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7/30/2010 - New Data Supports Link Between Diabetes Drugs, Fractures. Avandia, Actos increase chances of broken bones in older men and women, study shows - (Updated: 7/30/2010) |
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New research finds that two widely prescribed diabetes drugs may raise the risk of broken bones in postmenopausal women with type 2 diabetes.
There was also a fracture risk seen among men who had been prescribed either Avandia or Actos plus a loop diuretic.
This isn't the first time such an association has been seen, raising doubts as to whether these drugs, which belong to the class of medications known as thiazolidinediones (TZDs), should be the first choice for treating type 2 diabetes. |
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New Data Supports Link Between Diabetes Drugs, Fractures
Avandia, Actos increase chances of broken bones in older men and women, study shows
By Amanda Gardner
HealthDay Reporter
THURSDAY, July 29 (HealthDay News) -- New research finds that two widely prescribed diabetes drugs may raise the risk of broken bones in postmenopausal women with type 2 diabetes.
There was also a fracture risk seen among men who had been prescribed either Avandia or Actos plus a loop diuretic.
This isn't the first time such an association has been seen, raising doubts as to whether these drugs, which belong to the class of medications known as thiazolidinediones (TZDs), should be the first choice for treating type 2 diabetes.
"This raises the question of whether this class of drugs is best for patients. There are a lot of other great drugs you can use in diabetes, the best of which is to give patients insulin, which has no real side effects and has been used for 80 years," observed Steve Hammes, chief of endocrinology at the University of Rochester Medical Center. "It's more and more clear that, as a first-line agent, TZDs are probably not a good idea."
"This has been my worst worry for the longest time," added Dr. Mary Ann Banerji, director of the Diabetes Treatment Center at the State University of New York (SUNY) Downstate Medical Center in New York City. "Also, what about loop diuretics? We use all of these things, and the issue we should really be thinking through is what about other drugs we can use? What's the risk benefit?"
The findings may skew physicians away from both drugs, but especially Avandia, said Hammes.
Earlier this summer, a U.S. Food and Drug Administration advisory committee dealt rosiglitazone (Avandia) a blow when it concluded that Avandia raises the risk of heart attack and should only stay on the market with tightened controls.
Pioglitazone (Actos), on the other hand, has not been associated with an increased cardiac risk.
But the fracture risk in both drugs has been seen before and is already included in the labeling for the medications.
"I think there's enough data to put into question whether to use Avandia," Hammes said. "Most physicians are going to shy away from it and, in our clinic, we shy away it and if you're going to put someone on a TZD, you're going to put them on Actos."
These researchers analyzed data from an earlier observational study of diabetes patients, some of whom were taking TZDs.
Women over 50 who had broken bones were 71 percent more likely to have been prescribed a TZD.
In men, the increased risk (more than triple) was seen among those taking both TZDs and loop diuretics, but not in just one or the other.
And in both genders, the risk went up the longer a person was on the medication, which, according to Banerji, poses a particular problem.
"People have diabetes for many years not a short period of time. You can't put patients on these for a long period of time," she said. "We have to be very careful about prescribing TZDs at all and need to wait for the new class of TZDs that understands the [disease] process enough to hit the right target and not all these unanticipated targets."
But Hammes did point out that the study, which will appear in the October issue of the Journal of Clinical Endocrinology & Metabolism, did have some limitations. It was not, for instance, a randomized controlled study nor was the original study the data came from designed to look at this question.
The authors, from the University of Michigan and other institutions, called for larger, randomized trials.
More information
The U.S. National Library of Medicine has more on thiazolidinediones.
SOURCES: Mary Ann Banerji, M.D., professor, medicine, and director, diabetes treatment center, State University of New York Downstate Medical Center, New York City; Steve Hammes, M.D., Ph.D., chief, endocrinology, University of Rochester Medical Center, Rochester, N.Y.; October 2010, Journal of Clinical Endocrinology & Metabolism
Last Updated: July 29, 2010
Copyright © 2010 HealthDay. All rights reserved.
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7/29/2010 - Delirious Hospital Patients a High-Risk Group, Study Finds |
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Elderly hospital patients with delirium are at increased risk for dementia, institutionalization and death, a new study has found. Delirium is the most common complication among elderly hospital patients, Joost Witlox, of the Medical Center Alkmaar in the Netherlands, and colleagues noted.
In their report, published in the July 28 issue of the Journal of the American Medical Association, the researchers reviewed the findings of 51 previous studies that examined the association between delirium and long-term outcomes in elderly patients. The analysis showed that patients with delirium were more likely than other patients to have died after an average follow-up of 22.7 months.
(Note from the Editor: If your elderly loved one starts to exhibit strange behaviors in the hospital, please ask your physician if this might be delirium, which is treated differently than dementias. It is particularly important to avoid use of complicated regimens that incorporate antipsychotics, benzodiazepines, narcotics, and/ or anticholinergics in the management of agitation. Because many of these drugs can cause delirium, combinations of them may increase agitation and create challenges to further therapeutic decisions regarding the management of agitation.) |
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Delirious Hospital Patients a High-Risk Group, Study Finds
TUESDAY, July 27 (HealthDay News) -- Elderly hospital patients with delirium are at increased risk for dementia, institutionalization and death, a new study has found.
Delirium is the most common complication among elderly hospital patients, Joost Witlox, of the Medical Center Alkmaar in the Netherlands, and colleagues noted.
In their report, published in the July 28 issue of the Journal of the American Medical Association, the researchers reviewed the findings of 51 previous studies that examined the association between delirium and long-term outcomes in elderly patients. The analysis showed that patients with delirium were more likely than other patients to have died after an average follow-up of 22.7 months.
"Moreover, patients who had experienced delirium were also at increased risk of institutionalization and dementia," the researchers wrote.
The findings could help improve patient care, Witlox's team noted in a news release from the journal's publisher.
"The low rate of survival and the high rates of institutionalization and dementia indicate that older people who experience delirium should be considered an especially vulnerable population," the authors wrote.
Further research is needed to determine the reasons for poor long-term outcomes after delirium, how certain characteristics of delirium (such as duration) may affect patient prognosis, and how to reduce the risks associated with delirium, the study authors added.
More information
The AGS Foundation for Health in Aging has more about delirium. |
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7/28/2010 - 10 Tips to Boost Your Metabolism |
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Gender plays a role. "The average man's metabolism is about 10 (percent) to 15% higher than a woman's," Goldsmith notes. That's mainly because men have more muscle mass than women do, which means they burn more calories. "Muscle does the work to help you move, while fat just sits there," says John Porcari, a Fitness advisory board member and director of the clinical exercise physiology program at the University of Wisconsin-La Crosse. Not only that, but women's bodies are designed to hold on to body fat in case of pregnancy. Talk about unfair.
The good news is, you can make your metabolism faster, experts say, despite genetics and gender. These are the 10 simple secrets to boosting it big-time.
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10 tips to boost your metabolism
By Maura Kelly, Fitness magazine
Last winter I put on a few extra pounds. No biggie — I do it every year. The weight usually comes off in the spring once I stop chowing down on pasta and bread and shift my outdoor running program into high gear. But this year the scale refused to budge. At all.
"Maybe your metabolism is slowing," a friend suggested. She had a point; I was in my 30s, after all, which is when scientists say the ebb usually starts. Yikes! How could I rev it back up and drop the flab? Here's what I learned to turn up the burn — and how you can do it too.
The M factor
Metabolism sounds mysterious and complicated, but it's actually pretty simple: It's the amount of energy (aka calories) our bodies need daily. About 70% of those calories are used for basic functions, such as breathing and blood circulation, says Rochelle Goldsmith, director of the Exercise Physiology Lab at Columbia University Medical Center. An additional 20% is fuel for physical activity, including working out, fidgeting, walking and even holding our bodies upright while standing. The remaining 10% helps us digest what we eat (it's true; eating burns calories!). The trouble begins when you consume more calories than your body needs to do these things: That's when you pack on the pounds.
You can partly thank your parents for the speed of your metabolism. Genes contribute to the levels of appetite-control hormones we have floating around in our bodies, Goldsmith explains. "Some people are genetically programmed to be active; they're naturally restless and use more energy," she says. Those are the lucky high-metabolism types.
Gender also plays a role. "The average man's metabolism is about 10 (percent) to 15% higher than a woman's," Goldsmith notes. That's mainly because men have more muscle mass than women do, which means they burn more calories. "Muscle does the work to help you move, while fat just sits there," says John Porcari, a Fitness advisory board member and director of the clinical exercise physiology program at the University of Wisconsin-La Crosse. Not only that, but women's bodies are designed to hold on to body fat in case of pregnancy. Talk about unfair.
The good news is, you can make your metabolism faster, experts say, despite genetics and gender. These are the 10 simple secrets to boosting it big-time.
1. Exercise more often.
Working out is the No. 1 way to keep your furnace cranking. The more lean muscle you have, the more calories you burn all day. That's because muscle uses energy even when you're resting. Exercise enough and you can help prevent the natural metabolic slowdown that can begin as early as your late 20s, according to Goldsmith.
FAMILY FITNESS CHALLENGE: 8-week guide to get moving this summer
Your amp-it-up game plan: five workouts a week. "Do three days of aerobic activity and two days of weight lifting," advises Shawn Talbott, an exercise physiologist, a nutritional biochemist and the executive producer of Killer at Large, a documentary about the U.S. obesity epidemic.
2. Kick up your cardio.
Aerobic intervals will help you maximize your burn, doubling the number of calories you torch during a workout, studies show. Intervals also keep your metabolic rate higher than a steady-pace routine does for as long as an hour after you stop exercising, according to Michele Olson, a Fitness advisory board member and professor of exercise science at Auburn University at Montgomery in Alabama. That means you could blast as many as 65 additional calories after your sweat session. The ideal metabolism-boosting interval routine is to "go hard for a couple of minutes, then take it down to an easier pace for a minute or two, and keep alternating like that throughout your workout," Talbott says.
Just pick your cardio carefully. Aim for exercises that require your body to work its hardest by using a lot of muscle groups, Talbott says. That means running is better than cycling. Or try a cardio circuit. "Do a variety of activities — like running stadium stairs, jumping rope and squat thrusts — for two minutes each, aiming for a total of 10 minutes," Olson says. "That will really rock your metabolism."
3. Put some muscle behind it.
Too many women steer clear of weight machines, fearing that they'll bulk up. Or they work only their legs and skip their arms. Don't make this mistake. A head-to-toe strength routine will turbocharge your calorie-blasting quotient. Add five pounds of muscle to your body and you can zap as many as 600 calories an hour during your workout, Olson says. Be sure to choose a weight-lifting routine that targets your core, legs, arms, chest and shoulders; challenging numerous muscles will help your body function like a calorie-burning machine, Goldsmith says. Find some great total-body strength workouts at www.fitnessmagazine.com/totalbody.
4. Don't skip meals.
We know you're superbusy, but make sure you grab lunch. "Simply chewing, digesting and absorbing food kicks your metabolism into gear," says Jim White, a national spokesperson for the American Dietetic Association.
"The more frequently you eat, the more often it revs up." Conversely, missing a meal, or going too long between meals, brings your metabolism to a crawl. "Your body switches into starvation mode and your system slows down to conserve energy," White explains. Keep your engine humming by having three healthy meals of 300 to 400 calories and two snacks of 200 to 300 calories every day, he advises.
5. Fill up on smart foods.
Start by serving yourself protein at every sitting, says Dr. Darwin Deen, medical professor in the department of community health and social medicine at City College of New York and a co-author of Nutrition for Life. Not only does your body need it to help build lean muscle mass, but protein also takes more calories to digest. To get your fix, have low-fat yogurt at breakfast, chicken in your salad at lunch and salmon for dinner. Between meals, snack on protein-rich walnuts. They contain omega-3 fatty acids, which help promote weight loss by increasing your feelings of fullness, according to a recent study in the journal Appetite.
EATING: In 4-diet study, all who watched calories lost weight
While you're at it, eat more foods that slowly release the sugar you need for sustained energy, like high-fiber fruits and veggies and whole-grain breads and pastas. Munch a food high in fiber three hours before your workout and you'll also burn extra fat, a study at the University of Nottingham in England found.
Sipping java can also help. "Caffeine stimulates the production of adrenaline, which speeds up the metabolism," White says. Research shows that caffeine can significantly accelerate your burn. Just limit yourself to no more than two cups a day; too much caffeine can overtax your system, resulting, ironically, in fatigue.
6. Eat breakfast.
It will switch your metabolism from idle to high speed. That's because your level of cortisol, a hormone that helps you use calories to build muscle, is highest just before you get up in the morning. When you eat an a.m. meal, your body is primed to turn those calories into muscle pronto — the only time during the day this happens. Take advantage of the natural torching process by having a healthy breakfast of scrambled eggs, low-fat turkey bacon and a piece of whole-grain toast.
7. Get off your butt.
Sitting too much — at the computer at work, at home in front of the TV — slows your metabolism, even if you're exercising regularly. An easy fix is to stretch, stroll and fidget throughout the day. That's what scientists call NEAT, or non-exercise activity thermogenesis, and it can boost your burn and help you drop weight, says Dr. James Levine, professor of medicine at the Mayo Clinic in Rochester, Minn., and author of Move a Little, Lose a Lot.
Q&A: Levine shares how to drop weight without 'exercise'
The proof: In a study of lean volunteers who were fed extra calories, those who paced frequently, for example, maintained their weight, while the people who did no additional walking got chubbier. If you take advantage of every opportunity to walk and climb stairs, it can make a big difference. "A woman who needs to lose weight would have to burn about 190 to 200 extra calories a day to lose 10% of her body weight, which you can do by increasing your overall activity level," Goldsmith says. "Try striding around your house or office when you're on the phone, standing up at your desk whenever you can and walking to your co-worker's cube instead of e-mailing her."
8. Go to bed earlier.
Deprive yourself of sleep and your body starts to respond as if it were under siege. "When you get two hours less shut-eye than you normally do, your system becomes stressed and produces about 50% more cortisol," Talbott says. "That in turn triggers your appetite."
At the same time, lack of zzz's throws the body's hunger hormones leptin and ghrelin out of whack, making you more likely to overeat. Skimp on pillow time for too long and you could be facing a serious weight problem, says Michael Breus, author of Good Night: The Sleep Doctor's 4-Week Program to Better Sleep and Better Health. In a 16-year study of sleep-deprived women published in the American Journal of Epidemiology, researchers found that those who slept seven to eight hours a night had the lowest risk for major weight gain, while women who got six hours a night were 12% more likely to pile on a significant number of pounds, and those who logged five hours or less were 32% more likely to gain weight.
9. Schedule a nighttime workout.
Do a 20- to 30-minute moderate-intensity cardio routine before you hit the hay to keep your metabolism humming all night, Porcari says. The average woman's metabolic rate naturally decreases by about 15% while she sleeps, but an end-of-day sweat session will make the drop closer to 5%, he explains. So take the dog for an evening walk or go for a bike ride with your family after dinner. And don't worry that the activity will keep you awake: As long as you exercise at least two and a half hours before lights out, you should be able to drift off with no problem, Breus says.
10. Check your meds.
Some of the most dramatic metabolic dips occur when women start taking birth control pills and widely prescribed antidepressants known as serotonin reuptake inhibitors, or SSRIs. "These drugs commonly slow the metabolism because they affect the functioning of the thyroid gland, which regulates how our bodies use energy," says Dr. Kent Holtorf, a thyroidologist and the founder of the National Academy of Hypothyroidism. Depo-Provera, a contraceptive that's injected every three months, seems to cause the most weight gain. "It's high in the hormone progestin, which stimulates insulin secretion, leading to increased appetite and a lowered metabolism," Holtorf explains. "It also signals the body to store fat." (Oral contraceptives, which contain less progestin, aren't as problematic.) If you've recently started taking any new medication and the scale is inching upward, ask your doc if there's an alternative treatment that is less likely to cause weight gain.
Copyright 2010. First printed in the July/August 2010 issue of Fitness magazine.
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7/27/2010 - Study Looks at Overtreatment of Prostate Cancer |
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| Researchers found that more than 75% of men who have been diagnosed with low-risk prostate cancer undergo either a prostatectomy or radiation therapy, suggesting an overtreatment of the disease. Active surveillance might be a better alternative for some men with low-risk disease, two experts said in an accompanying commentary. WebMD |
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Aggressive Treatment for Prostate Cancer Is the Norm
Study Finds Majority of Men Diagnosed With Low-Risk Disease Get Radiation or Radical Surgery
By Kathleen Doheny
WebMD Health News
Reviewed by Louise Chang, MD
July 26, 2010 -- More than 75% of men diagnosed with low-risk prostate cancer undergo aggressive treatment -- either complete removal of the prostate or radiation therapy, according to a new study.
That's true, the researchers found, even in men with a low level of prostate-specific antigen (PSA) of under 4 nanograms per milliliter, one of the factors taken into account when treatment decisions are made.
''If we knew for sure everyone with a PSA under 4 would not die of prostate cancer, case closed," says researcher Mark N. Stein, MD, a medical oncologist at The Cancer Institute of New Jersey and assistant professor of medicine at the UMDNJ-Robert Wood Johnson Medical School, New Brunswick.
But that's far from true, Stein says. And that makes the balance between overtreatment and undertreatment difficult, he says. The report is appears in the Archives of Internal Medicine.
"The tremendous improvement in survival has been attributed to early detection and treatment," Stein and his colleagues write. "However, there have been concerns about the potential overdiagnosis and overtreatment of localized prostate cancer."
In the study, they looked at data from nearly 124,000 men with newly diagnosed prostate cancer from 2004 to 2006 to determine which men received aggressive treatment.
More than 192,000 new cases of prostate cancer were diagnosed in 2009, according to the American Cancer Society, and more than 27,000 men died of it.
Assess Your Risk for the 5 Most Common Cancers
Prostate Cancer Treatment Patterns: A Closer Look
Stein and his team looked at data from the SEER database, which drew from 16 tumor registries and covers about 26% of the U.S. population.
In all, 14% of the men had a PSA of 4 nanograms per milliliter or lower.
The PSA test measures prostate-specific antigen, a protein produced by the prostate. Typically, the higher the PSA level, the higher the risk of prostate cancer, although some men can have an elevated PSA without cancer and some men can have cancer without an elevated PSA. Most healthy men without prostate cancer will have a PSA of less than 4 nanograms per milliliter, so that level is a general cutoff as to whether to proceed to biopsy, although some say the threshold should be lower and adjusted for age.
Fifty-four percent of the men diagnosed with prostate cancer with a PSA at 4 or lower had low-risk disease, they found. That was also defined as being at stage T2a or lower, with a Gleason score of 6 or lower. A Gleason score, Stein says, is based on "how the cancer looks under the microscope." Scores of 8-10 (10 highest possible) are high-grade tumors, according to the American Cancer Society.
More than 75% of these men with so-called low-risk disease got aggressive therapy, Stein found -- either radical prostatectomy, complete removal of the gland, or radiation therapy.
The decisions are difficult, Stein tells WebMD. "Guys with PSAs under 4 could have lethal cancers," he says.
''These results underscore the fact that PSA level, the current biomarker, is not a sufficient basis for treatment decisions," the researchers write. What's needed, Stein says, are other markers -- such as specific genetic signatures tied to higher-risk disease -- to better predict the risk of a lethal cancer.
Aggressive Prostate Cancer Treatments: Other Opinions
The new research adds statistics to what has long been known, says Stuart Holden, MD, medical director of the Prostate Cancer Foundation and head of the Louis Warschaw Prostate Cancer Center at Cedars-Sinai Medical Center, Los Angeles, who reviewed the study for WebMD.
"This article is saying that PSA when used alone as a screening tool will tend to uncover many cancers that are harmless and do not need to be treated," he says."However, it will also discover some that do need to be treated."
Aggressive treatment for low-risk cancers is due, he says, to the lack of knowledge experts still have about prostate cancers, Holden says. It's not always possible to distinguish between harmless and aggressive cancers.
Another expert agrees prostate cancer is often overtreated. "There's no question there is a problem of overtreatment of prostate cancer," says Matthew Cooperberg, MD, assistant professor of urology at the University of San Francisco, who has published on the topic of low-risk prostate cancers.
''I think the authors are slightly unfair in their estimation of our ability to risk-stratify the disease and target treatment appropriately," he tells WebMD, noting that doctors take into account other factors besides the PSA level when deciding on the best course of treatment, such as age and other medical tests.
In a commentary accompanying the study, Richard Hoffman, MD, of the University of New Mexico and Steven Zeliadt, PhD, of the University of Washington point out that "once a man is diagnosed as having an early-stage cancer, regardless of his age, he faces a treatment decision."
More recently, however, the commentary writers say, another option has been proposed. Called active surveillance, it involves deferring treatment and monitoring the disease closely. It's a more aggressive approach than the previous and similar approach called watchful waiting, Stein tells WebMD.
"Instead of immediate treatment for men with low-risk disease, active surveillance involves monitoring the cancer by PSA testing and DRE [digital rectal exam] every 3 to 6 months and performing prostate biopsies every 12 to 24 months," the commentary authors write.
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7/26/2010 - Your Health: Should men also be screened for osteoporosis? Asked to name a health problem that affects one in five men, few people might think of osteoporosis. |
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"It's always been viewed as a disease of women," says Amir Qaseem, a physician who directs a research and education program at the American College of Physicians in Philadelphia. "But it's a very important public health issue for men, too. It's under-diagnosed and undertreated."
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Your Health: Should men also be screened for osteoporosis?
By Suzy Parker, USA TODAY
WOULD YOUR BONES PASS THE BMD TEST?
Those initials stand for bone mineral density. The lower your BMD, the more likely you are to break bones, especially in old age.
To screen for osteoporosis (low bone mineral density), doctors usually use a DXA, or dual energy X-ray absorptiometry, machine. It scans your hip, spine or forearm with a very low dose of radiation.
The tests are recommended for people who have a high risk for bone loss, including women over 65. Routine use in men is under debate, although it is recommended by some groups.
By Kim Painter, USA TODAY
Asked to name a health problem that affects one in five men, few people might think of osteoporosis.
That's because the bone-loss disorder strikes many more women, one in two over a lifetime. Women, on average, have smaller skeletons. As they age, they lose bone mass earlier and faster.
"It's always been viewed as a disease of women," says Amir Qaseem, a physician who directs a research and education program at the American College of Physicians in Philadelphia. "But it's a very important public health issue for men, too. It's under-diagnosed and undertreated."
But exactly how to find and help men whose bones are thinning — which increases their risk for broken hips and other fractures — is controversial for one reason: Men's bones aren't studied much.
This month, that lack of research led an influential group to pass up a chance to recommend osteoporosis screening for men. In a draft statement, the U.S. Preventive Services Task Force said, "Surrent evidence is insufficient to assess the balance of benefits and harm" of asking millions of men to take bone measurement tests — and asking the health care system to invest in more bone-scanning machines and bone-building drugs for those men..
The group did update its recommendations for women, saying all women over 65 and certain younger women should be screened. (The draft recommendations are open to public comment until Aug. 3 at www.ahrq.gov/clinic/draftix.htm).
Help that's too little, too late
But men should take note: Qaseem's group and the National Osteoporosis Foundation have looked at the same sparse research and decided to recommend bone scans for men at high risk, including those older than 65 or 70.
The scans do detect bone loss in men. What's not known is whether prescribing drugs and other treatments to men with low scores will stop them from breaking bones. But data do point in that direction, says foundation president Robert Recker .
Right now, men often get too little help, too late, he says. Recker, a physician at Creighton University School of Medicine in Omaha, says he sees too many men like the fiftysomething laborer who came to his office recently after many months of severe back pain. He had undiagnosed osteoporosis.
Six percent of all men over 50 are destined to break a hip, says the National Institute of Arthritis and Musculoskeletal and Skin Diseases. And studies show that when they do, they are more likely than women to die or require long-term care.
That may be because the men are in worse health to begin with, says Eric Orwoll, a bone-health specialist at Oregon Health & Science University in Portland. In any case, he says, men should know that if they break any bone after age 50, they are at high risk for breaking another and should be evaluated for osteoporosis.
Other risk factors include:
• Low body weight. Thin men, just like thin women, are at higher risk.
• A family history of osteoporosis.
• Smoking, heavy drinking and diets low in calcium and vitamin D.
• Certain medications, including glucocorticoids.
• Certain conditions, including low testosterone. |
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7/23/2010 - US News Top Hospital Rankings 2010 - 2011 |
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It's no secret that all hospitals are not equal. The special quality shared by the 152 that made it into the new 2010-11 Best Hospitals rankings (out of nearly 5,000 that were considered), and even more so by the 14 in this year's Honor Roll, is their ability to take on and meet the most difficult challenges. Their operating rooms showcase delicate, demanding procedures—excising a cancerous portion of a pancreas without destroying the rest of the fragile organ, say, or restoring function to an arthritis-ravaged hand through a creative blend of fusing joints and splicing tendons. They are referral centers for ill patients with multiple risks—advanced age plus heart failure plus diabetes, perhaps.
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Best Hospitals 2010-11: The Honor Roll
By AVERY COMAROW
Posted: July 14, 2010
It's no secret that all hospitals are not equal. The special quality shared by the 152 that made it into the new 2010-11 Best Hospitals rankings (out of nearly 5,000 that were considered), and even more so by the 14 in this year's Honor Roll, is their ability to take on and meet the most difficult challenges. Their operating rooms showcase delicate, demanding procedures—excising a cancerous portion of a pancreas without destroying the rest of the fragile organ, say, or restoring function to an arthritis-ravaged hand through a creative blend of fusing joints and splicing tendons. They are referral centers for ill patients with multiple risks—advanced age plus heart failure plus diabetes, perhaps.
Patients at these centers are not exempt from picking up hospital-based infections, getting the wrong drugs, or becoming victims of other medical errors. No matter how skilled or deep their expertise, even "best hospitals" don't do everything right. But when high stakes call for unusual capabilities, they are hospitals that can save lives that might be lost or preserve quality of life that might be sacrificed. That is why U.S. News has published the Best Hospitals rankings for 21 years: to help guide patients who need high-stakes care because of the complexity or difficulty of their condition or procedure. For 2010-11 we analyzed 4,852 hospitals, virtually every one in the United States, in 16 specialties from cancer and heart disease to respiratory disorders and urology. Only 152 centers appear in even one of the 16 specialty rankings. Fourteen ultra-elite Honor Roll hospitals had very high scores in six or more specialties.
In 12 of the 16 specialties, the quality of hospital care can determine life or death. Therefore the largest part of each hospital's score in those 12 specialties came from death rates and other hard data on patient safety, volume, and various care-related factors such as nursing and patient services. The rest of the score was derived from a reputational survey of specialists. The 50 highest scorers were ranked. Scores and complete data for another 1,740 unranked hospitals are also available. In the four other specialties—ophthalmology, psychiatry, rehabilitation, and rheumatology—hospitals were ranked on reputation alone. The number of deaths in these specialties is so low that mortality data and certain other categories of data are not relevant factors.
A detailed description of the analysis in the 12 specialties is available. In brief, death rate, care-related factors, and patient safety added up to slightly more than two-thirds of each hospital's score. The reputation portion of the score used responses from nearly 10,000 physicians, who were surveyed in 2008, 2009, and 2010 and asked to name five hospitals they consider among the best in their specialty for difficult cases, ignoring cost or location.
The Honor Roll requirements were so stiff that 99.7 percent of all centers in the nation were excluded. A hospital had to be ranked in at least six specialties, but ranking alone was insufficient for inclusion. It also had to have an extremely high score (in statisticians' terms, at least 3 standard deviations above the mean). That earned 1 point per specialty. Reaching the top of the Honor Roll called for even higher scores (4 or more standard deviations above the mean), earning 2 points, in far more specialties. The highest-ranked hospitals on the Honor Roll, which is ordered by points, had high scores in 15 of the 16 specialty rankings. Johns Hopkins stands at No. 1—as it has for the last 20 years.
Rank Hospital Points Specialties
1
Johns Hopkins Hospital, Baltimore 30 15
2
Mayo Clinic, Rochester, Minn. 28 15
3
Massachusetts General Hospital, Boston 27 15
4
Cleveland Clinic 26 13
5
Ronald Reagan UCLA Medical Center, Los Angeles 24 14
6
New York-Presbyterian University Hospital of Columbia and Cornell 21 11
7
University of California, San Francisco Medical Center 20 11
8
Barnes-Jewish Hospital/Washington University, St. Louis 17 10
9
Hospital of the University of Pennsylvania, Philadelphia 16 12
10
Duke University Medical Center, Durham, N.C. 16 10
11
Brigham and Women's Hospital, Boston 14 10
12
University of Washington Medical Center, Seattle 14 8
13
UPMC-University of Pittsburgh Medical Center 13 8
14
University of Michigan Hospitals and Health Centers, Ann Arbor 12 8
See rankings in all 16 specialties:
Cancer
Diabetes & Endocrinology
Ear, Nose & Throat
Gastroenterology
Geriatrics
Gynecology
Heart & Heart Surgery
Kidney Disorders
Neurology & Neurosurgery
Ophthalmology
Orthopedics
Psychiatry
Pulmonology
Rehabilitation
Rheumatology
Urology
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7/23/2010 - MRIs suggest link between brain, irritable bowel syndrome |
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A new study has found a possible connection between IBS and the brain. Researchers at McGill University and UCLA used MRI scans to reveal changes in the brains of women with the disorder. The researchers took MRI scans of 55 IBS patients and 48 healthy women for comparison. The women with IBS tended to have different amounts of brain gray matter in certain areas; for example, decreases in gray matter in parts of the brain that govern attention and areas that suppress pain.
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Irritable bowel syndrome associated with brain changes
Irritable bowel syndrome
A study shows that some women with irritable bowel syndrome have specific structural changes in their brains. (Genaro Molina, Los Angeles Times / July 22, 2010)
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By Shari Roan, Los Angeles Times
July 22, 2010 | 11:02 a.m.
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Irritable bowel syndrome has been a tough disorder to understand. Studies have failed to show any structural problems in the gut that would account for the symptoms of pain, bloating, diarrhea and constipation. However, the disorder is real, affecting as many as 15% of Americans.
A new study has found a possible connection between IBS and the brain. Researchers at McGill University and UCLA used MRI scans to reveal changes in the brains of women with the disorder. The researchers took MRI scans of 55 IBS patients and 48 healthy women for comparison. The women with IBS tended to have different amounts of brain gray matter in certain areas; for example, decreases in gray matter in parts of the brain that govern attention and areas that suppress pain.
A link between the brain and chronic pain has been identified in other disorders, such as lower back pain, migraines, fibromyalgia and hip pain. The study on IBS suggests that, like these other conditions, the problem may be due to the brain's inability to inhibit the pain response.
"Discovering structural changes in the brain, whether they are primary or secondary to the gastrointestinal symptoms, demonstrates an 'organic' component to IBS and supports the concept of a brain-gut disorder," Emeran Mayer, a co-author of the study at UCLA, said in a news release. "Also, the findings remove the idea once and for all that IBS symptoms are not real and are 'only psychological.' The findings will give us more insight into better understanding IBS."
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For more information on irritable bowel syndrome, see this website from the National National Institute of Diabetes and Digestive and Kidney Diseases. The study, which was funded by the National Institutes of Health, was published Thursday in the journal Gastroenterology. |
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7/22/2010 - Vitamin E Is Vital to Alzheimer’s Risk Reduction |
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| Alpha-tocopherol, one of the more common forms of Vitamin E, has been widely studied for potential protective effects against the onset of Alzheimer’s Disease. Francesca Mangialasche, from the Karolinska Institutet (Sweden), and colleagues studied a group of 232 men and women, ages 80 years and older, who were dementia-free at the study’s start. |
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Vitamin E Is Vital to Alzheimer’s Risk Reduction
2010-07-14 Supplementation | Vitamins |
Vitamin E Is Vital to Alzheimer’s Risk Reduction
Alpha-tocopherol, one of the more common forms of Vitamin E, has been widely studied for potential protective effects against the onset of Alzheimer’s Disease. Francesca Mangialasche, from the Karolinska Institutet (Sweden), and colleagues studied a group of 232 men and women, ages 80 years and older, who were dementia-free at the study’s start. The researchers follows the subjects for 6 years, tracking the onset of Alzheimer’s Disease and measuring blood levels of all eight natural vitamin E components. Those subjects with higher blood levels of all the vitamin E family forms were at a markedly reduced risk of developing Alzheimer’s Disease, as compared to subjects with lower levels. After adjusting for confounding factors, the team reports the risk reduction in those with the higher blood levels of all the vitamin E family forms was 45-54%, depending on the vitamin E component. The researchers conclude that: “The neuroprotective effect of vitamin E seems to be related to the combination of different forms, rather than to alpha-tocopherol alone.”
Continue reading…
Francesca Mangialasche, Miia Kivipelto, Patrizia Mecocci, Debora Rizzuto, Katie Palmer, Bengt Winblad, Laura Fratiglioni. “High plasma levels of vitamin E forms and reduced Alzheimer’s disease risk in advanced age.” Journal of Alzheimer's Disease, Volume 20 Number 4, Pages 1029-1037, 5 July 2010; DOI: 10.3233/JAD-2010-091450.
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7/21/2010 - Sepsis threatens hospital patients (and others), study finds |
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| Using data from 363,897 patients, they established that sepsis, a life-threatening blood infection, occurred in 2.3% of those patients and that septic shock, dangerously low blood pressure from said blood infection, occurred in 1.6%. (Editor's Note: Handwashing is not just for nurses and doctors who visit you in the hospital, but for everyone. Even if you are not in the hospital, report any non-healing infection you have to your physician. These serious blood infections can happen anywhere - hospital or home.) |
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latimes.com
Sepsis threatens hospital patients (and others), study finds
By Tami Dennis, Los Angeles Times
July 20, 2010
Add sepsis to your list of post-surgery worries. Or, if you're so inclined, to your list of worries in general.
First, we'll look at the hospital picture. Researchers at Methodist Hospital, Weill Cornell Medical College, set out to document the incidence, mortality rate and risk factors for sepsis and septic shock after general surgery. And what they found wasn't pretty.
Using data from 363,897 patients, they established that sepsis, a life-threatening blood infection, occurred in 2.3% of those patients and that septic shock, dangerously low blood pressure from said blood infection, occurred in 1.6%. Compare that with the better-known threats of pulmonary embolism — 0.3% of patients — and heart attacks (a.k.a. myocardial infarctions) — 0.2% of patients.
The researchers write:
"Case mortality rates in patients with sepsis and septic shock exceed those of [myocardial infarction] and pulmonary embolism] combined by nearly 10-fold. Therefore, our level of vigilance in identifying sepsis and septic shock needs to mimic, if not surpass, our vigilance for identifying MI and PE. By identifying 3 major risk factors for the development of and death from sepsis and septic shock in general-surgery patients, we can heighten our awareness for sepsis and septic shock in these at-risk populations."
Those three risk factors, by the way, are being older than 60, needing emergency surgery and having some other disease or condition as well.
Here's the abstract of the sepsis study published Monday in Archives of Surgery, and the "in other words" news release from Methodist Hospital in Houston.
And here's more on sepsis and septic shock from Merck.com.
Note that surgery certainly isn't necessary for sepsis to take hold.
That brings us to the outside-the-hospital picture. For a more personal account of what sepsis can do, there's this article from the Daily Press in Newport News, Va.: Amputee Relearns Life.
It begins: "Jackie Richard was hospitalized for what she thought was a stomach ache. In fact, she had developed sepsis, a life-threatening condition in which a person's body tries to fight off a severe infection that has spread through the bloodstream. Sometime after emerging from the fog that followed a two-week coma, Richard realized doctors had amputated her hands and her lower legs to save her life."
The Surviving Sepsis Campaign says this about the condition:
"Each year, severe sepsis strikes an estimated 750,000 people in the United States alone. The rate of severe sepsis is expected to rise to 1 million cases a year by 2010 as the population ages. Any kind of infection — bacterial, viral, parasitic or fungal — anywhere in the body can trigger sepsis."
Copyright © 2010, The Los Angeles Times |
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7/20/2010 - Fish eaters show lower risk of age-related eye disease |
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Older adults who eat fatty fish at least once a week may have a lower risk of serious vision loss from age-related macular degeneration, a new study suggests.
The findings, reported in the journal Ophthalmology, do not prove that eating fish cuts the risk of developing the advanced stages of age-related macular degeneration, or AMD.
But they add to evidence from previous studies showing that fish eaters tend to have lower rates of AMD than people who infrequently eat fish.
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Fish eaters show lower risk of age-related eye disease
Mon, Jul 19 2010
By Amy Norton
NEW YORK (Reuters Health) - Older adults who eat fatty fish at least once a week may have a lower risk of serious vision loss from age-related macular degeneration, a new study suggests.
The findings, reported in the journal Ophthalmology, do not prove that eating fish cuts the risk of developing the advanced stages of age-related macular degeneration, or AMD.
But they add to evidence from previous studies showing that fish eaters tend to have lower rates of AMD than people who infrequently eat fish.
They also support the theory that omega-3 fatty acids -- found most abundantly in oily fish like salmon, mackerel and albacore tuna -- may affect the development or progression of AMD.
AMD is caused by abnormal blood vessel growth behind the retina or breakdown of light-sensitive cells within the retina itself -- both of which can cause serious vision impairment. AMD is the leading cause of blindness in older adults.
There is no cure for AMD, but certain treatments may prevent or delay serious vision loss.
A U.S. government clinical trial found that a specific high-dose mix of antioxidants -- vitamins C and E, beta- carotene and zinc -- can slow the progression of AMD that is in the intermediate stages, and doctors now commonly prescribe it for such patients.
Whether fish or omega-3 supplements can stall AMD progression is not yet clear. But a follow-up to the U.S. antioxidant trial is now looking at whether adding fish oil and the antioxidants lutein and zeaxanthin to the original supplement regimen brings additional benefits.
For the current study, Bonnielin K. Swenor and colleagues at Johns Hopkins University in Baltimore analyzed data from 2,520 adults aged 65 to 84 who underwent eye exams and completed detailed dietary questionnaires.
Fifteen percent were found to have early- or intermediate-stage AMD, while just under 3 percent were in the advanced stage of the disease.
Overall, Swenor's team found, there was no clear relationship between participants' reported fish intake and the risk of AMD. However, there was a connection between higher intake of omega-3-rich fish and the odds of advanced AMD.
Study participants who ate one or more servings of such fish each week were 60 percent less likely to have advanced AMD than those who averaged less than a serving per week.
That was with factors like sex, race and smoking habits -- which have been linked to AMD risk -- taken into account; women appear to be at greater risk of AMD than men, while whites are at greater risk than African Americans and smokers face a higher risk than non-smokers.
Still, the findings do not prove that omega-3-rich fish bestowed the benefit.
"While the current research indicates that a diet rich in omega-3 fatty acids can reduce the risk of late AMD in some patients, more research is still necessary," Swenor told Reuters Health in an email.
She pointed out that this study was "cross-sectional" -- meaning it assessed participants at one time point, rather than following them over time to see whether self-reported fish eaters were less likely to develop AMD. So it is not clear whether participants' reported diet habits preceded the development of the eye disease.
The study also relied on people to accurately recall and report their typical eating patterns, which is subject to error.
Nor is it clear, Swenor said, why greater consumption of omega-3-rich fish was related to a lower risk of advanced, but not earlier-stage, AMD.
For now, she suggested that people with AMD discuss all their "dietary options" with their ophthalmologist.
In general, though, eating fish regularly is considered a healthy move. The American Heart Association, for example, recommends that all adults aim to eat fish, preferably fatty varieties, at least twice per week, for the potential benefits for heart health.
SOURCE: link.reuters.com/xut38m Ophthalmology, online July 13, 2010.
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