of care.

I witness manipulative tactics like this by insurance companies every day that make it difficult for patients to navigate the system and get the quality care they're entitled to. The question is: Have enough Americans had similar experiences that the president's speech will serve as a wake up call to take action? Maybe Obama's simple yet stirring speech will inspire people to support the efforts to fix this problem, rather than let politics derail it.

Did he leave out details? Yes, there are still a lot of specifics to be worked out, which is why laughter erupted in the chamber when President Obama said, "There remain some significant details to be ironed out." But that's where Congress steps in to consider the various options and ideas, and to find compromise in order to close the deal.

So much of what has and will be written about the president's speech is partisan: The focus is on whether Obama will regain popularity in the polls and reinvigorate a faltering presidency or if Republicans will succeed in killing health care reform once again. From my perspective, this is not a chance to win a political victory. This is about finally being within reach of a health care system that works -- for everyone.

Russell Turk, M.D., is an obstetrician and gynecologist in Fairfield County, Connecticut.

Patients With Medical Homes Receive Better Primary Care At No More Cost

02 Sep 2009    

A one-year evaluation at Group Health Cooperative is the first to demonstrate the measurable benefit to both patients and staff when a primary care practice adopts a "patient-centered medical home" model. This model gives patients more time with doctors, more preventive care, and improved collaboration among caregivers. The September 2009 American Journal of Managed Care will publish the results - which include significantly fewer emergency room visits and hospitalizations.

Much national attention is focused on the medical home model as a way to improve health outcomes, control costs, and help solve the U.S. shortage of primary care (from generalists). A medical home provides expanded primary care that is personalized, focuses on prevention, actively involves patients in making decisions about their care, and helps coordinate all their care and get their health needs met.

The new study provides some of the nation's first empirical evidence of the benefits of this new type of care. It compared a random sample of the 9,200 patients at Group Health's medical home to a control group. At one year, patients at the medical home:

• Had 29 percent fewer emergency room visits, 11 percent fewer hospitalizations that primary care can prevent, and 6 percent fewer in-person visits
• Reported higher ratings on six scales of patient experience
• Used 94 percent more e-mail, 12 percent more phone, and more group visits and self-management support workshops Received better health care, including needed screening tests, management of their chronic illnesses, and monitoring of their medications

"A medical home is like an old-style family doctor's office, but with a whole team of professionals," explained evaluation leader Robert J. Reid, MD, PhD, an associate investigator at Group Health Center for Health Studies and Group Health's associate medical director for preventive care. "Together, they make the most of modern knowledge and technology - including e-mail and electronic medical records - to give patients excellent care and reach out to help them stay healthy."

Now 25 medical home projects are active in 17 states. Still, to date, much enthusiasm for the medical home has been based on qualitative observation. This evaluation provides more quantitative evidence.

Only 10 percent of the medical home doctors, nurses, and staff felt "burned out" or emotionally exhausted, vs. 30 percent of controls. Reducing burnout is key to improving health care. "Many primary care providers work so hard, they feel like they're on a hamster wheel," Dr. Reid said. They often also earn much less than specialists, particularly outside such systems as Group Health, which pay doctors a salary to care for a group of patients, not "fee for service" (more money for more tests and treatments). The shortage of U.S. primary care providers is a crisis, he added. Most U.S. medical students choose to specialize, and primary care physicians retire earlier than specialists do.

Group Health put much thought - and resources - into improving primary care in the medical home pilot. Each primary care doctor (family physician or general internist) was responsible for fewer patients: 1,800 instead of 2,300. That left time for outreach, coordination, daily "team huddles," and longer office visits: 30 vs. 20 minutes. But it also meant investing $16 more per patient over the year in extra staffing: for 72 percent more clinical pharmacists, 44 percent more physician assistants, 18 percent more medical assistants, 17 percent more registered nurses, and 15 percent more primary doctors. On average, patients at the medical home used $37 more specialty care, perhaps because the enhanced primary care detected previously hidden health problems.

"Our evaluation showed these costs were recouped within the year," Dr. Reid said. The main reason was emergency room savings of $54 per patient in the course of the year. "These findings are important because they provide a 'proof-of-concept' that investments in a medical home can achieve relatively rapid returns across a range of key outcomes." Impressed by the return on investment, Group Health is expanding the medical home model from its Factoria medical center in Bellevue, WA, to all 26 of its medical centers.

"Patients fortunate enough to have health care centered on their needs and delivered by Group Health have already seen the future," said Paul Grundy, MD, MPH, president of the Patient Centered Primary Care Collaborative. "This work is a new model that can help address our nation's need for better access to primary care."

Group Health Cooperative funded the medical home pilot and evaluation. Dr. Reid's co-authors are Paul Fishman, PhD; Onchee Yu, MS; Tyler R. Ross, MA; James T. Tufano, MHA, PhD; Michael P. Soman, MD, MPH; and Eric B. Larson, MD, MPH.

Source:  Rebecca Hughes
Group Health Cooperative Center for Health Studies

Nasal Spray Flu Vaccine Becoming Available

By LAURAN NEERGAARD

October 3, 2009

AP

WASHINGTON -The long-awaited first vaccinations against swine flu — the squirt-in-the-nose kind — begin early next week in parts of the country, and states are urging people to be patient until more arrives.

Just a trickle of vaccine, 600,000 doses of the nasal spray FluMist, will be divided among 21 states and four large cities by Tuesday, with more small shipments to more states later in the week.

"We're moving this out as quickly as we can," said Oregon's public health director, Dr. Mel Kohn, who hopes shipments arrive in time to begin some vaccinations on Monday. "This doesn't do any good sitting in a warehouse."

Most states are aiming their first small batches at health care workers, hoping to keep them well enough to be on the job as cases of swine flu — what doctors prefer to call the 2009 H1N1 strain — are rapidly increasing nationwide.

In Chicago, firefighters will share first doses with hospitals, to get some emergency responders protected, too.

And Pennsylvania will target its initial 58,000 FluMist doses mostly to 5- to 9-year-olds in parts of the state where H1N1 is most active. It's the school-age kids who are getting infected most, said Pennsylvania's acting physician general, Dr. Stephen Ostroff, and the under-10 crowd is going to need two doses of swine flu vaccine.

Stay tuned: How much vaccine is available and for whom is going to change week by week.

"This is really just the beginning," said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention. "We need a little bit of patience the first couple of weeks."

Indeed, some states were surprised that the first shipments were FluMist, which is only for healthy people ages 2 to 49, which leaves out some of the groups at high risk for H1N1 flu.

The more common flu shot will be close behind, part of the 6 million to 7 million doses of vaccine the CDC expects to ship around the country by the end of next week.

Far larger batches — about 40 million doses — start shipping the second week of October. That's when states expect enough of both shots and FluMist to start heavily targeting the high-risk groups: pregnant women, children and young adults from 6 months to 24 years, the young and middle-aged who have flu-risky conditions like asthma or diabetes, and caregivers of infants.

Hospitals in Pinellas County, Fla., plan to give new parents a special reminder. On the newborn checklist — infant car seat, going-home outfit — comes a plea to get themselves vaccinated before discharge. Because newborns can't be vaccinated, "the only way to protect your baby is for Mom, Dad and the family to receive the vaccine," the flyer says.

By the end of October, Arizona expects 1 million doses on hand, enough for schools to start onsite vaccination programs, said Health Services Director Will Humble.

What about everybody else? Massachusetts officials are warning that people who aren't at high risk from swine flu may have to wait until November for an H1N1 shot.

In other states, officials are more optimistic. Milwaukee has earmarked its first shipment for health workers and its second for schoolchildren, kindergarten through high school.

Then by late October, "we should be able to open it up to anyone who wants it," said Milwaukee's disease-control chief, Paul Biedrzycki. "We're expecting two to three times the demand for seasonal flu vaccines."

This year brings an unusually complex vaccination schedule: Most people will need two different inoculations, one against regular winter flu and the H1N1 vaccine. Plus, children under 10 will need two H1N1 doses.

The federal government bought the nation's entire supply of H1N1 vaccine and is dividing doses as they arrive among states according to population. State health departments submit orders, and doses are shipped to the vaccination sites the states deemed able to quickly get shots into arms and squirts up noses — a mix of doctors' offices, hospitals, drugstores and public clinics. CDC in turn will track those shipments to see how fast vaccine is used, and for whom, to ensure the populations at highest risk are vaccinated.

Associated Press writers Carla Johnson in Chicago, Marc Levy in Harrisburg, Pa., Christine Armario in Tampa, Fla., Bob Christie in Phoenix, Dinesh Ramde in Milwaukee, Tim Fought in Portland, Ore., Dan Joling in Anchorage, Alaska, and Steve LeBlanc in Boston contributed to this report.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

2009-10-02 20:27:02

10/16/2009

It's a scary vaccination situation

By: Jeffery Kurz

Every year, the flu season and the task of vaccinating the most vulnerable can get complicated, but for a lot of health care workers, nothing compares to this year.

"We've had difficult years, but this is obviously the worst," Mary Lenzini told me.

She should know. Lenzini is president of the Visiting Nurse Association of Southeastern Connecticut, which covers along the shoreline and in, from Old Saybrook to Rhode Island.

Lenzini's organization ordered 5,000 doses of the seasonal flu vaccine, but received just 810, and as a result has canceled all of the flu clinics planned for this season.

That leaves a lot of people, many of them the senior citizens who need it the most, in a position of having to scramble to find the vaccine.

Visiting nurse associations, or VNAs, as they're typically called, have traditionally been the source of seasonal flu vaccines, in many cases because they have a long tradition of serving the elderly. Providing flu vaccines is also a way of bolstering finances.

According to the Department of Health and Human Services, in an average year 226,000 Americans are hospitalized because of seasonal influenza and about 36,000 die from it. Most of those who die from it are el-derly.

So, as if it needs to be said, the shortage of the seasonal flu vaccine, or even a delay in its availability, is for many a serious issue.

What's complicating the situation this year is preparation for the H1N1 influenza virus. The nation's manufac-turers were under pressure to provide millions of doses of the vaccine for H1N1, also called the swine flu. In part because of that pressure, the distribution of the seasonal flu vaccine has been cut back, or delayed, in many parts of the country, including Connecticut.

There's no getting around the impression that H1N1 is scary, and the public attention being drawn to this new strain of flu, and much media hype, has likely led to more interest in getting a vaccine for the seasonal flu, as well.

Despite the attention, or maybe even because of it, there remains confusion about the flu situation this year, and part of that is because the swine flu is a moving target. Nobody can really tell how severe it will get.

There are a couple of reasons why the H1N1 virus is at least a little scary. One is that it is pandemic, which simply means that it has spread to many countries.

Another is that it is a new strain of virus, which makes it much different from seasonal flu viruses. Seasonal vi-ruses are related, so if you've had the flu in the past, your body has built up some immunity. Bodies have no such preparation when it comes to H1N1.

There are two types of vaccines targeted for the 2009 H1N1 influenza; neither will do any good when it comes to preventing seasonal flu viruses.

The nasal spray vaccine, the one mostly available at the moment, is also referred to as live, attenuated, which means it is weakened to not cause illness. The nasal spray is licensed for people from 2 to through 49 years old.

The H1N1 flu shot is inactivated vaccines, which means it contains killed virus. The flu shot has preservatives, including thimerosal, which some have suspected of being linked to autism, though studies and reviews of studies have shown that's not the case.

Because the seasonal flu season can last from November to May, it's probably a good idea to get the seasonal flu vaccine even if it's as late as December, or even later.

Let's hope that in the effort to combat a scary new virus, the situation with the one we're familiar with hasn't been made worse.

©www.MyRecordJournal.com 2009

Pomegranate juice has been touted by health experts for its myriad of health benefits. A single glass of pomegranate juice constitutes nearly forty percent of the US RDA or recommended daily allowance of Vitamin C. It additionally has an influx of Vitamin A, E and folic acid. Pomegranate juice is rich in antioxidants, even surpassing the antioxidant content present in purple grape juice, cranberry, blueberry, orange, red wine or green or black tea by three folds.

Numerous studies have revealed the major benefits to health from consuming pomegranate juice. Below stated are the twelve ways in which it is a boon to our health.

Reduces Incidence of Breast Cancer and Skin Cancer
Research carried out in Israel reveal that pomegranate juice aids in obliterating breast cancer cells, while sparing healthy tissues. It could additionally prevent the malignant cells from developing.

Inhibitor of Lung Cancer
Studies conducted on mice have proved pomegranate juice could hinder lung cancer development.

Dawdles the spread of Prostate Cancer
It has been proven in mice to slacken the spread of prostate cancer and lower the risks of prostate cancer.

‘As good as’ Viagra
Pomegranate juice is the solution for those men that desire to bolster their act in bed. A glass of pomegranate juice is has been vouched to have analogous effects to that of a dose of Viagra. Studies suggest that its antioxidant rich nature raises the circulation of blood to the genital region. Almost half populace of men in the study felt that drinking pomegranate juice help them easily perform.

Stabiliser of PSA Levels
During a research conducted on fifty men having prostate cancer that underwent treatment, it was found that daily intake of eight ounces of pomegranate juice had a stabilising effect on the PSA levels, thus lowering the requirement for additional treatments like chemotherapy or hormone therapy.

Safeguards Neonatal Brain functioning
Research revealed that those expectant mothers who consumed pomegranate juice might be offering protection to the neonatal brain from harm subsequent to injury.

Helps prevent Osteoarthritis
Numerous studies reveal that cartilage deterioration could be averted by the regular intake of pomegranate juice. Pomegranate juice has a tendency to have an inhibiting action on the enzymes that cause cartilage damage.

Combats atherosclerosis
It helps to fight against the build up of plaque in the arteries that occurs due to atherosclerosis leading to lowered flow of blood raising chances of strokes and heart attacks. The juice could even annul earlier plaque that had developed. The studies reveal that pomegranate juice lowered the effects of stress and strain on blood vessel cells in the human body by eliciting the manufacture of nitric oxide which is the chemical believed to aid in maintaining optimal blood flow and keeping the arteries open.

Postpones the onset of Alzheimer’s Disease
A study conducted where in mice were reared to develop Alzheimer’s disease were offered pomegranate juice. These rats had perceivably lower accumulation of amyloid plaque and also exhibited better cognitive performance as compared to the control mice.

Lowering Bad Cholesterol levels
It is known to deplete the levels of bad cholesterol (LDL) and raise good cholesterol levels (HDL). It has also been shown to have blood thinning properties.

Reduces Blood Pressure Levels
A study revealed that daily consumption of 1.7 ounces of pomegranate juice helped in lowering the systolic blood pressure by nearly five percent.

Prevents Dental Plaque
Studies reveal that drinking pomegranate juice might be an innate means to averting dental plaque.

Disability Plan Could Be Another Roadblock To Health Reform Bill
12 Nov 2009  

The Washington Times reports that an "insurance plan championed by Sen. Edward M. Kennedy that would help elderly or disabled people avoid nursing homes ironically adds yet another sticking point to the comprehensive health care reform plans" in Congress.

Moderate Democrats and Republicans worry the Community Living Services and Support Act will increase the deficit and make the federal government responsible for another insurance program. "Under the proposal in the House-passed version of the overhaul, the CLASS Act fund would collect monthly premiums, estimated to be $65 in 2011, from the wages of all working Americans, unless they elect to opt out - a technique used to help drive participation. Once they pay premiums for five years, participants would be eligible for cash benefits to help them buy in-home care, if they can no longer care for themselves." Several senators have expressed concerns that purported savings on the plan don't start until 2016 and that benefits paid will outweigh premiums gathered  (Haberkorn, 11/11).

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

November 2009

No Quick Fix In the National Debate over Health Reform, Massachusetts Is Ahead of the Game
BY JOSEPH BEDNAR

As debate rages in Washington over the size, scope, and details of national health care reform, no one can say with any certainty what shape a final bill will take.

Supporters of government intervention in health care say the U.S. has an obligation to ensure that its people have access to basic medical services, while opponents point to the massive cost of a proposed new entitlement at a time of already-soaring federal debt.

But here in the Bay State, the recent law mandating health insurance for most residents and progress toward significant changes in the way hospitals and doctors are paid position the state on the cutting edge of the debate — and those developments, some predict, will make the transition to national health reform easier for Massachusetts than for other states.

“That’s what we’re hoping,” said Daniel Keenan, senior vice president of Government Relations at Mercy Medical Center. “From a policy perspective, it feels like we have resolved the access issue, and there’s a lot of discu

Is Your Home's Air Unhealthy? Try Plants. Plants Can Remove Harmful Indoor Airborne Contaminants, Study Says
By Bill Hendrick
WebMD Health News
Reviewed by Louise Chang, MD
Dec. 4, 2009 -- Certain plants can remove dangerous airborne contaminants commonly found in homes, new research suggests.

The contaminants plants can remove from the air include harmful volatile organic compounds such as benzene, toluene, octane, alpha-pinene, and trichloroethylene (TCE), the researchers say in a study published in the August issue of HortScience.

Of 28 indoor plants tested, Stanley Kays, PhD, of the University of Georgia and his horticultural team identified five “super ornamentals” that had the highest rates of contaminant removal, a process called phytoremediation.

These are the red ivy (Hemigraphis alternata), English ivy (Hedera helix), variegated wax plant (Hoya cornosa), asparagus fern (Asparagus densiflorus), and the purple heart (Tradescantia pallida), the study says.
The scientists placed the plants in glass, gas-tight containers, exposing them to common volatile organic compounds found indoors. And the plants did a good job of removing the airborne contaminants.
Researchers say there may be thousands of plants capable of removing airborne contaminants.

Volatile organic compounds are likely wafting about in every house, Kays tells WebMD. They’re given off by home furnishings, carpets, plastics, cleaning products, building materials such as drywall, paint, solvents, adhesives, and even tap water, Kays says.

The pollutants have been linked to many illnesses, including asthma, cancer, and reproductive and neurological disorders, and claim 1.6 million lives a year, he says, attributing that number to the World Health Organization.

Air inside homes and offices is often a concentrated source of such pollutants, in some cases up to 100 times more polluted than outdoor air, Kays tells WebMD.
No one yet knows why some plants are effective at remediation, but he and other scientists are digging for answers.

“We also want to determine the species and number of plants needed in a house or office to neutralize problem contaminants,” he says in a news release. “The idea that plants take up volatile compounds isn’t as much of a surprise as the poor air quality we measured inside some of the homes we tested.”

There is no affordable way for average consumers to determine the air quality of their homes, Kays says.
He tells WebMD that not all volatile organic compounds are toxic, and that some plants emit toxins, too. But placing some common ornamentals indoors has the potential to improve air quality, he says.

“In reality, you are much more in danger from these compounds inside than outside,” he tells WebMD. “All houses have these compounds. Even computers give them off. It would be advantageous then to have a few plants in your house. They also keep humidity at fairly constant levels.”

But there is no magic list on the horizon, he says.

“You might have some plants that are good with benzenes but not with formaldehyde, which comes from upholstery, carpet, a lot of sources,” he tells WebMD.

Hopefully, he says, in a few years there will be an affordable test that can alert people to the contaminants in their homes, and a list of the best plants to help clean the air.

“Ideally, we’d have an extension service that would send out a packet that would do the test for you to send back and get recommendations,” he tells WebMD.

He says scientists in Korea are “substantially ahead of us in phytoremediation research,” and one with whom he is collaborating, Kwang Jin Kim, PhD, of the National Horticultural Institute in Seoul, has evaluated the ability of 86 species to remove indoor formaldehyde.

Poor Outcomes Reported For CCI Patients Leaving Hospitals On Ventilators
By Susan Griffith
Case Western Reserve University
Dec. 5, 2009  

Patients, discharged from hospitals on ventilator support and with cognitive impairments, fare poorly four months later. Researchers from the Frances Payne Bolton School of Nursing at Case Western Reserve University report these findings in American Journal of Critical Care.

"Survival alone is not the only important outcome for patients," says Barbara Daly, the lead researcher on the National Institutes of Health-funded study, "Composite Outcomes of Chronically Critically Ill Patients 4 Months after Hospital Discharge."

She adds that having a better quality of life by living at home, breathing free from the ventilator and having normal cognitive function are also important factors constituting a positive outcome in the aftermath of a hospital stay.

The researchers studied chronically critically ill (CCI) patients, who are those who have survived a life-threatening illness but remain dependent on the high-technology services of a critical care unit. These patients had stays of longer than one week in the intensive care unit and spent more than three days on ventilator support.

Following 257 patients at two and four months after their hospital stays, researchers found that 112 (43.6%) had what they categorized as "better" outcomes (living at home, able to breathe independently, with normal cognitive functioning). The 159 patients who were functioning without any cognitive impairment at the time of hospital discharge had better outcomes, with 111 (69.8%) breathing without the ventilator at home by 4 months.

But the results for the 39 patients who required ventilator support at discharge were less encouraging; only one patient had achieved a "better" outcome. Of the study's 98 patients who had cognitive impairments at discharge, 29 (30%) recovered for a better outcome. A worse outcome is considered losing cognitive functioning, breathing on ventilator and living in a care facility.

Little has been known about what happens after CCI patients leave the hospital, says Daly, the nursing school's Gertrude Perkins Olivia Professor of Oncology Nursing and clinical ethics director at University Hospitals Case Medical Center.

"We believe that knowledge of exactly how rare 'better' outcomes are for those patients who are cognitively impaired and ventilator dependent at discharge is important information for ICU clinicians who are counseling families about treatment decisions," write the researchers.

In a past survey about ICU communications, family members raised concerns about not being informed about the long-term consequences of their family member's illness.

Helping doctors and nurses with information about the quality of life following the discharge, can help the medical professionals in care planning and informing family members about outcomes in the months to come.

Other contributors to the study are Associate Professors Sara Douglas and Patricia Higgins and Assistant Professor Carol Kelly and Professors Nahida H. Gordon, Elizabeth O'Toole and Hugo Montenegro from Case Western Reserve University.

A Comparison Of House, Senate Health Care Bills

12/26/2009

By RICARDO ALONSO-ZALDIVAR and ERICA WERNERAP

The Senate Democratic bill (Patient Protection and Affordable Care Act):

WHO'S COVERED: About 94 percent of legal residents under age 65 — compared with 83 percent now. Government subsidies to help buy coverage start in 2014. Of the remaining 24 million people under age 65 left uninsured, about one-third would be illegal immigrants.

COST: Coverage provisions cost $871 billion over 10 years.

HOW IT'S PAID FOR: Fees on insurance companies, drugmakers, medical device manufacturers. Medicare payroll tax increased to 2.35 percent on income over $200,000 a year for individuals, $250,000 for couples. A 10 percent sales tax on tanning salons, to be paid by the person soaking up the rays. Cuts to Medicare and Medicaid. Forty percent excise tax on insurance companies, keyed to premiums paid on health care plans costing more than $8,500 annually for individuals and $23,000 for families. Fees for employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.

REQUIREMENTS FOR INDIVIDUALS: Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those who are obligated to buy coverage and refuse to do so would pay a fine starting at $95 in 2014 and rising to $750.

REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but companies with more than 50 employees would pay a fee of $750 per employee if the government ends up subsidizing employees' coverage.

SUBSIDIES: Tax credits for individuals and families likely making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.

BENEFITS PACKAGE: All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage. The least generous would pay an estimated 60 percent of health care costs per year; the most generous would cover an estimated 90 percent.

INSURANCE INDUSTRY RESTRICTIONS: Starting in 2014: no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size. Starting upon enactment of legislation: children up to age 26 can stay on parents insurance; no lifetime limits on coverage.

GOVERNMENT-RUN PLAN: In place of a government-run insurance option, the estimated 26 million Americans purchasing coverage through new insurance exchanges would have the option of signing up for national plans overseen by the same office that manages health coverage for federal employees and members of Congress. Those plans would be privately owned, but one of them would have to be operated on a nonprofit basis, as many Blue Cross Blue Shield plans are now.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools. Would generally encourage employees to keep work-provided coverage.

DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Drug companies contribute $80 billion over 10 years with the majority of the money used to limit the prescription coverage gap in Medicare.

CHANGES TO MEDICAID: Income eligibility levels likely to be standardized to 133 percent of poverty — $29,327 a year for a family of four — for parents, children and pregnant women. Federal government would pick up the full cost of the expansion during the first three years. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.

LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.

ANTITRUST: Maintains the health insurance industry's decades-old antitrust exemption.

ILLEGAL IMMIGRANTS: Would be barred from receiving government subsidies or using their own money to buy coverage offered by private companies in the exchanges.

ABORTION: The bill tries to maintain a strict separation between taxpayer funds and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for the procedure. In plans that do cover abortion, beneficiaries would have to pay for it separately, and those funds would have to be kept in a separate account from taxpayer money. Moreover, individual states would be able to prohibit abortion coverage in plans offered through the exchange, after passing specific legislation to that effect. Exceptions would be made for cases of rape, incest and danger to the life of the mother.

—

The House bill (Affordable Health Care for America Act):

WHO'S COVERED: About 96 percent of legal residents under age 65 — compared with 83 percent now. Government subsidies to help buy coverage start in 2013. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.

COST: The Congressional Budget Office says the bill's cost of expanding insurance coverage over 10 years is $1.055 trillion. The net cost is $894 billion, factoring in penalties on individuals and employers who don't comply with new requirements. That's under President Barack Obama's $900 billion goal. However, those figures leave out a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, so the measure may be around $1.2 trillion.

HOW IT'S PAID FOR: $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million. The original House bill taxed individuals making $280,000 a year and couples making more than $350,000, but the threshold was increased in response to lawmakers' concerns that the taxes would hit too many people and small businesses.

There are also more than $400 billion in cuts to Medicare and Medicaid; a new $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; sizable penalties paid by individuals and employers who don't obtain coverage; and a mix of other corporate taxes and fees.

REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through a tax penalty of 2.5 percent of income. People can apply for hardship waivers if coverage is unaffordable.

REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt — a change from the original $250,000 level to accommodate concerns of moderate Democrats — and the penalty is phased in for companies with payrolls between $500,000 and $750,000.

Small businesses — those with 10 or fewer workers — get tax credits to help them provide coverage.

SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Beginning in 2013, through a new Health Insurance Exchange open to individuals and, initially, small employers. It could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.

BENEFITS PACKAGE: A committee would recommend a so-called essential benefits package including preventive services. Out-of-pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange.

INSURANCE INDUSTRY RESTRICTIONS: Starting in 2013, no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.

GOVERNMENT-RUN PLAN: A new public plan available through the insurance exchanges would be set up and run by the health and human services secretary. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors. But the final version — preferred by moderate lawmakers — would let the HHS secretary negotiate rates with providers.

CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 91 percent and states would pay 9 percent.

DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Phases out the gap in Medicare prescription drug coverage by 2019. Requires the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.

LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.

ANTITRUST: Would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price-fixing and bid rigging. The bill also would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative.

ILLEGAL IMMIGRANTS: Would be barred from receiving government subsidies but permitted to use their own money to buy coverage offered by private companies in the exchange.

ABORTION: Private companies in the exchange could not offer plans covering abortion if those plans received federal subsidy money. Most plans in the exchange would be affected, because most consumers in the exchange would be using federal subsidy money to buy coverage. The new government plan could not offer abortion coverage. Insurance  companies would be permitted to offer supplemental abortion coverage in separate plans that people could buy with their own money. Use of federal money for abortion coverage would be limited to cases of rape, incest or danger to the woman's life.

Copyright 2009 The Associated Press. All rights reserved. http://www.dailyfinance.com/article/a-comparison-of-house-senate-health-care/744134?flv=1

New Diabetes Drug Victoza Approved

Victoza Is a Once-Daily Injection for Adults With Type 2 Diabetes

Reviewed by Louise Chang, MD

Jan. 26, 2010 -- The FDA has approved Victoza (liraglutide), a once-daily injection to treat type 2 diabetes in adults.

Victoza is intended to help lower blood sugar levels along with diet, exercise, and selected other diabetes medicines. It isn't recommended as the first therapy patients try if they haven't adequately controlled their diabetes with diet and exercise alone.

Victoza belongs to a class of medicines known as glucagon-like peptide-1 (GLP-1) receptor agonists, which help the pancreas make more insulin after eating a meal.

“Diabetes is a leading cause of death and disability, with more than 1.5 million new cases diagnosed annually,” says Mary Parks, MD, director of the division of metabolism and endocrinology products at the FDA.

“Controlling blood sugar levels is very important to preventing or reducing the long term complications of diabetes, and Victoza offers certain patients with type 2 diabetes a treatment option for controlling their blood glucose levels," Parks says.

FDA's Victoza Decision

The FDA approved Victoza based on five clinical trials involving more than 3,900 people. In those trials, pancreatitis (inflammation of the pancreas) occurred more often in patients who took Victoza than in patients taking other diabetes medicines.

The FDA states that Victoza should be stopped if patients experience severe abdominal pain, with or without nausea and vomiting, and should not be restarted if blood tests confirm that they have pancreatitis. Victoza should be used with caution in people with a history of pancreatitis, according to the FDA.

The most common side effects observed with Victoza in the clinical trials were headache, nausea, and diarrhea. Other side effects included allergic-like reactions such as hives.

In its clinical trials, Victoza was not linked to an increased risk of cardiovascular events -- including heart attack, stroke, and death caused by heart disease -- in people who were mainly at low risk for such events. In keeping with FDA policy, Victoza will be studied further to check its cardiovascular safety in higher-risk groups.

Other postmarketing studies will evaluate the risk of thyroid cancer and other cancer risks, as well as the risks of seriously low blood glucose levels ( hypoglycemia), pancreatitis, and allergic reactions.

The FDA notes that in animal studies, Victoza caused tumors of the thyroid gland in rats and mice. Some of those tumors were cancers, which were more likely in rats that got doses of Victoza that were eight times higher than what people would receive.

It's not known if Victoza could cause thyroid tumors or a very rare type of thyroid cancer called medullary thyroid cancer in people. For that reason, the FDA says Victoza should not be used as the first treatment for diabetes until more studies are done.

Victoza should not be used in people who are already at risk for medullary thyroid cancer, such as those who have medullary thyroid cancer in the family, or those with a rare genetic condition called multiple endocrine neoplasia syndrome type 2.

Victoza has a risk evaluation and mitigation strategy to help patients and health-care providers understand the drug's risks and to ensure that the drug's benefits outweigh the risk of acute pancreatitis and the potential risk of medullary thyroid cancer. 

Victoza is made by the drug company Novo Nordisk. The launch price of the 1.2-milligram dose will be $8.03 a day.

Healthy Communication Between Patients and Physicians Reduces Errors