NEW Comed KMC-950 C-Arm is a Surprise Success (http://www.integritymed.com)

The new Comed KMC-950 took us by surprise.  We did not expect to see a Korean C-Arm that could go “toe-to-toe” with GE/OEC for quality, ease of use and features.  Think Samsung and Hyundai.

This is a COMED KMC-950 delivered in October 2011 to a surgery center client here in Florida.

And now the best part:?  The Comed KMC-950 is virtually half the price of a new GE/OEC C-Arm.

And it comes with a Two (2) Year Warranty.  That’s hard to beat.

Image quality is excellent, as the system uses a Varian rotating anode x-ray tube, and Toshiba image intensifier.  This is the same imaging chain as systems that sell for twice the price.

The COMED KMC-950 is universally loved at this surgery center in Florida. It is currently performing over 50 procedures a week, and is being used by 5 different doctors and 3 different C-Arm techs.

All of this is really good news for Pain Management, Orthopedics, and Sports Medicine.

Other standard built-in features include DICOM, USB, and CD Burning.

Unlike the GE/OEC and Philips model C-Arms, the COMED does NOT use batteries.  That means your C-Arm doesn’t have to be kept plugged-in, and you can forget about the $1500-2000 you now spend on replacing batteries every two years.

The system also features the market’s largest free-space of 32 Inches, and a 45-Degree Overscan– which is excellent for discograms, etc. etc.

And after the 2-Year Warranty is up?  Expect to pay 30-50% less for a service contract.  The systems have a simplified, modular design that makes them easier to service.

For brochures, quotes, trade-in values on your old C-Arm, and a current client reference list, please call 800-722-3646.

David

In Hospitals With Pay-For-Performance Programs, No Improvement In Patient Outcomes Seen

Main Category: Public Health
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 30 Mar 2012 – 0:00 PDT

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Paying hospitals to improve their quality of care, known as pay-for-performance, has gained wide acceptance in the U.S. and Medicare has spent tens of millions of dollars on bonuses and rewards for hospitals to improve. However, little is known about whether pay-for-performance actually improves patient outcomes over the long term. A new study from Harvard School of Public Health (HSPH) finds no evidence that the largest hospital-based P4P program in the U.S. improved 30-day mortality rates, a measure of whether patients survive their hospitalization.

Given that the Affordable Care Act calls for the Centers for Medicare and Medicaid Services (CMS) to expand pay-for-performance to nearly all hospitals in 2012, the findings call into question whether this payment approach will have a beneficial effect on patient care.

The study appears online March 28, 2012 in the New England Journal of Medicine.

“These results suggest that the way we have currently conceived of pay-for-performance is unlikely to have any meaningful impact on patient outcomes,” said Ashish Jha, associate professor of health policy and management at HSPH and lead author of the study.

The researchers, including senior author Arnold Epstein, professor and chair of the Department of Health Policy and Management at HSPH, analyzed data provided by 252 hospitals participating in Medicare’s Premier Hospital Quality Incentive Demonstration program. They examined 30-day mortality rates for more than 6 million patients with acute myocardial infarction, congestive heart failure, pneumonia, or coronary artery bypass graft surgery between 2004 and 2009. Non-Premier hospitals – those not part of Medicare’s pay-for-performance program – were used as a control group.

The results showed that there was no impact on patient outcomes for hospitals in the Premier pay-for-performance program compared with non-Premier hospitals. In addition, no difference was found in outcomes even for conditions in which mortality rates were explicitly incentivized – acute myocardial infarction and coronary bypass graft surgery. Even among poor-performing hospitals, which have the most to gain by improving quality of care, improvements were comparable to poor-performing non-Premier hospitals.

“Our findings suggest that both the size of the incentives and the targets matter. In the Premier demonstration, the incentives were small and patient outcomes were not the major focus. It is not surprising, in retrospect, that this program failed to improve patient care,” said Epstein.

“We need to better align financial incentives with delivery of high quality care,” said Jha. “This study suggests that in order to improve patient care, we are going to have to work a lot harder to identify and implement an incentive program that works.”

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KNX 1070: Criminal Trial Of Dr. Ehab Mohamed To Begin

LOS ANGELES (KNX 1070) — The trial of a former Beverly Hills plastic surgeon accused of trying to sell medical equipment he did not own is scheduled to begin next week.

Jury selection in the case of Dr. Ehab Mohamed is slated to begin next week.

The doctor, whose medical license has been suspended, has pleaded not guilty in the case and has not accepted a plea deal offered by prosecutors.

According to an investigation by KNX 1070, Dr. Mohamed has allegedly been in the country illegally since 2006 when his work visa was revoked by the State Department. He is an Egyptian national.

The doctor is also being investigated in connection with the death of a patient who underwent an all day liposuction procedure in his office.

RELATED POSTS:
» KNX 1070 Report: Medical Board Was Warned About Dr. Ehab Mohamed Years Before Patient Death
» Update: KNX 1070′s Investigative Reporter Continues His Probe Of Dr. Ehab Mohamed
» KNX Exclusive: Former Plastic Surgeon Living In The U.S. Illegally
» KNX Exclusive: Former Beverly Hills Cosmetic Surgeon Arrested In Sting

Glucocorticoid-Induced Osteoporosis: Management Strategies To Prevent Bone Loss And Related Fractures In High-Risk Patients

Main Category: Bones / Orthopedics
Also Included In: Arthritis / Rheumatology;  Crohn’s / IBD
Article Date: 29 Mar 2012 – 0:00 PDT

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Oral glucocorticoids are commonly prescribed for a wide variety of disorders, most commonly for rheumatoid arthritis, obstructive pulmonary disease and inflammatory bowel diseases. However, the use of these medications can result in rapid bone loss during the first three to six months of therapy, leading to increased risk of fragility fractures.

Although awareness of glucocorticoid-induced osteoporosis (GIO) has grown in recent years, it still remains vastly under-diagnosed and under-treated. As a result, and despite the availability of effective treatment options to reduce the risk of fractures, millions of patients around the world are left at risk of potentially serious fractures.

In an effort to address this serious problem, the International Osteoporosis Foundation (IOF) and the European Calcified Tissue Society (ECTS) have published a guidance document* which provides a framework for the development of national assessment and treatment guidelines.

Professor Juliet Compston, chair of the IOF-ECTS Glucocorticoid-induced Osteoporosis Guidelines Working Group and lead author of the paper, warned, “Clinicians need to be aware that bone loss occurs rapidly in the first three to six months after glucocorticoid therapy is initiated. To prevent fragility fractures in their patients, doctors must make primary prevention a priority in high-risk individuals.”

General measures in the management of patients treated with glucocorticoids may include minimisation of the dose of glucocorticoids, use of alternative formulations or routes of administration, or use of other immunosuppressive agents. Adequate levels of dietary calcium and vitamin D, appropriate physical activity, and avoidance of tobacco use and alcohol abuse should be advised. Monitoring of glucocorticoid-treated patients should include measurement of BMD at appropriate intervals, annual height measurements, vertebral fracture assessment if indicated and, in patients receiving bone protective therapy, assessment of compliance with therapy.

Professor Bente Langdahl, president of the European Calcified Tissue Society, stated, “In a multinational study of more than 60,000 postmenopausal women, as many as 4.6% were reported as currently taking oral glucocorticoids. This indicates that glucocorticoid-induced osteoporosis may affect a significant proportion of the older population. National health authorities, medical organizations and primary healthcare givers must work together to establish and implement guidelines for the proper assessment and care of bone health in these patients.”

The paper, authored by 26 experts from 17 countries, has been published in the journal Osteoporosis International. It provides a short overview of the epidemiology and pathophysiology of GIO, and outlines clinical investigation and treatment strategies, including how to adjust FRAX probabilities to account for dosage and other relevant risks. As well, it discusses intervention thresholds using different clinical scenarios. Information about cost effectiveness and safety of treatments for osteoporosis, monitoring strategies, and management of GIO in younger men and pre-menopausal women is also provided.

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*A framework for the development of guidelines for the management of glucocorticoid-induced osteoporosis. S. Lekawasam, J. D. Adachi, D. Agnusdei, J. Bilezikian, S. Boonen, F. Borgström, C. Cooper, A. Diez Perez, R. Eastell, L. C. Hofbauer, J. A. Kanis, B. L. Langdahl, O. Lesnyak, R. Lorenc, E. McCloskey, O. D. Messina, N. Napoli, B. Obermayer-Pietsch, S. H. Ralston, P. N. Sambrook, S. Silverman, M. Sosa, J. Stepan, G. Suppan, D. A. Wahl, J. E. Compston*; for the Joint IOF-ECTS GIO Guidelines Working Group. Osteoporos Int DOI 10.1007/s00198-012-1958-1

The paper can be freely downloaded until June 26, 2012 at
http://www.springerlink.com/content/w8l5p62h18602122/fulltext.pdf

An Appendix to the above paper is published in Archives of Osteoporosis DOI 10.1007/s11657-012-0070-7
International Osteoporosis Foundation

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Rheumatoid Arthritis Patients At Increased Mortality Risk If They Stop Their Statin Therapy

Main Category: Arthritis / Rheumatology
Also Included In: Statins;  Heart Disease
Article Date: 29 Mar 2012 – 1:00 PDT

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Patients with rheumatoid arthritis (RA) who discontinue use of statin therapy are at increased risk of death from cardiovascular disease and other causes. According to the findings of a population-based study now available in Arthritis Care Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology (ACR), RA patients should be advised of the importance of compliance to their statin therapy to reduce cardiovascular disease (CVD) mortality risk.

A report from the World Health Organization (WHO) estimates that RA affects up to one percent of the population in developed countries. Studies have shown that death rates among those with RA are 1.5-fold higher than in the general population, with CVD cited at the leading cause of mortality in this patient group. Statins – drugs such as atorvastatin (Lipitor) and rosuvastatin (Crestor) that are used to lower cholesterol and manage heart disease – are a common therapy for RA patients who are at greater risk of heart disease. Previous research reported 38% of RA patients permanently discontinue statin therapy, consequently increasing their heart attack risk by 67%.

“Our study provides evidence of the harmful effects of ceasing statin therapy,” said lead author Mary De Vera, Ph.D., with the University of British Columbia School of Population Public Health and Arthritis Research Centre of Canada. Using data from the British Columbia Ministry of Health records, researchers indentified 37,151 RA patients who received health services between January 1996 and March 2006. Of those with RA there were 4,102 patients who used statins. The team defined statin discontinuation as non-use of the prescribed medication for three months or more, anytime during the course of therapy.

The mean age of the RA group was 67 years, with 60% of the group being women. More than 16,144 person-years of follow-up were recorded for patients using statins, with roughly 45% of statin users discontinuing therapy at least once during the 4-year follow-up period. The authors reported 198 deaths from CVD and 467 deaths overall. Of the CVD deaths, 31% were from heart attacks and 15% from strokes.

Further analysis revealed that statin discontinuation was associated with a 60% increased risk of CVD deaths and 79% for deaths from all causes, which was not moderated by timing of the first statin prescription, age, or gender. “RA patients who discontinue statin therapy are at increased risk of death from cardiovascular disease,” concludes Dr. De Vera. “Our study findings emphasize the importance of medication compliance in RA patients who are prescribed statins.”

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November 1997

My name is Maria Elena Morgan. I am a professional writer/editor. I have many hobbies–knitting, crocheting, cooking, paranormal events, artist, singing, and of course, writing novels. I am widow with 3 genius children. Since 1988, I have been offworld many times, the most recent of which was this year. I have a hybrid teenage girl child by a Grey. My best alien friend is Red, a Reptilian, who is also a scientist. I have included a brief bio of Red in the sidebar.

Medicare/Medicaid Rule Increases Costs Without Improving Patient Outcomes For Defibrillator Implants

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Cardiovascular / Cardiology;  Medical Devices / Diagnostics
Article Date: 28 Mar 2012 – 0:00 PDT

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The cost to place an implantable cardioverter-defibrillator (ICD) increased by $844 per case after a new requirement from the Centers for Medicare and Medicaid Services (CMS) went into effect in February 2010, according to research presented at the American College of Cardiology’s 61st Annual Scientific Session. The Scientific Session, the premier cardiovascular medical meeting, brings cardiovascular professionals together to further advances in the field.

That cost, if applied to the approximately 150,000 ICDs implanted in the United States each year, translates to $126 million in additional medical costs. The cost increase results from a new CMS requirement mandating that practitioners providing deep sedation be independent from the practitioner performing an invasive procedure. Previously, nurses administered limited deep sedation under the careful scrutiny of the implanting physician during ICD procedures; now, the implants require an additional physician such as an anesthesiologist.

“There was little evidence to support the policy change with regard to patient safety or outcomes,” said Osama Abdel-Hafez, MD, an internal medicine resident at the Indiana University School of Medicine and the study’s lead author. “A policy that increases costs significantly without improvement in patient outcomes should be further reviewed.”

ICDs are small, battery-powered devices implanted in the chests of people at risk for sudden cardiac arrest. If the device detects a dangerous change in heart rhythm, it issues an electrical shock or other therapy to restore a normal heartbeat.

Patients remain conscious through most of an ICD implantation procedure, except for a brief period when doctors test the device by shocking the patient, which can be painful and requires deeper sedation.

“Deep sedation is not without complications,” Dr. Abdel-Hafez said. “However, there should be better selection of cases that need an anesthesiologist’s services. The CMS requirement was a blanket policy that covered all patients.”

A study from the same research team showed ICD implantation procedures that last longer in duration or that involve specific types of devices, such as biventricular ICDs, have a higher rate of sedation-related complications. Dr. Abdel-Hafez said having an anesthesiologist perform the sedation in such cases would make sense. Differentiating between higher- and lower-risk procedures could help improve patient outcomes without imposing unnecessary cost burdens, he added.

The researchers reviewed 431 ICD implants performed at Indiana University Health – Methodist Hospital. Just over half (243) were performed before the February 2010 policy change; 188 were performed after. After the policy change, patients spent an extra day in the hospital (on average, four days instead of three) and incurred an additional $844 in medical charges per case for a total of $158,000 in additional costs overall.

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The study was self-funded by the Indiana University School of Medicine.

Dr. Abdel-Hafez presented the study “Increased Cost for Implantable Cardioverter Defibrillator Implants Due to Medicare and Medicaid Services Sedation Policy”

American College of Cardiology

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Gene That Encodes Crucial Pain Receptor May Be Key To Individualizing Therapy For Major Health Problem

Main Category: Pain / Anesthetics
Also Included In: Breast Cancer;  Arthritis / Rheumatology;  Genetics
Article Date: 28 Mar 2012 – 1:00 PDT

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Nearly one in five people suffers from the insidious and often devastating problem of chronic pain.

That the problem persists, and is growing, is striking given the many breakthroughs in understanding the basic biology of pain over the past two decades. A major challenge for treating chronic pain is to understand why certain people develop pain while others, with apparently similar disorders or injuries, do not. An equally important challenge is to develop individualized therapies that will be effective in specific patient populations.

Research published online in Nature Medicine points to solutions to both challenges. A research team led by Prof. Jeffrey Mogil of McGill University in Montreal and Prof. Michael Salter of The Hospital for Sick Children (SickKids), affiliated with the University of Toronto, has identified a major gene affecting chronic pain sensitivity. The findings also suggest a new approach to individualizing treatment of chronic pain.

The gene that the researchers identified encodes the pain receptor known as P2X7. Specifically, the scientists discovered that a single amino-acid change in P2X7 controls sensitivity to the two main causes of chronic pain: inflammation and nerve damage.

The amino-acid change is known to affect only one function of P2X7 receptors – the forming of pores that permit large molecules to pass through – while leaving intact the other function, of allowing much tinier ions to flow through. Using a peptide that targets pore formation only, the researchers found that pain behaviours were dramatically reduced.

The scientists then examined genetic differences among human patients suffering from two distinct types of persistent pain: chronic post-mastectomy pain and osteoarthritis. In both cases, they found that individuals with genetically inherited low pore formation in P2X7 receptors experienced lower pain levels.

“Our findings indicate that it may be possible to develop drugs that block pores in this crucial receptor, while leaving its other function intact – thereby killing pain while minimizing side effects,” said Prof. Mogil, E.P. Taylor Professor of Pain Research in McGill’s Department of Psychology.

Prof. Salter, Anne and Max Tanenbaum Chair in Molecular Medicine at SickKids, said these discoveries “point toward a new strategy for individualizing the treatment of chronic pain.” Scientists from the U.S. and Israel also contributed to the study.

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Durable Home Medical Equipment Relieves Stress

Today many of us are balancing the job, caring for the kids, caring for ourselves, caring for our elderly parents, plus many other responsibilities. The days, weeks, and months seem to fill with immeasurable stress that leave us drained and sometimes in failing health. When it comes to our bodies or those that we care for, we need to take advantage of the most durable and high-quality medical equipment out there. When we get the best we know that ourselves or our loved ones will not be hurt using that medical equipment nor will they be prolonged in their recovery from injury.

Power Chairs

 

What many people may not know is that much of the best medical equipment out there can be obtained at little or no cost. Medicare, Medicaid, and health insurance will often cover the entire expense. So why not take advantage of the durable medical equipment out there that will help aid our loved ones in having the quickest recovery from injury or the best care for long-term assistance?

If you have an elderly parent that is prone to falling or cannot get around the house on their own, order a power chair from http://harveydurhamhealth.com/PowerMobilityDevices.html. They have great staff that are experts at finding just what your loved ones need. They will fill out the Medicare or insurance paperwork for you and have it delivered to your door for free. How stress-relieving is that? Or you may have had an injury at work or from the gym; you can get “at home therapy” items like hot and cold pads, http://harveydurhamhealth.com/AtHomeTherapy.html , or you can get an orthotic brace to help support that injured body part, http://harveydurhamhealth.com/OrthoticBraces.html. Maybe you or a loved one need a manual wheelchair, walker, or rollator, http://harveydurhamhealth.com/MobilityAssistanceDevices.html.

Do you or a loved one have diabetes? Harvey Durham Health also provides a wide range of diabetic supplies, http://harveydurhamhealth.com/DiabeticSupplies.html. They have testers, test strips, and diabetic shoes.

Why not take advantage of the durable medical equipment at little or not cost to you and alleviate the stress in your life?

About Harvey Durham Health:

We are a home medical supply company. If you or a loved one is experiencing limited freedom and mobility, Harvey Durham Health is here to help. Whether you are looking for mobility products, diabetic supplies, hospital beds, orthotics, back braces, heat pumps, or aids to everyday living, our professional staff can help provide you with the medical equipment you need to ensure your independence.

Call 1-866-632-9823
http://www.HarveyDurhamHealth.com
http://www.My-PowerChair.com

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Novel Methods Employed To Uncover Gene Mutations For Common Diseases

Main Category: Arthritis / Rheumatology
Also Included In: Genetics;  Heart Disease
Article Date: 27 Mar 2012 – 0:00 PDT

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Human geneticists have long debated whether the genetic risk of the most common medical conditions derive from many rare mutations, each conferring a high degree of risk in different people, or common differences throughout the genome that modestly influence risk.

A new study by Brigham and Women’s Hospital (BWH) researchers has harnessed data and new analysis tools to address this question in four common diseases: rheumatoid arthritis; celiac disease; coronary artery disease and myocardial infarction (heart attack); and type 2 diabetes.

The study is electronically published in Nature Genetics.

The researchers developed a new statistical method built upon “polygenic risk score analysis” to estimate the heritable component of these diseases that is explained by common differences throughout the genome.

Their method takes advantage of data from previously published genome-wide association studies, or GWAS, an approach used to scan DNA samples for common genetic markers seen throughout the population – called SNPs (single nucleotide polymorphisms).

According to senior author Robert Plenge, MD, PhD, BWH director of Genetics and Genomics in the Division of Rheumatology, Immunology and Allergy, “We used GWAS data and a Bayesian statistical framework to demonstrate that a substantial amount of risk to these four common diseases is due to hundreds of loci that harbor common causal variants with small effect, as well as a smaller number of loci that harbor rare causal variants.”

Using data on rheumatoid arthritis, they estimated that variation in hundreds of locations throughout the genome might explain 20 percent of rheumatoid arthritis risk, after excluding all of the known rheumatoid arthritis genetic risk factors.

They used computer simulations to demonstrate that the underlying genetic risk in rheumatoid arthritis is largely explained by many common alleles rather than rare mutations.

They observed similar results for celiac disease (43 percent), myocardial infarction (48 percent) and type 2 diabetes (49 percent).

“What is remarkable is that our statistical model was broadly applicable to several common diseases, not just rheumatoid arthritis,” said Plenge, who is also an assistant professor at Harvard Medical School and an associate member of the Broad Institute of MIT and Harvard. “Our study provides a clear strategy for discovering additional risk alleles for these and likely many other common diseases.”

According to the researchers, these methods can be applied to other genome-wide datasets (e.g., GWAS or whole genome sequencing) to estimate the degree to which there is a genetic component.

One exciting possibility is assessing the genetic basis of individual response to drugs.

“Our method may be particularly useful for diseases and related traits that cannot be easily studied in families,” said Eli Stahl, PhD, lead study author, BWH research associate and member of the National Institutes of Health-funded Pharmacogenomic Research Network (PGRN). “For traits such as treatment efficacy or toxicity, we often assume there is a genetic basis to the clinical variability observed among patients. Now, we have the statistical tools to quantify the extent to which this is the case directly.”

“Our study reinforces a common thread in the literature, that many subtle differences throughout the genome explain much of the differences in risk for individuals for all kinds of diseases – this has powerful implications for the genetic architecture of disease, for risk prediction and prognosis, as well as for basic biology and developing new drug targets,” said co-senior author Soumya Raychaudhuri, MD, PhD, BWH Division of Immunology, Allergy and Rheumatology, assistant professor of medicine at Harvard Medical School.

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