Here is to a happy and healthy 2009 from the team here at CERECONS!

With hospitals looking to become all-around wellness destinations, it is not surprising to hear that Kaiser Permanente has eliminated the use of artery-clogging trans fat from all of its Southern California facilities, over two years in advance of a new state law banning such fats from food-serving establishments throughout California. In banning trans fats from its patient menus, employee cafeterias, and vending machines, Kaiser Permanente is doing its part to protect individuals from an ingredient proven to increase the risk of coronary heart disease, the leading cause of death nationwide.

Trans fat can be found in vegetable shortenings, some margarines, crackers, cookies, snack foods, and other foods made with or fried in partially hydrogenated oils. Trans fat can add to the shelf life of foods and preserve flavor. However, trans fat is linked to heart disease, diabetes, and other illnesses, contributing to the premature deaths of many thousands of Americans each year.

The new state law, AB 97, has three notable phases that become effective at cooking establishments on January 1^st of these respective years:

• By 2009, all food or food additives on the premises that include fat, oil, shortening, and the like, must maintain the original label that was on the item at the time of purchase by the food facility.
• By 2010, additives with artificial trans fat are prohibited from use in spreads and frying (except for the deep frying of yeast dough and cake batter).
• By 2011, artificial trans fat is prohibited from use in the deep frying of yeast dough and cake batter. For the latter two phases, the law exempts food sold or served in a manufacturer’s original, sealed package.

In a disturbing trend a survey has found that in the last 3 months millions of Americans are stretching their drug prescriptions, saving themselves money, by either taking the medication less often or by taking a smaller dosage than the physician prescribed.

Findings of this survey, conducted by independent market research firm, ICR / International Communications Research, project that over 13.5 million Americans, equivalent to over 1/5 of U.S. adults who use long-term prescribed medication (including those taking injectable medications), in the last three months, have taken steps to stretch out their medications, either reducing the dosage or taking it less often than prescribed.

Over 12 million Americans taking oral medications and over 1 million adult Americans taking injectable medications are projected to have begun stretching their prescriptions in the last three months, based on questions about recent behaviors in taking medication.

About one in ten patients who take even critical medications that must be injected by a health professional, like a physician or home health care service, have figured out ways to stretch out these often very expensive doctor recommended prescriptions. Overall, for injectable medicines, the percentage of patients who indicate stretching prescriptions in the last three months ranges from 9% (half million Americans) for medications injected by a health care professional, to 22% (more than ¾ of a million Americans) for self-injected drugs like insulin for diabetics.

Issues of overall cost and the recent financial climate, including factors relating to insurance coverage and medication co-pay are given by respondents as the most cited reasons that they have begun stretching out their medication prescriptions. Further research is required to more clearly understand all of the reasons for prescription stretching and to show ongoing trends in this new economic environment.

According to BarackObama.com, Obama’s health insurance proposal features many ambitious and grand features such as coverage for pre-existing conditions, tax credits to small businesses that offer employer based health insurance coverage, preventive screenings, and much more. Obama’s health insurance plan may also include “medical home” where a primary doctor coordinates healthcare. “In a sense, his proposal is similar to an HMO with the primary doctor as a sort of healthcare czar for each individual and the emphasis on preventive medicine,” says CEO Eric Oster of InsuranceBureau.com.

The issue remains, how will such comprehensive health insurance coverage be paid for? Financial analysts believe the cost of Obama’s health insurance plan could add $1.17 trillion to federal spending over a nine-year period of 2010 to 2019. Currently, Obama’s plan would put out-of-pocket costs to families at about $2,000 less than the national average of about $12,000. Reversing tax cuts on higher income individuals is just one way Obama’s administration plans to pay for this extensive health care coverage.

With all the talk about federal bailouts and funding, one sector that is left out of most primetime conversations is the health care industry.  However the economic downturn will reach out to every market, and the medical space is not ‘immune’.

The InsuranceBureau.com has reported that state health care programs like the State Children’s Health Insurance Program (SCHIP) and Medicaid may experience severe cutbacks.  This is troubling news for many who are already struggling because of economic trouble. Many states have recently raised income requirements for enrollment to cover more people. For example, enrollment in SCHIP in California has now expanded to 300 percent above the poverty level, at just over $50,000 dollars in household income. “As people are losing their jobs in a difficult economy, more are enrolling in state sponsored healthcare programs,” explains InsuranceBureau.com CEO Eric Oster. Between unemployment and raising the income requirement level to include more households, the state healthcare benefit plan will need either Federal assistance to maintain its current levels of benefits or significantly trim health insurance coverage benefits.

If the states reduce income requirements or cut benefits drastically, consumers may need to find other options for health insurance coverage. InsuranceBureau.com has assisted millions of people in locating affordable health insurance coverage and offers ideas on how to save money on health insurance costs.

The DNA Repair Company (DNAR) announced today that it has identified a promising set of protein biomarkers that may aid in the treatment of a particularly aggressive form of breast cancer. These findings were presented at the CTRC-AACR San Antonio Breast Cancer Symposium.

The DNAR study was conducted in collaboration with investigators from the Dana-Farber Cancer Institute and Beth Israel Deaconess Medical Center, both in Boston. The lead author of the study, Brian Alexander, MD, physician resident at the Harvard Radiation Oncology Program and currently a White House Fellow, was selected as a recipient of the prestigious AstraZeneca Clinical Scholars Award in recognition of the merits of the study.

The study was conducted using clinical data with so-called “triple-negative” breast cancer, a form of the disease that is not responsive to therapies targeting estrogen receptors, progesterone receptors, or the HER2 receptor. The prognosis for triple-negative breast cancer is poor, due in part to the more limited set of treatment options available.

Clinical biopsies from 143 patients were examined to determine whether the modulation of various DNA repair proteins might have an impact on disease progression. DNA repair pathways correct DNA that has been damaged by many common forms of cancer treatment (e.g. chemotherapy and radiation) and play a central role in making tumors resistant to therapy.

With clinical samples from half of the patients, the investigators discovered a statistically significant correlation between the presence of four DNA repair proteins and recurrence-free survival. Investigators were then able to validate the correlation with progression-free survival seen in this cohort by testing the four proteins in the second group of patients. The marker panel distinguished a high risk group of patients with a medium time to recurrence of 14 months from low risk patients with median time to recurrence of >10 years. Even though a number of DNA repair markers produced statistically significant results individually, results observed with the four DNA repair marker panel were superior to those seen with a number of single markers.

These findings are significant, because they suggest that monitoring DNA repair protein profiles in patients with triple-negative breast cancer will contribute important insights as prognostic or predictive tools. In addition, DNA repair pathways may provide a promising target for developing novel therapies for the disease.

“These findings provide intriguing evidence that the activity of certain DNA repair pathways play an important role in determining how patients with triple-negative breast cancer will respond to therapy, and further validation will help focus drug development on approaches most likely to succeed,” said lead investigator Judy E. Garber, MD, MPH, Director of the Cancer Risk and Prevention Program at Dana-Farber and Associate Professor of Medicine, Harvard Medical School. “The frequently poor prognosis for patients with this form of breast cancer lends increased urgency to understanding the molecular basis of the disease, and its implications for treatment and new drug development.”

EMRs have garnered a tremendous amount of attention in the health care community.  Numerous studies have illustrated the potential for increased profitability if EMRs are utilized consistently, however they have not gained significant traction in the US, and it does not appear that the industry will be adopting this solution anytime soon.

In the United States, the development of standards for EMR interoperability is at the forefront of the national health care agenda. EMRs, while an important factor in interoperability, are not a critical first step to sharing data between practicing physicians, pharmacies and hospitals. Many physicians currently have computerized practice management systems that can be used in conjunction with health information exchange (HIE), allowing for first steps in sharing patient information (i.e., lab results, public health reporting) which are necessary for timely, patient-centered and portable care. There are currently multiple competing vendors of EHR systems, each selling a software suite that in many cases is not compatible with those of their competitors. Only counting the outpatient vendors, there are more than 25 major brands currently on the market. In 2004, President Bush created the Office of the National Coordinator for Health Information Technology (ONC), originally headed by David Brailer, in order to address interoperability issues and to establish a National Health Information Network (NHIN).

Under the ONC, Regional Health Information Organizations (RHIOs) have been established in many states in order to promote the sharing of health information. Congress is currently working on legislation to increase funding to these and similar programs.  The Center for Information Technology Leadership described four different categories of data structuring at which health care data exchange can take place.  While it can be achieved at any level, each has different technical requirements and offers different potential for benefits realization.

The four categories are:

1. Non-electronic data
2. Machine transportable data
3. Machine organizable data (structured messages, unstructured content)
4. Machine interpretable data (structured messages, standardized content)

There has been much discussion in recent weeks of the 14-year-old patient from Holtz Children’s Hospital in Miami living without a heart for more than 100 days. What has not been reported are the facts behind the struggle as to how initially and immediately treat the young patient in post-transplant failure. This patient was fairing so poorly that she could not be weaned from cardio pulmonary bypass. She faced great odds of expiring and was not in any condition to immediately endure a complicated surgical BiVAD insertion or another transplant, even if another organ was immediately available.

Her surgeons chose to use the TandemHeart device as a bridge to the surgical BIVAD when it was not possible to wean from bypass immediately post-transplant. The TandemHeart provided the surgeons with a means to provide bi-ventricular support without the complex and invasive cannulation techniques required of surgical VAD placement. This enabled physicians to get the support necessary with minimal metabolic stress to either the patient or her heart. With the support of the TandemHeart, the physicians had the time necessary to make important decisions regarding the subsequent treatment for this particular patient after a few days.

“The TandemHeart played a critical role in early treatment of this patient’s transplant failure,” says Dr. Marco Ricci, Assistant Professor of Surgery at Holtz Children’s Hospital. “While it is true that the next 100 days were accomplished thanks to the surgical bivad, we were really in a tough spot with few viable choices when we were unable to wean her from bypass. The TandemHeart was an important step in this case.”

The TandemHeart can be placed rapidly in the cath lab or operating room, providing effective, reliable, temporary circulatory support. To date, the TandemHeart has been used nearly 1,500 times in 28 countries at 130 different facilities by 300 different physicians.

Being diagnosed with a brain tumor can be devastating news. But thanks to a decade of advances in minimally invasive surgical procedures and improvements in instrumentation, patients today have a far better chance of recovery—without the risks of traditional “open-skull” surgery or other techniques.

A study published in the October 2008 issue of Operative Neurosurgery, evaluated operations performed by a single surgeon over 10 years and found that when a surgeon is equipped with sophisticated instruments and extensive experience, minimally invasive procedures can be used to remove certain brain tumors through the nose, both safely and effectively. The study focused on 812 patients, most with pituitary adenomas (a non-cancerous yet dangerous tumor of the brain), all of whom were operated on by Daniel F. Kelly, M.D., Director of the Brain Tumor Center at Saint John’s Health Center.

Dr. Kelly is a specialist in endonasal transsphenoidal surgery, a minimally invasive procedure that allows doctors to use a natural opening—a nostril—to access the pituitary gland and surrounding area. Earlier surgical strategies included cutting through the skull (craniotomy), or making an incision under the upper lip. This latter procedure, called sublabial transsphenoidal surgery, has major drawbacks including pain caused by the incision and lip retraction; in addition, numbness of the upper lip is a frequent side effect. Also, the nasal cavity must be packed with gauze for several days after surgery, adding to the patient’s discomfort.

“As our previous studies have shown, most patients prefer the idea of a minimally invasive procedure that can be carried out through a natural opening rather than an incision,” Dr. Kelly says.

Adena Health System has put LifeSize high definition video communications solutions to work linking neonatal patients in rural Ohio with pediatric specialists in Columbus. In its first year of use, the number of newborns transferred from Adena’s hospital in Chillicothe to the neonatal specialists at Nationwide Children’s Hospital in Columbus was cut in half – from 140 to 70 – improving patient care, cutting costs and sparing mothers, infants and their families of the burden of traveling to a specialist.

Using LifeSize HD video conferencing systems on a high-speed network, medical specialists can remotely examine tiny fingers and toes and hear every cough in crisp, crystal clear HD. Digital lab tests and imaging films are also shared between locations and doctors are able to consult with one another as if they were all standing in the same room.

“It’s incredible,” said Marcus Bost, CIO of Adena Health System. “The clarity is so good, our doctors can actually read the physician’s notes on the wall and see through to the exam area and into the nursery down the hallway with no problem. LifeSize has really raised the bar.”

“LifeSize is proud to be associated with Adena Health System and are inspired by their innovative use of video technology,” said Craig Malloy, CEO, LifeSize Communications. “Seeing LifeSize video conferencing products used to improve patient care and quality of life for newborn babies and their mothers reminds us of the dramatic potential of high definition video to change the way we live and work in the future.”