By Charles Bankhead, Staff Writer, MedPage Today. Patient survival varies significantly after lung transplantation.
The volume of procedures done by a transplant center explained only 15% of the variation in patient survival among the nation’s lung transplantation centers, according to a major study. An analysis of more than 15,000 lung transplants found that five-year survival ranged from 30% to 61.1% among the more than 60 U.S. centers performing lung transplants that were included in the study. While higher procedure volume had a significant association with patient survival after lung transplant, there were also significant survival variations after adjusting for volume differences, according to a report in the July 7 issue of the Journal of the AMA.
However, the analysis did not uncover any other potentially significant factors for the variations in outcome. “This study suggests that true variability exists in the quality of care provided across lung transplantation centers,” Gabriel Thabut, MD, PhD, of the Mayo Clinic in Rochester, Minn., and coauthors wrote in conclusion.
“There is a great need to explore practices at high-performing centers with the goal of exporting beneficial practices to lower-performing centers. If such efforts do not equalize outcomes for lung transplant recipients, consideration might be given to further regionalizing the lung transplantation system in the United States.”
The 61 active lung transplantation centers in the U.S. perform about 1,500 transplants per year. Single-center experiences have suggested practice variability that influences outcome. For example, studies from several large transplantation centers have demonstrated substantially better three-year survival compared with the 64% cited in the 2009 report of the International Society for Heart and Lung Transplantation Registry, the authors noted.
Reasons for the variability in outcome have yet to be determined, but “disentangling these multiple potential explanations” could identify ways to improve care and the lung allocation process. Toward that end, Thabut and coauthors analyzed data from the United Network for Organ Sharing registry and identified 15,642 lung transplant procedures performed from 1987 to 2009 at 61 U.S. centers still active as of 2008. To assess volume, the authors reviewed the 2008 experience and found that:
-19 centers performed one to 10 lung transplantations
Overall survival at one month, one year, three years, and five years was 93.4%, 79.7%, 63%, and 49.5%, respectively.
Characteristics of donors, recipients, and surgical techniques varied markedly across the 61 centers. After adjusting for the variation, the hazard ratio for five-year mortality varied from 0.70 to 1.71 for centers whose patients were low risk versus high risk. Higher procedure volume was associated with better long-term survival but accounted for only 15% of the survival variability among the 61 centers.
After adjusting for center volume, the authors found that significant variability persisted, which they could not trace to specific factors. However, they found some clues. For example, center performance was substantially more heterogeneous during the first year after transplantation than later on, suggesting variability in centers’ perioperative and early postoperative practices.
The authors cited three key implications of their findings:
-Continued examination of factors involved in performance variability is warranted
-MEDICARE PUTS BRAKES ON DME MONEY TRAIN
By Emily P. Walker, Washington Correspondent, MedPage Today: The Centers for Medicare and Medicaid Services (CMS) announced that it will cut reimbursement rates an average of one-third for durable medical equipment (DME) in nine major cities. The cuts signal the start of Medicare’s competitive bidding program, which will be used to determine the price Medicare pays for certain durable medical equipment, prosthetics, orthotics, and supplies.
A 2003 Medicare law replaced the standard fee-schedule rates and implemented a market-based approach that set reimbursement rates based on a competitive bidding program for DME. Competitive bidding was briefly implemented in 2008, but another law passed that year the Medicare Improvements for Patients and Providers Act ended the supplier contracts in effect at the time and temporarily delayed the program, resulting in CMS continuing to reimburse at the standard rate.
The bidding process just announced will result in reimbursement rates that are about 32% lower than current rates, which will save more than $17 billion over the next decade, according to a CMS press release. DME supplies include oxygen concentrators, semi-electric hospital beds, and diabetes test strips.
“When this program begins in January, Medicare beneficiaries in these nine areas will see substantially lower prices than they are paying now,” CMS Deputy Administrator and Director for the Center for Medicare Jonathan Blum said in the release.
Suppliers of DME were less enthusiastic. The American Association for Homecare, which opposes competitive bidding, said the new bidding program relies on “suicide bids” that will drive DME suppliers out of business. “The bid prices announced by HHS today will translate into unsustainable reimbursement rates for home care providers,” Tyler J. Wilson, president of the association, said in a release. “We’re willing to accept lower reimbursements and no one is more opposed to fraud that we are, but this bidding program will merely reduce access to care for the nation’s most vulnerable population.”
The release stated that the bidding program requires suppliers to submit “unsustainable” bids that are far below market rates in order to win a contract.
The cuts will go into effect at the beginning of 2011 in the following cities: Charlotte, N.C.; Cincinnati; Cleveland; Dallas; Kansas City, Mo.; Miami; Orlando; Pittsburgh; and Riverside, Calif.
From AskMen.com: Our bodies are nearly 70 percent water. We use water to regulate body temperature, protect our joints and organs, and to help transport oxygen to cells. But in order for water to keep our bodies in check, we need to make sure that its levels are replenished. Even a slight change in our water levels can lead to dehydration. And if we constantly fail to top-up on H2O whenever we lose it (and lose it a lot), then we may become chronically dehydrated. Thankfully, your body will let you know when this happens.
10. You’re overheating. When we’re dehydrate we stop sweating because sweat
9 stop producing tears.
8 you feel tired or fatigued.
7. Lightheaded and dizzy
6. muscle spasms or cramps.
5. Heart Palpitations
4. Your skin lacks elasticity.
3. You’re constipated.
2. Your urine is dark yellow
1. Your mouth is dry and your tongue is swollen.
Complete explanations of the above at http://www.foxnews.com/slideshow/health/2010/06/02/signs-youre-dehydrated-askmencom/#slide=1
Some Patients at Special Risk From the Heat: “The combination of circulatory drugs and vasodilation from the heat can drop blood pressure,” … “And medications with central nervous system activity, particularly the major tranquilizers, can impair patients’ brains in their ability to interpret [changes in the environment].” For patients on psychotropic medications, for instance, the heat could affect them both physically and mentally impairing both the body’s internal thermostatic mechanism to cool itself down, as well as the patient’s ability to protect themselves against the heat, Walls added.
In addition to beta blockers, diuretics, anticholinergics, antipsychotics, and the like, antihistamines can also have altered effects in the heat, according to Dr. Gerald Brody, an attending physician at Montefiore Medical Center in New York City. Brody said the can stop patients from sweating normally. Still, he warned that patients should not take it into their own hands to alter their medications because of an impending heat wave. “It’s a pretty complex decision-making process,” Brody said. “We don’t like asking patients to stop their medications carte blanche without some direction.” Rather, the key to preventing heat-related illness is, predictably enough, to stay cool.
From JohnW/MN: I have never been able to predict my humidity-caused breathing difficulty based on the relative humidity. A couple years ago I started tracking the dew point and I found that the dew point number provides consistent humidity information.
Dew Point = the amount of water in the air - the humidity.
When the temperature goes below the dew point, dew forms on the grass and car windows.
When the temperature rises above the dew point, the dew evaporates - absorbed by the warmer air.
Dew Point = General Breathing affect
55 = A Bit Humid Unaware of humidity problem
60 = Sticky Aware of humidity affecting breathing
65 = Muggy Difficult breathing - want relief
70 = Oppressive Must be indoors - air conditioned or dehumidified.
The internet gives me good dew point numbers for the outdoors but I often want to know about inside - is my air conditioner doing the job? I don’t have a dew point meter but I do have temperature and relative humidity instruments. Well, today I got the following from NOAA (National Oceanic and Atmospheric Administration)
To calculate dew point from temperature + relative humidity http://einstein.atmos.colostate.edu/~mcnoldy/Humidity.html
Patients seeking stem cell treatments for various conditions now have an online resource to help them evaluate the claims of clinics and companies around the world. Full story at http://www.medpagetoday.com/PublicHealthPolicy/StemCellResearch/20995
Find out what’s possible. Know what to ask. We have all heard about the extraordinary promise that stem cell research holds for the treatment of human diseases. Clinics all over the world claim to offer stem cell treatments for a wide variety of conditions. But are all of these treatments likely to be safe and effective? The ISSCR provides information to help you evaluate these claims. Learn more about what this site can provide.
By Ben Hirschler. Merck & Co Inc’s new two-in-one respiratory drug Dulera has been approved by the U.S. Food and Drug Administration, the U.S. company said on Thursday, confirming an earlier Reuters report. But Britain’s *SkyePharma Plc (SKP.L) said it was no longer hopeful of a U.S. green light for its rival combination treatment Flutiform.
The new product combines the dual action of an inhaled corticosteroid and a long-acting beta agonist (LABA) to improve lung function in asthma sufferers. That makes Dulera a rival for GlaxoSmithKline Plc’s (GSK.L) market-leading Advair and AstraZeneca Plc’s (AZN.L) Symbicort, both of which act in a similar way.
Recently the FDA has taken a critical look at LABA drugs, drawing up new warnings earlier this month for the inhaled treatments. Some analysts said the issues over LABA safety may have delayed the FDA’s decision on Dulera, which had initially been expected by April.In the end, however, the agency gave approval for the medicine and disclosed the move in an update on its website before Merck issued a press release. Merck… said it expected Dulera to be available in retail pharmacies across the United States by the end of July 2010. The drug is also being developed as a treatment for COPD.
SkyePharma, meanwhile, saw its stock end 18 percent lower after announcing that the FDA had set tougher than expected demands for approving Flutiform, which could prove insurmountable. “The company is working with its advisors to review all of the options available to it with a view to determining whether there is a viable way forward for Flutiform in the United States,” it said.
*London-based SkyePharma said during talks with the Food and Drug Administration, or FDA, it learned it would have to conduct a large safety study of Flutiform after it went on the market in addition to extra clinical work on the drug’s effects at different doses. The drug was first submitted for FDA approval in 2007 but SkyePharma and partner Abbott Laboratories (ABT) were told to do another clinical trial. Further hold-ups followed. More recently, the prospects for Flutiform in the U.S. were clouded further by FDA worries about the class of asthma drugs it belongs to, which also includes big sellers like GlaxoSmithKline PLC’s (GSK.LN) Advair. Flutiform, like Advair, is a combination of a corticosteroid and a long-acting beta agonist, both types of drugs. -By Jason Douglas, Dow Jones Newswires.
The lives of millions of people with chronic lung diseases could be transformed by a new system that is being tested in Stoke-on-Trent as a result of a partnership with Qinetiq. The new system works by measuring bio-markers - proteins whose concentration reflects the severity or presence of disease - in saliva.
Prof Monica Spiteri, of the Directorate of Respiratory Medicine at the University Hospital of North Staffordshire NHS Trust (UHNS), came up with the idea of testing saliva as a means of monitoring the everyday condition of patients with serious lung conditions, especially during flare-ups of the disease, which are the second biggest cause of emergency hospital admissions.
Early recognition of such impending flare-ups could alert patients and the GPs, consultants and nurses caring for them to begin or change treatment, which could avoid them being rushed into hospital.
Spiteri, professor of respiratory medicine at UHNS, said: ’Saliva analysis is currently used in other fields, such as testing for alcohol and drug levels, but we are among the first teams in the world to develop it to monitor the progression of COPD and other lung conditions. Using saliva is far more convenient and less invasive for the patient than having to give a blood sample.’ Spiteri’s team of research nurses, hospital specialists and GPs with a special interest in lung disease are now preparing for clinical trials of the system. Tests are currently being carried out to refine the portable machine before patient sample testing begins. In due course, the technology will be further miniaturised to produce a smart hand-held device to enable patients to monitor their own condition in the comfort of their home.
(HealthDay News) Exposure to biomass smoke from wood and other forms of biomass, such as animal dung and crop residues is associated with an increased risk of developing COPD, according to research published in the July issue of Chest. Guoping Hu, M.D., of Guangzhou Medical University in China, and colleagues analyzed 15 epidemiologic (11 cross-sectional and four case control) studies to determine the relationship between biomass smoke and COPD. Compared to individuals not exposed to biomass smoke, the researchers found that those exposed to biomass smoke had an odds ratio (OR) of 2.44 for developing COPD. They found that exposure to biomass smoke was a risk factor for COPD in men (OR, 4.30) and women (OR, 2.73), as well as in the Asian population (OR, 2.31) and the non-Asian population (OR, 2.56). In addition, biomass smoke exposure was found to be a risk factor for the development of chronic bronchitis (OR, 2.57), as well as a significant risk factor for development of COPD in cigarette smokers (OR, 4.39) and non-cigarette smokers (OR, 2.55).
“Our meta-analysis suggests that biomass smoke is associated with an increase in the risk of COPD,” the authors write. “Given the high prevalence of biomass smoke, especially in rural areas, the public health consequences of biomass smoke with regard to COPD are important and suggest that COPD incidence could be reduced by interventions targeting biomass smoke.” Abstract http://tinyurl.com/2dnp6wn
While smoking is considered the greatest risk factor for COPD, variants in the STAT1, NFKBIB/SIRT2, and GC genes play a role in susceptibility to the disease, according to new research out of Norway. In an effort to address the “lack of reproducibility of findings” they saw in genetic association studies, the investigators genotyped nearly 1,000 COPD patients with a smoking history of at least 2.5 pack-years.
The 257 single nucleotide polymorphisms (SNPs) were specifically assessed for associations with the binary COPD phenotype and two quantitative traits: post bronchodilator percent of predicted FEV1 and FEV1/FVC ratio. Researchers identified significant associations in both populations between the SNPs rs13010343 and rs2241704 located in STAT1 and NFKBIB/SIRT2, respectively, and the binary COPD phenotype.
“We conducted a robust genetic association study and found that variants in the STAT1, NFKBIB/SIRT2 and GC genes are likely to contribute to the susceptibility to COPD,” the authors concluded. “Functional tests need to be performed to find the molecular mechanism that drives the genetic association between COPD phenotypes and the above three genes.”
A new scam is targeting diabetic Medicare beneficiaries across Indiana, reports the Indiana Association of Area Agencies on Aging (IAAAA). According to Tamra Simpson, program director for SMP, also known as Senior Medicare Patrol, scammers have been telephoning beneficiaries from a Florida phone number, (737) 786-9211, claiming to be from Medicare or what sounds like “Med-care.” Complaints of similar calls have been reported from every area code in Indiana.
The callers initially seem legitimate because they already know the beneficiary’s name, doctor and medical condition. Reports say each caller has a foreign accent and offers diabetic testing supplies, heating pads, back braces and free blood pressure testing supplies.
The danger, Simpson says, is that the caller asks if the beneficiary has “the red, white and blue card,” then for the Medicare number on the card and the maiden name of the patient’s parent. In some instances, the caller also solicits the patient’s date of birth.
The SMP urges patients not to release any Medicare or personal information and to be aware of this and similar scams.
The Newsletter, like all the other endeavors of the Family of COPD Support Programs , is provided to you by COPD-Support, Inc . a non-profit member organization with IRS designation 501(c)(3). If you would like to be involved and help us provide these programs to the individuals who benefit from them, please consider joining us as a member. Further information is available at
A Game for Your Eyes and Ears
It’s a fascinating phenomenon. Now, what if this concept was applied to a video game? That’s what Synaesthete sets out to do. It’s a game that couples music and action.You take the role of a digital warrior. Enemies are encountered at different levels. To fight them, you must hit keys in time with the music.The game requires you to focus on two senses at once. You have to watch your character. You have to move it around the game world and dodge enemies. But at the same time, you must listen for the music. And then you have to react to the beat. It’s an exercise in sensory multitasking. Be sure to play the tutorial first. It’ll help familiarize you with the unique control scheme. From Kim Komando http://www.komando.com/downloads/category.aspx?id=4880
Cost: Free. Game Link: https://typo3.digipen.edu/index.php?id=986
Until next Friday,