Jerusalem, Israel Arieh O’Sullivan / The Me – Descending the Tower, the imposing new state-of-the-art inpatient hospital at Hadassah’s Ein Kerem Medical Center, Joseph Mapa was impressed. The chief executive officer of Toronto’s Mt. Sinai Hospital said he’s seen innovations he would like to bring back to Canada.

“It’s leading edge. Just the thinking behind it! Healing gardens, patient rooms, square feet, two beds per room, one bed per room, one window per patient…I mean these are huge developments,” Mapa told The Media Line. “It’s not something we wouldn’t do in the States, or in Canada, and it’s something you certainly want to see and showcased,” he adds.

Mapa was part of a first-ever delegation of CEOs from the top hospitals and medical centers across North America that were visiting Israel this week. This was the brainchild of Rafael Harpaz, director of the Economic Department for America and Africa at Israel’s Foreign Ministry.

“We think we have a lot to share with our friends and colleagues from the USA and Canada on medical technologies, cutting-edge technologies, readiness and preparedness and managing medical science through computers. I think these are areas where Israel has good experience,” Harpaz told The Media Line.

Israel’s life expectancy is much higher than the U.S. and its systems of socialized medicine ensures that everyone has access to basic healthcare while Israel spends a smaller percentage of its gross domestic product on health. There still are problems, most recently with doctors striking for higher wages last year. Its major hospitals are equipped with some of the latest medical technologies, which impressed the delegates.

“The American system has many great things, but also many things to learn from this country and I think that the level of medicine here and the level of training is every bit as good as medicine that I see now at the States,” Kevin Tabb, the CEO of Beth Israel Deaconess Medical Center in Boston, told The Media Line.

“In the States, for better or for worse, medicine in many ways is a business,” Tabb said. “It’s about making patients better, but it is also a financial business. But in Israel that really is not the case, and that is very interesting for people, especially for people from the United States, less so for Canada.”

Tabb said they shared data on costs and saw how care similar to that offered in the U.S. was extended with fewer resources in Israel.

“It’s amazing to see the relatively small budgets for an Israeli hospital, doing tremendous amount things, on what would be considered a pittance in the U.S. and that’s fascinating,” Tabb said.

The Tower at Hadassah is slated to be opened later this month and crews are busy scuttling around clearing away scaffolding and supplies. Not all of the floors are finished, but the fifth floor is spectacular with parquet floors and equipment still in plastic.

“This has been a tremendous exchange of North American healthcare leaders with Israeli healthcare leaders,” Amir Dan Rubin, president and CEO of Stanford University Medical Center. “While our political and reimbursement and systems are different, and the organization of our health systems are different, at the core we have common missions; taking care of patients and … research and education.”

“The challenges are similar here,” Rubin said. “We all have issues of how do we provide insurance coverage so there is the payment issue and there is the delivery system, there are access issues, there is improving quality and innovations and while our mechanisms are slightly different those themes are common.”

The group was briefed at Sheba Medical Center and is slated to visit Sourasky Medical Center, Beilinson Hospital — all in Tel Aviv — and Rambam Hospital in Haifa as well as the IDF Medical Forces center in Tzrifin where they will see the emergency unit that deploys at crises around the globe.

“We didn’t anticipate that so many of the CEOs of the big hospitals in North America would come and we are blessed with a delegation which is close to 50 top heads of hospitals and medical centers,” Harpaz said.

“We share the same challenges that we are facing in our medical treatment, and they appreciate that we are doing this, but on the other hand they are really impressed by all which Israel has to offer. And we have a lot to offer when it comes to medical technologies.”

At Sheba, the group observed a simulation of a mass casualty event, something that Israeli hospitals constantly drill for. Catherine Zahn, CEO of Toronto’s Centre for Addiction and Mental Health, found the spirit of Israelis compelling.

“There is a societal receptivity to open mindedness and forward thinkingness,” Zahn told The Media Line. “Like Israel, Canadians believe health care is a basic right of a citizen, a basic human right, rather than a commodity to be bought and sold. There is definitely a kinship there, but I think we have a lot to learn from the perspective of the ‘innovation nation’,” Zahn said.

“It’s also interesting to see how the situation in the Middle East, and the involvement of the military in the country actually probably contributes to that resilience and the attitude that if this doesn’t work out let’s pick up and do something else,” she added. “Picking up on the advances from military science and translating them into health care advances. Those are all very remarkable.”

These sentiments were echoed by her fellow Canadian, Mapa.

“The Israeli system is spectacular — from clinical care to service, to IT in particular, clinical technology, to crisis management,” Mapa said. “It’s state-of-the-art, I mean, its fantastic. We’re excited, but I tell you this not because I am excited, but you see it is evidence based…and that’s what turn us on. Turns me on for sure.”

View full post on Health Stories

Washington, D.C., United States (AHN) – The United States on Monday confirmed issuance of visa to ailing Yemeni President Ali Abdullah Saleh for a limited time to undergo medical treatment but refused to divulge time-period for which the visa is issued.

“We have issued a visa for Ali Abdullah Saleh,” said Victoria Nuland, the State Department spokesperson, adding, “It is strictly for medical treatment, and our expectation is that he will leave the United States when his medical treatment is complete.”

Asked to comment on the time period for which this visa is issued, Nuland said, “He’s got a visa for the period that he anticipated the medical treatment would last. If the treatment goes on longer and he needs to apply for an extension, he would do that with Homeland Security.”

Yemeni political players are expecting to utilize President Saleh’s absence to move the country “on a concrete transition plan to a more democratic Yemen,” said Nuland, adding, “We do believe that Saleh’s absence from Yemen at this critical juncture might, in fact, facilitate that dialogue and facilitate the transition process.”

Agreeing that, “it might be helpful to the transition process that he’s out of the country now,” Nuland reiterated, “It (the visa application) was not approved for political purposes. It was approved for medical treatment. The timing, we think, is fortuitous, however, and we hope that the Yemenis will use the time well.”

View full post on Health Stories

United States (KaiserHealth) – Dr. Donald Berwick, who oversaw Medicare and Medicaid until earlier this month, defended the programs Monday, but said they are trapped in a U.S. health system that promotes wasteful spending and inefficient care.

“Health care is broken,” Berwick said in an interview with Kaiser Health News. “… We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste and unreliable. Despite the best efforts of the workforce, we built it wrong. It isn’t built for modern times.”

Berwick said the 2010 federal health law is changing how doctors and hospitals are paid and deliver care though such new arrangements as accountable care organizations, which are designed to improve coordination and lower costs.

But he said it is unclear whether such efforts would produce results quickly enough to hold off critics, including most Republicans, who want to make more radical changes that would shift more of the burden to beneficiaries. “That is the central question, the nub…whether that will happen fast enough, I just don’t know.”

Despite being considered one of the foremost authorities on health quality and safety, Berwick was a controversial pick as administrator of the Centers for Medicare and Medicaid Services after Republicans accused him of supporting rationing care. Berwick denies the charge, but noted both private insurers and government programs impose limits on what they will cover.

After Republicans said they would not confirm his appointment, President Obama appointed him during a congressional recess in July 2010, which meant he could serve only for 18 months. His last day was Dec. 2.

Berwick previously led the Cambridge, Mass.-based Institute for Healthcare Improvement.

On other topics, Berwick told KHN:

• His failure to be confirmed did not affect his ability to get things done, though he would have preferred a longer term. “An agency of this size will do better with longer-term leadership commitment,” he said. Knowing his tenure could be short gave him a greater sense of urgency to achieve things, he said.
• His most challenging decisions involved state requests to cut Medicaid benefits and writing regulations to encourage doctors and hospitals to form accountable care organizations to work more closely, while not making the requirements overly burdensome.
• He criticized state efforts to limit hospital coverage for Medicaid recipients, currently under review by federal regulators. Hawaii has proposed a 10-day coverage limit on some enrollees; Arizona has proposed a 25 day limit. “It’s a nonsensical idea,” he said. “If a patient needs twenty days, the patient should get twenty days,” he said.
• Managed care done right is the best way to provide care, he said, but if states are not ready to take on the responsibility, it can lead to restrictions that prevent people from getting the care they need. Early in his career, Berwick worked for Harvard Health Plan, a nonprofit HMO based in Boston.

Berwick said he has not yet decided what to do next beyond spending more time with his family in Boston.

– Provided by Kaiser Health News.

View full post on Health Stories

Atlanta, GA, United States (AHN) – U.S. teens are not eating enough fruits and vegetables, according to a new study by the U.S. Centers for Disease Control and Prevention.

The findings, based on data complied from nearly 10,800 students in grades nine through 12 who took part in the National Youth Physical Activity and Nutrition Study 2010, found median consumption was 1.2 times per day for both fruits and vegetables.

Median fruit consumption was much higher among males than females, and much higher among grade nine students than among students in grades 10 and 12.

A little more than 28.5 percent, or one in four, of the high school students ate fruit less than once a day, and 33.2 percent ate vegetables less than once a day.

Only 16.8 percent of students ate fruit at least four times a day, and only 11.2 percent ate vegetables at least four times a day.

Vegetable consumption was lowest among Hispanic and black students, the study found.

Researchers said the findings show that most high school students do not meet the daily fruit and vegetable recommendations, and more needs to be done to see the recommendations are met.

The researchers wrote in the Nov. 25 issue of the CDC’s Morbidity and Mortality Weekly Report, “The infrequent fruit and vegetable consumption by high school student highlights the need for effective strategies to increase consumption.”

Steps have already been taken at schools throughout the country to remove sugary snacks, sodas, high fat, high salt and low nutrient dense foods. New programs such as farm-to-school initiatives, school gardens and salad bars aim to improve access to both fruits and vegetables.

View full post on Health Stories

New York, NY, United States (KaiserHealth) – For many adults, a routine visit to a primary care physician might involve blood tests, a urinalysis, an electrocardiogram, maybe a bone density scan. Too often, however, these tests are inappropriate and they cost a bundle, according to a recent study, not only for the health care system but also for individuals, who are increasingly footing more of the bill for their care.

The study, led by physicians from the Mount Sinai Medical Center and the Weill Cornell Medical College in New York, was published online in October in the Archives of Internal Medicine. The researchers examined the cost of common primary care practices that were identified as being overused earlier this year in a study by another group of physicians, known as the Good Stewardship Working Group. .

More From This Series Insuring Your Health

The working group, for example, had noted that blood and other diagnostic tests were often ordered even for patients who had no related symptoms or risk factors and said they should be discontinued in those cases. Also included on its list were imaging studies such as CT scans or MRIs for low back pain and Pap tests to screen for cervical cancer in teenagers.

Among the frequently inappropriate pediatric practices were writing prescriptions for antibiotics for children with sore throats who didn’t have a strep infection; recommending cough medicines for children with upper respiratory infections and ordering imaging tests for the heads of kids who took a spill but didn’t exhibit red-flag symptoms such as dizziness or loss of consciousness.

The newest study, using data from federal medical surveys, estimated that 12 of those unnecessary treatments and screenings accounted for $6.8 billion in medical costs in 2009. The activity most frequently performed without need was a complete blood cell count at a routine physical exam. In 56 percent of routine physicals, doctors inappropriately ordered such tests, accounting for $32.7 million in unnecessary costs. In terms of dollars, the biggest-ticket item by far was physicians ordering brand-name statins before trying patients on a generic drug first: That accounted for a whopping $5.8 billion of the $6.8 billion total.

Minal Kale, an internist at Mount Sinai School of Medicine and lead author of the study, says $6.8 billion was a conservative estimate of the cost of the inappropriate care. She notes, for example, that the study didn’t evaluate the cost of additional testing or procedures that result from an abnormal blood test reading result or imaging scan, even though in the absence of symptoms or risk factors the follow-up may be unnecessary and even cause harm. “The financial and other emotional results of that can be significant,” she says.

The original list of primary care activities upon which Kale and her colleagues based their financial analysis was developed by the Good Stewardship Working Group under a grant from the American Board of Internal Medicine Foundation and published first online in May. Working group members were composed of internists, family physicians and pediatricians who are part of the National Physicians Alliance, a group of 22,000 doctors that advocates universal, affordable health care.

The working group focused on common activities that no physician would argue against, says Stephen Smith, a family physician and professor emeritus at Brown University’s Alpert Medical School, who co-authored that group’s paper. That’s why you don’t see more controversial practices like the PSA blood test for prostate cancer, which was recently removed from the U.S. Preventive Services Task Force’s list of recommended screenings for most men. “What we were trying to do was change [physicians'] mindset, not cause firestorms of controversy,” says Smith.

So why would physicians continue to order tests and prescribe pricey drugs when there’s clear evidence that they’re not necessary in many cases and may even cause harm by exposing people to unneeded care?

One of the main reasons is the way doctors are trained, Smith says. “I think all of us practicing in the U.S. were raised in an educational environment where we got dinged if we didn’t order certain tests,” he says.

Defensive medicine also plays a role. “Nobody ever gets sued for ordering unnecessary tests,” says Doug Campos-Outcalt, a family physician in Phoenix and a past president of the Arizona Academy of Family Physicians.

And patient expectations drive some of the spending as well, say physicians, who note that sometimes simple directives, such as drinking less alcohol or getting more exercise, aren’t what patients want to hear. “If a doctor says, ‘Let’s talk about weight control,’ patients aren’t usually too happy,” says Campos-Outcalt. “They feel like there should be some testing.”

Doctors alone can’t turn the tide. Improving patient education and communication with doctors is key to helping change practice patterns, says Smith.

Still, one expert is encouraged that doctors came up with this list of wasteful spending, rather than leaving it to government bean counters. “It’s only the doctors that can get into the clinical detail and find out what sorts of things are not producing a benefit and might cause harm,” says H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, whose work has questioned whether much of the preventive screening people receive is helpful.

The dollar amounts identified in the current study may be a good start, but they don’t even begin to address the country’s spending issues, he says. In 2009, health spending grew to $2.5 trillion and accounted for 17.6 percent of the gross domestic product.

Kale suggests that specialist care be the next target that physicians take aim at to identify inappropriate, overused activities. Specialist income, after all, is primarily generated through procedures, while primary care is often conversation-based. “We have more to gain by examining [specialist care] more closely,” she says.

– Provided by Kaiser Health News.

View full post on Health Stories

Tel Aviv, Israel (AHN) – A shot of cortisone may stop trauma victims from developing post traumatic stress disorder, according to a new study.

Researchers with Tel Aviv University said that if the shot is given within six hours of experiencing a traumatizing event, the patient may reduce his or her chances of developing PTSD by 60 percent.

Professor Joseph Zohar said the findings are important as more U.S. soldiers return home from combat tours in Iraq and Afghanistan.

Cortisone naturally secretes in the body when a person suffers from trauma, Zohar said. He tested his theory first on lab rats and then in a double-blind study on humans in an emergency room.

With the rats, two groups of the rodents were exposed to the smell of a cat. One group was treated with cortisone right after the event. Zohar said the treatment was effective on the rats.

The people in the ER were given either a shot of cortisone or a placebo. Follow-up exams taken two weeks, one month and three months after the traumatic event showed a significant decrease in PTSD development in the patients receiving the shot.

A full report on the study is published in the October issue of the journal European Neuropsychopharmacology.

View full post on Health Stories

Washington, DC, United States (KaiserHealth) – What’s worse: Losing face or losing money?

Under laws in more than two dozen states and new Medicare rules that went into effect earlier this year, hospitals are required to report infections, risking their reputations as sterile sanctuaries, or pay a penalty. That’s left hospital administrators weighing the cost of ‘fessing up against the cost of fines.

For Clark Todd, CEO of Pacific Hospital in Long Beach, there’s only one way to go: “If we hide from the public then the tendency to keep the status quo is stronger than ever,” he said. “And that’s just not going to get the job done.”

It’s been more than a decade since a panel of top scientists declared hospital safety a national priority. Yet, about 90,000 patients still die each year from preventable infections resulting from routine surgeries and hospital care, according to the U.S. Centers for Disease Control and Prevention. Examples include infections resulting from contaminated tubes that deliver food and medications, and catheters that remove urine. Staph infections, which can be deadly, are a particularly serious problem.

Many more patients are irreparably harmed. Dave Meyer of Fair Oaks, Calif., a Sacramento suburb, was a general contractor before he broke his ankle in a motorcycle accident. Records indicate he contracted an infection at a local hospital that prevented his ankle from healing. He endured several surgeries and excruciating wound cleanings.

“Imagine taking an ice cream scoop and just taking half of your foot off. It looked like just this gaping hole,” said Meyer, adding: “I know that it would have been so much better if they used the proper hygiene in the hospital.”

Dr. Alfonso Torress-Cook of Pacific Hospital couldn’t agree more. “Hospitals are dirty,” he said. An epidemiologist and head of the hospital’s infection control program, Torress-Cook came to this for-profit teaching hospital five years ago with a clear goal: to sharply reduce the hospital’s infection rate.

Back then, the medical staff viewed infections at the 184-acute care bed facility as largely unavoidable and treated them with antibiotics, he said. The approach was costly: An infection can add $42,000 to a patient’s bill in the intensive care unit, according to the Leapfrog Group, an advocacy group that represents large employers like General Motors, Chrysler and Sprint.Now, hand washing at Pacific Hospital, especially in the ICU, is so routine nurses complain their hands are chapped. That’s just one of many changes. Nurses here wash patients every day. Janitors are given enough time to properly clean rooms. Even those coming in for surgery are asked to take a shower before showing up.Torress-Cook opened a closet to show off another weapon in the hospital’s anti-infection arsenal: an ultraviolet light, hooked up to the hospital’s air ventilation system, that kills airborne germs.At first the employees were skeptical, said Todd. But California’s new public reporting law, which went into effect in 2010, and Medicare’s decision to start withholding two percent of payments from hospitals that keep their rates secret, have helped his cause.”I think that gives administrators like me even more reason to get involved in this matter,” said Todd. “And more clout with our medical staff to work against some of these traditional behaviors.”Pacific Hospital is working to bring down bloodstream infections that result from tubes that deliver medication and nutrients, and has virtually eliminated methicillin-resistant Staphylococcus aureus (MRSA) and surgical infections.That has caught the attention of competitors and potential customers. And it’s become a source of pride for its employees.Indeed, researchers have found concern over a hospital’s public image is an even more powerful motivator than fear of losing market share.”Many hospitals will measure quality and voluntarily put it up, even without the government involved,” said Dr. Michael Rapp, director of the Quality Measurement and Health Assessment Group of the Centers for Medicare and Medicaid Services. “But certainly once it’s required for all hospitals to do that there’s the peer pressure and they’re going to be looking at how they do compared to others.” The fear of losing millions of dollars isn’t an idle threat either. Starting this year, hospitals have to reveal their catheter-associated blood stream infections if they want their Medicare bills paid in full. Next year, they’ll have to report surgical-site infections. The list will grow longer in the coming years. Rapp anticipates that nearly all U.S. hospitals will comply. Now, only half volunteer their data, he said. Still, the stigma of unclean wards and fear of lawsuits can make hospitals reluctant to report. When the law went into effect in California,’ hospitals out of 400 didn’t send in any data. State regulators, who acknowledge the first year of data collection was riddled with errors, are not imposing penalties. There are other concerns: Competitors may undercount, making more honest players look bad, and some hospitals simply do more surgeries or have sicker patients, said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. “The measures aren’t perfect and don’t adequately account for the differences among patients,” said Foster.For hospitals in cities like Long Beach or quieter, rural areas like Ukiah, keeping track of the frenetic activity in their facilities can be daunting.Ukiah is a verdant and woodsy town north of San Francisco, in Mendocino County. At the small, 78-bed nonprofit hospital, patients and staff all seem to know each other, trading warm hellos on a warm spring day. It’s not hard to imagine how quickly word of even one infection can spread.That’s something Sue Mason, a half-time nurse at Ukiah Valley Medical Center, worries about. “We have nothing to hide,” she said.Mason has a big job and only 20 hours a week to do it: She’s charged with tracking and preventing infections. Every morning, she checks the computerized lab tests and tries to chase down new cases. In the nationwide push for greater transparency of hospital performance, though, Mason is an overwhelmed foot soldier. She has little time to eliminate the very infections she’s charged with reporting.”I’d like to be out on the floor more with the nurses. I could monitor their hand hygiene compliance and educate them as I see them doing their job,” Mason said. Instead, she spends most her day in front of the computer crunching data.Mason must report not just the infections that occur, which are rare here, she said, but details of every surgery, every patient who tests positive or negative for gruesome antibiotic-resistant bugs, like MRSA.Even at Pacific Hospital, where infection rates are some of the lowest in the nation, hospital chief Todd preaches constant vigilance, “These initiatives have to be felt with some passion and they have to be implemented with consistency and strong will.”It will take some time before patients can know the full risk of entering their local hospital. At present, most states and Medicare publish just a short list of infections.In the coming years, though, as the federal health law continues to take effect, the noose will tighten even more. Starting in 2012, Medicare will reduce payments to hospitals with poor infection rates in their intensive care units.There is great hope, among researchers and hospital chiefs, that this double-barreled approach of public reporting and financial sanctions may be the best cure for what has proven to be a chronic condition in hospitals.

– Provided by Kaiser Health News.

View full post on Health Stories

The number of women in the U.S. who gave birth at home rose 20% between 2004 and 2008, a new study shows.

View full post on Health Stories

Toronto, Ontario, Canada (AHN) – Newly resigned Canadian Liberal Party leader Michael Ignatieff has learned that his career path should be built on education, not politics. He learned his lesson the hard way through a humiliating defeat in the hands of the Tories and New Democratic Party on Monday.

Ignatieff announced Thursday he will go back to teaching. Prior to his political stint as MP for the Etobicoke-Lakeshore riding since 2006 and as Liberal Party leader since 2010, Ignatieff was a professor at prestigious universities in the U.S. and Britain such as Harvard, Oxford and Cambridge.

This time he will teach at the University of Toronto’s Faculty of Law, Department of Political Science, Munk School of Global Affairs and the School of Public Policy and Governance.

The teaching position was previously held by former Canadian Prime Minister Pierre Trudeau, Liberal MP and former Ontario Premier Bob Rae and former Reform leader Preston Manning. It was offered to them by the school’s Massey College during a period of transition in their professional lives.

With his return to academia, Ignatieff said he ended his political career. He said he will use his political and personal experiences to teach students the lessons and mistakes he made in his career and life. Ignatieff said he loves teaching more than being a politician.

The 64-year old resigned Liberal leader, who lost his reelection bid, is returning to his alma mater. He earned his undergraduate degree from the University of Toronto’s Trinity College and acquired a doctorate in history from Harvard.

View full post on Education Stories

Food companies should revamp their marketing to children by advertising foods that are healthy, four U.S. agencies said on Thursday in proposing voluntary principles for the food industry.

View full post on Health Stories