That crisis comes from just day-to-day emergencies. Emergency rooms are far from ready to handle the mass casualties that a bird flu epidemic or terrorist strike would bring, the institute warned Wednesday in a three-volume report.
"If you can barely get through the night's 911 calls, how on earth can you handle a disaster?" asked report co-author Dr. Arthur Kellerman, Emory University's emergency medicine chief.
That ERs are overburdened isn't new. But the probe by the IOM, an independent scientific group that advises the government, provides an unprecedented look at the scope of the problems and recommends urgent steps for health organizations and local and federal officials to start fixing it.
Topping that list is a call for coordinating care so that ambulances don't waste potentially lifesaving minutes wandering from hospital to hospital in search of an ER with room. The idea is to set up regionalized systems that manage the flow much like airports direct flight traffic. That also should direct patients not just to the nearest ER but to the one best equipped to treat their particular condition making sure stroke victims go to stroke centers, for example.
Other recommendations:
Congress should establish a pool of $50 million to reimburse hospitals for the unpaid emergency care they provide to the poor and uninsured.
Congress should ensure that more of the nation's disaster-preparedness funding goes to the hospitals and emergency workers who will provide that care. Typical government grants to hospitals for bioterrorism preparation are $5,000 to $10,000 not enough to equip one critical-care room. When it comes to getting ready for a bird flu outbreak, few hospitals even have the ventilation equipment needed to isolate patients. And emergency medical services received only 4 percent of the $3 billion distributed by the Department of Homeland Security in 2002 and 2003 for emergency preparedness.
The board that accredits the nation's hospitals should establish strong guidelines to reduce crowding and ambulance diversion.
At the root of the problem: Demand for emergency care is surging, even as the capacity for hospitals, ambulance services and other emergency workers to provide it is dropping.
There were almost 114 million emergency room visits in 2003, up from 90 million a decade earlier. During the same time, the total number of U.S. hospitals decreased by 703, and the number of ERs by 425. And the total number of hospital beds nationwide dropped by 198,000, as hospitals strive toward more outpatient care which in turn leaves fewer beds for ER patients to move into when they're seriously ill.
Too often, busy ERs stabilize those patients and then have to leave them lying on gurneys in the hallway for 48 hours or more until a room becomes available and they can be admitted to the hospital. That's not only a time of misery for the patient, but it means less timely care and potentially poorer care, without the specialized equipment and expertise available to inpatients, the report found.
Children have even scarcer help. They make up more than a quarter of all ER visits, yet one survey found only 6 percent of emergency departments had all the supplies needed, such as child-size equipment, to treat them.
Before getting to the hospital, the EMS system emergency medical services that include ambulances and paramedics is fragmented. How well-trained and prompt local paramedics are varies greatly; there are no nationwide standards. Many ambulance services can't even effectively communicate with hospitals or other first responders because of antiquated equipment.
The American College of Emergency Physicians called the report groundbreaking but said Congress must heed recommendations to fund the necessary improvements. ¶ 8:04 PM 0 comments
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ALZHEIMER'S DISEASE ST GEORGE-HYSLOP INOSITOL SCYLLO-INOSITOL AMYLOID
BETA CLINICAL TRIALS NEUROBIOLOGY
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Description
Certain variants of a simple sugar ameliorate Alzheimer's-like disease
in mice, according to a new study by Canadian researchers. Although the
studies are still in the early stages, the findings could lead to new
therapies that prevent or delay the onset of Alzheimer's disease.
Newswise - Certain variants of a simple sugar ameliorate
Alzheimer's-like disease in mice, according to a new study by Canadian
researchers. Although the new studies are still in the early stages,
the findings could lead to new therapies that prevent or delay the
onset of Alzheimer's disease.
The new studies show that some types of a sugar called
cyclohexanehexol-also known as inositol-prevented the accumulation
of amyloid ? deposits, a hallmark of Alzheimer's disease.
Scyllo-inositol treatment also improved cognitive abilities in the mice
and allowed them to live a normal lifetime. The study appeared in
advance online publication of the journal Nature Medicine on June 11,
2006.
HHMI international research scholar and senior author Peter St
George-Hyslop cautioned that the chemicals tested in these studies are
not the type of inositol sold commercially as a nutritional supplement.
That type-myo-inositol-has been shown previously to be ineffective
at breaking up amyloid aggregates, he said.
In the brain of a person with Alzheimer's disease, small proteins
called amyloid ? aggregate into plaques, and a protein called tau
clumps into neurofibrillary tangles. The brain becomes inflamed and
neurons atrophy and die. It's not completely clear what kind of amyloid
? peptide (monomers, oligomeric aggregates, or fibrillar aggregates) is
responsible for the onset of disease, said St George-Hyslop of the
University of Toronto. "Because we were able to show that
scyllo-inositol specifically dispersed the high-molecular-weight
oligomeric aggregates, this study confirms that the initiating event is
the accumulation of oligomeric aggregates of amyloid ? peptide," he
said.
Previous work by JoAnne McLaurin, also of the University of Toronto and
lead author of the Nature Medicine paper, showed that several types of
inositol could stop amyloid proteins from aggregating in test tubes. To
see if these compounds could do the same in living animals, St
George-Hyslop, McLaurin, and colleagues tested them in transgenic mice
with human genes that predispose them to an Alzheimer's-like disease.
When the researchers treated these mice with scyllo-inositol, all of
the animals' disease symptoms improved. Cognitive function was
improved, amyloid plaques disappeared, inflammation declined, and the
mice lived longer.
The scientists found that scyllo-inositol conferred these benefits not
only if the mice were treated when they were very young and
disease-free, but also if they were treated after the onset of disease.
As a model system, these mice "are pretty good, but they're not a
perfect replica of the disease," St George-Hyslop said. The mice do
not develop tau tangles, he explained, but they are prone to amyloid
plaques, brain inflammation, cognitive disturbance, and early death,
just like humans with Alzheimer's disease.
The researchers found that the scyllo-inositol worked better than the
epi-inositol version. Scyllo-inositol produced more dramatic benefits
overall, while epi-inositol worked only transiently and only when given
before disease symptoms appeared.
Scyllo-inositol "is an exciting experimental therapy, but until it
has actually been tested in humans, it should not be considered the
cure for Alzheimer's disease," St George-Hyslop said. "There are
many things that are very promising when done in animal models that
turn out to either not work in humans or to have unexpected
toxicity."
A public Canadian company called Transition Therapeutics has regulatory
approval for clinical trials of scyllo-inositol in humans with
Alzheimer's disease and started them about a week ago. St George-Hyslop
has a small financial interest in the company.
St George-Hyslop and his colleagues are optimistic that scyllo-inositol
will be less toxic to humans than some previous drug candidates for
Alzheimer's disease. A vaccine designed to destroy amyloid ?, for
example, was first tested successfully in the same type of mice used in
the scyllo-inositol studies, but the vaccine turned out to be toxic in
some humans. It caused an autoimmune reaction in about 10 percent of
patients who were immunized, St George-Hyslop said.
Autoimmune responses shouldn't be a problem with scyllo-inositol.
"This compound works by a different mechanism and doesn't involve
immunizing a patient with his own protein, which was probably the
origin of the allergic reaction to the vaccine," the researcher said.
Another complication with previous attempts to treat Alzheimer's
disease has been that some compounds-such as beta secretase
inhibitors-cannot enter the brain easily, St George-Hyslop explained.
Scyllo-inositol, on the other hand, readily passes through the
blood-brain barrier where it is made available to the central nervous
system.
Even if scyllo-inositol does prove safe and effective in humans,
patients will likely still need drugs designed to attack other aspects
of Alzheimer's pathology, such as tau neurofibrillary tangles, St
George-Hyslop said.
"Alzheimer's disease is probably going to be treated by a cocktail of
drugs," he predicted. "Some of them might be this compound, or one
like it, that blocks the toxicity and aggregation of amyloid."
--------------------------------------------------------------------------------
[ From: Jagannath Chatterjee
[ Date: Sun, 11 Jun 2006
Dear Members,
I have been warning against the use of serum based
vaccines and medicines. These products are almost always
contaminated and carry the risk of spreading dangerous
diseases. Medical insiders know that uncontaminated serum
is a contradiction in terms. Serum can only be
"relatively pure", whatever that means. The risk of
genetic contamination is 100% as we do not screen the
serum for defective genes.
Now we have a very large drug MNC showing no regrets
about passing on HIV to patients in Asia through a serum
based medication.
Regards,
Jagannath.
June 10, 2006
http://www.cbsnews.com/stories/2003/05/22/health/main555154.shtml
Bayer Sold HIV-Risky Meds
By David McHugh
The Associated Press
FRANKFURT, Germany, May 22, 2003
(AP)
Quote
"Decisions made nearly two decades ago were based on the
best scientific information of the time and were
consistent with the regulations in place. They cannot be
judged on the information available today." Bayer AG
(AP) Chemical and drug maker Bayer AG said Thursday it
acted "responsibly, ethically and humanely" during the
1980s in selling a blood-clotting product that stopped
potentially fatal bleeding in hemophiliacs but was linked
to the risk of HIV infection.
The company's statement was in response to a New York
Times report that it sold millions of dollars worth of an
older version of the medication in Latin America and Asia
while marketing a newer, safer product in the United
States and Europe.
Bayer division Cutter Biological continued selling old
stocks of the medicine for more than a year after it
introduced a version in February 1984 that was heat-
treated to kill HIV, according to documents obtained by
the Times.
The medicine, called Factor VIII concentrate, can stop or
prevent potentially fatal bleeding in people with
hemophilia, a genetic condition that prevents blood from
clotting normally.
Early in the AIDS epidemic, the medicine was made using
plasma from 10,000 or more donors. There was not yet a
screening test for HIV, the virus that causes AIDS, so
even a small number of HIV-positive donors could taint a
large pool of plasma recipients.
As a result, thousands of hemophiliacs became infected
with HIV. Bayer and three other companies that made the
concentrate have paid about $600 million to settle more
than 15 years of lawsuits accusing them of making a
dangerous product, the newspaper said.
The Times said at least 100 hemophiliacs in Hong Kong and
Taiwan alone contracted AIDS after using the older
product, and that many have since died. Li Wei-chun said
her son, who died in 1996 at the age of 23, was among the
victims.
"They did not care about the lives in Asia," she said.
"It was racial discrimination."
Cutter also sold the older medicine in Argentina,
Indonesia, Japan, Malaysia, and Singapore after February
1984, according to the documents. The newspaper said
Cutter shipped more than 100,000 vials of unheated
concentrate, worth more than $4 million, after it began
selling the safer product.
The sales continued partly because of Cutter's desire to
deplete stocks of the older medicine, and partly because
of fixed-price contracts, for which the company believed
the older product would be cheaper to make, the newspaper
said.
In March 1983, the federal Centers for Disease Control
warned that blood products appeared responsible for AIDS
among hemophiliacs. Three months later, Cutter sent a
letter to distributors in nearly two dozen nations saying
that AIDS was "the center of irrational response in many
countries."
In late 1984, as Hong Kong hemophiliacs began testing
positive for HIV, some doctors wondered whether Cutter
was sending "AIDS-tainted" medicine into less-developed
nations.
But the company assured its distributor that the unheated
product posed "no severe hazard" and was the "same fine
product we have supplied for years."
In May 1985, Dr. Harry M. Meyer Jr., the Food and Drug
Administration's blood-products official, called the
companies to a meeting, believing they had broken an
agreement to stop selling the older medicine, the Times
said. But Meyer decided to handle the matter quietly
instead of notifying the public, the newspaper said.
Food Allergies
A food allergy occurs when your immune system responds defensively to a specific food protein that is not harmful to the body.
The first time you eat the offending food, your immune system responds by creating specific disease-fighting antibodies (called immunoglobulin E or IgE). When you eat the food again, the IgE antibodies spring into action, releasing large amounts of histamine in an effort to expel the "foreign invader" from your body. Histamine is a powerful chemical that can affect the respiratory system, gastrointestinal tract, skin or cardiovascular system.
What Are the Symptoms of a Food Allergy?
Symptoms may appear almost immediately, or up to two hours after you've eaten the food. Symptoms can include a tingling sensation of the mouth, swelling of the tongue and throat, hives, skin rashes, vomiting, abdominal cramps, difficulty breathing, diarrhea, a drop in blood pressure, or even a loss of consciousness. Severe reactions -- called anaphylaxis -- can result in death.
Which Foods Most Often Cause Allergic Reactions?
There are six foods that cause over 90% of food allergies - milk, eggs, peanuts, wheat, soy, and tree nuts (such as walnuts, pecans and almonds).
How Are Food Allergies Diagnosed?
Your doctor may do a radioallergosorbent blood test (RAST) to check the number of antibodies produced by your immune system. Elevated levels of certain types of antibodies can help your doctor identify specific food allergies.
The doctor may also perform an allergy skin test, also called a scratch test, to identify the substances that are causing your allergy symptoms.
By keeping a food diary, your doctor will have a much better starting point to determine the foods that could trigger your allergies. You may be asked to eliminate all potentially allergenic foods and then add them back to your diet one at a time to see if they prompt any reaction. This is called an "elimination and challenge diet."
How Are Food Allergies Treated?
The best way to cope with a food allergy is to strictly avoid the foods that cause a reaction. Mild reactions often will subside without treatment. For rashes, skin creams may ease discomfort while antihistamines can help reduce itching and other symptoms.
For more serious reactions, corticosteroids such as prednisone will help to reduce swelling. In life-threatening situations, an epinephrine injection can immediately begin to reverse symptoms and is the only effective treatment option.
How Can I Be Prepared?
Once you and your doctor have determined which foods you should avoid, stay away from them. However, it is important that you maintain a healthy, nutritious diet. Ask your doctor to recommend foods that will provide you with the necessary nutrients.
You should also be aware of the ingredients in processed foods. Be sure to read labels. A registered dietitian can help you learn how to read food labels to discover hidden sources of food allergens.
If you are prone to allergic reactions, ask your doctor to prescribe an epinephrine injection kit and carry it with you at all times.
Next: Hay Fever
View the full table of contents for the Allergy Guide.
Reviewed by the doctors at The Cleveland Clinic Department of Pulmonary, Allergy and Critical Care Medicine.Edited by Cynthia Haines, MD, WebMD, March 2006.
SOURCE: The Food Allergy and Anapylaxis Network
By MIKE STOBBE, Associated Press Writer 6 minutes ago
U.S. hospitals have saved an estimated 122,300 lives in the last 18 months through a massive campaign to reduce lethal errors, the leader of the national effort said Wednesday.
"I think this campaign signals no less than a new standard of health care in America," said Dr. Donald Berwick, a Harvard professor who organized the campaign.
About 3,100 hospitals participated in the project, sharing mortality data and carrying out study-tested procedures that prevent infections and mistakes. Experts say the cooperative effort was unusual for a competitive industry that traditionally doesn't like to publicly focus on patient-killing problems.
"We in health care have never seen or experienced anything like this," said Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations.
Berwick announced the campaign's results Wednesday morning at a hospital conference in Atlanta. O'Leary was one of hundreds of industry dignitaries and representatives in attendance.
Medical mistakes were the focus of a widely noted 1999 national report that estimated 44,000 to 98,000 Americans die each year as a result of errors and low-quality care.
That year, Berwick president of the Institute for Healthcare Improvement, a Massachusetts-based nonprofit organization challenged health care leaders to improve care quality and prevent mistakes.
In December 2004, he stepped up the challenge by announcing a "100,000 Lives Campaign." He set a June 14, 2006, deadline to sign up at least 2,000 U.S. hospitals in the effort and implement six types of changes.
Perhaps the best known of the six changes was to deploy rapid response teams for emergency care of patients whose vital signs suddenly deteriorate.
Hospitals generally have teams that respond when patients develop sudden heart or breathing problems. That work is common in emergency departments. The measure was designed to make sure the service is available around-the-clock to other units, and to encourage lower-ranking medical staff members not to be intimidated about calling for help.
Another urged checks and rechecks of patient medications to protect against drug errors. A third focused on preventing surgical site infections by following certain guidelines, including giving patients antibiotics before their operations.
The hospitals also were asked to contribute monthly mortality data to Berwick's organization, which attempted to track the impact.
The effort was endorsed by federal health officials, health insurers, hospital industry leaders, the American Medical Association and others. About 3,100 hospitals signed up, representing about 75 percent of the nation's acute care beds.
About 86 percent sent in mortality data. Roughly a third said they were implementing all six measures, and more than half committed to at least three, Berwick said.
Campaign workers examined 2004 data for the participating hospitals to determine how many people were expected to die during the 18 months of the campaign.
They then checked the count of actual deaths reported. They also made mathematical adjustments for severity of illnesses and for volume of cases, to make a more fair comparison of the two time periods more fair. They also made estimates for participating hospitals that did not report data, Berwick said.
"This is estimation it isn't counting," he said.
Various estimates placed the number of saved lives at between 115,000 and 149,000, but the best guess was 122,342, he said.
Berwick challenged the hundreds of hospital representatives at the conference to continue to improve. He also proposed another goal all hospitals should implement all six changes by the beginning of 2007.
