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Menopause onset brings higher cholesterol levels, heart disease risk
Cholesterol levels increase sharply at the onset of menopause, which may elevate the risk of coronary heart disease, according to a study in the Dec. 15/22, 2009, Journal of the American College of Cardiology (content.onlinejacc.org/cgi/content/abstract/54/25/2366/). The study indicated that early intervention by physicians could reduce this risk. Researchers analyzed data from 1,054 women who participated in the Study of Women's Health Across the Nation. SWAN is a multisite, epidemiologic study, funded by the National Institutes of Health, that has followed more than 3,000 middle-age American women since 1996. The study indicated that regardless of women's ethnicity, the levels of total cholesterol, low-density lipoprotein cholesterol and apolipoprotein B were significantly greater around the year of the final menstrual period than levels before and after that time. Author Karen A. Matthews, PhD, suggested that physicians order a lipid panel for their patients nearing meno [Read more]
Epidemiology resources spread thin in state health departments
The number of state health department epidemiologists and the tasks they can perform have decreased since 2006, according to a study published in the Centers for Disease Control and Prevention's Dec. 18, 2009, Morbidity and Mortality Weekly Report (www.cdc.gov/mmwr/preview/mmwrhtml/mm5849a1.htm). The report and public health experts indicate that the reduction in health departments' epidemiology capacity is due in part to diminished federal public health preparedness funding, and states' overall budget cuts. Annual grants to states through federal preparedness funding decreased from a high of $1 billion in 2002 to approximately $698 million in 2008. The reduction coincided with a decrease in bioterrorism/emergency epidemiology and surveillance capacity, the report states. For physicians, this means possibly less guidance on how to treat public health emergencies, and more patients with illnesses that potentially could have been prevented had data been available, the report's a [Read more]
Medicare cost plans face uncertain future
Under federal law, the more than 20 Medicare cost plans operating in areas deemed to have sufficient competing Medicare Advantage options for beneficiaries must shut down by 2011 or else convert to Medicare Advantage plans themselves. But a December 2009 report from the Government Accountability Office said some insurers are worried about the effects those conversions would have on the program. Insurers who manage cost plans cited planned future reductions to Medicare Advantage payments and increased financial risk as their primary concerns about converting the products. Officials from more than half of the organizations offering cost plans also worried about the potential disruption to beneficiaries caused by transferring them from one plan to another, GAO said. Cost plans are special types of Medicare HMOs that are paid based on the reasonable costs of delivering covered services. They enroll a small number of beneficiaries compared with Medicare Advantage plans, which accept f [Read more]
Physician counseling boosts likelihood of women getting breast cancer screening MRI
Women at high or intermediate risk of breast cancer were more likely to agree to have an MRI screening test if they were counseled by their physicians about the benefits of the test, according to a new study. Researchers from the American College of Radiology Imaging Network set out to determine why 42% of women at elevated risk for breast cancer declined an all-expenses-paid MRI screening exam. Their findings were published in the January Radiology (radiology.rsna.org/content/254/1/79.abstract). Of the 1,215 women offered the MRI in the study, 512 declined to participate. The main reason, given by 25% of those who declined the exam, was claustrophobia. Another 18% said they didn't have time for the exam, and 5% cited a reluctance to have the necessary injection of contrast material. But when the women were counseled by their physicians, they seemed more likely to overcome their reservations and get the screening exam, said lead author Wendie Berg, MD, PhD, a breast imaging sp [Read more]
MRSA surgical infections exact heavy clinical, financial toll
Methicillin-resistant Staphylococcus aureus, the hard-to-control superbug, wreaks havoc on the surgical patients who contract it and is a financial burden for hospitals, new research shows. Compared with patients who go home from surgery uninfected, patients with MRSA infections are 35 times more likely to be readmitted to the hospital and seven times more likely to die within three months, according to a study in the December 2009 PLoS ONE (www.plosone.org/article/info%3adoi%2f10.1371%2fjournal.pone.0008305). PLoS ONE is a multidisciplinary, peer-reviewed journal published by the nonprofit Public Library of Science. The study also found that patients infected with MRSA after surgery spent an additional three weeks in the hospital and cost $60,000 more to care for. "My experience as a doctor for over 30 years is that these infections, once they develop, are just terribly hard to get rid of," said Daniel J. Sexton, MD, senior author of the study. "When you add the time -- every [Read more]
Wrong surgeries a product of poor communication
Communication failures such as poor handoff of critical information between surgical team members are the leading cause of surgeries involving the wrong patient, the wrong side, the wrong body part, the wrong implant or the wrong procedure. Poor communication was the cause of one in five adverse events reported to the Veterans Health Administration system from 2001 to 2006, according to a study published in November's Archives of Surgery (archsurg.ama-assn.org/cgi/content/abstract/144/11/1028/). Problems during the perioperative timeout process were a root cause of errors more than 15% of the time. The mistakes appeared to be rare, occurring once every 18,955 surgeries, although a definitive wrong surgery rate could not be established, because some errors go unreported, the study found. A total of 209 adverse events were reported, as were 314 "close calls" in which mistakes were caught before patients were harmed. Of the adverse events, 12% were serious enough to merit root cause [Read more]
Needlestick injuries in med school common -- and often unreported
Medical students commonly stick themselves with needles and do not report it, placing them at increased risk for contracting bloodborne pathogens, according to a study in the December Academic Medicine (journals.lww.com/academicmedicine/abstract/2009/12000/_.36). Researchers surveyed 699 residents at 17 U.S. general surgery residency programs about needlestick injuries they received in medical school. Fifty-nine percent said they sustained at least one needlestick injury during medical school. Of those, 21% said their most recent injury occurred at school but nearly half did not report the incident. "I don't put the responsibility on students, because when I talk to them, I find that they choose not to report injuries because [they are discouraged] by the cumbersome internal reporting procedures," said Martin A. Makary, MD, MPH, a study author, associate professor of surgery at Johns Hopkins University School of Medicine and associate professor of health policy and management [Read more]
Sharp spending hike seen for 10 costliest procedures
The number of dollars required to pay for each of the 10 most expensive hospital procedures grew at rates that far outpaced the increase in average yearly hospital care costs, according to a report issued Dec. 2 by the Agency for Healthcare Research and Quality (www.hcup-us.ahrq.gov/reports/statbriefs/sb82.jsp). Experts say the growth in these numbers are most likely due to more people accessing these services and advancements in technology that have made the procedures more successful, albeit more costly. "We cannot just look at the cost of the procedure," said Elena Losina, PhD, associate professor of orthopedics at Brigham and Women's Hospital in Boston. "We need to know what that investment is buying. We still need to figure out how to pay for it, but the value should be assessed by the cost per quality-adjusted life years." Researchers analyzed inflation-adjusted data from the agency's Healthcare Cost and Utilization Project. The total cost of hospital care grew 6.3% from [Read more]
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