03.31.08
Posted in Uncategorized at 11:50 pm by Luis
NEW YORK (AP) -- You can skip the mouth-to-mouth breathing and just press on the chest to save a life. In a major change, the American Heart Association said Monday that hands-only CPR - rapid, deep presses on the victim's chest until help arrives - works just as well as standard CPR for sudden cardiac arrest in adults.
Experts hope bystanders will now be more willing to jump in and help if they see someone suddenly collapse. Hands-only CPR is simpler and easier to remember and removes a big barrier for people skittish about the mouth-to-mouth breathing.
"You only have to do two things. Call 911 and push hard and fast on the middle of the person's chest," said Dr. Michael Sayre, an emergency medicine professor at Ohio State University who headed the committee that made the recommendation.
Hands-only CPR calls for uninterrupted chest presses - 100 a minute - until paramedics take over or an automated external defibrillator is available to restore a normal heart rhythm.
This action should be taken only for adults who unexpectedly collapse, stop breathing and are unresponsive. The odds are that the person is having cardiac arrest - the heart suddenly stops - which can occur after a heart attack or be caused by other heart problems. In such a case, the victim still has ample air in the lungs and blood and compressions keep blood flowing to the brain, heart and other organs.
A child who collapses is more likely to primarily have breathing problems - and in that case, mouth-to-mouth breathing should be used. That also applies to adults who suffer lack of oxygen from a near-drowning, drug overdose, or carbon monoxide poisoning. In these cases, people need mouth-to-mouth to get air into their lungs and bloodstream.
But in either case, "Something is better than nothing," Sayre said.
The CPR guidelines had been inching toward compression-only. The last update, in 2005, put more emphasis on chest pushes by alternating 30 presses with two quick breaths; those "unable or unwilling" to do the breaths could do presses alone.
Now the heart association has given equal standing to hands-only CPR. Those who have been trained in traditional cardiopulmonary resuscitation can still opt to use it.
Sayre said the association took the unusual step of making the changes now - the next update wasn't due until 2010 - because three studies last year showed hands-only was as good as traditional CPR. Hands-only will be added to CPR training.
An estimated 310,000 Americans die each year of cardiac arrest. Only about 6 percent of those who are stricken outside a hospital survive, although rates vary by location. People who quickly get CPR while awaiting medical treatment have double or triple the chance of surviving. But less than a third of victims get this essential help.
Dr. Gordon Ewy, who's been pushing for hands-only CPR for 15 years, said he was "dancing in the streets" over the heart association's change even though he doesn't think it goes far enough. Ewy (pronounced AY-vee) is director of the University of Arizona Sarver Heart Center in Tucson, where the compression-only technique was pioneered.
Ewy said there's no point to giving early breaths in the case of sudden cardiac arrest, and it takes too long to stop compressions to give two breaths - 16 seconds for the average person. He noted that victims often gasp periodically anyway, drawing in a little air on their own.
Anonymous surveys show that people are reluctant to do mouth-to-mouth, Ewy said, partly because of fear of infections.
"When people are honest, they're not going to do it," he said. "It's not only the yuck factor."
In recent years, emergency service dispatchers have been coaching callers in hands-only CPR rather than telling them how to alternate breaths and compressions.
"They love it. It's less complicated and the outcomes are better," said Dallas emergency medical services chief Dr. Paul Pepe, who also chairs emergency medicine at the University of Texas Southwestern Medical Center.
One person who's been spreading the word about hands-only CPR is Temecula, Calif., chiropractor Jared Hjelmstad, who helped save the life of a fellow health club member in Southern California
Hjelmstad, 40, had read about it in a medical journal and used it on Garth Goodall, who collapsed while working out at their gym in February. Hjelmstad's 15-year-old son Josh called 911 in the meantime.
Hjelmstad said he pumped on Goodall's chest for more than 12 minutes - encouraged by Goodall's intermittent gasps - until paramedics arrived. He was thrilled to find out the next day that Goodall had survived.
On Sunday, he visited Goodall in the hospital where he is recovering from triple bypass surgery.
"After this whole thing happened, I was on cloud nine," said Hjelmstad. "I was just fortunate enough to be there."
Goodall, a 49-year-old construction contractor, said he had been healthy and fit before the collapse, and there'd been no hint that he had clogged heart arteries.
"I was lucky," he said. Had the situation been reversed, "I wouldn't have known what to do."
"It's a second lease on life," he added.
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On the Net:
Heart Association: http://www.americanheart.org/handsonlycpr
Sarver Heart Center: http://www.heart.arizona.edu/
© 2008 The Associated Press.
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Posted in Uncategorized at 11:50 pm by Luis
WASHINGTON (AP) -- Chronic heartburn is a daily acid bath for the esophagus, and complications from it are on the rise. New government figures show a worrisome increase in esophagus disorders from severe acid reflux. The worst one, esophageal cancer, is continuing its march as the nation's fastest-growing malignancy.
What to do if you're one of the estimated 3 million Americans whose eroded esophagus means high risk for this especially deadly cancer? More doctors are trying to zap away the worst damage, beaming radiofrequency energy down the throat to burn off precancerous cells.
While it's not yet certain that will block cancer from ever forming, the studies are promising enough that specialists have begun debating how to better find at-risk patients, people who suffer a condition called Barrett's esophagus. Ironically, a damaged esophagus may no longer feel the burn of acid reflux, keeping sufferers in the dark.
"You become desensitized. You can go a long time without knowing you have Barrett's," warns Dr. John I. Allen of the American Gastroenterological Association.
Heartburn sometimes is a temporary problem, but it also can signal gastrointestinal reflux disease, or GERD, where a loose valve allows stomach acid to regularly back up into the delicate esophagus. Millions have GERD, which is on the rise along with expanding waistlines. For most people, acid-suppressing medications are the answer.
But severe reflux over many years can cause serious problems for a fraction of people. The lining of the esophagus erodes until it bleeds, narrows to make swallowing difficult or, worse, starts to repair itself with more acid-resistant intestinal cells that happen to be more cancer-prone. That last condition is called Barrett's esophagus, and sufferers are 30 times more likely than the average person to go on to develop esophageal cancer.
Hospitalizations for all reflux-caused esophageal disorders doubled between 1998 and 2005, says a sobering new count by the U.S. Agency for Healthcare Research and Quality.
And over the past two decades, esophageal cancer has risen six-fold. About 16,470 Americans will be diagnosed with it this year, according to the American Cancer Society. Fewer than one in five survives five years, and 14,280 are predicted to die this year.
Hence a renewed focus on Barrett's patients, to try to prevent their damage from progressing to cancer.
The good news is that esophageal cancer is slow to develop, so Barrett's patients are given regular down-the-throat exams to spot precancerous changes in cells. Those termed "high-grade dysplasia" are the most dangerous - one in five of those patients will get full-blown cancer within five years.
Cutting out the esophagus has long been standard treatment to stop high-grade dysplasia from turning into cancer. Don't go straight to that extreme step, say guidelines issued last week by the American College of Gastroenterology.
Instead, the new guidelines urge a two-step process: Send a device down the throat to carefully slice off the precancerous layer and make sure it hasn't already turned into invasive cancer. Then burn away the remaining Barrett's tissue with other endoscopic techniques in hopes of getting healthy cells to grow back in its place - as long as patients stay on long-term, acid-controlling drugs, too.
There are various ways to burn away the problem areas, but specialists increasingly are turning to a device named Barrx that lets them nestle a balloon directly onto the esophagus lining and beam RF energy straight into it.
Small studies suggest Barrx can successfully treat precancerous spots in about 90 percent of patients with no return in two years and counting. Specialists are anxiously awaiting a more in-depth study, to be released later this spring, that compared 120 patients who got either Barrx or a sham procedure.
"It'll have very impressive results," promises Dr. Richard Sampliner of the University of Arizona Health Sciences Center, one of the 19 participating medical centers.
A big question, though, is whether precancerous cells still lurk under the new healthy cells that form, ready to grow again. So patients getting Barrx or other ablation treatments today can't yet abandon regular endoscopic exams.
"Common sense suggests if we eliminate the Barrett's segment, we're going to eliminate the cancer in people. That really will take decades to know for certain," cautions Dr. John Carroll of Georgetown University Hospital.
But Carroll is optimistic enough that this spring, Georgetown begins a study to see if it's worth doing Barrx treatment even earlier - in patients whose Barrett's esophagus hasn't yet developed precancerous spots.
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Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
© 2008 The Associated Press.
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Posted in Uncategorized at 11:50 pm by Luis
CHICAGO (AP) -- Two big studies offer good news to people with high blood pressure, finding that novel ways to use cheap drugs already on the market can lower their risk of heart attacks, stroke and death - even if they are very old.
Both studies were stopped early so the surprising benefits could be made known. Doctors presented results Monday at an American College of Cardiology conference in Chicago.
"It is never too late to start" on blood pressure drugs, said Dr. Nigel Beckett of Imperial College in London, who led one study in the elderly that also was published online by the New England Journal of Medicine.
More than 70 million Americans have high blood pressure - readings of 140 over 90 or more - and only a third have it well controlled by medicines. Guidelines advise starting on one, usually a "water pill," and adding others as needed.
With each new medication, "You get more pills, more copays," said Dr. Kenneth Jamerson of the University of Michigan. "Our idea is, if you have to add on, why not do two right off the bat" in a single pill.
He led a study testing a single daily pill combining a diuretic and the ACE inhibitor benazepril versus a daily pill containing benazepril and a calcium channel blocker, amlodipine. ACE inhibitors dilate blood vessels to lower pressure. Calcium channel blockers do the same in a different way.
A total of 11,462 people in the United States and Nordic countries were given one combo or the other. Their average age was 68, and besides high blood pressure they were obese, had diabetes or other health problems.
Neither they nor their doctors knew which drugs they were taking until the study was stopped in October after it was clear that people on the ACE-calcium blocker combo were doing better.
Those people had about 15 percent fewer heart-related problems or strokes - 531 among the 5,721 in this group versus 653 events among the 5,741 others, Jamerson said.
Six months of treatment with either combo brought blood pressure to an acceptable range for 73 percent of patients.
The study was paid for by Novartis, which sells Lotrel, the combo that proved better, and Jamerson consults for the company. The drugs are all sold as generics, although the doses in some require two pills a day instead of one.
The findings could shape treatment guidelines due to be reviewed in a few months, said Dr. Daniel Jones, a University of Mississippi blood pressure specialist and president of the American Heart Association.
Doctors can start with a combination, but few do, partly for lack of evidence, he said.
Guidelines also may change to reflect a second study that found dramatic benefits for treating people in their 80s, an age when blood pressure drugs were not known to be safe or effective.
"The over-80s are the most rapidly expanding segment of our population," and the prevalence of blood pressure rises as people age, Beckett noted.
His study assigned 3,845 older people in Europe, China and several other countries to take the diuretic indapamide or dummy pills plus the ACE inhibitor perindopril as needed to reach a goal of 150/80 from an average starting pressure of 173/91.
The study was stopped last July after monitors saw that those on the diuretic had 39 percent fewer fatal strokes and 21 percent fewer deaths from any cause - benefits far exceeding what researchers predicted.
Jones called it one of the most important studies at the cardiology meeting and a key advance for older people. The study did not include frail older people in nursing homes, who might reap less benefit than healthier people, doctors noted.
Also at the conference:
-The diabetes drug Actos shrunk artery buildups that can lead to heart disease when tested against glimepiride, an older diabetes drug, in a study of 360 diabetics led by Cleveland Clinic cardiologist Steven Nissen.
"This is the first time in which a diabetes therapy has been shown to slow or prevent" heart disease, he said. Results were published online by the Journal of the American Medical Association.
-A combined analysis of six studies on Celebrex, the only COX-2 inhibitor painkiller still on the market since the withdrawal of Vioxx, gives reassurance of the drug's relative safety for people who do not have big heart disease risk factors when they start taking the drug.
It tested doses used by people with rheumatoid arthritis and other severe chronic pain - roughly double the levels used by people with more common osteoarthritis.
The federally funded study was published in the journal Circulation.
"It gives me some comfort" about the safety of Celebrex, said Nissen, who is leading a larger study of the Pfizer Inc. drug and other painkillers.
© 2008 The Associated Press.
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03.29.08
Posted in Uncategorized at 11:48 pm by Luis
CHICAGO (AP) -- Is it safe to have your arteries unclogged at a hospital that lacks heart surgeons who can operate if something goes wrong?
Many states ban this except in emergencies like heart attacks. But more small hospitals are trying it in non-urgent cases, and the largest study ever done of this, released on Saturday, suggests it may not be as risky as has been feared.
If confirmed by other ongoing studies, it could change policies in many states. That would mean money for community hospitals struggling to stay profitable and options for patients who must travel to big cities for care.
"What we don't want is a huge proliferation of hospitals" doing this without strict quality safeguards, or in places that already have many heart centers, said Dr. Ralph Brindis, a heart specialist at the California-based Kaiser Permanente health plan.
He heads a 300,000-patient national database maintained by the American College of Cardiology used in the study. Results were reported at a joint meeting of several cardiology groups in Chicago.
Blocked arteries deprive the heart of blood and can lead to a heart attack. A popular treatment is angioplasty. Doctors push a tiny balloon into an artery, inflate it to flatten the clog, and often place a stent to prop the vessel open.
Medical guidelines allow most hospitals to do these for heart attacks. However, most angioplasties are for chest pain and non-urgent situations, and the rules say hospitals should not offer these unless they have doctors who can do bypass surgery if problems arise.
Small hospitals, which can earn $15,000 or more on each angioplasty, have pressed for a new look at the guidelines. They say stents that came on the market in recent years have made angioplasty safer, by limiting how many times the balloon is inflated and the risk of puncturing an artery.
The patient registry is not definitive science, but suggests that at small hospitals doing this now, with strict quality controls, safety is pretty good.
Researchers compared results from January 2004 through March 2006 on 9,029 patients who had angioplasty at 61 centers without on-site cardiac surgery to 299,132 patients at 404 centers with heart surgeons. Only about half of the hospitals without surgical backup did more than three dozen angioplasties a year.
Yet complications and success rates were similar, said study leader Dr. Michael Kutcher of Wake Forest University in Winston-Salem, N.C.
Roughly four of every 1,000 patients needed emergency bypass surgery - far less than in the past. Nearly 2 percent died at hospitals without backup surgery versus just over 1 percent at larger hospitals, but there was no significant difference once researchers factored in age, severity of illness and other differences among patients.
Results did not differ for urgent or non-urgent angioplasties, though a greater portion of those at small hospitals were emergencies.
The findings should lead to a new look at the guidelines, Brindis said.
"We know from European centers that it can be done safely and effectively. Over half of all angioplasties in Europe and in many countries are done without on-site surgical backup," he said.
"It could have a huge impact in this country," said Dr. W. Douglas Weaver, a Detroit heart specialist and president-elect of the American College of Cardiology.
Dr. Harlan Krumholz, a quality-of-care researcher at Yale University School of Medicine, said: "I think we are at a place where it can be done safely. But there is no reason to do it unless there is not a major center nearby. That is the catch - we should not have these everywhere."
The issue has been most contentious in New Jersey. The nation's most densely populated state has 18 hospitals with heart surgery programs - one within a half-hour of virtually every resident - and they don't want more competition.
New Jersey's participation in a nine-state study comparing how patients fare at hospitals with and without heart surgeons led to a lawsuit against the state. Some big hospitals claimed patient safety was jeopardized, but a court allowed the state to remain in the study. The results aren't expected for at least two years.
James and Marie Clark of Roselle Park, N.J., took part in the study. Marie, 76, had nonemergency angioplasty and a stent last September; her 75-year-old husband got the same treatment last week, both at Raritan Bay Medical Center, a 388-bed community hospital in northeastern New Jersey.
Both said they had no qualms about going to a hospital without backup heart surgeons because their longtime cardiologist did the procedures.
"I didn't have any fear," said James Clark, a retired electrician. "I just didn't give it a thought."
Doctors will wait for more definitive studies to say the practice is safe, said Brindis, the Kaiser Permanente doctor.
"What they're concerned about is, is it the best possible practice? If all things were equal would it be best for your aunt to have angioplasty in a hospital with surgical backup?"
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Medical writer Marilynn Marchione reported from Chicago; Business writer Linda A. Johnson reported from Trenton, N.J.
© 2008 The Associated Press.
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03.28.08
Posted in Uncategorized at 11:47 pm by Luis
WASHINGTON (AP) -- What do former patients think about the care they received at your local hospitals? The government wants to make it easier for you to find out.
Federal health officials in recent years have made strides to improve transparency in health care. But measuring how well hospitals do their job can be technical. New patient satisfaction scores, which went online Friday, cover basic premises that just about every hospital patient and their family members can understand.
For example:
-Did doctors treat patients with courtesy and respect?
-How often were the room and bathroom cleaned?
-Was the area around the room quiet?
-Did the patient get immediate help after pressing a call button?
Those questions were included in a survey used to evaluate more than 2,500 hospitals around the country.
"You don't have to be a technical expert to understand this information and its implications," said Joyce Dubow, senior adviser at the AARP, the senior advocacy group. "If you ask somebody whether they were cared for with respect, they get that."
Health and Human Services Secretary Mike Leavitt said consumers - and the Medicare program - pay for care whether it's good or not. Informing consumers about how well a hospital performs a particular task or how much it charges for a particular service will serve as incentives for health care providers to do better.
"The current sector is all about volume," Leavitt said. "The future is about value."
The government's Web site, http://www.hospitalcompare.hhs.gov , lets consumers compare up to three hospitals. Users will be able to see the scores for such things as how often nurses communicated well with their patients; hospitals nationwide averaged 73 percent on that particular question. Consumers will also be able to see how well the average hospital in their state fared on each question.
The data was collected by hospitals from a random sample of patients from October 2006 and June 2007. The government led development of the survey, which was administered 48 hours to six weeks after the patients were discharged.
Federal officials said they recognize that patients needing emergency care won't use the comparison Web site, nor should they. However, more than 60 percent of all patients go to a hospital for elective procedures.
The site will also help hospitals focus improvements where patients feel it is most needed, said Rich Umbdenstock, president and CEO of the American Hospital Association.
"Ultimately, this tool benefits everyone," Umbdenstock said.
Overall, federal officials said rural hospitals seemed to fare better than urban ones when it came several measures of patient satisfaction.
"I think that has to do with rural hospitals being more of a fabric of the community," said Herb Kuhn, acting deputy administrator at the Centers for Medicare and Medicaid Services.
Officials acknowledge that few consumers compare quality information about insurance plans, hospitals and other providers to make decisions about their care. A recent Kaiser Family Foundation survey estimated that fewer than one in five patients did. However, that's an increase from 12 percent in 2000.
Leavitt acknowledged that the government's efforts to evaluate the quality of health care are lacking. He likened the current situation to the earliest of video games, a table tennis game called Pong.
"We're not very good at this, but we're making a lot of progress," he said.
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On the Net:
Hospital Compare: http://www.hospitalcompare.hhs.gov
© 2008 The Associated Press.
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