Hospitals take on
post-ICU syndrome, helping patients recover
Hospitals are doing more to help the growing number of patients who receive
treatment for serious illness in the intensive-care unit—only to find their
release is the start of a whole new set of problems.
With medical advances, even the sickest patients now often survive
potentially life-threatening conditions after a stay in intensive care. Many
experience aftereffects, not only of the illness but also of the very
medical care that may have saved their lives.
Doctors call it "post-intensive care syndrome" and say it is becoming more
common. In the ICU, patients may be heavily sedated and hooked up to a
ventilator, keeping them immobile, breathing and free of pain. But they can
develop a temporary brain injury known as "ICU delirium," that is linked to
later problems with memory and thinking. As many as 80% of ICU survivors
have some form of cognitive or brain dysfunction, according to the Society
of Critical Care Medicine, and some never recover. Many experience
post-traumatic stress symptoms, depression, fatigue and prolonged muscle
More than five million patients are admitted to an intensive care unit each
year for conditions such as respiratory failure and heart failure, and for
monitoring after invasive surgery.
Especially at risk of developing post-ICU syndrome are patients who have
Sepsis can rage through the body and restrict blood flow to vital organs
including the brain. It kills 258,000 people a year and leaves about 1.4
million survivors at risk for long-term disability, according to the
nonprofit Sepsis Alliance, an advocacy group. It was the most expensive
condition treated in U.S. hospitals in 2011, costing more than $20 billion;
between 2000 and 2009, the number of hospitalizations with a principal
diagnosis of sepsis increased 148%, accounting for 1 out of every 23
patients, according the federal Agency for Healthcare Research and Quality.
Researchers are studying the link between delirium and sepsis as well as
other causes, such as powerful sedatives. Septic patients are most likely to
develop delirium, and they are at higher risk of developing post-ICU
disabilities than those with other illnesses who develop delirium, research
Now, many hospitals are starting to modify standard ICU practices, such as
giving patients breaks from constant ventilation, avoiding over-sedation,
monitoring them closely for signs of delirium and getting them out of bed to
walk as soon as feasible. They are adopting protocols to treat sepsis
Because much ICU care is necessary and many complications unavoidable,
critical-care experts also are focusing on post-ICU rehabilitation,
including educating patients, families and primary-care doctors about
recovering from intensive care.
E. Wesley Ely, professor of medicine and critical care at Vanderbilt
University, which opened an ICU Recovery Center last year, recommends
"hard-core physical and mental rehabilitation" for people recovering from
A group called The Sepsis Alliance, is developing handouts on post-sepsis
issues for patients to provide to physicians, and it is using Facebook and
other social media to help patients connect with each other.
Theodore Iwashyna, a critical-care physician and researcher at the
University of Michigan Health System, is studying survivorship after
critical-care illness. He says post-ICU patients need the same kinds of
occupational and physical therapy as heart attack and stroke survivors.
In the past two years, a Critical Care Survivorship pilot program developed
at Indiana University helped more than 100 ICU survivors and their
caregivers. Malaz Boustani, chief innovation and implementation officer at
Indiana University Health, says more than 88% had evidence of cognitive
impairment and 40% suffered from depression. The program enhanced post-ICU
care and reduced the number of emergency room visits and hospital
readmissions, Dr. Boustani says.
In a Vanderbilt study, patients who survived critical illness and completed
12 weeks of in-home cognitive and physical rehabilitation scored better on
tests of their ability to plan and perform tasks with multiple steps,
compared with survivors who didn't undergo rehabilitation.
Visit the Wall Street Journal for the article.
Philips HeartStart FRx, HeartStart HS1 Home, and HeartStart HS1 OnSite
Automated External Defibrillators (AED)
The FDA is alerting all users of the Philips HeartStart FRx, HS1 Home and
HS1 OnSite AEDs manufactured between 2005 and 2012 that these devices may
fail to deliver a shock in the event of an emergency. If you have this
device, please contact Philips Healthcare immediately for a replacement
In September 2012, Philips Healthcare initiated a Voluntary Medical Device
Recall of HeartStart Frx, HeartStart HS1 Home, and HeartStart HS1 OnSite
AEDs after determining that an internal electrical component in the AED
could fail, and the device could incorrectly indicate it is ready for use.
This recall affects approximately 700,000 devices.
In a Medical Device Safety Notice dated Nov. 19, 2013, Philips provided
customers with updated information about the failure of an electrical
component that could cause the AEDs to fail to deliver appropriate shock.
The notification also directed consumers to a Maintenance Advisory1
All owners of the Philips HeartStart AEDs should contact Philips Healthcare
immediately at 1-800-263-3342, and select option 5 for technical support.
Live technical support is available Monday – Friday, 7:00 am – 5:00 pm
Keep the recalled HeartStart AED in service until Philips Healthcare
replaces the device or you can obtain another working AED. Despite current
manufacturing and performance problems, the FDA considers the benefits of
attempting to use an AED in a cardiac arrest emergency greater than the risk
of not attempting to use the defibrillator.
Please be aware that the Philips HeartStart AEDs are designed to
automatically test themselves at regular intervals to ensure they are ready
for use. The HeartStart AED should emit a triple chirp sound and have a
flashing “i-button” if it detects a serious problem that could prevent the
HeartStart AED from delivering an electrical shock.
If your Philips HeartStart AED is emitting a series of triple chirps while
in stand-by-mode, please contact Philips Healthcare immediately for a
replacement unit. Keep the recalled HeartStart AED in service until Philips
Healthcare replaces the device or you can obtain another working AED.
The FDA continues to closely monitor all AED manufacturers’ quality system
design practices and device malfunctions that have persistently contributed
to AED recall and Medical Device Reports.
In September 2012, the FDA classified Philips’ recall of HeartStart AED
devices as a Class II recall after determining that the chance of serious
adverse consequences or death due the device failure is remote. In this
current situation, the FDA believes that because the patients who need these
devices are in a life threatening situation, the chance of serious adverse
consequences or death directly related to AED failure is very difficult to
In March 2013, the FDA issued a Proposed Order2 requiring manufacturers of
AEDS and accessories to submit premarket approval (PMA) applications. The
FDA is currently reviewing and considering the comments provided by the
public, and will take them into consideration when issuing a final order.
Visit the FDA for more information.
help each other, one food item at a time
MUNCIE — The staff and volunteers of IU Health Ball Memorial Hospital and
Blackford Hospital aren’t immune to the economic struggles that affect their
friends and neighbors. They, too, have a hard time paying bills. They also
wonder anxiously about getting laid off in the future. They’re as concerned
about living paycheck to paycheck as everyone else in East Central Indiana.
And they also go hungry.
In the last year, their peers at the hospitals have created the Employees
Helping Employees Assistance Program, an opportunity for those with a few
extra dollars to help those without.
“We offer a competitive compensation package here and great benefits, but
we’re a part of the community and our employees have the same struggles
everyone is having,” said Emily German-Brown, the chairperson of the
Employees Helping Employees committee. “When we started to see requests for
groceries and things like that, we decided to create a food pantry to help
our employees and volunteers who may need that help.”
With 3,000 employees, the hospital is one of the largest employers in
Delaware County. Although some outside of the hospital environment might
think most hospital staffers are doctors making six-figure salaries, that’s
not the case. As with any large company, the hospital employs people along a
range of pay scales, including on a part-time level.
The 500 volunteers also come from diverse economic backgrounds and might
need help with food from time to time, according to pantry organizers.
The pantry, which opened on Nov. 20, is located near the employee parking
garage in the IU Health BMH facility, an area organizers describe as easy to
get to but not heavily trafficked.
Items for the pantry will come from internal food drives and Second Harvest
Food Bank of East Central Indiana, which provided the first installment
last week. The IU Health BMH Foundation has entered a partnership with the
agency and will pay the customary convenience fee applicable to other local
Employees and volunteers can use the pantry anonymously and are only asked
to list the number of people in their households on the sheet provided, per
Second Harvest’s request.
There are no income and time guidelines for who can use the pantry and how
often. Users are simply asked to take what they need, remembering others
also visit the pantry.
Visit the Muncie Press for the story.
Study links high
sodium 'fizzy' medicines to raised heart risks
Millions of patients worldwide taking effervescent, dispersible and soluble
medicines have an increased risk of heart attacks and strokes because of the
high salt content of such drugs, scientists said.
Researchers from Britain's University of Dundee and University College
London found that with some "fizzy" versions of painkillers, vitamin
supplements or other common medicines, taking the maximum daily dose would
on its own exceed daily recommended limits for sodium, the main component of
High salt intake has been linked to high blood pressure, or hypertension,
which is a key risk factor for strokes, heart attacks and other
cardiovascular diseases. In a study published in the British Medical
Journal, they found that patients taking dispersible forms of drugs had
a 16 percent increased risk of a heart attack, stroke or vascular death
compared with patients taking the non-high-sodium versions of the same
Jacob George, an honorary consultant in clinical pharmacology at Dundee who
led the study, said patients, and consumers of over-the-counter medicines -
such as soluble aspirin, effervescent vitamin C, or Bayer's Alka Seltzer for
example - "should be warned about the potential dangers" of high sodium
intake in medicines.
Doctors, he added, should be aware of the potential dangers and prescribe
fizzy or soluble forms of drugs "with caution, only if the perceived
benefits outweigh the risks".
For this latest study, George's team tracked more than 1.2 million patients,
comparing those taking sodium-containing effervescent, dispersible and
soluble medicines with those taking non-sodium versions of the same drugs.
The study ran between 1987 and 2010 and patients were tracked for an average
of just over seven years.
During this time, over 61,000 new so-called cardiovascular events -
including heart attacks and strokes - occurred in the patients being
studied. Beside the 16 percent higher risk of a heart problem or stroke, the
team also found patients taking sodium-containing drugs were seven times
more likely to develop high blood pressure, and their overall death rate was
28 percent higher. (Reuters)
Visit Business World for the article.
hospitals to join health information exchange
Thirty-four Chicago-area hospitals are banding together to share secure
patient data through a new health information exchange. Healthcare officials
say the effort will help hospitals better care for patients and reduce
unnecessary and expensive tests.
MetroChicago HIE, scheduled to launch early next year, is an online portal
that will allow for patient information, such as lab tests, imaging, health
conditions, medicines and treatment, to be shared in real time among
hospitals, doctors and eventually patients themselves.
The initiative, led by the Metropolitan Chicago Healthcare Council, a trade
group representing 170 hospitals and health care organizations, is expected
to be announced Monday. The group said it will be among the country's
largest health information exchanges.
Digitizing patient health information and allowing it to be shared among
disparate providers can help prevent errors by ensuring that everyone
involved in a patient's care, including primary care doctors, specialists
and emergency departments, has access to the same information, said Guy
Alton, chief financial officer at St. Bernard Hospital.
The 210-bed Englewood hospital, which treats a largely transient and poor
population of patients, sees between 10,000 and 12,000 patients in its
emergency room each year who have limited means to pay for services. Often,
Alton said, those patients also have received treatment recently at other
hospitals, where they may have had lab tests or imaging services or been
given prescription medicines.
For patients, particularly those with chronic illnesses and thick medical
files, the data repository can help reduce the time they must spend filling
out paperwork and briefing providers on their medical history. It also can
help by tracking their prescriptions, which can be difficult for some with
complex medical conditions.
Hospitals, meanwhile, see the information exchange as a chance to save
money, reduce medical errors and coordinate patient care, all increasingly
important initiatives because of changes in the way they're paid by
government and private insurers.
Sharing data metrowide is "a logical and necessary step in how health
(information technology) can positively impact clinical care," said Dr.
Julio Silva, the information exchange's medical director and the chief
medical information officer for Rush University Medical Center. "If you
think about any individual institution's ability to provide an environment
that allows for great quality of care as efficiently as possible, the
availability of this new data is incredibly valuable."
That's particularly true in a region as large as Chicago, where the hospital
and healthcare market remains largely fragmented, despite a recent wave of
consolidation. For example, a patient might seek primary care in the suburbs
but have a specialist at an unaffiliated hospital downtown. A patient might
visit a separate emergency department or urgent care center.
The initial group of hospitals participating includes 10 owned by Advocate
Health Care, 10 by Presence Health, four by Sinai Health System, three by
Rush and two each by Centegra Health System and Franciscan St. James Health.
Three independent safety-net hospitals — Norwegian American, St. Bernard and
Swedish Covenant — also will participate.
From 20 to 30 others in the region are expected to join by summer. Officials
hope that eventually, each of the Chicago metro area's 89 hospitals will
sign on. Plans to expand include other organizations, including skilled
nursing centers and long-term care facilities. The council hired Ft. Worth,
TX-based Sandlot Solutions Inc. to host the exchange. Terms were not
Dan Yunker, the council's senior vice president, who is also chief executive
of the startup insurer Land of Lincoln Health, said the cloud-based service
is secure and adheres to privacy standards set by the Health Insurance
Portability and Accountability Act.
Hospitals generally will be charged on a per-record basis. Though officials
would not discuss details of the contract, St. Bernard Hospital plans for
annual costs of roughly $100,000, Alton said.
Visit the Chicago Tribune for the article.
RSNA Conference coverage - Radiological Society of North America (RSNA)
annual meeting in Chicago, Dec. 1–6, 2013
divide between radiology, interventional oncology
Deeper collaboration between radiology and radiation oncology is necessary
to realize the full potential of the two specialties whose paths diverged
nearly 50 years ago, said Damian E. Dupuy, M.D., who presented the Annual
Oration in Diagnostic Radiology as part of the RSNA Opening Session on
"Our patients and the medical community will reap the benefits of a
stronger collaboration," Dr. Dupuy said in his presentation, "We Must
Stand on the Shoulders of Giants."
Dr. Dupuy contrasted the role of the two specialties from the 1970s to
today. "In the good old days, it was 'we image and diagnose' and 'you
treat,'" said Dr. Dupuy, director of tumor ablation at Rhode Island
Hospital and a professor of diagnostic imaging at the Warren Alpert
Medical School of Brown University in Providence, R.I. "Today, we must
look at our strengths and weaknesses and work together to treat patients."
In his appeal for collaboration, Dr. Dupuy invoked the words of Anthony L.
Zietman, M.D., M.B.B.S., a professor of radiation oncology at Harvard
Medical School and presenter of the RSNA 2012 Annual Oration in Radiation
Oncology. Dr. Zietman has noted that radiation oncology is very good at
irradiating the microbes of small volume disease, while most ablative
technologies handle larger tumors but they don't address microscopic
disease. "Imagine how powerful it could be if we put them together," Dr.
There are financial benefits to collaboration, he added. In the treatment
of inoperable non-small cell lung cancer (NSCLC), interventional oncology
may be able to provide a more cost-effective treatment, he said.
"Radiofrequency ablation (RFA) and stereotactic body radiation therapy (SBRT)
have similar treatment outcomes for inoperable NSCLC, but RFA is about a
third of the cost of SBRT," Dr. Dupuy said. "That's something we need to
look at when the cost of lung cancer care in the U.S. is projected to be
$14 billion by 2020."
In the new healthcare paradigm where evidence-based medicine is an
increasingly important determinant of treatment decision-making, Dr. Dupuy
said a cohesive team approach to cancer care makes the most sense. In
order to change practice patterns, he said, it is also critical for novel
technologies, such as image-guided tumor ablation (IGTA), to be rigorously
studied in the National Cancer Institute's multicenter format, Dr. Dupuy
said. IGTA and SBRT are currently the two alternative treatments for
inoperable NSCLC patients.
Dr. Dupuy urged radiologists to help in the reunification process by
seeking greater interdepartmental activities and sharing resources like
medical physics and imaging.
Visit RSNA for the report.
Toshiba’s new MR
technologies make exams faster for better patient care and safer CT exams
with dose reduction technology
To help healthcare providers image patients faster and more comfortably,
Toshiba America Medical Systems, Inc. is introducing enhancements to its
Vantage Titan MR product line. The new technologies improve workflow,
image quality and patient comfort.
Flexible Coils: The high-density, 16ch Flex SPEEDER coils conform closer
to the patient’s anatomy, improving signal-to-noise ratio for enhanced
image quality. The light-weight coils are available in medium and large
sizes and are ideally suited for general orthopedic and body imaging.
3T 32ch Head SPEEDER Coil: The 32ch Head SPEEDER coil provides superior
image quality for high-end neuro applications in 3T imaging, such as fMRI
and Diffusion Tensor Imaging, with high signal-to-noise ratio and high
spatial and temporal resolution.
Rapid Transport System (RTS): The light-weight and easy-to-maneuver RTS is
designed for transporting patients to the MRI suite for scanning without
the need for repositioning, improving workflow and throughput. The RTS
docks over the MR system’s couch, so the patient stays on one table during
the entire imaging process, ensuring patient safety.
Healthcare providers can now deliver the safest CT exam possible, as
Toshiba Medical Systems’ most advanced dose reduction technology, Adaptive
Iterative Dose Reduction 3D (AIDR 3D), comes standard on all new Aquilion
CT systems: Aquilion ONE ViSION Edition, Aquilion ONE, Aquilion Premium,
Aquilion PRIME, Aquilion RXL and Aquilion LB.
AIDR 3D is Toshiba’s third-generation iterative dose reconstruction
software that incorporates significant system enhancements by reducing
radiation dose compared to conventional scanning. It helps Toshiba CT
customers achieve the As Low As Reasonably Achievable (ALARA) principle,
while still producing the image quality needed for accurate diagnoses.
Visit Toshiba’s in RSNA Booth #7330, North Hall. For more information,
visit the TAMS website at
"Brilliant Machines" software transforms the patient experience by
reducing wait times and helping hospital staff increase efficiency
GE Healthcare, a unit of General Electric Company (NYSE: GE), unveiled
four software breakthroughs to deliver improved clinical capabilities,
productivity and diagnostic confidence for clinicians.
Up-to-date, reliable and accurate software is critical to quality care for
the patient and usability for the clinician. GE Healthcare recently
announced a $2 billion investment in software development that is focused
on maximizing asset performance, improving hospital operations management,
improving clinical effectiveness and optimizing care across entire
populations. And now, GE Healthcare's Xeleris 3.1, DV24.0, VolumeRAD,
Enterprise Imaging Solutions and iCenter further demonstrated this
In nuclear medicine, one of the greatest challenges clinicians face is
access to the advanced and unique applications required to harness the
power of nuclear medicine examinations. The latest release of GE
Healthcare's Xeleris software enables automation, personalization and
access to these advanced applications.
Nuclear medicine clinicians will gain access to specific image results
where and when they are needed. With its open interface architecture,
Xeleris applications can now be launched through an integrated unified
desktop from the Universal Viewer, as well as using the generic
Application Programming Interface with other PACS vendors, providing
radiologists and nuclear medicine physicians with tools previously only
available on the Xeleris workstation, for enhanced access and
"The personalized workflow and unique new clinical applications will give
clinicians the information they demand with speed, convenience and
flexibility," said Nathan Hermony, general manager for GE Healthcare's
nuclear medicine business.
GE Healthcare MRI's mission is to deliver the best clinical solutions with
great patient experience at the right cost and quality. This year, GE
Healthcare MRI is pleased to announce DV24.0, a unique software platform
featuring innovative applications like Silent Scan.
Additionally, DV24.0, with FOCUS, takes Diffusion Imaging to the next
level with the ability to optimize for image quality and signal to noise.
FOCUS provides high-resolution, organ-specific Diffusion-Weighted Imaging
(DWI) and Diffusion Tensor Imaging (DTI) for a small field of view. MAVRIC
SL, a new technique designed for imaging the joints of patients with MR
conditional implants, is also featured in DV24.0 and is setting new
standards in musculoskeletal radiology.
GE Healthcare's VolumeRAD offers improved detection and management of
patients with lung nodules compared to conventional radiography for
imaging of the chest. As the first thoracic radiographic tomosynthesis
product with a specific indication, this advanced application aims to
improve the detection of lung nodules and the subsequent management of
patients. VolumeRAD is 7.5 times more sensitive than chest X-Ray in
detecting lung nodules 4mm -- 6mm in diameter, and patients benefit from
low dose by receiving only 1.6 times more radiation than a 2 view (PA and
LAT) chest x-ray exam.
GE Healthcare is introducing its expanded suite of Enterprise Imaging
Solutions to help lower IT costs, improve clinician productivity, expand
networks of care and enhance diagnostic confidence. The launch features
Centricity 360 solution that connects unaffiliated clinicians and patients
through a professional online collaboration tool and gives them secure on
demand access to imaging applications. Centricity 360 is the newest
addition to GE's PREDICTIVITY solutions, which harnesses the power of the
Industrial Internet to help industrial organizations achieve zero
unplanned downtime and peak productivity. GE Healthcare's Enterprise
Imaging Solutions also include Centricity PACS with Universal Viewer and
Centricity Clinical Archive, recently validated by IHS as the Number One
global vendor neutral archive (VNA).
GE Healthcare's iCenter provides instant access to critical information
such as asset status, location, maintenance history, and use and planning
-- which helps enable data-driven decisions and improved operational
results. Now information is easier to digest with a more dynamic,
customizable and colorful user interface. Improvements mean fewer clicks,
a built-in analytics engine for more visual and intuitive data depiction,
user security enhancements, and integrated guided tours. iCenter is the
platform for future online service applications from GE Healthcare.
Visit GE Healthcare at booth number 4033 in McCormick Place south hall.
Visit here for the Digital press kit: