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¶ 12:00 PM 0 comments
Research hospitals in your area to find the best care for specific illnesses
The more a hospital performs a procedure, the better the results in most cases
Specialty training for hospital staff often can result in better patient outcomes
By Elizabeth Cohen
CNN
ATLANTA, Georgia (CNN) -- Chuck Toeniskoetter says he's alive today because of a nurse and a paramedic who came to his aid when he collapsed one snowy day high atop a mountain.
Studies are now finding that not all hospitals are created equal for every medical emergency.
They didn't administer CPR. They didn't give him life-saving drugs. They didn't treat him at all. What they did was get him to the right hospital.
The helicopter ambulance pilot wanted to take Toeniskoetter to the closest hospital. But the nurse and the paramedic suspected he'd had a stroke and urged the pilot to go to a certified stroke center, 15 minutes further away.
"They stood on the runners of the helicopter and were relentless with the pilot," Toeniskoetter remembers. "They saved my life."
At Sutter Roseville Medical Center in Roseville, California, Toeniskoetter received TPA, a drug that dissolved the clot in his brain. It's likely that at the other hospital -- the one the helicopter ambulance pilot wanted to take him to -- he wouldn't have received TPA.
Studies are now finding that not all hospitals are created equal for every medical emergency. Whether it's a stroke, a high-risk birth, or a heart attack, the research says it's worth doing whatever it takes to get to the right place. "A lot of people think hospitals are all the same," said Dr. Samantha Collier, chief medical officer at HealthGrades, which ranks hospitals. "They're not."
Consider this:
A new study in the Archives of Internal Medicine says heart attack patients have a higher chance of surviving if brought to one of U.S. News & World Report's Top 50 hospitals for treating heart problems.
A study earlier this year in the New England Journal of Medicine finds very low birth weight newborns are more likely to survive if treated in a high-level neonatal intensive care unit that takes care of a large volume of very low birth weight babies.
So how can you know which hospital is right for your medical needs?
Research hospitals on the Internet
"If we're going to spend hours on the Internet doing research before we buy a car, we should spend at least as much time researching hospitals," said Collier.
Her company's Web site, healthgrades.com, ranks hospitals by specialty, as does The Leapfrog Group. You can find out the best place to get hip surgery in Topeka, Kansas, or the best place to have a baby in New York City.
JointCommission.org lists hospitals that have certification for various medical specialties. Hospitalcompare.hhs.gov has detailed information about procedures performed at different hospitals.
Ask the right questions
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If the information isn't available on the Internet, you'll have to call the hospital's quality office. Collier says ask about volume; hospitals that perform a high number of a given procedure -- heart bypass surgery, hip replacement -- usually have the best results, studies show. Leapfrog and HealthGrades have information about what constitutes high volume for various procedures.
Staffing also plays a key role. "Let's say I'm having a surgery where it's highly likely I'm going to have a stay in the intensive care unit," said Suzanne Delbanco, CEO of Leapfrog. "Your risk of dying in an ICU drops 40 percent if the doctors working there are 'intensivists,' which means they have specialty training in critical care. Ask if they have that kind of staffing."
What about an emergency?
It may sound strange, but it's possible to anticipate many emergencies.
Experts recommend thinking about what emergencies are most likely to happen in your family. Perhaps your mother has a heart condition, or perhaps you have a high-risk pregnancy and are at risk of having a premature baby.
Art Caplan, a bioethicist at the University of Pennsylvania, says the first step is to find out where an ambulance would take you if you dialed 911. If you want to go elsewhere, you might be out of luck. Often you can't persuade an ambulance driver to go to a stroke center if you've had a stroke, or to go to a children's hospital if your child is injured.
But you can be an informed consumer and check with emergency service providers in your area to find which hospital you'd be taken to and see whether you'd be able to negotiate a different destination.
After Chuck Toeniskoetter's experience, he started the Stroke Awareness Foundation, to help others choose the right hospital if they've had a stroke.
When he thinks about how the nurse and the paramedic argued for him to go the extra 15 minutes to the stroke center, he says he'll always be grateful.
"Those were the shortest 15 minutes of my life," he says. ¶ 4:50 PM 0 comments
Our nation's drugs safety program is broken. In recent years the Food and Drug Administration (FDA) has been too cozy with the powerful prescription drug industry and approved dangerous and deadly medicines such as Vioxx, Paxil and Ketek. Vioxx is linked to heart disease, Paxil to suicide in children and Ketek to liver failure.
The good news is the Senate is considering drug safety legislation this week that will protect consumers from dangerous drugs like Vioxx and inform doctors of drug safety concerns.
Tell the bill's sponsors, Senators Ted Kennedy (D-Mass) and Mike Enzi (R-Wyo), that you support the bipartisan "Food and Drug Administration Revitalization Act" (S. 1082), and that they should oppose any amendments that will weaken the bill.
To take action, click on this link or paste it into your browser:
https://www.uspirg.org/action/health-care/petition?id4=ES
Then, ask your friends and family to help too by forwarding this e-mail to them.
Background
When Merck, the makers of Vioxx, first learned that their drug could cause serious health problems including heart attack and stroke, they could have told doctors and their patients. They didn't.
When GlaxoSmithKline, makers of the antidepressant Paxil, learned that it was linked to an increased risk of suicidal behavior in children, they could have sounded the alarm. They didn't.
These companies had the opportunity to do the right thing by giving doctors and patients the information they needed to make safe and informed medical decisions. They consciously chose not to tell the public the whole truth.
The problem is clear and there is bi-partisan agreement in Washington that something needs to be done. The pharmaceutical industry can't, and has proven that it won't, police itself. Lawmakers must reform the Food and Drug Administration so that it focuses on its original mission of ensuring that our medicines are safe.
The good news is that bi-partisan legislation, the "Food and Drug Administration Revitalization Act" (S. 1082) will reduce the number of consumers who die or suffer from adverse side effects cause by unsafe prescription drugs.
Tell the bill's sponsors, Senators Ted Kennedy (D-Mass) and Mike Enzi (R-Wyo), that you support the bipartisan "Food and Drug Administration Revitalization Act" (S. 1082), and that they should oppose any amendments that will weaken the bill.
To take action, click on this link or paste it into your browser:
https://www.uspirg.org/action/health-care/petition?id4=ES
Then, ask your friends and family to help too by forwarding this e-mail to them.
Sincerely,
James Browning
PennPIRG State Director
JBrowning@PennPIRG.org
http://www.PennPIRG.org ¶ 11:09 AM 0 comments
By MARILYNN MARCHIONE, AP Medical Writer 1 hour, 3 minutes ago
Chest compression not mouth-to-mouth resuscitation seems to be the key in helping someone recover from cardiac arrest, according to new research that further bolsters advice from heart experts.
A study in Japan showed that people were more likely to recover without brain damage if rescuers focused on chest compressions rather than rescue breaths, and some experts advised dropping the mouth-to-mouth part of CPR altogether. The study was published in Friday's issue of the medical journal The Lancet.
More than a year ago, the American Heart Association revised CPR guidelines to put more emphasis on chest presses, urging 30 instead of 15 for every two breaths given. Stopping chest compressions to blow air into the lungs of someone who is unresponsive detracts from the more important task of keeping blood moving to provide oxygen and nourishment to the brain and heart.
Another big advantage to dropping the rescue breaths: It could make bystanders more willing to provide CPR in the first place. Many are unwilling to do the mouth-to-mouth part and become flummoxed and fearful of getting the ratio right in an emergency.
Sudden cardiac arrest when the heart suddenly stops beating can occur after a heart attack or as a result of electrocution or near-drowning. It's most often caused by an abnormal heart rhythm. The person experiencing it collapses, is unresponsive to gentle shaking and stops normal breathing.
In the new study, researchers led by Dr Ken Nagao of Surugadai Nihon University Hospital in Tokyo analyzed 4,068 adult patients who had cardiac arrest witnessed by bystanders. Of those, 439 received chest compressions only from bystanders, and 712 received conventional CPR compressions and breaths.
Any CPR attempt improved survival odds. However, 22 percent of those who received just chest compressions survived with good neurological function compared with only 10 percent of those who received combination CPR.
"Eliminating the need for mouth-to-mouth ventilation will dramatically increase the occurrence of bystander-initiated resuscitation efforts and will increase survival," Dr. Gordon Ewy, a cardiologist at the University of Arizona College of Medicine in Tucson, writes in an accompanying editorial.
A big caveat: The combination CPR in the Japanese study was given according to the old guidelines of 15 presses for every two breaths, not the 30 presses recommended now.
The American Heart Association said the study supports a focus on chest presses, but the association does not expect its advice to change. It recommends that bystanders provide compression-only CPR if they are "unwilling or unable" to do mouth-to-mouth breathing at the same time and for emergency dispatchers to give instructions on that.
The association wants to see survival results from programs that use compression-only CPR for cardiac arrest.
"It is important to note that victims of cardiac arrest from non-cardiac causes, like near-drowning or electrocution, and almost all victims of pediatric cardiac arrest benefit from a combination of rescue breathing and chest compressions," a heart association statement says.
More than 300,000 Americans die from cardiac arrest each year. About 75 percent to 80 percent of all cardiac arrests outside a hospital happen at home, and effective CPR can double a victim's chance of survival.
Roughly 9 out of 10 cardiac arrest victims die before they get to the hospital partly because they don't get CPR.
28 Feb 2007
New research published in the March issue of Psychological Science may help elucidate the relationship between religious indoctrination and violence, a topic that has gained renewed notoriety in the wake of the September 11th terrorist attacks. In the article, University of Michigan psychologist Brad Bushman and his colleagues suggest that scriptural violence sanctioned by God can increase aggression, especially in believers.
The authors set out to examine this interaction by conducting experiments with undergraduates at two religiously contrasting universities: Brigham Young University where 99% of students report believing in God and the Bible and Vrije Universiteit in Amsterdam where just 50% report believing in God and 27% believe in the bible.
After reporting their religious affiliation and beliefs, the participants read a parable adapted from a relatively obscure passage in the King James Bible describing the brutal torture and murder of a woman, and her husband's subsequent revenge on her attackers. Half of the participants were told that the passage came from the Book of Judges in the Old Testament while the other half were told it was an ancient scroll discovered in an archaeological expedition.
In addition to the scriptural distinction, half of the participants from both the bible and the ancient scroll groups read an adjusted version that included the verse:
"The Lord commanded Israel to take arms against their brothers and chasten them before the LORD."
The participants were then placed in pairs and instructed to compete in a simple reaction task. The winner of the task would be able to "blast" his or her partner with noise up to 105 decibels, about the same volume as a fire alarm. The test measures aggression.
As expected, the Brigham Young students were more aggressive (i.e. louder) with their blasts if they had been told that the passage they had previously read was from the bible rather than a scroll. Likewise, participants were more aggressive if they had read the additional verse that depicts God sanctioning violence.
At the more secular Vrije Universiteit, the results were surprisingly similar. Although Vrije students were less likely to be influenced by the source of the material, they blasted more aggressively when the passage that they read included the sanctioning of the violence by God. This finding held true even for non-believers, though to a lesser extent.
The research sheds light on the possible origins of violent religious fundamentalism and falls in line with theories proposed by scholars of religious terrorism, who hypothesize that exposure to violent scriptures may induce extremists to engage in aggressive actions. "To the extent religious extremists engage in prolonged, selective reading of the scriptures, focusing on violent retribution toward unbelievers instead of the overall message of acceptance and understanding," writes Bushman "one might expect to see increased brutality" ¶ 8:28 AM 0 comments
