No Link Found Between Elderly Patient Activity And Hospital Falls

Main Category: Seniors / Aging
Also Included In: Public Health;  Medicare / Medicaid / SCHIP
Article Date: 31 Oct 2011 – 1:00 PDT

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In 2008, as part of a larger initiative aimed at reducing preventable hospital errors and lowering costs, Medicare stopped reimbursing for the treatment of injuries related to in-hospital falls.

Geriatricians were quick to point out that this measure could have an unintended negative consequence. In trying to keep elderly patients from falling, they said, it was possible that hospitals might discourage patients from moving about at all. And for the elderly, even a few days of immobility can produce what’s called “hospital-associated deconditioning”: a loss of muscle mass, aerobic capacity, and sense of balance that reduces a patient’s ability to function after he or she is discharged from the hospital.

But while it might seem obvious that elderly patients who move around more would be more likely to fall, a new study from University of Texas Medical Branch at Galveston researchers suggests otherwise. Analyzing the mobility patterns of elderly patients fitted with small electronic devices that counted every step they took, the scientists determined that patients who suffered in-hospital falls actually moved around no more than patients who did not fall.

“We matched 10 patients who had fallen with 25 who had not fallen based on age, gender, reason for admission, illness severity, and mobility status before admission,” said UTMB assistant professor Steven Fisher, lead author of a paper on the study now online in Archives of Physical Medicine and Rehabilitation. “All of these people had worn step activity monitors during their stay in the hospital, and when we analyzed the data from these devices we found no statistical difference in the amount of walking between the groups.”

According to Fisher, the study’s results suggest reducing elderly patients’ mobility doesn’t just risk hospital deconditioning – it also may do little toward the prevention of falls.

“Hospital falls are a complex issue, with a number of factors at work,” Fisher said. “In our study, for example, we found that cognition was a big factor – patients suffering from delirium were more likely to fall.”

In addition, Fisher pointed to the hospital environment as a potential contributor to falls. All of the falls noted in the study took place at night, and 60 percent of them were related to visits to the bathroom.

It is likely not possible to eliminate older patient falls altogether, Fisher observed. “Evidence is accumulating, however, that even small amounts of activity can be beneficial in this context,” he said. “What we see from this study is that getting that benefit doesn’t necessarily mean increasing the risk of falling.”

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About the hospital bed

Do you ever go to the hospital ?yes you are ,if you have sick you will have to go to the the hospital to see doctor,and if your friends in hospital ,you will go to the hospital to see him.

So the hospital is familiar to all of us.

When we go to the inpatient, we will see many different kinds of diseases in it. Sometimes people will die in the hospital when they have heavily disease. By the way, the most people have small problems with them, maybe he has cold, toothache, stomach pain and so on. Sometimes, I would not like to the hospital, where is bad smelling ,and maybe a die person through your side, which is very horrible.

But we can’t leave out the hospital Bed. We all will have hospital beds to us in the hospital. And the medical equipments are important, if we can’t have a good rest ,it will do harm to our pain ,even which will make out more sick .It is serious. So if we in hospital ,we should choose a comfortable medical hospital Bed, we should make sure if it is undamaged,soft,and convenient. By the way ,in general, the electric medical hospital Bed in the hospital is well ,and would not make the disease worse. Even the hospital bed is not well, it will immediately get new beds. So maybe it is not a problem at all ,but you also pay attention to your hospital Bed,and by the way , you should notice the medical hospital furniture.

Do you also know about the operating table, obstetric table/delivery bed ?

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The EU is subsidising illegal fishing

“The Rich get Richer”

Sherry Slater | The Journal Gazette

Last updated: August 4, 2011 6:09 p.m.

One of Warsaw’s Big Three is getting a little bit bigger.

DePuy Orthopaedics Inc. plans to invest $27 million in manufacturing and research equipment at its Warsaw operations, according to an abatement request filed with the city of Warsaw.

The orthopedic devices maker, which employs 1,150, doesn’t expect to add jobs as part of the project, according to the filing.

Warsaw officials this week approved the request, giving the company a 10-year break on taxes assessed on the machinery. The equipment is scheduled to be installed sometime before 2014.

The investment will be divided between manufacturing equipment, $20 million, and research and development equipment, $7 million.

Jessica Masuga, DePuy spokeswoman, wrote in an email that the equipment “will add important new state-of-the art capabilities and increase efficiency at the Warsaw facility.” She declined to comment further.

The planned spending spree is only one of several changes for the international company.

DePuy is also breaking in a new president, Andrew Ekdahl, who took office in June. His predecessor, David Floyd, resigned in February amid lawsuits alleging the company sold defective hip replacement implants.

Ekdahl’s career with the company spans more than 20 years with responsibility for operations on multiple continents.

Biomet Inc., Zimmer Holdings Inc. and DePuy lead the orthopedics industry cluster in Kosciusko County. Health care products maker Johnson Johnson is DePuy’s parent company.

The orthopedics industry combined to produce a $3.7 billion impact on Kosciusko’s economy in 2009, according to study results released in April by OrthoWorx. The Warsaw-based non-profit supports the orthopedics industry.

The study by the Business Research Center shows that in 2009, Kosciusko County’s orthopedic industry cluster provided 13,000 jobs, generated $2.4 billion in direct output and paid $114 million in state and local government tax revenue.

The average annual wage for the county’s medical device workers was more than $70,000, which is more than $11,000 greater than the state average and $12,000 above the national average.

George Robertson, president of the Kosciusko Economic Development Corp., said economic development professionals especially like to see two types of business spending: equipment and RD.

When companies invest in equipment, they are continuing to remain state-of-the-art, he said. When they invest in research and development, the company is creating new and better products, he said.

“There was never a question” whether Warsaw officials would approve the abatement request, said Robertson, who didn’t work with DePuy on this project. “Those are great investments by a great company.”

sslater@jg.net

Xencor Initiates Phase 1 Study Of XmAb®5871 Therapeutic Antibody For The Treatment Of Autoimmune Diseases

Main Category: Arthritis / Rheumatology
Also Included In: Immune System / Vaccines;  Clinical Trials / Drug Trials
Article Date: 28 Oct 2011 – 1:00 PDT

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Xencor, Inc., a company using its proprietary Protein Design Automation® (PDA) platform technology to engineer next-generation antibodies, announced today the initiation of a Phase 1 clinical trial of XmAb®5871, the company’s therapeutic antibody for the treatment of autoimmune diseases. XmAb5871 uses a novel dual-targeted approach to potently suppress autoimmune disorders that may avoid some of the side effects seen with other therapeutic antibodies that modulate immune response. The advancement of XmAb5871 into clinical stage testing demonstrates the broad potential of Xencor’s antibody engineering technology in immune and inflammatory diseases in addition to oncology.

Earlier this year, Amgen and Xencor entered into an option agreement to develop XmAb5871. Under the terms of the agreement, Amgen has the option to an exclusive worldwide license following the completion of a pre-defined Phase 2 study. Xencor will lead all clinical development until that time.

“XmAb5871 is Xencor’s first therapeutic antibody for immune disorders, and is the fifth XmAb product to enter clinical testing,” said Bassil Dahiyat, Ph.D., president and CEO of Xencor. “Xencor’s robust product pipeline in oncology, and now autoimmune disease, is evidence of the broad applicability of our XmAb technology across multiple therapeutic areas.”

XmAb5871 is a humanized monoclonal antibody that uses a uniquely selective dual-targeting mechanism for B cell inhibition by targeting the antigen CD19 and co-engaging CD32b (FcγRIIb), thereby suppressing autoimmune response. Preclinical studies published in the Journal of Immunology showed that XmAb5871 potently suppresses autoimmune response in humanized mouse models of systemic lupus erythematosus (SLE), without the depletion of B cells. This suggests that XmAb5871 may be an effective immunosuppressant in multiple indications, including SLE and rheumatoid arthritis, without the serious safety issues associated with B cell depletion seen with other antibody therapeutics targeting autoimmune disorders.

The endpoints of the Phase 1 study are safety, pharmacokinetics and a number of biomarkers of immunomodulatory drug activity.

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Study Indicates Nanoparticles Could Help Pain-Relieving Osteoarthritis Drugs Last Longer

Main Category: Arthritis / Rheumatology
Also Included In: Pain / Anesthetics
Article Date: 28 Oct 2011 – 1:00 PDT

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A novel study demonstrates that using nanoparticles to deliver osteoarthritis drugs to the knee joint could help increase the retention of the drug in the knee cavity, and therefore reduce the frequency of injections patients must receive. This research was presented Oct. 23 – 27 at the 2011 American Association of Pharmaceutical Scientists (AAPS) Annual Meeting and Exposition in Washington, D.C.

Osteoarthritis affects 30 million Americans and is the most common joint disorder. It is projected to affect more than 20 percent of the U.S. population by 2025. Aging, obesity and joint injury can lead to osteoarthritis, which is characterized by progressive erosion of articular cartilage (cartilage that covers the bones). The disease can occur in all joints, most often the knees, hips, hands and spine, and currently there are no pharmacological treatments that halt the disease progression. For large joints, a drug could be injected into the joint to help limit potential side effects, like pain. A significant challenge in treating osteoarthritis this way is the short duration the medicine stays in the affected joint after injection.

Lead researcher Michael Morgen, Ph.D., and his colleagues from Bend Research and Pfizer propose to address this challenge with injectable nanoparticles that help retain osteoarthritis drugs in the knee joint. Test results show that 70 percent of the drug nanoparticles remain in the knee cavity after one week. In contrast, for most current formulations, the drug disperses within one to two days.

In this new process, positively charged nanoparticles carrying a drug attach to the negatively charged, naturally occurring molecules in the knee to form a gel. This gel acts as a depot that slows drug escape from the knee cavity.

“Current delivery methods do not maintain the drug in the knee for very long, which limits the effectiveness of therapeutic agents,” said Dr. Morgen. “We hope that this type of sustained release technology, when used with current or new osteoarthritis drugs, will allow patients to be effectively treated with drug injections every three months instead of once a week.”

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NIH Study Shows Benefits, Limits Of Therapy For Rare Inflammatory Syndrome

Main Category: Arthritis / Rheumatology
Also Included In: Immune System / Vaccines
Article Date: 28 Oct 2011 – 1:00 PDT

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A study shows that the medication etanercept reduces the frequency and severity of symptoms of TNF receptor-associated periodic syndrome (TRAPS), a rare inherited condition characterized by recurrent fevers, abdominal pain and skin rashes. The study, published in Arthritis Rheumatism, also points out the need for the development of additional therapies to more thoroughly ease symptoms and prevent long-term complications of the disease. The study was released by researchers at the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the National Institutes of Health.

TRAPS is associated with mutations in the gene coding for tumor necrosis factor receptor 1 (TNFR1), a critical molecule in receiving inflammatory signals in the body’s immune system. Etanercept, trade name Enbrel is one of a class of drugs that block tumor necrosis factor, a protein implicated in the harmful inflammation in TRAPS, as well as a number of common rheumatic diseases, including rheumatoid arthritis. While the drug has been used in the treatment of TRAPS for about 10 years, this is the first formal study to look at its effectiveness long-term, said Richard Siegel, M.D., Ph.D., NIAMS acting clinical director and one of the senior authors.

The study was conceived in 2001 by Keith Hull, M.D., Ph.D., then a rheumatology fellow in the NIAMS under the supervision of Daniel Kastner, M.D, Ph.D., one of the discoverers of the TNF receptor mutations in TRAPS, and now the scientific director of the NIH’s National Human Genome Research Institute. The initial study enrolled 15 patients with TRAPS. Each patient kept a daily diary of attacks, symptom severity, and use of additional medicines, and had periodic blood tests to measure acute phase reactants, proteins that are produced by the liver to fight infection and serve as markers of inflammation in the blood.

While on treatment with etanercept, patients reported lower symptom scores and a greater number of symptom-free days each week.

“Patients generally reported that their attacks still happened, but they were less severe and don’t last as long,” said Dr. Siegel. “They were still having discomfort, but in between attacks, they could be relatively symptom-free.”

Etanercept also reduced levels of acute phase reactants, particularly during asymptomatic periods.

To find out whether etanercept was effective as a long-term treatment, NIAMS’ Ariel Bulua, Ph.D., a medical student in the NIH’s Clinical Research Training Program, contacted all 15 patients treated with etanercept seven to nine years after the conclusion of the initial study period. Dr. Bulua arranged for them to revisit the NIH Clinical Center and be evaluated, if they had not continued to be followed regularly.

Despite the overall beneficial effects of etanercept, most patients discontinued the drug during the follow-up period due to a perceived lack of efficacy or painful injection site reactions, which could be related to the skin manifestations of the disease. The three patients who remained on the drug, however, continued to report benefits, suggesting that for some, the drug can be an effective long-term treatment option.

However, the study did not show whether etanercept could prevent the long-term consequences of TRAPS, chiefly a condition called amyloidosis, in which inflammatory proteins build up in the body, damaging the kidneys, heart and other organs, said Dr. Siegel.

“We are concerned that it may not prevent amyloidosis because we have not completely suppressed inflammatory markers the way we would want to,” Dr. Siegel said. “Etanercept studied in this group of TRAPS patients in an organized way works, but not as well as we would like for it to. Patients are still having some residual symptoms, attacks of fevers and rashes. We are still looking for other pathways to target in this disease.”

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Policymakers Should Prepare For Major Uncertainties With Medicaid Expansion

Main Category: Medicare / Medicaid / SCHIP
Article Date: 28 Oct 2011 – 1:00 PDT

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The number of low-income, uninsured Americans enrolling in Medicaid under the expanded coverage made possible by the Affordable Care Act (ACA) of 2010 could vary considerably from the levels currently projected by the Congressional Budget Office (CBO) and the Centers for Medicare and Medicaid Services (CMS), according to a new study by Harvard School of Public Health (HSPH) researchers. They report that it’s probably more realistic to say somewhere between 8 million and 22 million may enroll in Medicaid by 2014 instead of the 16 million predicted by the CBO.

Medicaid, which is jointly funded by the federal and state governments, covers the health care costs of eligible low-income individuals and families. The Affordable Care Act of 2010 expands Medicaid to cover additional low-income adults in all states by 2014.

“The lower estimate of Medicaid enrollees suggests that the ACA will not be as successful as envisioned in insuring low-income Americans; the high-end estimate implies that the federal cost of expanding Medicaid eligibility will be a good deal higher than expected and accounted for,” said Arnold Epstein, John H. Foster Professor of Health Policy and Management and chair, Department of Health Policy and Management at HSPH and the study’s senior author.

The study was published online October 26, 2011, and will appear in the November print edition of Health Affairs.

The HSPH researchers, including lead author Benjamin Sommers, assistant professor of health policy and economics, and Katherine Swartz, professor of health economics and policy, created a simulation model to determine the range of reasonable projections, estimating eligibility, participation, and population growth using prior research and other data.

The researchers’ model predicts that the number of people enrolling in Medicaid under health reform may vary by more than 10 million, with a “best-guess” estimate of 13.4 million, and a possible range of 8.5 million to 22.4 million. Their model estimates that annual federal spending for new Medicaid enrollees will range from $34 billion to $98 billion in 2019, and that 4,500 to 12,100 new physicians will be needed to care for new enrollees.

Prior research shows that a decreasing number of doctors are willing to treat new Medicaid patients, due to low reimbursement rates. This suggests that policymakers will need to take additional steps to ensure that there are enough providers to care for new Medicaid enrollees.

Last year, Medicaid covered nearly 69 million Americans, at an annual cost of over $400 billion. This means that even with the highest-cost estimate of $98 billion, Sommers and colleagues project that the Medicaid expansion under the ACA will represent less than one-quarter of total spending in the program.

“In the end, Medicaid enrollment will be determined largely by the extent to which federal and state efforts encourage or discourage eligible people from enrolling,” Swartz said. “The budget scoring rules require CBO to produce one cost number but that number is an estimate. Policymakers are better served if they have the range of cost estimates so possible higher costs are anticipated.”

Support for the study was provided in part by the Agency for Healthcare Research and Quality.

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“Policy Makers Should Prepare for Major Uncertainties in Medicaid Enrollment, Costs, and Needs for Physicians Under Health Reform,” Benjamin Sommers, Katherine Swartz, and Arnold Epstein, Health Affairs, November, 2011.

Harvard School of Public Health

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How to Find a Reliable Dealer to Sell Your Lab Equipment

sell lab equipment

sell lab equipment

If you are looking to sell lab equipment, it is important that you find a reliable dealer to buy it. Lab equipment is quite expensive, especially that used for advanced applications such as blood gas and electrolyte analysis, chemistry, immunology, hematology, microbiology, and so on. So to benefit from a good price, you have to sell the devices to a reliable dealer.

Finding a Reliable Supplier – Steps Involved

There are many different ways that can help you locate a medical equipment dealer. The proper use of the available resources can easily help you locate a laboratory equipment dealer that you can trust. Going by the following steps can help:

  • Browse the web – Browsing the Internet is one of the easiest and most convenient ways to locate dealers. Just entering the right terms or keywords on search engines can yield very specific results. Looking through the listings of lab product dealers in web directories and the yellow pages is a very dependable way of finding the right dealer for your lab equipment.
  • Shortlist suppliers – The next step involved in choosing a dealer is to shortlist dealers you think can offer you a good price for your product.
  • Type of equipment: See if your dealer will buy a device whether it is working or not if you are trying to sell equipment that is not in proper working order.
  • Compare quotes and conditions: Check out the quotes and conditions that different buyers offer, including shipping costs and whether they are included in the price.
  • Choose your dealer – From the short-listed category, choose the dealer that can offer you the best deal. A CCR (Central Contractor Registration -certified vendor of laboratory devices is a good choice. Such dealers specialize in buying used lab gadgets from universities and government institutions, and recertifying them for sale.

Sell to a Dealer Specializing in Refurbishing Lab Devices

A dealer that specializes in selling refurbished lab devices is a good choice. Such dealers buy used equipment and put them through a revamping process before offering it for sale to needy laboratories. The vendors have certified personnel look through the used device, repair it and replace parts so that it works as good as new. Original manufacturer specifications are taken into account. They offer the product for sale with limited parts warranty at a reasonable price. So selling your lab equipment to these reliable dealers is an ideal option and can fetch you a good price.

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Osteoarthritis Of The Knee Burden Higher In African-Americans While Hand OA Lower Than Caucasians

Main Category: Arthritis / Rheumatology
Article Date: 24 Oct 2011 – 0:00 PDT

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New research suggests African Americans have a higher burden of multiple, large-joint osteoarthritis (OA), and may not be recognized based on the current definition of “generalized OA.” African Americans were also more likely to have knee OA, but less likely to be affected by hand OA than Caucasians according to the findings reported in Arthritis Rheumatism, a peer-reviewed journal of the American College of Rheumatology (ACR).

OA is the most common type of arthritis and typically affects multiple joints. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) estimates that more than 27 million adults, 25 years of age and older, are burdened by OA. With the percentage of those affected by OA increasing as the population ages, NIAMS projects that 67 million individuals will have doctor-diagnosed arthritis by 2030. While previous studies have investigated radiographic or symptomatic OA patterns using combinations of joint sites, research of multi-joint involvement has mainly been limited to Caucasian women.

For the current study, part of the Johnston County Osteoarthritis Project, Dr. Amanda Nelson from the University of North Carolina at Chapel Hill-UNC Rheumatology/Thurston Arthritis Research Center and colleagues, analyzed radiographic data for the hands, knee (tibofemoral [TFJ] and patellofemoral joints), hips and spine (lumbosacral) in African American and Caucasian men and women who were 45 years of age and older. The team identified 16 mutually exclusive hand OA phenotypes in 2083 participants and 32 whole-body phenotypes in 1419 individuals. Information on age, gender, race and body mass index (BMI) was also collected through questionnaires and clinical examination.

After adjusting for age, gender and BMI, analysis showed that African Americans had significantly less frequent OA in finger tip joints (distal interphalangeal), alone and with other hand joint sites compared to Caucasians. African Americans compared with Caucasians were twice as likely to have knee (TFJ) OA and had 77% greater odds of knee and spine OA together. Frequencies of OA in hand joint sites other than distal interphalangeal joints were comparable between both races.

Study participants had a mean age of more than 65 years, with a mean BMI categorizing them as obese. One third of participants were male and two thirds were Caucasian. Overall 42% of the study subjects had knee OA, 36% had hip OA and 32% OA of the hand. Spine OA was most common, occurring in 62% of participants. “Racial differences in OA phenotypes were more significant than gender disparity,” concluded Dr. Nelson. “Our findings suggest a substantial health burden of large-joint OA, particularly hip and spine, among African Americans and further studies that address this concern are warranted.”

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