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Leading the News
Research
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Leading the News
Accuracy of CT Colonography for Detection of Large Adenomas and Cancers
New England Journal of Medicine (09/18/08) Vol. 359, No. 12, P. 1207; Johnson, C. Daniel; Chen, Mei-Hsiu; Toledano, Alicia Y.
Computed tomographic colonography (CTC) may be as accurate at screening for colorectal cancers and pre-cancerous polyps as conventional colonoscopy. Researchers, led by Mayo Clinic Arizona's Dr. C. Daniel Johnson, came to this conclusion after using CTC and conventional colonoscopy on 2,531 patients in the same day. They found that CTC correctly identified adenomas and carcinomas with 84 percent accuracy. On a per-patient basis, CTC also identified large suspicious growths with 90 percent accuracy. These detection rates were comparable to those of traditional colonoscopy. Overall, CTC identified 30 significant pre-cancerous lesions in 27 patients that were not detected using colonoscopy, while missing one lesion that was found conventionally.
Research
A Chemical Map Of The Mind
Chemical & Engineering News (09/08/08) Vol. 86, No. 36, P. 13; Halford, Bethany
Positron emission topography (PET) is being used by more pharmaceutical researchers to see how their compounds reach and affect the brain. According to Richard Hargreaves, head of basic neuroscience at Merck & Co., PET shows a disease's molecular pathology and allows scientists to see the molecular targets of the medications they are developing. Drugmakers use PET either to track a lead compound through the body, or to see how much of a drug is needed for a particular molecular target in the brain. According to Lars Farde, chief scientist for CNS and pain research with AstraZeneca and professor of psychiatry at Sweden's Karolinska Institute, scientists believe that about 500 or 1,000 of the 12,000 genes expressed in the brain can be drug targets, but finding the right radioligands to map them is as challenging as finding the drug that researchers want to track. The tracers used for PET have also helped scientists learn more about Alzheimer's disease, as some of them bind specifically to the plaques in the brain associated with Alzheimer's. Three plaque tracers are now in Phase II clinical trials, with the future possibility of screening for Alzheimer's in high-risk individuals.
X-Ray Collateral Damage
Journal of the American Medical Association (09/17/08) Vol. 300, No. 11, P. 1291
Italian researchers, led by M. Mancuso, have found that radiation can indirectly cause cancer in cells beyond those that are directly targeted by the radiation. Their study, published in the Proceedings of the National Academy of Sciences, suggests that current estimates of cancer risk due to radiation exposure may be too low. Mancuso and his colleagues x-rayed mice born with a gene that gives them a higher risk of developing brain tumors. Approximately 62 percent of the mice given whole-body radiation developed cerebellar tumors and died at 23 weeks compared with 39 percent of mice that were irradiated while enclosed in a cylindrical lead shield designed to protect their heads and upper torso. None of the mice that were not irradiated developed brain tumors. Shielded mice treated before irradiation with a chemical that inhibits cell-to-cell communication also showed no DNA damage and far less apoptosis.
Chemo, Radiation After Pancreatic Cancer Surgery Prolongs Life
Johns Hopkins Gazette (09/15/08) Vol. 38, No. 3, Wasta, Vanessa
Pancreatic cancer patients treated with a combination of radiation and chemotherapy survive approximately six months longer than those who only receive surgical intervention, according to Johns Hopkins radiation oncologist Joseph Herman and his colleagues. Their study, published in the Journal of Clinical Oncology, included a meta-analysis of the records of 616 Johns Hopkins patients who underwent surgical removal of their pancreas. The researchers then compared the survival of 345 patients who only had surgery with the 271 patients who were then treated with radiation and 5-fluorouracil-based chemotherapy.
Study Says Gel Lessens Mammogram Pain
Age (Australia) (09/16/08)
The use of Lidocain gel prior to a mammogram can lessen the pain of the procedure, according to a study conducted by Colleen K. Lambertz of Luke’s Mountain States Tumor Institute, and colleagues. The study, which involved more than 400 women, was published in Radiology. Of the participants, 75 percent in the Lidocain group said they would have another mammogram. Those participants who used the Lidocain gel also reported significantly less discomfort caused by the mammogram compared to those who took an oral painkiller.
Technology
3-D MRI Technique Helps Radiologists Detect High-Risk Carotid Disease
Science Centric (09/16/2008)
Three-dimensional magnetic resonance imaging (3-D MRI) is able to accurately detect bleeding within the walls of diseased carotid arteries, according to University of Toronto Prof. Alan R. Moody and his colleagues. Their study, published in the October issue of Radiology, included 11 patients between the ages of 69 and 81 years. Moody and his team performed 3-D MRIs on all patients and then surgically removed the complicated plaques from the patients diseased arteries. They found a strong connection between the lesions detected by the MRI and the lesions found using microscopic analysis of the tissue samples.
Taming Health Messaging
Government Health IT (08/27/08) Moore, John
Healthcare workers will be able to contact one another quickly with their chosen mode of communication using unified communications (UC) technology. Advocates of UC say the solution offers more messaging options, better collaboration tools and the ability to reach the right person at the right time. UC integrates voice, messaging, e-mail, audio, Web or video conferencing and instant messaging communication solutions using servers and software. Products on the market offer features that show whether an individual is logged on to the system and how he or she should be contacted. More adoption of UC has been seen on the administrative side than in clinical settings. Healthcare organizations will need to build UC technology into established work flow on the clinical side and will face challenges in complying with regulations such as the Health Insurance Portability and Accountability Act.
Medical-Legal Issues
Hospitals and Insurers Try Flat Fees--Again
BusinessWeek (09/15/08) No. 4099, P. 71; Arnst, Catherine
A new managed care program offered by Caritas Christi Health Care in Massachusetts could be the new prototype for preventive care if it succeeds in keeping rates fair for both doctors and patients. Both the organization and the state's most prominent insurer, Blue Cross Blue Shield of Massachusetts, want a statewide transition from fee-for-service care to managed care that charges each patient a set fee each year, with adjustments for age and illness. Insureds under a managed care system would receive preventive treatment for ailments like obesity, allowing the state to reduce healthcare spending by up to 50 percent, according to a recent PricewaterhouseCoopers study. The current healthcare system encourages doctors and hospitals to focus on volume, rather than on quality, which translates into unnecessary tests and treatments for many patients. Until the payment structure for hospitals and physicians is overhauled, universal coverage will be unattainable, say experts. In Massachusetts, which recently introduced a universal coverage plan, the state's plan is running $150 million over budget. Ralph de la Torre, MD, the new CEO of Caritas, looks to Danville, Pa.-based Geisinger Health System as a successful model of managed care. The organization began charging flat fees for coronary artery bypasses for the last two years, and in a follow-up study of 181 patients, the readmission rates fell 44 percent, and treatment fees dipped 5 percent.
Clinical Practice
A Carrot-and-Stick Approach to Handwashing
Lubbock Online (09/04/08) Jain, Majog
Handwashing among healthcare workers still has not improved enough, even though alcohol-based gels are now available. Majog Jain, MD, an infectious disease physician, says the healthcare sector needs to admit the "Just do it!" approach does not work, and the single intervention strategy needs to be replaced with a carrot-and-stick approach. This approach encompasses the use of incentives and awards for those who comply with handwashing protocols, letters to repeated violators and notes in their credentialing file or employment file. Additionally, healthcare organizations must institute a monitoring practice to gauge the rate of compliance, provide feedback, and recommend areas for improvement to achieve higher compliance rates among staff members. Monitoring programs can include appointing designated employees who will observe handwashing among their coworkers.
Industry News
Disruptive Innovation in Healthcare Delivery
Health Affairs (Quarter 4, 2008) Vol. 27, No. 5, P. 1329; Hwang, Jason; Christensen, Clayton M.
Researchers contend the high costs of healthcare nationwide can be reduced when hospitals and physician practices narrow their organizations to one business model. Practices must eliminate processes and procedures that can be done more efficiently and cost effectively through other means. For example, care for chronic diseases is best addressed through a user network model where information is shared among members. Procedures that can be done outside the hospital or practice in facilities with the appropriate skill and technological resources for a lower cost. These facilities should be allowed to fill a niche when hospitals or primary care practices cannot do so with their given resources and obligations. However, these players in the healthcare market must remain connected through health information technology to ensure care is coordinated for the betterment of each patient. Once the business model of care is modified with flexible components sharing patient data, health savings accounts will be more successful by offering patients an incentive to seek out the best care at the best price, according to researchers.
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