A team of surgeons from Kleinert Kutz and Associates and the University of Louisville have performed yet another hand transplant at the Jewish Hospital Hand Care Center. Surgeons document the surgery, which was the facility’s first double hand transplant, by using Twitter, to provide short, real-time updates as the procedure takes place.

Breidenbach said, “The patient’s family is very excited about being able to follow the surgery online instead of occasional updates throughout the surgery by hospital personnel. We want others to follow the surgery as well to understand how it all works, identifying and connecting bones, arteries and veins. Our team has already performed five hand transplants over the past eleven years and we have been reconnecting fingers, hands and arms for more than 50 years.”

“We live in a real-time world today where people want to know what’s happening as it is happening,” said Marty Bonick, president and CEO, Jewish Hospital Medical Campus. “This is a chance for us to tell the world about our latest hand transplant as it happens and also take the mystery out of an innovative procedure.”

To follow the surgery, go to www.twitter.com/jewishhospital

The Composite Tissue Allotransplantation program is a partnership of physicians and researchers at Jewish Hospital Hand Care Center, Kleinert Kutz & Associates, and the University of Louisville. The group developed the pioneering hand transplant procedure. The hand transplant is sponsored by the Department of Defense, Office of Naval Research and Office of Army Research to further research in the composite tissue allotransplantation program.

As the unofficial end of summer quickly approaches with Labor Day weekend, many Americans are planning one last hurrah by gathering with family and friends for cookouts and picnics. Essential ingredients for a successful party include sunny weather, good company and delicious – and safe – food. Food safety and quality testing company Intertek offers the following tips for packing the perfect cooler and advice for safe grilling to keep your party food at optimum temperatures during your outdoor celebration.

When packing for a cookout or picnic, it’s best to bring one cooler for beverages and a separate cooler for food. Because beverage coolers are opened more frequently, cold air can escape, causing the internal temperature to rise. Be sure to pack your food cooler with ice packs along with loose ice so it will remain below 40 F, reducing the risk for harmful bacteria to grow.

When grilling food, it is important to use a meat thermometer to ensure proper temperatures. To verify safe internal temperatures, beef and poultry should be grilled to 170 F, while hamburgers are best at 160 F. Additionally, to avoid cross contamination, do not use the same utensils for raw and cooked food.

If you have leftovers, immediately put perishable food away in a cooler containing ice or ice packs. Discard any leftovers that have been outside for more than two hours; however if the temperature exceeds 90 F, discard food left out only after one hour. When in doubt, throw it out.

In what may be one of the first known iPhone 4 “video calling” medical consultations since the phone’s release, surgeons at Valley Presbyterian Hospital near Los Angeles and University of Arizona used the advanced technology to successfully collaborate long distance in “real time” on a wound consultation for a patient.

Using the FaceTime feature on the new iPhone 4, Dr. David G. Armstrong, Professor of Surgery at the University of Arizona’s Southern Arizona Limb Salvage Alliance (SALSA), was able to instantly connect with Dr. Lee Rogers, Associate Director of Valley Presbyterian Hospital’s Amputation Prevention Center, near Los Angeles by video calling. What is essentially a simple phone call, turned into a long distance consultation and second opinion for a patient who recently underwent surgery.

“Video consultation over the Internet has been available for a few years, but its utility in the clinical setting has been limited by the necessity of having a transportable computer, camera, and appropriate software,” said Dr. Rogers. “Now, nearly everyone carries a phone in their pocket. It is this compact accessibility that will lead to the adoption of this technology for medical consultations.”

“While the University of Arizona has had one of the world’s top telehealth systems, the ability to communicate quickly with something that is an afterthought has the potential to alter how we work with our colleagues and patients,” said Dr. Armstrong.

“Just as with the iPod in music and the laptop in computing, it is not the change in technology, but the change in form factor and ubiquity that alters this landscape.”

The use of iPhone 4 technology is just the most recent cutting-edge technology to help surgeons at Valley Presbyterian Hospital’s Amputation Prevention Center, which opened earlier this year.

While many U.S. companies initially hoped they could preserve much of their existing group health plans under the new grandfather provision, a new survey by Hewitt Associates, shows that almost all now believe they will not. Ninety percent of companies said they anticipate losing grandfathered status by 2014, with the majority expecting to do so in the next two years.

Under the “grandfather” provision of the U.S. Patient Protection and Affordable Care Act, companies can maintain many of their current health care coverage provisions and are required to make fewer changes to plan documents and administrative procedures in order to comply with the new law. Companies can lose their grandfather status if they take certain steps such as reducing benefits, significantly raising co-payment charges, significantly raising deductibles or changing insurance carriers.

According to Hewitt’s survey of 466 companies—representing 6.9 million employees—most companies expect to lose grandfather status because of health plan design changes (72 percent) and/or changes to company subsidy levels (39 percent). Employers also cited consolidation of health plans (16 percent), changes to insurance carriers (16 percent) and union negotiations (15 percent) as additional reasons. More than three-quarters of companies (77 percent) said that recently released guidance on preventive care did not impact their decision to maintain grandfathered status.

Hewitt’s survey found that of those companies with self-insured plans, most (51 percent) expect to first lose grandfather status in 2011 and another 21 percent plan to lose status in 2012. This timing is similar for companies with fully insured medical plans, with the vast majority expecting to lose status in 2011 (46 percent) or 2012 (18 percent).

“Employers reviewing their existing health care strategies in light of reform are focused on answering two questions: What changes do I need or want to make to my health care plans? And how can I make them without significantly increasing costs?” said Ken Sperling, leader of Hewitt’s Health Management practice. “After assessing the grandfather provision, large companies realize they already comply with many of the requirements of non-grandfathered plans, so the changes they’ll need to make aren’t likely to add a significant cost or administrative burden. Most large employers would rather have the flexibility to change their benefit programs than be tied down to the limited modifications allowed under the new law.”

The latest data from the Centers for Disease Control’s (CDC) National Health Statistics Reports shows continued use of the nation’s emergency rooms for conditions that could be treated in an urgent care setting.

Of the 116.8 million visits covered by the 2007 Emergency Department (ED) Summary, only 16.4% were actually admitted to a hospital or kept for observation, while the overwhelming majority (62%) were referred to their primary care provider or a specialist for follow up. Another 35% were referred back to the ED “as needed”, presumably because those patients did not have a regular doctor. Over one third of the patients categorized their pain levels as “none” or “mild”; the chief complaints continue to be (as they were in the 2006 data) upper respiratory issues, otitis media (earache), abdominal pain, wounds, and obstetrics complications.

While in the ED, 45.5% of the patients had a procedure, the majority of which were common procedures such as administration of IV fluids, splinting or wrapping, repair of a laceration, or a nebulizer treatment. Urgent care centers can treat the vast majority of these issues and others—issues that don’t require an inpatient stay and are not life or limb-threatening emergencies—at a lower cost and usually a much shorter wait time than the ED. Urgent care centers perform all of those common procedures and are set up to provide referrals back to primary care or specialists. Urgent care centers are open for extended hours, as well as on weekends, providing easy access.

While there will continue to be uncertainty about what seemingly minor conditions truly belong in the ED, and patients should always err on the side of caution, it is clear from the latest CDC data (based on the chief complaints, levels of pain, types of treatment and ultimate discharge plans for most patients) that many ED patients likely could have been treated in an urgent care center.

A team of Allegheny General Hospital (AGH) physicians led by neurosurgical pioneer Peter Jannetta, MD, has made an important new discovery linking the central nervous system to the onset and progression of type 2 diabetes mellitus. Reporting today in the journal Surgical Neurology International, Dr. Jannetta and his colleagues present evidence from a prospective clinical trial that vascular compression of a section of the brain called the medulla oblongata is a factor in some patients with type 2 diabetes and that microvascular decompression surgery (MVD) may be an effective treatment for the condition.

Recognized world-wide as one of the preeminent authorities on diseases associated with vascular compression of the cranial nerves, Dr. Jannetta is credited with developing the MVD technique, which is now generally considered the surgical standard of care for a host of debilitating cranial nerve diseases, including trigeminal neuralgia, hemifacial spasm, vertigo, Meniere’s disease and spasmodic torticollis.

Microvascular decompression is a procedure that involves repositioning compressive arteries in the brain and placing a protective pad between the nerve and artery.

Dr. Jannetta, who serves as Vice Chair of Academics in AGH’s Department of Neurosurgery, and his team have performed more than 6,000 such operations.

Over the past three decades, research by Dr. Jannetta and others has led to observations about the potential role of vascular compression in metabolic syndromes such as hypertension and diabetes.

A disease of epidemic proportions in the United States, type 2 diabetes mellitus is a chronic condition marked by high levels of sugar (glucose) in the blood. Although obesity is a primary risk factor for the disease, it can also develop in those who are not obese, especially among the elderly. Without medical intervention or aggressive lifestyle changes, type 2 diabetes often leads to serious cardiovascular, vision and renal problems.

In a previous, retrospective study of 15 patients with type 2 diabetes who were operated on by Dr. Jannetta for an unrelated right-sided cranial nerve disease, arterial compression of the right anterolateral medulla oblongata was documented in every single case (Stroke 1999:30:1707-10).

The medulla oblongata is the lowermost portion of the brain, continuous with the spinal cord, that is responsible for respiration, circulation and the body’s autonomic reflexes, including function of the pancreas.

“Insulin resistance, or hyperinsulinemia, is central to the development of type 2 diabetes mellitus. We have documented previously that pulsatile arterial compression of the right anterolateral medulla oblongata is associated with autonomic dysfunction that adversely impacts the pancreas and increases insulin resistance. Building upon that knowledge, we hypothesized that decompressing the right cranial nerve X – or the vagus nerve – and the medulla oblongata could result in better glycemic control for patients with this disease,” said Dr. Jannetta.

Ten patients with steadily progressive type 2 diabetes mellitus and visible right lateral medullary compression by arterial loops on MRI were enrolled in the team’s follow up study. Each patient in the trial underwent right retromastoid craniectomy and microvascular decompression. At intraoperative visual evaluation, the vascular compression was even more severe than seen on MRI scans in 9 of the 10 patients, Dr. Jannetta said.

Patients in the study were followed for 12 months post-operatively, during which time no changes in diet, weight or activity level were permitted. In addition to blood glucose monitoring, studies of glycemic control, pancreatic function and insulin metabolism were performed regularly by the team.

Study participants whose glycemic control either improved or did not worsen during the course of the trial were considered “good” responders, while “failed” responders had no slowing in the natural progression of the disease.

Results of the trial showed that seven of the ten patients who underwent MVD experienced significant improvement in their glucose control, based on measurement of diabetes markers (changes in hemoglobin A1c, fasting blood glucose and serum insulin levels) and decrease of diabetes medication dosages. One patient was able to discontinue his diabetic medications entirely.

Dr. Jannetta said body mass index also appeared to be an important factor in who responded well to surgery. Those in the study who had the best outcome from MVD had BMIs classified as overweight while those who did not respond had BMIs in the obese category.

“Diabetes is a tremendously difficult condition to manage and, for patients, to live with. Though our study involves a relatively small sampling of patients, we believe that it represents a major breakthrough in our understanding about the central nervous system etiology of the disease and the potential of surgical intervention as an alternative therapy for a significant subset of patients. The next step is a much larger prospective clinical investigation to further corroborate what we have found,” Dr. Jannetta said.

Commenting on the study in an accompanying editorial, Sunil Patel, MD, Chair of the Department of Neurosciences at the Medical University of South Carolina and Joyce Nicholas, Ph.D., Associate Professor in MUSC’s Department of Biostatistics and Epidemiology, concur on the importance of the AGH team’s work and the need for continued investigation:

“These observations point the way to further questions that need to be answered to conclude definitively that pulsatile arterial compression of the right antrolateral medulla is an independent risk factor for type 2 diabetes mellitus. Like Dr. Jannetta’s earlier observations on essential hypertension, the observations presented [in the current study] are valuable starting points for questions related to the exact location of arterial compression relevant to type 2 diabetes mellitus, the best experimental measure of response, and the subset of patients most likely to benefit from microvascular decompression surgery. We encourage their continued efforts and those of other researchers in addressing the questions raised by this valuable contribution to our understanding of the disease and its treatment.”

In addition to Dr. Jannetta, other AGH physicians who participated in the study include neurosurgeon Ray Sekula, MD, endocrinologist Peter Grondzioski, MD, and research coordinator Lynn Fletcher, RN.

The reviews are in, and retirees give the thumbs up to health insurance exchanges. In an independent survey of 443 retirees who use a health insurance exchange to compare and choose private individual Medicare and supplement plans, 85% of their reviews were positive. Top-rated responses were:

• Health insurance exchanges are a welcome addition to the U.S. health insurance system; and
• Everyone should have access to a health insurance exchange.

When asked the most appealing aspect of health insurance exchanges, the number one cited answer was “Exchanges make it easier to compare and select plans that meet my needs and budget.”

The survey was fielded in June and July 2010 by Extend Health, Inc., which operates the largest private Medicare exchange in the country at www.ExtendHealth.com.

“Our retiree customers are at the leading edge of what is next in healthcare – individuals with access to health insurance through an exchange,” said Bryce Williams, CEO of Extend Health. “These survey results suggest that the exchanges authorized by health care reform legislation passed earlier this year will be greeted with enthusiasm when they go into operation for individuals and small businesses in 2014.”

The questions and detailed results from the survey are as follows:

After overcoming a series of facial reconstructive surgeries for the removal of an 18 pound, melon-sized tumor from her face, followed by a devastating earthquake that resulted in loss of family and homelessness – Marlie Casseus faces another challenge.

“Marlie is having difficulty breathing due to an infection,” stated Janelle Prieto, Director of IKF’s Wonderfund. “She needs to go in to Holtz Children’s Hospital for surgery. She has come so far and has overcome so much – we will not let her die and we are appealing to the community for help.”

In 2005, IKF’s Wonderfund through the generous donations that came in from throughout the U.S., funded a series of facial reconstructive surgeries that removed a massive tumor that covered most of Marlie’s face. The tumor was as a result of Polyostotic Fibrous Dysplasia, a genetic bone disease that can affect any bone in the body. Marlie’s mouth and nasal passages were blocked prior to the initial surgery. She could not speak and was only able to eat and breathe through one narrow passage.

IKF’s Wonderfund is a program of Jackson Memorial Foundation, made possible by Holtz Children’s Hospital. The philanthropic program helps critically ill children, throughout the world, gain immediate access to life-saving and life-changing medical treatments.

In a few short weeks, teams across the country will kick off the 2010 football season. And this year, preventing concussions is top of mind for athletes and sports officials from the NFL to the high school level with new regulations and educational material aimed to better protect players.

The Brain-Pad experts offer five concussion prevention tips for sports player and parents in preparation for the start of the fall sports season.

1.) Proper exercise and training. Regular neck exercises to strengthen and elongate the muscles can help provide stronger support during impact. A strong neck can keep muscles in place and lessen the impact of jolts to the head that can cause concussions.

2.) Don’t forget the mouth guard. Many think a mouth guard is effective just to protect the teeth. But studies have shown mouth guards can reduce lower jaw impact that causes concussions. A dual arch mouth guard, like Brain-Pad’s line of performance mouth guards, is the best concussion defense for inside your mouth. Unlike traditional mouth guards that offer protection for either the upper or lower teeth only, Brain-Pad is a dual arch or bi-molar mouth guard. It stabilizes the jaw into a neutral position, creating a safety space at the base of the skull that greatly reduces the risk of jaw-impact concussions, TMJ injuries, and injuries caused by hits to the face mask.

3.) Listen to your body. One of the most important things a player can do is recognize the warning signs of a concussion. A common misconception is that unconsciousness must occur if it’s a concussion injury. Symptoms can be as subtle as a headache, fatigue, confusion, dizziness, sensitivity to light, or nausea.

4.) Speak up. If you are a player or a parent and think a concussion injury may have occurred, let the coach or trainer know immediately. It is better to be mistaken than to go days without treatment because of uncertainty.

5.) Know the concussion myths. A concussion does not only occur from hits to the top of the head. A player can also suffer a concussion from lower jaw impact and hits below the chin. That’s another reason why dual arch mouth guards such as Brain-Pad are an important piece of concussion prevention.

The Department of Veterans Affairs (VA) committed the last of its $1.8 billion in Recovery Act funds July 31, one of the first federal agencies to achieve that milestone. Projects at more than 1,200 sites in all 50 states, the District of Columbia and Puerto Rico will increase access to health care and services to Veterans, while creating jobs and stimulating the economy.

“Veterans across the Nation are benefiting from these Recovery Act funds,” said Secretary of Veterans Affairs Eric K. Shinseki. “Recovery Act projects are improving medical care, speeding claims processing, enhancing our national cemeteries, advancing our energy efficiency, and generating jobs for Americans.”

VA rapidly put American Recovery and Reinvestment Act (Recovery Act) funding to work to improve its medical facilities, revitalize its national cemeteries, hire claims processors, upgrade technology systems and assist states in acquiring, building or remodeling state nursing homes and domiciliary facilities for Veterans.

The funding received by VA is part of President Obama’s economic recovery plan to improve services to America’s Veterans. By obligating these funds quickly, VA is revitalizing its infrastructure and moving needed money into the economy.

Using Recovery Act funds, VA entered into 1,521 contracts with 696 contractors. Three-quarters of the contractors are Veterans owned businesses, either service disabled Veteran owned businesses or Veteran owned small businesses.

Health Care Services Enhanced

VA obligated $1 billion to improve VA medical care facilities across the country through building renovations, roadway and walkway repairs, high cost equipment replacement, security improvements, new construction, replacement of steam lines and boiler plants, upgrades in emergency power distribution, and purchases of additional emergency generators among others.

To help Veterans access care, Recovery Act projects in VA medical facilities will add or improve more than 26,000 parking spaces and 39 elevator banks are being built or upgraded. VA will upgrade nearly 14,000 inpatient bed spaces, while 16 pharmacy renovation projects will help Veterans get medicines quicker and more efficiently. More than 14,400 clinical improvement projects, some with multiple exam rooms, will be undertaken.

Funds are also helping ensure VA health care facilities function more efficiently (by reducing annual recurring maintenance and upkeep cost) and are equipped to provide world-class care to Veterans.

Specific projects include:

• Bedford, Mass., VA Medical Center (VAMC) mental health unit renovation, $7.165 million;
• Philadelphia VAMC emergency room renovations, $4.74 million;
• Cleveland VAMC surgical suite refurbishment, $8.5 million;
• New Haven, Conn., VAMC private and semi-private inpatient units, $7.743 million;
• Hines, Ill., VAMC electrical distribution infrastructure upgrade, $8 million.

VA serves 5.5 million Veterans annually in its hospitals, outpatient clinics and rural health programs.

Energy Conservation

VA is promoting energy conservation and reducing its environmental footprint by investing $200 million in Recovery Act funds for renewable energy generation technologies, metering systems, and energy conservation and water-saving measures. In total, the renewable energy systems awarded represent more than 9 megawatts of planned power generating capacity from solar, wind, and cogeneration technologies.

Two national cemeteries, in Bourne, Mass., and San Joaquin, Calif., anticipate producing enough electricity to supply nearly all of their energy needs.

VA is installing solar photovoltaic systems at facilities in Albuquerque, N.M.; Tucson, Ariz.; Dublin, Ga.; Calverton, N.Y.; San Joaquin, Calif., and Riverside, Calif.

VA is erecting a wind turbine in Bourne, Mass., and is constructing a geothermal system at its medical center in St. Cloud, Minn.

In addition, VA is building renewably fueled cogeneration systems at five medical facilities: Togus, Maine; White River Junction, Vt.; Chillicothe, Ohio; Loma Linda, Calif.; and Canandaigua, N.Y.

VA is installing metering systems at all VA-owned facilities to monitor energy utilities, including electricity, water, chilled water, steam, and natural gas consumption.

VA is also investing $197 million in energy and water infrastructure improvements. VA facilities across the country are upgrading their facilities to reduce energy consumption and water usage and better manage related costs.

Claims Processing Improvements

VA is working to improve the systems for processing claims to more quickly and efficiently deliver benefits to Veterans. VA has obligated $150 million to hire, train and equip new employees to improve claims processing and speed the delivery of benefits to Veterans. VA has hired approximately 2,700 temporary and permanent employees to assist with processing Veterans’ claims for VA benefits.

National Cemeteries Revitalized

Throughout VA’s system of 131 national cemeteries, 391 improvement projects are underway using $50 million in Recovery Act funding. VA is restoring and preserving 49 historic monuments and memorials, becoming more energy efficient by investing in renewable energy sources (solar and wind), moving forward on nine energy conservation projects, and improving access and visitor safety with 49 road, paving and grounds improvement projects.

Recovery Act funds are also being used to raise, realign, and clean approximately 200,000 headstones and markers, repair sunken graves, and renovate turf at 22 VA national cemeteries.

One-time Benefit Payments

The Recovery Act provided one-time $250 economic recovery payments to eligible Veterans, their survivors, and dependents to help mitigate the effects of the current economy. $7.1 million were intended for administrative support of the one-time benefit payments. VA was able to successfully administer the program with a savings of approximately $6.1 million, and may return the remaining funds to the US Treasury.