As the House of Representatives and the Senate debate companion bills to make health care more affordable and accessible, a coalition of obesity and public health experts today urged Congress not to overlook the needs of the more than 15 million Americans who suffer from severe obesity and are at the greatest risk for chronic disease and death.

Through a newspaper advertising campaign targeting lawmakers, Shape Up America! — the anti-obesity crusade launched by former Surgeon General C. Everett Koop — and 20 organizations and public health officials published an “Open Letter to Congress” to lay out the need for affordable, quality medical care for Americans with “morbid obesity,” a chronic medical condition of genetic, environmental and behavioral origins where the amount of excess weight is often more than 100 pounds. Stating that the severely obese are 2-3 times more likely to die of preventable disease than Americans at a healthy weight, the “open letter” urges Congressional action so that any health reform package provides severely obese Americans with access to a comprehensive obesity counseling and treatment regimen, including the option of weight-loss (bariatric) surgery followed by appropriate lifelong medical care and nutritional monitoring.

“As the Congress considers reform to the health care system, no workable agenda can overlook the pressing issue of combating obesity in America, including addressing the difficult challenges associated with morbid obesity,” said Barbara Moore, Ph.D., president and CEO of Shape Up America!. “An intensified focus on improving the health outcomes of those with severe or morbid obesity is essential to reducing the risks that threaten the lives and future health of more than 15 million Americans.”

Declaring that morbidly obese Americans — now representing approximately 5.9 percent of the U.S. population — have been left out of the health reform debate, the “open letter” zeroes in on the reasons why many severely overweight individuals are not receiving quality medical care. This includes the continued belief that morbid obesity is a moral failing of overeating and lack of willpower and thus, not really a serious medical condition. According to extensive medical research, morbid obesity is not only a disease in itself but is directly linked to more than 30 serious diseases and medical conditions, from Type 2 diabetes, stroke and high blood pressure to asthma, osteoarthritis and sleep apnea. As a result, morbid obesity is a major factor in the nation’s $147 billion yearly price tag for treating obesity-related diseases.

Of equal significance, the “open letter” refutes the conventional wisdom that adults and adolescents needing to lose 100 pounds or more can achieve lasting weight loss through methods that are effective for the moderately obese — diet, exercise, behavior modification and drug therapy. Although these interventions work in some significantly overweight individuals, controlled studies show these efforts alone are usually ineffective for the majority of morbidly obese patients. This is in contrast to a growing body of research demonstrating that weight-loss surgery followed by appropriate lifelong medical care produces significant, lasting weight reduction in the majority of morbidly obese patients and can lead to the complete resolution of obesity co-morbidities.

Today, two major kinds of bariatric surgery are performed in the U.S. — Roux-en-Y gastric bypass (RYGB) and laparoscopic adjustable gastric banding (LAGB) — to address the issue of morbid obesity. Of the two, LAGB is less invasive and results in fewer major complications. But regardless of the type of weight-loss surgery performed, long-term studies show that up to 10-14 years after surgery, morbidly obese patients maintained a much greater weight loss and more favorable levels of diabetes, cholesterol and hypertension, as compared to those who did not have surgery. Other studies find a significant reduction in the risk of death from obesity-related chronic diseases in patients who had surgery, including a 92 percent drop in death from diabetes, a 60 percent reduction in cancer deaths and a 56 percent reduction in deaths from cardiovascular disease.

Based on this data, a number of prominent medical societies have issued consensus statements that morbidly obese patients should be offered the option of weight-loss surgery that is followed by appropriate lifelong medical care, including nutritional monitoring. This consensus is also supported by the Centers for Medicare and Medicaid Services, many state Medicaid programs and even a number of commercial payers.

When it comes to controlling health costs, the obesity advocates make the case that weight-loss surgery for the severely obese produces significant cost savings, especially now that patients have access to less invasive surgical options offering cost-effective care with fewer major complications. This is also the conclusion of commercial payers which recognize that weight-loss surgery for the morbidly obese improves or resolves the serious medical conditions directly linked with excess body weight, including Type 2 diabetes, heart disease, hypertension, and high cholesterol.

Source: Shape Up America!

In the past year, an estimated more than one million patients were hospitalized and nearly three million visited emergency rooms in the United States as a result of asthma, according to a new comprehensive national survey.(1, 2) Additionally, approximately one in three asthma patients 12 and older surveyed were hospitalized, visited emergency rooms or had other unscheduled healthcare visits due to their asthma in the past year.(2) Findings from Asthma Insight and Management (AIM), a survey of 2,500 current asthma patients 12 and older, 1,004 adults without asthma and 309 physicians in the United States, showcase the burden of this chronic disease. AIM was conducted to provide a benchmark on progress in asthma care since the last landmark asthma survey in the U.S., Asthma in America (AIA), conducted in 1998. AIM is the largest and most comprehensive national survey of asthma in the United States conducted in more than a decade.(2)

AIM revealed that while there have been incremental declines in emergency room visits and the number of patients reporting missed work or school days due to asthma, there have been no improvements in hospitalizations or other unscheduled emergency visits for asthma over the past decade.(2) The percentage of adults with asthma who were hospitalized, due to asthma, seven percent, was the same in 2009 as in 1998, and slightly more patients reported other unscheduled emergency visits due to asthma in 2009 (26 percent) than in 1998 (25 percent). There were incremental improvements in emergency room visits and the number of patients reporting missed work or school days due to asthma in 2009; 16 percent of adults with asthma visited the emergency room in 2009 compared with 19 percent of patients in 1998, and 20 percent of patients reported missed work or school days in 2009 compared to 25 percent in 1998.(2)

“The AIM survey reveals significant unmet needs with regard to the current state of asthma care in the United States,” said Eli Meltzer, M.D., AIM physician advisor and co-director of the Allergy and Asthma Medical Group and Research Center, San Diego, California. “We know more about how to manage asthma and prevent symptoms than ever before, but that knowledge is apparently not being translated into better outcomes for patients.”

According to AIM, asthma has a significant impact on patients’ daily lives, with significantly more adults with asthma reporting activity limitations when compared to adults without asthma. In the AIM survey, adults with asthma took more than three times as many sick days in the past year compared to adults without asthma, and had to limit their daily activities more than twice as often.(2)

Additional findings include:

– One in five asthma patients live in fear of hospitalizations or emergency room visits due to asthma and 29 percent of patients say that fear of asthma exacerbations keeps them from doing the things they want.(2)
– Twelve percent of asthma patients who had an episode in the past year when asthma symptoms were more frequent or severe than normal report that these episodes last between seven and 13 days, while 18 percent reported that these episodes last three to four days. The mean duration of these episodes is 6.5 days.(2)
– Asthma patients report a 33 percent decline in average productivity at times of the year when asthma was at its worst compared to a typical day.(2)
– Adult asthma patients reported taking an average of 12.4 sick days compared with 3.6 sick days for adults without asthma in the past year, and 37.9 days in which they limited their activities compared with 15.8 days for adults without asthma in the past year.(2)
– Twenty-eight percent of adult asthma patients say they feel “a lot” or “some” limitations in social activities due to their asthma compared to 14 percent of adults without asthma who say they feel “a lot” or “some” limitations in social activities due to their health.(2)

“These results demonstrate that too many patients may simply accept a high burden of asthma symptoms,” said Stuart Stoloff, M.D., AIM physician advisor and clinical professor of family and community medicine, University of Nevada School of Medicine, Reno, Nevada. “Through education, physicians can help patients understand current asthma treatment guidelines and help them avoid symptoms when possible and get back to the daily activities they enjoy.”

Despite the physical and emotional burden of asthma, the majority of current asthma patients surveyed believe their asthma is well managed. More than 70 percent of patients surveyed believe that their asthma is either completely or well controlled. However, nearly half (47 percent) of these patients were classified as having very poorly controlled asthma according to the survey’s classification of control, which is based on accepted guidelines, and another 24 percent were defined as not well-controlled.(2)

Results from AIM also suggest that based on frequency of use of quick-relief inhalers, many patients may not be managing their asthma properly. Sixteen percent of asthma patients surveyed said they use their quick-relief inhaler daily, while an additional seven percent reported using their quick-relief inhaler three to six times a week.(2) The National Asthma Education and Prevention Program (NAEPP) guidelines state that asthma patients 12 and older could, in part, be classified as having not well controlled disease if they use their quick-relief inhaler for symptom control more than two days per week, and more frequent use may indicate a need for maintenance medication.(3) Based on the guidelines, daily use of asthma maintenance medications may be needed to prevent asthma symptoms in patients whose disease is not well managed, yet 39 percent of patients agree “strongly” or “somewhat” that maintenance medications are not necessary when asthma symptoms are not experienced regularly.(2) In addition, 42 percent of survey respondents reported that they had stopped taking their maintenance medication for a week or longer in the past year.

Patients’ lack of an accurate understanding of well-controlled asthma based on the guidelines may be a result of ineffective communication with their physicians. The AIM survey reveals that physicians often use terms that patients are unfamiliar with, such as “asthma exacerbations,” making effective communication difficult. The term “asthma exacerbations” is frequently used by physicians — 69 percent of family practice physicians, 93 percent of pulmonologists and 76 percent of allergists report regularly using this term when discussing asthma with their patients – yet only 24 percent of asthma patients say they have heard the term. Patients report being most familiar with the term “asthma attack” (97 percent report they have heard the term), while 71 percent of family practice physicians, 57 percent of pulmonologists and 58 percent of allergists use this term regularly when discussing asthma. Patients and physicians also report familiarity with the term “asthma flare-up.” Seventy-one percent of patients say they have heard of asthma “asthma flare-ups” and 73 percent of family practice physicians, 57 percent of pulmonologists and 78 percent of allergists report using this term regularly when discussing asthma.(2)

Asthma is a chronic lung disease that affects 22 million adults and children in the United States according to the National Heart, Lung and Blood Institute (NHLBI).(4) Of the general American adult population surveyed in AIM, approximately 8 percent of adults have been diagnosed with current asthma and have symptoms or had an asthma attack in the past year, or are taking medication for their disease. Another six percent have been diagnosed with asthma in the past, but have not had asthma symptoms or an asthma attack in the past year, or are not currently using medications for asthma. However, a much larger proportion of the general adult population surveyed, 31 percent, report that other family members have asthma. Indeed, nearly half of the general adult population surveyed (45 percent) report that they or another family member have had asthma.(2) For more detailed information about the AIM survey and its findings, please visit www.TakingAIMatAsthma.com.

AIM was conducted by the national public opinion research organization Abt SRBI Inc. during the summer of 2009. Serving as advisors on the project were Michael Blaiss, M.D.; Eli Meltzer, M.D.; Kevin Murphy, M.D.; Robert Nathan, M.D.; and Stuart Stoloff, M.D. The survey was sponsored by Schering Corporation; Schering-Plough and Merck & Co. Inc. merged on November 3, 2009.

1. U.S. Census Bureau, Current Population Survey, Annual Social and Economic Supplement. 2008. http://www.census.gov/population/www/socdemo/age/age_sex_2008.html
2. Asthma Insights and Management (AIM) Survey: Executive Summary. 2009.
3. “National Asthma Education and Prevention Program Expert Panel Report
3: Guidelines for the Diagnosis and Management of Asthma.” National Institutes of Health. National Heart, Lung, and Blood Institute. 2007. http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf
4. “Asthma.” National Heart, Lung, and Blood Institute Diseases and Conditions Index. September 2008. http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html

Source: Merck

Published in the November issue of the Journal of the American Dental Association, the study followed 200 patients (101 women and 99 men) in private dental practices in Sweden whose dentists used a computerized system, “HeartScore,” to calculate the risk of a patient dying from a cardiovascular event within a 10-year period.

Designed by the European Society of Cardiology, HeartScore measures cardiovascular disease risk in persons aged 40-65 by factoring the person’s age, sex, total cholesterol level, systolic blood pressure and smoking status.

Patients with HeartScores of 10 percent or higher, meaning they had a 10 percent or higher risk of having a fatal heart attack or stroke within a 10-year period, were told by dentists to seek medical advice regarding their condition.

Twelve patients in the study, all of them men, had HeartScores of 10 percent or higher. All women participating in the study had HeartScores of 5 percent or less.

Of the 12 male patients with HeartScores of 10 percent or higher, nine sought further evaluation by a medical care provider who decided that intervention was indicated for six of the patients. Two patients did not follow the dentist’s recommendation to seek further medical evaluation and one patient was only encouraged by his dentist to discontinue smoking. Physicians for three patients were not able to confirm their risk for cardiovascular disease.

All 200 patients enrolled in the study were 45 years of age or older with no history of cardiovascular disease, medications for high blood pressure, high cholesterol or diabetes and had not visited a physician during the previous year to assess their glucose, cholesterol or blood pressure levels.

The study’s authors conclude that oral health care professionals can identify patients who are unaware of their risk of developing serious complications as a result of cardiovascular disease and who are in need of medical interventions.

According to the authors, “With emerging data suggesting an association between oral and non-oral diseases, and with the possibility of performing chairside screening tests for diseases such as cardiovascular disease and diabetes, oral health care professionals may find themselves in an opportune position to enhance the overall health and well-being of their patients.”

Source: American Dental Association

Swine Influenza or swine flu is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. Swine flu viruses cause high levels of illness and low death rates in pigs. Swine influenza viruses may circulate among swine throughout the year, but most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930.

Swine Flu or Influenza Symptoms

Influenza (also known as the flu) is a contagious respiratory illness caused by flu viruses. It can cause mild to severe illness, and at times can lead to death. The flu is different from a cold. The flu usually comes on suddenly and may include these symptoms:

- Fever (usually high)
- Headache
- Extreme tiredness
- Dry cough
- Sore throat
- Runny or stuffy nose
- Muscle aches
- Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults

These symptoms are usually referred to as “flu-like symptoms.”

How To Know if You Have H1N1 Flu or Swine Flu?

Your respiratory illness might be the flu if you have sudden onset of body aches, high fever, and respiratory symptoms, and your illness occurs during the usual flu season in the Northern Hemisphere. However, during this time, other respiratory illnesses can cause similar symptoms to the flu. In addition, influenza can also occur outside of the typical flu season. It is impossible to tell for sure if you have the flu based on symptoms alone. Doctors can perform tests to see if you have the flu if you are in the first few days of your illness.

Flu is a serious disease and it’s important to take action to protect yourself. If you do get sick, however, there are steps you can take to treat the flu.

How can human infections with swine influenza be diagnosed?

To diagnose swine influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 7 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to CDC for laboratory testing.

What medications are available to treat swine flu infections in humans?

There are four different antiviral drugs that are licensed for use in the US for the treatment of influenza:

- amantadine
- rimantadine
- oseltamivir
- zanamivir

While most swine influenza viruses have been susceptible to all four drugs, the most recent H1N1 influenza viruses isolated from humans are resistant to amantadine and rimantadine.

How to protect or prevent oneself from getting infected?

There is currently no vaccine available yet to protect against swine flu. For now, these steps can help protect your health:

- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
- Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
- Avoid touching your eyes, nose or mouth because germs spread this way.
- Stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.
- Try to avoid close contact with sick people.
- If you get sick with influenza, stay home and limit contact with others to keep from infecting them.

Source: CDC

The U.S. Food and Drug Administration today announced the Safe Use Initiative, a program aimed at reducing the likelihood of preventable harm from medication use.

“Too many people suffer unnecessary injuries from avoidable medication misuse, errors and other problems. The FDA is launching the Safe Use Initiative to develop targeted solutions for reducing these injuries,” said FDA Commissioner Margaret A. Hamburg, M.D.

Millions of people are harmed every year from inappropriate medication use. Many injuries occur as a result of incomplete access to information about a drug, a patient, or the patient’s condition.

Other preventable sources of harm include unintentional misuse of medications, medication abuse, and attempts at self harm. Unintended exposure to prescription medications such as opioid drugs can cause harm, even death, in a single dose, if taken by someone other than the patient who was prescribed the medication.

“Only through coordinated interventions across all sectors of the health care system can we substantially reduce preventable injuries from using medications,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research. “All participants in the health care community have a role to play in reducing the risks and preventing injuries from medication use.”

More detailed information on the new program was contained in a report, titled, “FDA’s Safe Use Initiative – Collaborating to Reduce Preventable Harm from Medicines.” The report was released by Drs. Hamburg and Woodcock at FDA’s annual Science Writers Symposium at the agency’s White Oak Campus in Silver Spring, Md.

As outlined in the report, the FDA intends to collaborate with health care professionals and other stakeholders to identify drugs and drug classes that are linked to preventable harm. A list of specific problems, cross-sector interventions for reducing harm from these problems, and the metrics for success will be developed.

The report highlights several risk-reduction projects that may benefit from Safe Use collaborations, including evaluating consumer medication information, communicating about the risk of inadvertent overexposure to acetaminophen, implementing safeguards against surgery fires caused by alcohol-based surgical preps, and avoiding contamination of multiple use medication vials.

To further advance the Safe Use Initiative, the FDA intends to hold a series of public meetings to gather feedback as the candidate list is being developed and will open a public docket to receive comments on the report and proposed candidate cases.

The agency also today made public new FDA guidance for companies that manufacture, market, or distribute over-the-counter liquid medications packaged with dosage delivery devices such as calibrated cups, droppers, syringes and spoons.

The guidance document, titled “Dosage Delivery Devices for OTC Liquid Drug Products,” was posted for advanced viewing in the Federal Register today.

Accidental overdoses can be caused by dosage delivery devices that are unclear or are inconsistent with the labeled dosing instructions.

“This new drug dosage guidance document is an example of steps that can be taken to ensure safer medication use,” said Woodcock. “Many accidental overdoses result from confusion about exactly how much of a drug to take. Better measuring devices will help patients, parents, and other caregivers use the right amount of these medications – the safest and most effective dose – especially for children.”

For more information: http://www.fda.gov/Drugs/DrugSafety/ucm187806.htm

Pulmonary arterial hypertension (PAH) patients using infused drugs have suffered serious injury or in some cases died from medication errors in hospitals and other inpatient settings, according to a peer-reviewed study by Accredo Health Group and several university hospitals that surveyed doctors, nurses and pharmacists. The study, which was presented at the American College of Chest Physicians’ annual meeting and will be published in the medical journal CHEST, examined medication errors for patients infused with epoprostenol (Flolan®) and treprostinil (Remodulin®) and provided guidelines to help reduce these risks.

Pulmonary arterial hypertension is a debilitating, life-threatening condition without a cure that can lead to heart failure and lung transplants. Epoprostenol and treprostinil inhibit the blood from clotting and also widen blood vessels to ease blood pressure in the lungs and reduce strain on the heart. The medications belong to a group called prostacyclins, which need to be continuously infused into the body for pulmonary hypertension patients to survive. The drugs are dosed in extremely small quantities and giving a patient too much or too little can lead to patient injury or death.

“Prostacyclins are the most potent drugs used to treat PAH and have a very narrow therapeutic window, making the proper use of medications paramount to keep patients safe,” said Mark A. Tankersley, Ph.D., director of health outcomes solutions at Accredo Health Group, Inc. and one of the authors of the study. “These patients are in an extremely vulnerable condition – normally in the advanced stages of this debilitating condition. Our survey exposes the severity of the problem but also presents some possible solutions to address it.”

An electronic survey of 97 clinicians at treating facilities found that 68 percent reported errors associated with administering prostacyclins and 28 respondents reported serious errors including nine that resulted in death. A separate telephone survey found that 17 of 18 nurses at pulmonary arterial hypertension centers reported serious medication errors, including three deaths. The results showed that medication errors included providing the wrong drug to the patient, improper dosing, incorrectly flushing the patient’s catheter line and accidental stoppage of the infusion pump.

Researchers made the following recommendations: clearer record-keeping, clinician training, double-checking dosage factors (concentration, patient weight, pump rate and time), color coding cassettes for different drugs, marking line connections for drugs, proper medication storage, ensuring that the infusion pumps are working correctly, and requiring two nurses to sign-off on administering the medication.

PAH affects about 20,000 Americans and presently does not have a cure. One form of pulmonary arterial hypertension has no known cause. For other patients, it results from congenital heart disease, HIV infection, thyroid disease, and the use of certain diet medications or street drugs. The condition is often misdiagnosed in its early stages, but as the condition worsens it can lead to fainting, lightheadedness during physical activity, swelling in the legs and ankles, and bluish toned lips and skin (cyanotic).

CHEST, the official publication for the American College of Chest Physicians, will publish the article in an upcoming issue. Researchers at Accredo Health Group, The University of Texas Southwestern Medical Center at Dallas, University of California at San Diego, and University of California at San Francisco authored the study and suggested guidelines for protocols.

For more information about this study, visit www.medcoresearch.com.

Source: Medco Health Solutions, Inc.

“Results of this trial now confirm the place of radiation therapy in the management of patients who have high risk features following surgery for melanoma involving the lymph nodes,” Bryan Burmeister, M.D., lead author of the study and a radiation oncologist at Princess Alexandra Hospital in Brisbane, Australia, said. “In some institutions, radiation treatment is routine protocol, while in others, the protocol has been either for patients to just be observed, or receive some type of adjuvant chemotherapy or immunotherapy. I encourage patients with melanoma to talk to their doctors about whether radiation should be added to their treatment plan.”

When melanoma has spread from its original site to the lymph nodes, treatment typically involves surgically removing cancerous and remaining lymph nodes in that region, a surgery called a lymphadenectomy. This multicenter, randomized trial examined the effects of external beam radiation treatment after surgery for melanoma patients who had a high risk of the cancer returning to the lymph nodes (regional recurrence).

During external beam radiation therapy, a beam (or multiple beams) of radiation is directed through the skin to the cancer and the immediate surrounding area in order to destroy the main tumor and/or any nearby cancer cells that remain after surgery. The treatments are outpatient and generally painless, much like receiving an X-ray.

From March 2002 to September 2007, 217 patients from 16 cancer centers who had undergone a lymphadenectomy for melanoma cancer were randomized to receive radiation treatment within 12 weeks after surgery or be observed, with a median follow-up of 27 months.

Results of the study show there was significant improvement in the control of regional recurrence among patients who underwent radiation therapy, compared to the observation group.

For more information on radiation therapy for skin cancer, visit www.rtanswers.org.

Source: American Society for Radiation Oncology

A study led by Heather Rosen, MD, MPH, research fellow in the Department of Plastic Surgery at Children’s Hospital Boston and Harvard Medical School, found that uninsured children were over three times more likely to die from their trauma-related injuries than children who were commercially insured, after adjustment for other factors such as age, gender, race, injury severity and injury type in an analysis of data from the National Trauma Data Bank. Moreover, publicly-insured children were 1.19 times more likely to die from trauma when compared with commercially-insured children.

According to the federal Emergency Medical Treatment and Active Labor Act (EMTALA), all hospitals are required to treat patients until they are medically stable, regardless of insurance status. “We have this idea that everyone is treated equally, yet the mortality rate after trauma among uninsured children is much higher when compared to children with commercial insurance,” says Rosen.

The study, involving researchers from Children’s, Harvard Medical School, and Brigham and Women’s Hospital, collected and analyzed data from the National Trauma Data Bank, a consortium of more than 900 trauma centers across the country.

The researchers examined data from 174,921 trauma patients aged 17 years and younger. Patients were divided into three groups: uninsured, publicly insured, and commercially insured.

After adjusting for factors such as race, age, gender, injury type and injury severity, results showed that uninsured trauma patients were over three times more likely to die after trauma than patients who were commercially insured by plans such as Blue Cross/Blue Shield and worker’s compensation. Furthermore, patients with public insurance, including Medicaid and the State Children’s Health Insurance Program (SCHIP), were 1.19 times more likely to die than commercially insured patients.

Because the study was retrospective, the researchers cannot say definitively why insurance status may affect mortality rate in spite of EMTALA. “This paper provokes more questions than it answers,” says Rosen, who is currently doing her residency in general surgery at the University of Southern California’s Keck School of Medicine. “Should we be more vigilant about investigating whether EMTALA laws are being violated? Is this happening more often than we care to admit?”

The researchers speculate about several possible explanations for their findings. One is that trauma patients with public insurance or no insurance may be transferred from one hospital to another, causing a delay in definitive treatment. Uninsured patients may also undergo fewer medical tests, leading to inadequate diagnoses or missed injuries. In addition, if uninsured patients do not speak English as their first language or are less educated overall, they may be less able to communicate with medical providers about their medical history and quality of care after sustaining an injury.

“This study suggests that there may be a direct effect of possessing insurance. We need to work harder to get to the point where every person has access to health care in this country,” Rosen says.

Because emergency trauma treatment should theoretically begin before providers know a patient’s insurance status, researchers insist that further investigation is needed to determine why these health disparities exist. For the future, Rosen would like to conduct a prospective study of the processes involved in pediatric trauma care according to insurance status, looking at differences in quality of care in real time.

The article, “Lack of Insurance Negatively Affects Trauma Mortality in U.S. Children,” is published in the October issue of the Journal of Pediatric Surgery.

Source: Children’s Hospital Boston

In recognition of National Pancreatic Cancer Awareness Month, the Pancreatic Cancer Action Network is issuing a challenge to increase the number of people aware of the deadly disease through an online interactive campaign “Pancreatic Cancer: Know it. Fight it. End it.”

Supporters can visit www.knowitfightitendit.org to play a match game to test their knowledge of pancreatic cancer and get their family and friends involved by forwarding the game. In addition to the game, the new website also informs visitors about simple ways to raise awareness and take action in their communities, and hear stories of hope and inspiration from survivors of this disease.

“Our goal with this campaign is to increase the number of people who know about this disease so they can help fight it and ultimately end it,” stated Julie Fleshman, president and CEO of the Pancreatic Cancer Action Network. “Although pancreatic cancer is the fourth leading cause of cancer death in our country, many American’s do not realize the severity of this disease. We hope this viral campaign will educate the public in a fun, unique way and bring new community volunteers and advocates to the cause.”

It is important now more than ever to get more American’s involved in the fight against pancreatic cancer because experts project the number of cases will increase by 55 percent by 2030. Pancreatic cancer has the highest mortality rate of all major cancers with a five year survival rate of just 5 percent. According to the American Cancer Society, in 2009, more than 42,000 people will be diagnosed with pancreatic cancer in the United States, and over 35,000 will die from the disease.

In addition to the Know it. Fight it. End it. campaign, the organization encourages people to support National Pancreatic Cancer Awareness Month by participating in the following activities:

– Buy a limited edition My Tempur-Pedic Teddy Bear® – As part of the Tempur-Pedic Hugs Back Campaign, net proceeds from the plush teddy bear will benefit the Pancreatic Cancer Action Network. The bear is filled with the company’s proprietary, pressure-relieving TEMPUR® material – making it perfect for snuggling – and is co-branded with the Pancreatic Cancer Action Network logo. Bears can be purchased throughout the holiday season at select bedding retailers, by calling 888-225-7560 or online at http://www.tempurpedic.com/teddy_bear for $59 each.
– Shop at Z Gallerie – In memory of Shirley Zeiden, mother of the company’s founders, Z Gallerie will donate a portion of in-store and online sales from November 2nd through November 8th. Shop or find a store near you at www.zgallerie.com.
– Visit www.pancan.org – Find out ten different ways to easily make a difference this November and throughout the year.

To learn more about the Pancreatic Cancer Action Network visit www.pancan.org.

Source: Pancreatic Cancer Action Network

Lymphoma is a cancer of white blood cells called lymphocytes that are largely responsible for maintaining the body’s immunity, and EBV is one of the most common human viruses that can have a long-lasting impact on the body’s immune system. Immune-compromised patients who receive HSCT, especially from mismatched donors or matched but unrelated donors, may be at higher risk of developing EBV-lymphoma than other patients with immune deficiencies. Previous studies have suggested that EBV-lymphoma occurs most often in the first few months post-transplant.

The researchers hypothesized that aggressive EBV-lymphomas may be more responsive to control or eradication with EBV-specific cytotoxic T lymphocyte (CTL) treatment (CTLs are highly specialized white blood cells that build the body’s defenses against disease). To test their theory, the team infused EBV-specific CTL lines into two groups of patients: those who were undergoing HSCT and were at high risk of developing EBV-lymphoma, and patients who had already developed lymphoma. The study reported that CTL treatment successfully prevented the development of EBV-lymphoma in all 101 patients in the at-risk group who received the therapy prophylactically and achieved sustained complete remission in 11 of the 13 patients (80 percent) treated therapeutically (those who already had the disease).

“Therapy with EBV-specific CTLs was effective for these severely immunocompromised patients. The CTLs successfully reached tumors, multiplied, and were able to kill the tumor cells,” said lead study author Helen Heslop, MD, of the Center for Cell and Gene Therapy at Baylor College of Medicine, The Methodist Hospital, and Texas Children’s Hospital.

While the successful outcomes result from a number of factors in the study, the researchers attribute some of the success of the trial to timely treatment. The CTL lines were infused soon after stem cell transplantation, when the existing white blood cell count was still low and was not quickly regenerating, allowing the infused cells to more quickly multiply and mediate anti-viral and anti-tumor effects. In addition, by marking and tracking the CTL genes, the team was able to demonstrate that the cells could survive for up to nine years in the body, conferring long-term protection.

With strong clinical outcomes, the study team is working to determine the most appropriate role and timing for CTL infusions. Some newer therapies (such as monoclonal antibodies) offer prophylactic and therapeutic options, but, despite their availability, they cannot offer long-term protection. Therefore, treatment with CTLs may be reserved for the highest risk patients – those with a diagnosis of immune deficiency or a history of EBV-lymphoma, or those who develop elevated EBV levels after therapy with monoclonal antibodies.

Importantly, the study found that this type of therapy is not only effective, but economically advantageous. A preliminary analysis showed that a patient-specific CTL line can be manufactured, tested, and infused for approximately $6,000, a cost that compares well with other modalities used in the treatment of EBV-lymphoma. Moreover, the team determined that it is possible to manufacture cells in one location and ship them to another center for infusion, with reproducible and consistent results and clinical outcomes.

“It’s important to note that this promising therapy is not only effective, but it is also a cost-effective option for high-risk patients,” said Dr. Heslop.

Source: American Society of Hematology