Leeds heart surgery data 'wrong'

30 March 2013 Last updated at 08:48 ET

Leeds General InfirmaryClinicians say the ‘wrong’ data was used by NHS managers

Children’s heart surgery was wrongly suspended at Leeds General Infirmary because of “incomplete” information, a senior doctor has said.

The unit was shut after the NHS medical director said data showed mortality figures were higher than expected.

But cardiologist Elspeth Brown said the data did not include all the operations, and that staff were confident in their clinical work.

NHS managers say various factors contributed to the suspension.

NHS medical director Sir Bruce Keogh said data suggested a death rate twice the national average.

Ms Brown told the BBC that, since the announcement, she and colleagues had been examining the data that was used to make the decision.

“We do now know that the figures that were presented… were simply wrong, they were incomplete, did not include all the operations in Leeds, and that they had then been subject to some statistical analysis which generated this headline figure.

“We’ve been looking very hard at the figures over the last three years and we are confident that our mortality figures are well within what would be expected. All the clinicians in Leeds are very happy with our figures at present.”

The hospital is at the centre of a long-running dispute over the future of children’s heart services, and an NHS review said surgery would be better focused at fewer, larger sites.

However, the High Court ruled just last week that the Leeds unit should be kept open – a move that was superseded a day later by Sir Bruce suspending surgery.

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Leeds heart surgery data ‘wrong’

30 March 2013 Last updated at 08:48 ET

Leeds General InfirmaryClinicians say the ‘wrong’ data was used by NHS managers

Children’s heart surgery was wrongly suspended at Leeds General Infirmary because of “incomplete” information, a senior doctor has said.

The unit was shut after the NHS medical director said data showed mortality figures were higher than expected.

But cardiologist Elspeth Brown said the data did not include all the operations, and that staff were confident in their clinical work.

NHS managers say various factors contributed to the suspension.

NHS medical director Sir Bruce Keogh said data suggested a death rate twice the national average.

Ms Brown told the BBC that, since the announcement, she and colleagues had been examining the data that was used to make the decision.

“We do now know that the figures that were presented… were simply wrong, they were incomplete, did not include all the operations in Leeds, and that they had then been subject to some statistical analysis which generated this headline figure.

“We’ve been looking very hard at the figures over the last three years and we are confident that our mortality figures are well within what would be expected. All the clinicians in Leeds are very happy with our figures at present.”

The hospital is at the centre of a long-running dispute over the future of children’s heart services, and an NHS review said surgery would be better focused at fewer, larger sites.

However, the High Court ruled just last week that the Leeds unit should be kept open – a move that was superseded a day later by Sir Bruce suspending surgery.


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Cancer survivors deserve ‘care plan’

28 March 2013 Last updated at 21:03 ET

Anxious cancer survivorA survey found that a quarter of cancer survivors feel isolated after treatment

All cancer patients should receive a ‘recovery package’ at the end of their treatment offering ongoing support, the government has announced.

Currently as many as three in four patients do not receive any information on coping with the long-term effects of their illness, figures suggest.

The care plans will identify patients’ financial, mental and physical needs.

Ministers called on the NHS to take “urgent action” to help cancer survivors in England.

Macmillan Cancer Support, who helped develop the proposals with the Department of Health, said at the moment many patients felt isolated once treatment had ended.

Very few cancer patients are given any written information on recurrence or side-effects of treatment, the charity said.

Nor are they told how to contact someone outside of routine follow-up if they have any problems.

The recovery package is essentially a checklist for doctors and nurses to assess what emotional, physical and practical needs a patient might have after their treatment has ended.

This may include referrals to mental health or social services as well as advice on financial support.

Care plans will also forward patients to physical activity services to help them regain their strength and fitness.

Isolated

A national survey of cancer survivors has shown that around a quarter feel isolated after treatment and 30% say they have numerous issues that are not being addressed, which include fears about their cancer spreading.

Macmillan estimate that currently around 200,000 people do not get a package of support after their treatment ends.

Public health minister Anna Soubry said there are currently around 1.8m people who have or have been treated for cancer, a figure set to rise to 3.4m by 2030.

“This joint document calls on NHS England and local NHS teams to take urgent action and consider our recommendations when they provide cancer services based on their local community’s needs.

“Whether it’s specialist help to get back to work or being recommended to do a physical activity group, local NHS teams need to consider providing a new range of care services for cancer survivors to tackle their needs and improve their quality of life.”

Ciarán Devane, chief executive of Macmillan Cancer Support added that many cancer patients are crying out for this type of personalised support.

“If the NHS does one thing for cancer survivors it should be to commission this recovery package for its local population.

“We also need to keep on top of how cancer patients’ quality of life is affected long-term.”


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HIV, hepatitis tests urged for 7,000 Oklahoma dental patients

By Steve Olafson

OKLAHOMA CITY | Sat Mar 30, 2013 11:24am EDT

OKLAHOMA CITY (Reuters) – A Tulsa, Oklahoma, health center on Saturday began drawing blood samples from patients who may have been exposed to viruses at an oral surgery dental clinic that is under investigation.

As many as 7,000 of Dr. W. Scott Harrington’s patients are being notified by letter that health officials recommend they be tested for hepatitis and HIV.

The investigation began when one of Harrington’s patients tested positive for HIV and Hepatitis C. But a subsequent blood test showed the patient tested positive only for Hepatitis C, said Tulsa health department officials in a press release on Saturday.

Even so, a complaint filed by the Oklahoma Dental Board cites Harrington for an array of safety and health violations that created contamination risks for his patients. He is scheduled to appear before a dental board hearing on April 19 and has voluntarily closed his practice and surrendered his license.

Harrington’s patients are being offered free blood screening on a walk-in basis at the North Regional Health and Wellness Center in Tulsa.

A hot line has also been established to answer questions and more than 400 people have called it so far, officials said.


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Researchers Test Implanted Brain Stimulator for Alzheimer’s

News Picture: Researchers Test Implanted Brain Stimulator for Alzheimer'sBy Barbara Bronson Gray
HealthDay Reporter

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THURSDAY, March 28 (HealthDay News) — Researchers are testing whether applying electrical stimulation directly to the brains of people with Alzheimer’s disease might improve thinking, focus and alertness.

The process, called direct brain stimulation, or deep brain stimulation (DBS), has been used to treat Parkinson’s disease and is being tested as a treatment for other conditions, including traumatic brain injuries and obesity, according to the researchers.

Two women have had the electronic brain stimulators implanted, and eight more patients will participate in this initial research.

“There are a lot of studies out there that say physical or mental stimulation may reduce the risk or impact of Alzheimer’s disease, so we wondered if increasing stimulation to certain parts of the brain may be protective,” explained study co-author Dr. Douglas Scharre, director of the division of cognitive neurology at Ohio State University.

Scharre said that while Alzheimer’s tends to affect the temporal, parietal and frontal lobes of the brain, he wanted to focus particularly on the frontal lobe for two reasons: it’s typically the last brain area to degenerate, and its functions — decision-making, problem-solving, focus and alertness — are necessary for a person to be independent.

Placing the DBS system involves two steps. First, in a surgical procedure that requires about a three-day hospital stay, the patient has tiny holes made in each side of the skull, and hair-thin wires are placed in precise spots of the brain using computer-guided technology. The wires are fed through the neck — in the subcutaneous tissue just under the skin — and left there for about a week while the burr holes heal, explained Scharre.

Then, in an outpatient surgery, the patient has two battery packs that look like heart pacemakers placed on each side of the chest. The wires placed the week before are then connected to the batteries.

Six weeks after the second surgery, the stimulator is turned on. “My job [as the neurologist] is to find the right settings to get the maximum benefit,” said Scharre. Each wire has four contacts, providing a wide range of different voltage combinations, and the challenge is to determine the right amount to produce the best benefit, he explained.

The research could potentially be of value to millions of Americans: a recent report from the Alzheimer’s Association found that one in every three seniors now dies while suffering from Alzheimer’s or another form of dementia. Alzheimer’s disease becomes progressively disabling with loss of memory, thinking skills, the ability to socialize and independence.

To assess the effects of DBS, the researchers give short tests to the patients, starting about two months after the surgeries, to evaluate their level of attention and alertness, and to see how fast they can complete a particular task. For example, one test shows a variety of different geometric shapes all over the page, and [the patient] is asked to pick out all the stars in a 30-second timeframe.

In addition to the evaluation of thinking-related functions, the researchers look for brain wave changes and perform MRI scans, PET imaging, brain scans and spinal fluid analysis. Scharre said the researchers will need a year’s worth of data to assess each patient and about two years to achieve the goal of involving 10 people in the research.

The first person to have the pacemaker implanted was Kathy Sanford, 57, who has early onset Alzheimer’s and has just finished 12 weeks of stimulation. “Initially, we’ve seen some improvements in speed of processing and she did better on shifting tasks,” reported Scharre. “While we’re happy we’re seeing changes, I would be very, very cautious; the real test is whether we see sustained effects over time.”

Kathy’s father, Joseph Jester, said the family has already seen signs that Kathy’s memory is improving.

Kathy is highly motivated to participate in the study, Jester explained. “She has two daughters and a grandson who she is worried about, and [she] hopes if this treatment works, they would have an alternative should they inherit this disease.”

Jester said while he appreciates the opportunity for Kathy to participate in the study, it has been time consuming and sometimes disappointing as the physicians adjust and readjust pacemaker settings. “The doctors assure us that [her settings] are on the best place possible and we need patience as she goes forward from here.”

As for other potential downsides to participating in the research, the two patients who have had the pacemakers and battery packs surgically placed have had no complications, according to Scharre. Should they have any problems associated with the actual stimulation, it’s easy to just turn it off, he noted.

Experts encouraged caution at this point in the study.

“This is interesting but preliminary research,” said Maria Carrillo, vice president of medical and scientific relations at the Alzheimer’s Association. But it is good to see alternative treatment methods for Alzheimer’s are being tested, she added.

MedicalNews
Copyright © 2013 HealthDay. All rights reserved.

SOURCES: Douglas Scharre, M.D., neurologist and director, division of cognitive neurology, Ohio State University, Columbus; Maria Carrillo, Ph.D., vice president, medical and scientific relations, Alzheimer’s Association, Chicago; Joseph Jester



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Continuing to work with states to build new systems of health coverage

By Cindy Mann CMS Deputy Administrator and Director, Center for Medicaid and CHIP Services

CMS is committed to working in partnership with states in administering their Medicaid and Children’s Health Insurance Programs (CHIP) and to providing flexibility in pursuit of our shared goals.

Premium assistance has been a longstanding option in both Medicaid and CHIP and is one way to accomplish those shared goals.  CMS provided guidance in December of last year on how states might use these options to develop state-based solutions that meet both the state’s unique needs and requirements of the programs

In response to some questions that have been raised by states, today we are issuing some clarifying guidance.   Today’s Frequently Asked Questions explain the basic requirements that apply when a state chooses the premium assistance option and the guidelines we would apply when a state requests a waiver to implement premium assistance.  Under both approaches, individuals remain Medicaid beneficiaries and continue to be eligible for benefits and cost-sharing protections established by law.

As we review waiver proposals, HHS will consider factors that will impact cost effectiveness, such as those introduced by the creation of Health Insurance Marketplaces.

We remain committed to working with states and providing them with the flexibility and resources they need to build new systems of health coverage.  Premium assistance is simply one option, and we will continue to work with states on solutions that work best to meet shared goals.  We encourage states to come to us with their delivery system ideas, and look forward to continuing to work with states on these and other innovative approaches.

Premium Assistance FAQ


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Celiac diagnoses rose during 2000s: study

By Andrew M. Seaman

NEW YORK | Fri Mar 29, 2013 3:41pm EDT

NEW YORK (Reuters Health) – The number of Americans diagnosed with celiac disease continued to rise over the past decade but leveled off in 2004, according to a new study.

Researchers analyzed data on a small but representative sample of people living in Olmsted County, Minnesota, and found that between the years 2000 and 2010, the number of new cases of celiac disease increased from about 11 people per 100,000 to about 17 people per 100,000.

“We’re finding a lot more celiac disease,” said Dr. Joseph Murray, the study’s senior author from the Mayo Clinic in Rochester, Minnesota.

“Some of that is probably that we’re better at detecting it, but the fact that we’re finding it all the time shows that there are a number of new cases,” he added.

In people with celiac disease – which includes about 1 percent of Americans, according to most estimates – the immune system reacts to gluten, a protein found in wheat, barley and rye. Eating foods with gluten damages the small intestine and keeps it from absorbing nutrients.

Classic symptoms of celiac are diarrhea and weight loss, according to Murray’s report.

Previous studies have shown that the number of people living with the condition increased over time, but few studies looked at the number of new cases being diagnosed in recent years.

The researchers used medical records for people living in Olmsted County, which is home to the Mayo Clinic and two affiliated hospitals, and where the health of most of the population is tracked through research projects.

Over the entire decade starting in 2000, some 249 people were diagnosed with celiac disease in the county. People as young as one year old and as old as 85 received a diagnosis, and about 63 percent of the new cases were women.

Between 2000 and 2001, 26 people were diagnosed with celiac disease, which works out to about 11 per 100,000 people at the time. By 2002 to 2004, that number had climbed to 67 – or about 18 people per 100,000, and remained about the same from then on.

“This study shows not only did it go up, but it kind of plateaued in 2004 and it remained stable at that elevated level,” Murray said.

He and his colleagues write in The American Journal of Gastroenterology that the increased incidence of celiac disease may be partly due to doctors knowing about the signs and symptoms of celiac disease and screening people at risk, but not entirely.

“Something has changed in our environment that’s driving an increased incidence of celiac disease,” Murray said.

In their report, Murray and his colleagues note that gastrointestinal infections have been linked to the development of celiac disease. So has high consumption of gluten-containing foods, like breads, bagels and pizza.

Dr. Alessio Fasano, director of the Center for Celiac Research at MassGeneral Hospital for Children in Boston, agreed that something in the environment seems to be triggering the various genetic and biological factors that drive celiac disease.

“If you lead the lifestyle of three or four generations ago, you don’t see this epidemic. I do believe what we’re witnessing with celiac disease is that we’re changing the environment way too fast for our body to adapt to it,” said Fasano, who was not involved with the study.

“When we’re born we are like a marble block. What carves this into a wonderful sculpture is the environment,” Fasano added.

Murray told Reuters Health that people should see their doctors if they have a family history of celiac disease, or are experiencing its most common symptoms – including iron deficiency, weakness, tiredness, diarrhea, passing gas and weight loss.

SOURCE: bit.ly/YIl26a The American Journal of Gastroenterology, online March 19, 2013.

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