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April 24, 2015   Download print version

Once cash cows, university hospitals now source of worry for schools

Proper diet might cut the risk of developing Alzheimer’s

Doctors take sides on USPSTF recommendation

Scientists to share real-time genetic data on deadly MERS, Ebola

More than 26,000 have been infected with Ebola: WHO

Recall: LuSys Laboratories, Inc., Ebola Virus One-Step Test Kits

Could maple syrup help cut use of antibiotics?

3M new Tegaderm CHG I.V. Port Dressing


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May 2015

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Once cash cows, university hospitals now source of worry for schools

Teaching hospitals have long been points of pride for major universities, and in recent years revenue from medical services has served as a lifeline for some schools that have struggled with falling state aid and pressure to slow tuition increases.

Now the marriages between universities and their cash-cow clinical operations are starting to fray as changes stemming from the 2010 healthcare law threaten to make university hospitals less profitable.

Some schools are keeping a closer eye on their hospital operations to weather the coming storm, but others, including Vanderbilt University and Emory University, are distancing themselves from their medical centers and returning to their teaching roots.

University-affiliated hospitals tend to charge more for their services than so-called community hospitals because they are also funding research and instruction and handling particularly complex cases. That makes them less attractive to the exchange-based insurance networks created under the Affordable Care Act. Another factor raising costs: Most university hospitals are in urban areas and treat a high share of patients who are uninsured or covered by Medicaid.

Hospital—and therefore university—administrators have also been spooked by impending cuts to “disproportionate share” hospitals, which treat indigent patients, and uncertainty over how states will continue to fund Medicaid payments.

Academic medical centers have historically run operating margins of 3% to 5%, but McKinsey predicted in a 2013 report that those margins could drop by four to five percentage points by 2019, pushing some into the red.

Officials from those schools acknowledged the volatility ahead and said they were comfortable with their hospital operations but monitoring the changing landscape.

Moody’s raised its outlook on the University of Arizona to stable from negative last month after that school’s struggling hospitals, clinics and insurance company were acquired by nonprofit Banner Health.

The U.S. has about 120 academic health centers, composed of teaching hospitals with close ties to medical schools. Major teaching hospitals make up about 5% of all hospitals, but account for nearly a quarter of clinical care based on total hospital revenue, according to the Association of American Medical Colleges.

Some of the largest are now getting a checkup. Vanderbilt, a private university in Nashville, TN, said in November it was spinning off its medical center, which narrowly avoided a fiscal 2014 loss thanks to steep cost cuts. The two will still be affiliated, but the university will shed its significant exposure to the struggling hospital: about $3 billion of the $4 billion the school forecasts in fiscal 2015 revenue is related to its healthcare arm. The hospital, meanwhile, will gain flexibility to raise more debt because it won’t be limited by the university’s plan to maintain an Aa2 credit rating.

A similar deal was struck by Emory, which gets $2.5 billion, or more than 61% of total revenue, from clinical operations, up from 47.4% a decade ago. The Atlanta university said in February that it is in talks to spin off its Emory Healthcare arm, which consists of six hospitals plus outpatient clinics, in a partnership with nonprofit WellStar Health System.

Still, other schools are taking the opposite tack, hoping that pulling their hospitals closer can unearth cost savings and better align clinical operations with research and teaching needs.

Loma Linda University, a health-sciences institution in Southern California, in coming months is set to announce a single governance structure for its schools, hospital system and physician practices.

That will mean a radical change in its financial statements. Net patient revenue for fiscal 2014 at Loma Linda University Medical Center was $1.08 billion, dwarfing university revenue of $304 million.

“Every time the environment becomes unstable, universities that own their systems are trying to sell them and universities that don’t are trying to buy them,” said Daniel Jones, chancellor at the University of Mississippi, a state school. “Everybody’s unhappy with their circumstances.” Jones had argued against spinning off the institution’s medical center in Jackson, saying that a singular focus on financial returns would hurt the public mission of the state’s only comprehensive trauma center. Instead, he has expanded patient volume and maintained a large referral base by teaming up with community hospitals. The medical center brought in more than 40% of operating revenue for Mississippi’s eight-school higher-education system last year, up from 27% a decade earlier.

Ohio State University, which gets nearly half its system operating revenue from healthcare, initiated a plan last year to improve margins and save $100 million by pursuing more competitive pricing for supplies and services and taking a more conservative approach to hiring. Visit the Wall Street Journal for the story.



Proper diet might cut the risk of developing Alzheimer’s

Researchers successfully tested a special diet they designed that appears to reduce the risk for developing Alzheimer’s disease.

The study compared the so-called MIND diet with the popular, heart-healthy Mediterranean diet and the DASH diet, which is intended to help control high blood pressure. The MIND diet borrows significantly from the other two, and all are largely plant-based and low in high-fat foods. But the MIND diet places particular emphasis on eating “brain-healthy” foods such as green leafy vegetables and berries, among other recommendations.

The study, conducted by researchers at Rush University Medical Center in Chicago, found strict adherence to any of the three diets lessened the chances of getting Alzheimer’s. But only the MIND diet seemed to help counter the disease even when people followed only some of the diet’s recommendations. The research was observational, not randomized or controlled, and therefore isn’t evidence the MIND diet caused a reduced risk for Alzheimer’s. Instead, the research shows there is an association between the two.

The MIND diet combines elements of the heart-healthy Mediterranean diet and the DASH diet, which aims to reduce high blood pressure. The MIND diet also includes ‘brain-healthy’ foods such as lots of green leafy vegetables, blueberries and nuts. A study found adhering strictly to any of the three diets lowered the risk for Alzheimer’s disease. But only the MIND diet had significant benefits even with moderate adherence.

The study is part of a small body of research investigating how nutrition can improve brain health and stave off the cognitive decline and memory impairment that comes with Alzheimer’s disease and other forms of dementia. Experts say there is growing awareness that lifestyle factors—not just genetics—play a prominent role in the development of Alzheimer’s, and researchers hope to come up with an optimal diet that will lessen the chances of developing the disease. An estimated 5.1 million people in the U.S. have Alzheimer’s, a number expected to grow to 7.1 million by 2025, according to the Alzheimer’s Association.

“It’s a relatively new field compared with heart disease and diabetes and nutrition,” said Martha Clare Morris, a professor of neurological epidemiology at Rush. “As we learn more and more I think we would definitely modify or update the [MIND] diet based on the latest research,” said Dr. Morris, who was first author of the study, published recently in the journal Alzheimer’s & Dementia.

The MIND diet, which took two years to develop, stands for Mediterranean-DASH Intervention for Neurodegenerative Delay. Researchers modified the Mediterranean and DASH diets based on evidence from animal and human studies looking at nutrition and the brain. DASH stands for Dietary Approaches to Stop Hypertension.

The study involved 923 participants who didn’t have dementia at the start of the research. Their ages ranged from 58 to 98, with a median age of 81. Participants, who were followed on average for 4.5 years, were questioned annually on how often they ate from among 144 different food items. Subjects whose diet choices adhered closely to the MIND diet had a 53% reduced risk for developing Alzheimer’s. Risk was reduced by 54% with the Mediterranean diet and 39% with the DASH diet.

Significantly, even moderate adherence to the MIND diet helped lessen the risk for Alzheimer’s, by 35%. By comparison, moderate adherence to the Mediterranean or DASH diets didn’t affect the chances of getting the disease. Visit the Daily Times for the study.



Doctors take sides on USPSTF recommendation

In reaffirming its position on breast cancer screening, the United States Preventive Services Task Force (USPSTF) received mixed but mostly unfavorable reviews from a small sample of practicing physicians responding to a MedPage Today request.

Representing radiologists, primary care physicians, and obstetrician/gynecologists, the respondents focused on the same two issues that have kept the USPSTF recommendation at the center of controversy: routine screening starting at age 50 and biennial screening, irrespective of age. Some comments credited the task force with trying to make the best of a difficult job.

"Though the USPSTF report text skillfully addresses the complexities in assessing whether there is a true benefit to breast cancer screening, communicating these benefits to women and their physicians is a fraught process," said Kenneth D. Mandl, MD, of Boston Children's Hospital and Harvard. "In general, women have been advised to undergo mammography and to believe that it is purely beneficial. Sometimes pamphlets with selected misleading statistics support the advice. The data on harms, however, are clear and rarely communicated."

In contrast, other respondents went on the attack from the beginning and never let up. Radiologist Daniel Kopans, MD, a long-time vocal advocate for breast cancer screening, took issue with virtually the entire 50-page document, providing comments too extensive to include in a single news story. A sampling of his reaction:

Biennial screening starting at age 50 -- "a specious and cynical suggestion. The USPSTF suggests that women should decide for themselves, but since [the USPSTF] ratings determine insurance, they have taken away the decision for women ages 40 to 49, and women ages 50 to 74 will only have screening coverage every 2 years. The panel based their recommendations on a subjective value judgment."

Most of the benefits of screening are limited to women 50 to 74 -- "The USPSTF appears to be unaware that more than 40% of the years of life lost to breast cancer are among women diagnosed in their 40s."

Benefits versus harms -- "The panel is misleading women and the public in suggesting that there is any major 'overdiagnosis' of invasive breast cancers ... . "The inexperienced panel is perpetuating misinformation that has been shown to be based on flawed analyses, but the panel is clearly unaware of the facts. There is little if any 'overdiagnosis' of invasive cancers."

Kopans, senior radiologist in breast imaging at Massachusetts General Hospital in Boston, cited the makeup of the USPSTF as the principal source for the flaws he found in the draft recommendation.

"None of the members of the 2014 to 2015 United States Preventive Services Task Force panel had any expertise in breast cancer care, and no one on the panel had any expertise in breast cancer screening," said Kopans. "The lack of knowledge and lack of experience on the panel are evident in the numerous errors found in almost every paragraph of this summary document."

The 2015 recommendation does recognize the potential benefit of individualized screening for high-risk women, "a welcome change from the 2009 guidelines," said Davide Bova, MD, medical director of diagnostic radiology at Loyola University Medical Center in Chicago. However, Bova took issue with the core recommendations: biennial screening ("greater risk of advanced-stage disease at diagnosis), lack of benefit for routine mammography in women younger than 50, and lack of support for women older than 74. In his practice, radiologists follow recommendations supported by the American Cancer Society and American College of Radiology.

Family physician B. Lewis Barnett Jr., MD, of the University of Virginia in Charlottesville, offered support for the USPSTF process, but noted how primary care and radiology often are at odds about how to advise patients regarding breast cancer screening. "Our family medicine department closely pays attention to the USPSTF recommendations on all evidence summary issues, so we've basically been following these recommendations on all evidence summary issues," said Barnett.

The concept of "pseudo-disease," the diagnosis and treatment of benign or inconsequential breast disease, is difficult for patients -- and many physicians -- to grasp. Visit MedPage Today for the report.



Scientists to share real-time genetic data on deadly MERS, Ebola

Genetic sequence data on two of the deadliest yet most poorly understood viruses are to be made available to researchers worldwide in real time as scientists seek to speed up understanding of Ebola and MERS infections.

The project, led by British scientists with West African and Saudi Arabian collaboration, hopes to encourage laboratories around the world to use the live data -- updated as new cases emerge -- to find new ways to diagnose and treat the killer diseases, and ideally, ultimately, prevent them.

"The collective expertise of the world's infectious disease experts is more powerful than any single lab, and the best way of tapping into to make data freely available as soon as possible," said Jeremy Farrar, director of the Wellcome Trust global health charity which is funding the work.

The gene sequences, already available for MERS cases and soon to come in the case of Ebola, will be posted on the website for anyone to see, access and use.

Middle East Respiratory Syndrome (MERS) is a viral disease which first emerged in humans in 2012 and has been spreading in Saudi Arabia and neighboring countries since then. It is caused by a coronavirus and has already killed more than 430 people.

An unprecedented epidemic of Ebola virus in West Africa has killed more than 10,000 people in the past year and infected more than 25,000 mainly in Guinea, Sierra Leone and Liberia.

Despite the many deaths caused by Ebola and MERS, researchers still know relatively little about the viruses -- including what animals might be acting as "viral reservoirs" -- and scientists are battling to develop safe and effective cures or vaccines against them.

Paul Kellam, a professor at Britain's Sanger Institute, said mapping the gene structure, or sequencing the genome, of a virus can tell scientists a lot about how it is spreading and changing, and help in the search for better ways to diagnose, treat and prevent infections.

Yet while this kind of data is invaluable to researchers, it is rarely shared swiftly or freely enough among them. Saudi Arabia was widely criticized at the start of the MERS outbreak for being slow to cooperate with experts around the world wanting to conduct crucial research on the disease.

Kellam said Saudi authorities are now committed to sharing viral data widely and immediately, keen to enlist the help of international scientists in controlling MERS. Visit Reuters for the story.



More than 26,000 have been infected with Ebola: WHO

More than 26,000 people have been infected with Ebola since the outbreak began and more than 10,800 have died, the World Health Organization said Wednesday. The UN health body also warned that the decline in confirmed cases appeared to have stagnated, urging increased efforts to stop transmission of the deadly virus.

In all, 26,079 people have contracted the disease over the past 16 months, and 10,823 of them have died, almost all of them in Guinea, Liberia and Sierra Leone.

After tearing through the three countries like wildfire, the spread of the virus has slowed to a crawl. In the week leading to April 19, 33 new confirmed cases were reported, with 21 in Guinea, 12 in Sierra Leone and none in Liberia. That compares to 37 new confirmed cases the week before, and 30 the week before that.

"The decline in confirmed cases of Ebola virus disease has halted over the last three weeks," the WHO said in its latest report. "To accelerate the decline towards zero cases will require stronger community engagement, improved contact tracing and earlier case identification," it said.

On the bright side, Liberia, once the hardest hit country, has reported no new cases of Ebola since the last confirmed case died on March 27 and was buried a day later.

If no new cases emerge, Liberia should be declared Ebola-free on May 9, 42 days, or two incubation periods, after the burial of the last confirmed victim.

The situation was more mixed in Guinea. The 21 new confirmed cases there marked a decrease from 28 a week earlier, and only one new confirmed case was reported in the capital Conakry, down from six the week before. But of 11 confirmed Ebola deaths during the week leading to Sunday, six died in their communities with the diagnosis only made post-mortem.

And for three consecutive weeks, fewer than half of new cases have come from lists of people known to have been in contact with Ebola patients, meaning health authorities still lack a full overview of transmission chains.

Perhaps most worrying: last week Guinea reported 163 unsafe burials of victims of the highly contagious disease, up from 72 a week earlier.

The WHO however said the sharp increase was likely due to more reporting of such burials amid increased vigilance.

Community resistance to efforts to halt the outbreak also continue to be a problem in Guinea, where 11 people were sentenced Wednesday to life in prison for murdering eight Ebola workers last September. Visit Yahoo for the report.



Recall: LuSys Laboratories, Inc., Ebola Virus One-Step Test Kits

A recall has been issued for the LuSys Laboratories, Inc., Ebola Virus One-Step Test Kits because the FDA has not cleared or approved the kits for use or sale. The results obtained from these test kits have not demonstrated to be accurate and should not be used as in vitro diagnostic tests for Ebola infection. A false positive result may be life-threatening by potentially placing the patient in an isolation cohort with Ebola infected patients. A false negative test result may be life-threatening by causing a lack or delay in treatment of the patient and risking infecting healthcare providers, family and other close contacts. 

Visit here for the recall notice.



Could maple syrup help cut use of antibiotics?

A concentrated extract of maple syrup makes disease-causing bacteria more susceptible to antibiotics, according to laboratory experiments by researchers at McGill University.

The findings, which will be published in the journal Applied and Environmental Microbiology, suggest that combining maple syrup extract with common antibiotics could increase the microbes’ susceptibility, leading to lower antibiotic usage. Overuse of antibiotics fuels the emergence of drug-resistant bacteria, which has become a major public-health concern worldwide.

Prof. Nathalie Tufenkji’s research team in McGill’s Department of Chemical Engineering prepared a concentrated extract of maple syrup that consists mainly of phenolic compounds. Maple syrup, made by concentrating the sap from North American maple trees, is a rich source of phenolic compounds.

The researchers tested the extract’s effect in the laboratory on infection-causing strains of certain bacteria, including E. coli and Proteus mirabilis (a common cause of urinary tract infection). By itself, the extract was mildly effective in combating bacteria. But the maple syrup extract was particularly effective when applied in combination with antibiotics. The extract also acted synergistically with antibiotics in destroying resistant communities of bacteria known as biofilms, which are common in difficult-to-treat infections, such as catheter-associated urinary tract infections.

The scientists also found that the extract affects the gene expression of the bacteria, by repressing a number of genes linked with antibiotic resistance and virulence. Visit McGill for the study.



3M new Tegaderm CHG I.V. Port Dressing

3M Critical and Chronic Care Solutions announces the launch of its new 3M Tegaderm CHG Chlorhexidine Gluconate I.V. Port Dressing, designed for patients with implanted port devices under their skin and connected to a catheter for the purpose of central venous infusions.

The new offering combines, for the first time, a transparent, port-site dressing with a separate, compatible antimicrobial CHG gel pad device that’s also clear and designed specifically for ports. This allows for continuous, unobstructed observation of the I.V. insertion site, even in the presence of saline, blood and exudates.

In addition, an adhesive-free window on the dressing ensures that it doesn’t stick to the needle or patient during dressing removal. And the CHG gel pad not only provides immediate and continuous antimicrobial protection, but it is designed to conform around the needle at the insertion site.  Because the cover dressing and CHG gel pad accommodate a variety of non-coring Huber needles, only one size is needed, making it a versatile option. Both the dressing and pad flex with patient movement and can be worn for up to seven days.

A version of the product containing the dressing but not the CHG gel pad device will be made available later this summer. Visit 3M for more information.