Medical, Pharma Groups Ask CMS for Details on Payment Database

On Monday, several medical societies and a pharmaceutical industry group sent a letter to CMS asking for more details about how data will be displayed on its soon-to-be released physician payment database, Wall Street Journal‘s “Pharmalot” reports (Loftus, “Pharmalot,” Wall Street Journal, 7/28).

Treat Sleep Apnea Non-Surgically and Prevent Other Medical Complications

saDid you know…there is a simple, non-surgical solution to treat sleep apnea and the many serious risks and health problems that go along with it? Continue reading

Decrease the Side Effects of Vaccines

“My veterinarian made me do it! I love my veterinarian so much, that I do exactly what he/she tells me to do. We all listen to the alternative practitioners warning about the potential side effects and how vaccination is not a simple thing but is a true medical procedure with risks and benefits just like all medical procedures. But I’m scared because I’ve heard that it can have dangerous, life threatening consequences, not just for my pets but for my kids and me, too. I’m just so afraid not to get those booster shots, that I get the reminders for in the mail, all the time. It seems all we ever get are scare tactics thrown at us if we raise any objections to these vaccines. We’re just told about how risky and unconscionable it is to NOT vaccinate. The ultimate blow being when my vet tells me, I won’t be able to bring my pet back to the clinic unless I vaccinate and boost regularly. What if I have an emergency, then what?”

Sound familiar? What are we supposed to do in the face of such tactics? For those of us who dare to recommend caution about vaccination, especially annual boosters and/or even the appropriate time  Continue reading

Using Innovative, Low-Cost, Medical and Diagnostic Tests

In the developing world, the availability of many medical technologies is limited by cost, durability, and ease-of-use. This is especially true of expensive diagnostic devices, which are critical for detecting diseases that are endemic in developing countries. However, researchers are working to develop low-cost, user-friendly alternatives that could improve the ability of healthcare providers to diagnose a range of conditions.

Harvard researchers have developed an alternative microfluidic device that replaces standard silicon, glass, or plastic substrates with treated paper. Fluids flow through the microchannels in the paper device in the same way that they would in a standard chip. Researchers have used the device to test for glucose and protein in urine, but hope to adapt it for the possibility of testing blood samples for HIV/AIDS, dengue fever, or hepatitis. While a traditional microfluidic device costs between $10 and $1,000USD, the materials to create the paper devices, known as microPADS, cost only three cents. The design of the microPAD device allows for several tests to be conducted simultaneously, furthering the cost and resource savings.

To help better diagnose infectious diseases such as malaria and tuberculosis, researchers have developed a microscope that attaches to any cellular telephone with a camera feature. The device, known as a Cell Scope, is able to illuminate pathogens in a sample treated with fluorescent molecular “tags.” It is estimated that the production of first Cell Scopes will cost roughly $1,000 each, but with further developments the price could drop to just a few hundred dollars, including the cell phone. Not only can an individual use the microscope to view the pathogens, but they can also send an image to a healthcare facility for assistance making an appropriate diagnostic determination.

Efforts have also been made by scientists at the Burnet Institute to improve HIV-testing procedures. A prototype monitoring test has been designed for use in remote settings. The new test, which uses a finger-prick blood sample, allows individuals to determine their CD4+ T-cell count within 30 minutes. The CD4+ T-cells are critical for healthy immune system function and their levels are a deciding factor with regard to starting anti-retroviral therapy. Standard CD4 tests are often not available in the developing world due to their cost, the need for specialized equipment and trained personnel, and the long wait period to obtain test results.

Though these diagnostic technologies offer improvements in the developing world, as The Wall Street Journal reports, acceptance may be slower in the United States. Some researchers have found success when applying African healthcare models to rural areas of the U.S., and results using low-cost technologies originally conceived for use in the developing world may follow this trend. The use of innovative low-cost testing methods may also assist with telemedicine initiatives, as they allow healthcare providers to conduct necessary tests and provide better diagnostic information to consultants. Through discussion among global health experts – as allowed by telemedicine initiatives like icons in Medicine – innovative diagnostic tools and other cost-saving measures may become more popular, and help to provide improved care worldwide.

Communication Gap Seen Between Patients, Doctors

What doctors think they are telling hospital patients, and what those patients actually hear, may be very different, a small study suggests.

The findings, from a study of 89 patients at one U.S. hospital, add to research showing that doctors and patients are often not on the same page when discussing diagnoses and treatment.

In interviews with the patients on the day of their discharge, researchers found that only 18 percent even knew the name of the main physician in charge of their hospital care. Meanwhile, just 57 percent left the hospital knowing what their diagnosis was.

In contrast, two-thirds of the 43 physicians interviewed thought their patients knew their name, and 77 percent believed their patients were aware of their diagnosis.

Drs. Douglas P. Olson and Donna M. Windish of Yale University School of Medicine in New Haven, Connecticut, report the results in the Archives of Internal Medicine.

The finding that many patients were unsure of their diagnosis or their doctor’s name may sound surprising, but it is not new, according to Olson. Past studies have found that the majority of hospital patients cannot name their main physician, and frequently cannot name their medical problem.

However, the current study also shows that many doctors mistakenly believe their patients know more than they do.

“What’s new here is the discrepancy between doctors and patients,” Olson told Reuters Health. “Patients aren’t really getting the take-home message.”

The communication gaps go beyond names and diagnoses, the study found. Of patients in this study who were prescribed a new medication during their hospital stay, one-quarter said their doctor never told them about it. And very few — 10 percent — said their doctor discussed the drug’s potential side effects with them.

In contrast, all physicians in the study said they at least sometimes told patients about any new prescriptions, and 81 percent said they described the possible side effects at least some of the time.

In recent years, the medical community has increasingly focused on improving doctor-patient communication. In residency programs at academic hospitals, for instance, doctors-in-training are taught to include patients in discussions rather than talking amongst themselves in front of patients, Olson pointed out.

“But there’s still a disconnect,” he said, adding that even when patients say they understand, that often turns out not to be the case.

One explanation, according to Olson, may be that many hospitalized patients are elderly and have complex medical problems — not just one diagnosis, but several co-existing health conditions — and the information they receive during their stay “could understandably be overwhelming.”

And compared with 30 or 40 years ago, Olson noted, patients’ hospital stays are now typically much shorter; that leaves them with less time to absorb and fully understand information about their condition and any treatment changes.

One potential way to address the communication gaps would be to give patients and families written information, in addition to spoken explanations, during the hospital stay — and not only at discharge, Olson said.

“It’s important for us to take a step back and see how some system changes might improve communication,” he said.

Steps patients and their family members can take include writing down any questions as they come up so they can raise them with the doctor later, according to Olson.

Family involvement is important, he noted, particularly for older patients with more complex medical problems and multiple medications.

“How is my life going to be different when I leave the hospital?” is a good general question that patients can ask their doctors, Olson recommends. It can help start a discussion about a range of concerns, including any lifestyle adjustments and medication changes that need to be made, he said.

Olson also advised that patients lacking a primary care doctor get the number of someone at the hospital whom they can call with any questions after they are discharged.

Short-Term Stress Boosts Anti-Tumor Activity

PALO ALTO – In a study on laboratory mice, researchers at the Stanford University School of Medicine have shown that bouts of relatively short-term stress can boost the immune system and protect against one type of cancer.

The researchers also said that the beneficial effects of this occasional angst could last for weeks after the stressful situation has ended.

The finding is surprising because chronic stress has the opposite effect-taxing the immune system and increasing susceptibility to disease.

“This is the first evidence that this type of short-lived stress may enhance anti-tumor activity. This is a promising new way of thinking that calls for more research. We hope that it will eventually lead to applications that help us to care for those who are ill, by maximally harnessing the body’s natural defenses while also using other medical treatments,” said Dr. Firdaus Dhabhar.

The researchers studied a particular type of skin cancer called squamous cell carcinoma that is known to be vulnerable to attack by the immune system.

Certain types of stress, such as the so-called fight-or-flight response to an immediate but temporary threat, has been shown to increase the recruitment of immune cells to the surface of the skin and the surrounding lymph nodes-presumably in preparation for imminent injury.

“Acute stress galvanizes an organism’s protective systems. But although it’s one of nature’s fundamental survival systems, thus far it’s been rather underappreciated,” said Dhabhar.

The researchers focused on understanding the physiological effects of both acute and chronic stress.

They investigated the effect of short-term, or acute, stress on 30 laboratory mice exposed for 10 weeks to thrice-weekly doses of cancer-causing ultraviolet light.

They found that fewer of the mice that had been acutely stressed developed skin cancer during weeks 11 through 21, and that those that did exhibited a lower total amount of tumors (a measurement called tumor burden) than the non-stressed mice.

The stressed mice weren’t protected indefinitely-almost 90 percent of the mice in both groups developed cancer after week 22, though the stressed group continued to have fewer tumors until week 26.

“It’s possible that the pre-tumor cells were eliminated more efficiently in the group that was stressed.

There may also have been a longer-term enhancement of immunity as we have seen in our non-cancer-related studies. However, acute stress did not lower tumor burden beyond week 26. We are in the process of determining why,” said Dhabhar.

However, other stress-induced changes lingered for weeks.

The researchers found that, during the same time period, the skin of the stressed mice had higher levels of immune-activating genes than did the control group, almost as if the mice were preparing for battle.

He compared the effect to how drug-makers often increase the potency of vaccines by including generic immune-activating molecules called adjuvants.

But he is convinced that acute stress may be better for us than most of us think, and that bio-behavioral interventions are worth investigating.

The study will be published in the journal Brain, Behavior, and Immunity.

Light, Photosynthesis Harmful to Fresh Produce

TEL-AVIV –  A study conducted by Israeli researchers suggests that exposure to light, and possibly photosynthesis, may help disease-causing bacteria to invade fresh produce, making them impervious to washing.

According to background information in a report published in journal Applied and Environmental Microbiology, past studies have already shown that salmonella enterica attaches to the surface of fresh produce, and finds its way below the surface of the skin through pores called stomata, where it can hide from and resist washing and food sanitizers.

In the new study, researchers from the Agricultural Research Organization at the Volcani Center in Israel and Tel-Aviv University examined the role that light and photosynthesis might play on the ability of salmonella bacteria to infiltrate lettuce leaves via stomata.

They exposed sterile iceberg lettuce leaves to bacteria either in the light, in the dark, or in the dark after 30 minutes of exposure to light.

Incubation in the light or pre-exposure to light resulted in aggregation of bacteria around open stomata and invasion into the inner leaf tissue.

Incubation in the dark, on the other hand, resulted in a scattered attachment pattern and very little internalization.

According to the researchers, the increased propensity for internalization in the light may be due to several factors.

First, they say, in the absence of light plants enter a period of dormancy, where stomata are closed and no photosynthesis takes place. In the light, the stomata are open.

Additional findings also suggest that the bacteria are attracted to the open stomata by the nutrients produced during photosynthesis, which are not present in the dark.

“The elucidation of the mechanism by which Salmonella invades intact leaves has important implications for both pre- and postharvest handling of lettuce and probably other leafy vegetables. The capacity to inhibit internalization should limit bacterial colonization to the phylloplane and consequently might enhance the effectiveness of surface sanitizers,” say the researchers.

Facebook May Boost your Brain’s Working Memory

LONDON – Some social networking sites, like Facebook, could help improve a person’s working memory, according to an expert.

Dr. Tracy Alloway, a psychologist at Stirling University, says that working memory – the ability to recall things over a short period of time – could be the key to success.

She believes that it may be possible to train the brain’s working memory just like an athlete trains muscles, reports the Independent.

Alloway said that some technological inventions, such as Facebook, might actually improve working memory because they require people to hold a lot of information in their heads.

However, other such websites, like spell-checks and Twitter, which requires only small bite-sized phrases, may work against improving working memory.

Instead, these websites could be contributing to some people’s lack of success, she suggested.

Alloway said that she had devised an on-line game that can improve working memory, which may help the young develop working memory skills as well helping to combat memory loss in the elderly.

Animals Using One Side of their Brains are More Successful

SYDNEY – A new study has determined animals that process information using a preferred hemisphere of the brain fare better those who use both sides of their brain simultaneously.

According to a report by ABC News, the study suggests the brain operates like a dual processor in a computer, with each of the brain’s two sides kicking into action depending on the content or context of the information.

Dr Culum Brown of the Department of Biological Sciences at Macquarie University in Sydney, and colleague Maria Magat, focused their research on several different types of Australian birds, such as gang-gangs, sulfur-crested cockatoos and Australian king parrots.

All of the birds participated in two tests designed to test their cerebral lateralisation, meaning how strongly each bird preferentially processes information using either hemisphere of the brain.

The first task was a simple pebble-seed discrimination test, where the birds had to pick seeds out of a background of similar sized pebbles.

The second task was more demanding.

The researchers attached food to the end of a suspended string that the birds had to manipulate with their beaks and feet in order to get the tasty reward.

Birds with a preference for using either of their eyes or either of their legs did better than birds that used both eyes and both legs equally.

This means that the most successful birds have a very strong cerebral lateralisation, which “is influenced by both genes and experience,” according to Brown.

He and Magat found that the pattern of lateralisation, left or right bias, did not predict success as much as the strength of the particular bias did.

Carrying the findings over to humans, this suggests, in part, that a right-handed person isn’t more successful than a left-handed one, and vice-versa.

But people who always favour a certain hand, foot or eye for certain tasks will likely perform better than those who don’t exhibit obvious preferences.

Brown said that there are several reasons why such specialized division of the brain confers benefits to the individual.

“Firstly, it means that a given hemisphere can become increasingly specialized at processing certain types of information,” he said.

According to Brown, assigning particular tasks to each side of the brain avoids conflict between the two hemispheres, and allows “multiple sources of information to be processed simultaneously, that is to say, animals can multitask like a dual processor in a computer.”

Frequent Nasal Irrigation May Increase Infections

NEW YORK – New evidence suggests that daily nasal irrigation may increase the risk of sinus infections.

Nasal irrigation with warm saline has been promoted as way to cleanse the sinuses and help prevent infections. However, using this therapy too often may not be beneficial.

The latest study, presented at the American College of Allergy, Asthma, & Immunology (ACAAI) annual meeting, included 68 adults who used nasal irrigation frequently for one year and then stopped therapy for one year. The patients were compared to 24 control patients who did not discontinue nasal irrigation.

The researchers found that number of sinus infections decreased by 62.5 percent after the participants stopped using nasal irrigation. Additionally, after stopping nasal irrigation, they were 50 percent less likely to develop sinus infections than those who continued with daily therapy.

Mucus in the nose contains important immune system molecules that help the body fight against infections. Because nasal irrigation eliminates this mucus, the authors suspect that it may lead to an increased risk of infection.

Egyptian Mummies Had Clogged Arteries

CAIRO – Rich Egyptians living 3,500 years ago may have been walking around with the same clogged arteries that modern Americans now battle, according to a presentation Monday at the American Heart Association’s annual meeting.

A group of scientists said that, on a whim, they performed a computerized tomography (CT) scan on a collection of 22 mummies housed at the Egyptian National Museum of Antiquities in Cairo to see if they too suffered from the plaque build-up in arteries that lead to coronary artery disease.

“We didn’t believe it was going to be so intense,” said Adel H. Allam, the lead author of a letter to the editor published Tuesday in the Journal of the American Medical Association. “We thought that we would find it, but maybe very rarely, and we thought that if we did find it, it wouldn’t be so severe.”

The plaque was, of course, long gone. The mummies lived between 1981 B.C. and 364 A.D., and only 16 of the mummies had heart tissue left. However, doctors could see evidence of advanced atherosclerosis (plaque build-up that causes hardening of the arteries) by looking for calcium deposits in a CT scan used to diagnose people today.

Gene Therapy Raises Hope for the Color Blind

SEATTLE – Researchers in the US have made a breakthrough discovery which could bring a cure for colour blindness and other diseases that can lead to a total loss of sight.

Using gene therapy, the boffins successfully treated a pair of squirrel monkeys that could not differentiate between red and green.

The development could bring new treatments for a variety of different diseases that are triggered by faulty cone cells at the back of the eye. The problem can lead to diseases such as macular degeneration, which often causes complete blindness.

The research, which was led by Jay Neitz, professor of ophthalmology at the University of Washington, has been published in the scientific journal Nature, reports The Daily Express.

Professor Neitz said: “People who are colour blind often feel that they are missing out. If we could find a way to do this with complete safety in human eyes, as we did with monkeys, I think there would be a lot of people who would want it.

“Beyond that, we hope this technology will be useful in correcting lots of different vision disorders.”

Trouble Thinking? Better See the Dentist

NEW YORK – A new study hints that good oral care – regular brushing and flossing and trips to the dentist — may help aging adults keep their thinking skills intact.

In a study, researchers found that adults aged 60 and older with the highest versus the lowest levels of the gum disease-causing pathogen Porphyromonas gingivalis were three times more likely to have trouble recalling a three-word sequence after a period of time.

Dr. James M. Noble of Columbia College of Physicians and Surgeons in New York City and colleagues also found that adults with the highest levels of this pathogen were two times more likely to fail three-digit reverse subtraction tests.

The findings, reported in the Journal of Neurology, Neurosurgery, and Psychiatry this month, are based on more than 2300 men and women who were tested for periodontitis and completed numerous thinking skills tests as part of the National Health and Nutrition Examination Survey III conducted between 1991 and 1994.

Overall 5.7 percent of the adults had trouble completing certain memory tasks and 6.5 percent failed reverse subtraction tests. Participants with the highest (greater than 119 units) versus the lowest (57 units or lower) pathogen levels were most likely to do poorly in these tests.

Research has already established a strong association between poor oral health and heart disease, stroke and diabetes, as well as Alzheimer’s disease. Gum disease could influence brain function through several mechanisms, the researchers note; for example, gum disease can cause inflammation throughout the body, a risk factor for loss of mental function.

In a related commentary, Dr. Robert Stewart, of King’s College in London, United Kingdom, says this study adds to a “quietly accumulating” body of evidence tying oral and dental health with brain function.

SOURCE: Journal of Neurology, Neurosurgery, and Psychiatry, November 2009

Novel Cancer Therapy Found by TA Researchers

TEL AVIV –  Tel Aviv University researchers have invented a technique to destroy malignant cells in the breast while leaving healthy ones untouched. If the results produced in lab tests on mice can be applied to human patients, the result could be a revolution in cancer care, though human clinical tests are years away, at best.

The killing of cancerous cells in the lab was accomplished by using a chemical generally used to treat strokes. The work by Prof. Malka Cohen-Armon of TAU’s Sackler Medical School was just published in the open online journal, BioMed Central.

The international research team she headed found that potent phenanthridine derived polyADP-ribose polymerase (PARP) inhibitors that were originally designed to protect cells from cell death under stress conditions such as stroke or inflammation efficiently eradicate MCF-7 and MDA231 breast cancer cells without impairing normal cells.

Cohen-Armon said they made the discovery “by chance,” but that the findings provide “a new therapeutic approach for a selective eradication of abundant human cancers.”

Male and Female Chromosomes do Communicate with Each Other

LONDON – Scientists in the University of Leicester’s Department of Genetics have for the first time revealed that the male and female do truly communicate -at least at the fundamental genetic level.

The research counters scientific theory that the X and Y chromosomes – that define the sexes – do not communicate at all.

In the study, Dr. Zoe Rosser and colleagues have shown that exchange of DNA does actually occur between the X and Y in the regions previously thought to be completely isolated.

“Recently it was shown that the Y chromosome can talk to itself – swapping bits of DNA from one region to another, and potentially giving it a way to fix mutations that might affect male fertility. In this new research we’ve now shown that it actually maintains a genetic conversation with the X chromosome, potentially giving it a way to fix other kinds of mutations, too. So, maybe it’s not quite the dysfunctional loner we have always imagined it to be,” said Professor Mark Jobling, who led the study.

It is the Y chromosome in men that determines maleness by triggering development of testes rather than ovaries in the early embryo.

“These days the X and Y are a very odd couple, but long ago, before mammals evolved, they were an ordinary pair of identical chromosomes, exchanging DNA in a companionable way through the process of genetic recombination. However, once the Y chromosome took on the job of determining maleness, they stopped talking to each other. The X remained much the same, but the Y set out on a path of degeneration that saw it lose many of its genes and shrink to about one third the size of the X. Some scientists have predicted that it will eventually vanish altogether,” said Jobling.

“These new findings from the Department of Genetics of the University of Leicester now challenge this interpretation of the Y chromosome’s fate,” he added.

The researchers discovered that the conversation between the X and Y chromosome goes both ways, and it is also clear that mutations arising on a decaying Y chromosome can perhaps be passed to the X – the Y chromosome’s revenge.

In future, the researchers will assess how widespread X-Y exchanges have been during evolution, and what the likely functional effects might be.

 

The study has been published in the American Journal of Human Genetics.