acknowledges link between delays and patient deaths
In a contentious hearing before Congress, a senior official from the
Department of Veterans Affairsâ watchdog agency acknowledged for the first
time on Wednesday that delays in care had contributed to the deaths of
patients at the departmentâs medical center in Phoenix.
The disclosure by an official from the departmentâs inspector generalâs
office, coming after more than two hours of tough, sometimes confrontational
exchanges with members of the House Veterans Affairs Committee, was a
significant development in what has become a heated dispute over the quality
of care at the Phoenix hospital, where revelations of secret waiting lists
and other schemes to disguise long delays in care turned into a national
The Veterans Affairs medical center in Phoenix, where 1,700 patients were
not placed on the official waiting list for doctorsâ appointments, a report
by the agencyâs inspector general found. Republicans characterized the
acknowledgment as an about-face, and expressed frustration and some anger
that a report on the Phoenix hospital issued by the inspector general last
month contained language widely viewed as playing down concerns about a link
between the medical-care delays and veteransâ deaths.
As the waiting-list scandal began to break in Phoenix this spring â and soon
became a national controversy that led to the ouster of the departmentâs
secretary, Eric Shinseki, and the suspension of the hospitalâs director â
claims were made by whistle-blowers and on Capitol Hill that the deaths of
as many as 40 veterans could be attributed to delays in care.
In its report last month, however, the inspector general said that while it
found that 28 veterans in Phoenix, including six who died, had experienced
âclinically significantâ delays in care, its investigators were unable to
âconclusively assertâ that any deaths had actually been caused by the
That language was added after department officials reviewed an initial draft
â standard practice with such reports. Some congressional Republicans
objected to the late-stage inclusion of the language, arguing that it
appeared to improperly exonerate the department. They also asked whether
senior department officials had pushed to include the language. But
officials from the inspector generalâs office said no such request had been
At Wednesdayâs hearing, the acting Veterans Affairs inspector general,
Richard J. Griffin, stood firmly by the wording of the report. But under
questioning by Representative David Jolly, Republican of Florida, Dr. John
D. Daigh, the assistant inspector general for healthcare inspections,
conceded that medical-care delays in Phoenix had contributed to some patient
Dr. Daigh did not say how many times he believed medical-care delays had
contributed to deaths in Phoenix. In addition to the six veterans who died
after experiencing clinically significant delays, the inspector generalâs
office revealed Wednesday that 293 veterans had died out of 3,409 cases it
reviewed in Phoenix.
Griffin, a former deputy director of the Secret Service, told Jolly that a
careful reader of his report would have understood that delays might have
contributed to deaths. Jolly asserted that Griffin was undercutting âthe
confidence we have in the I.G. by not being able to answer that very simple
question: Did it contribute to the deaths of veterans, yes or no?â
Representative Jeff Miller, Republican of Florida, who is the chairman of
the committee, said, âThe confirmation from I.G. officials today that delays
contributed to the deaths of Phoenix-area veterans, and I.G. officialsâ
admission that they couldnât rule out the possibility that delays caused
deaths, changes the entire bottom line of the I.G.âs Phoenix report.â
Miller added: âAbsent these qualifying statements, the I.G.âs previous
assertions that it could not âconclusively assertâ that delays caused deaths
are completely misleading. Itâs absolutely inexplicable and outrageous that
the I.G.âs Phoenix report failed to clearly make these distinctions.â
Earlier in the hearing, Griffin defended the addition of the disputed
sentence in the final report, saying that changes were common between drafts
of inspector general reports in all departments of the federal government.
He also emphasized that medical conclusions drawn by his office were
overseen by board-certified physicians on his staff, and restated that he
stood by the findings of last monthâs report. To say definitively that some
patients would have lived had they gotten care sooner âwas a bridge too far
for our clinicians,â he said.
Also on Wednesday, the department took a step toward remedying the main
cause of long delays at many medical centers â shortages of doctors, who can
make more at private hospitals â by proposing raising physician and dentist
salaries by $20,000 to $35,000.
Visit the New York Times for the report.
Medical labs make
test results easier for patients to understand
As more patients gain direct access to lab reports and test results,
healthcare providers are offering new tools to help them navigate the maze
of numbers and use the data to better manage their own care.
Individual patients now can see their results on a wide variety of medical
tests including complete blood counts, urinalysis and allergy tests, under a
federal rule that went into effect in April and pre-empted a number of state
laws prohibiting disclosure to individuals. The results must be available on
request within 30 days, no physician's authorization required. Laboratories
have until Oct. 6 to comply.
The 30-day window provides doctors with time to review sensitive or
complicated lab findings and meet with the patient in person to discuss
them. For routine tests, though, more labs and hospitals are sending results
directly to the patient, in some cases on the same day that the doctor
Quest Diagnostics, which provides diagnostic information services to about
30% of U.S. adults a year, launched a new secure patient website, MyQuest by
Care360, when the federal rule went into effect on April 7. Patients can
view their lab results on the site at no charge within 48 to 72 hours in
most states, or get them on a recently enhanced mobile app. Since the April
7 website launch, Quest says it has delivered more than 700,000 lab results
to users, four times the number sent in the prior six months.
Experts say patients with direct access to lab tests can spot worrisome
results that may be overlooked or delayed at doctors' offices. Research
suggests it is fairly common for abnormal test results to slip through the
Rather than showing patients copies of the raw lab reports typically sent to
doctors, Quest now offers graphs and other visual depictions of results for
common markers like cholesterol and blood sugar, putting them in relation to
reference or normal ranges and including links to more detailed information.
A study led by Dr. Brian Zikmund-Fisher and published last month in the
Journal of Medical Internet Research suggested that only 38% of patients
with lower health literacy and numeracy skills could correctly identify when
levels of hemoglobin A1Câthe common measure of blood-sugar control for
diabetesâwere outside the reference range. His team is now designing a
Web-based application to display blood sugar test results in a format that
will be easy to understand when numbers are heading into a danger zone.
Managed-care giant Kaiser Permanente, which owns its own labs and has
operations in eight states and Washington, DC, has since 2008 steadily
increased the types of test results directly available to members on its
KP.org patient portal. In Colorado most test results are released in one or
two days; in California they are released immediately.
Visit the Wall Street Journal for the article.
A blood test for
depression proves the illness is not a matter of will
A new test that identifies particular molecules in the blood could help
doctors diagnose patients with clinical depression, according to a new study
published in the journal Translational Psychiatry. The blood test can
also predict which therapies would be most successful for patients, and lays
the groundwork for one day identifying people who are especially vulnerable
to depression -- even before theyâve gone through a depressive episode.
But perhaps just as important, said lead investigator Eva Redei, Ph.D., is
the potential the test has for taking some of the stigma out of a depression
diagnosis. When depression can be confirmed with a blood test like any other
physical ailment, she said, thereâs less stigma about having the disease and
The most effective way to treat depression is to treat it early, but past
studies show that it takes an average of two to 40 months to diagnose
depression -- if it gets diagnosed at all. Redeiâs depression blood test
could lead to faster and more accurate diagnoses, thereby transforming the
way depression is treated.
If Redeiâs findings are independently replicated and confirmed, then
approved by the Food and Drug Administration, laboratories across the U.S.
could incorporate the test into their battery of routine exams. This is in
contrast to MDDScore, a depression blood test owned by Ridge Diagnostics
that was announced in 2012. Because the test is proprietary to Ridge
Diagnostics, doctors have to submit samples to the companyâs lab in North
Carolina, where the company analyzes the blood and sends back results.
Redei's test, however, "can be done by any clinical laboratory anywhere,
just like a cholesterol test,â Redei explained. âThat is, assuming that we
can go through the FDA approval [process] fast.â
"Being aware of people who are more susceptible to recurring depression
allows us to monitor them more closely,â said David Mohr, Ph.D., co-lead
author of the study in a press release. âThey can consider a maintenance
dose of antidepressants or continued psychotherapy to diminish the severity
of a future episode or prolong the intervals between episodes.â
Redei acknowledged that the next step in research would be to run the tests
on larger samples in order to validate the models and then submit them for
Major depressive disorder affects an estimated 6.7 percent of the U.S.
population and is the leading cause of disability for Americans ages 15 to
44, according to the Anxiety and Depression Association of America. Despite
the research hurdles she still needs to overcome, Redei is confident that
her test can make a positive impact on the millions who struggle with
depression -- not only by making treatment more precise, but by bringing
psychiatry "into the 21st century,â Redei said.
Visit the Huffington Post for the article.
delivers supply chain visibility to hospitals and suppliers
GHX announced GHX Compass, a new online tool to help North American
hospitals and healthcare suppliers gain greater visibility into key
performance indicators (KPIs) for greater supply chain automation, savings
At a time when the healthcare industry is facing tremendous pressure to
lower costs while improving patient care, GHX Compass provides the more than
18,000 provider sites and 10,000 suppliers in the GHX Global Network of
supply chain, finance and clinical professionals with on-demand access to
key metrics such as volumes, contract match percentage, and exception rates
for providers; and volumes, exceptions, and order conversion rates for
suppliers. Visibility into these metrics enables organizations to set supply
chain goals, track organizational progress, and benchmark performance
against âbest in classâ peer organizations.
With the GHX Compass dashboard, customers can track individual results
with year-over-year and period-over-period trending via interactive charts
and graphs. GHX Compass helps customers stay on track and exceed their
performance objectives through default goals applied annually or to a
customerâs fiscal year period, challenging customers to continuous
GHX rigorously evaluated the dashboard metrics and modeled results showing
that the more organizations automate business processes, the greater the
savings that can be achieved. GHX Compass includes a view that shows
potential savings from other GHX solutions for contract, price and item
master management, as well as order cleaning and channel consolidation.
Visibility into your organizationâs operational and financial performance in
areas such as purchase order and invoice growth, contract match, and
exceptions is also included along with aggregated KPIs and contributor data
on a monthly, quarterly, and yearly basis. Savings data is modeled at the
highest level of the organization and then one level below to represent
GHX Compass is multi-browser compliant, certified on IE 8-11, Safari, Chrome
and Firefox with a responsive design to be viewed on tablets and smart
phones and is available now for pilot customers, with general
availability October 1, 2014.
Visit GHX for more information.
Vitamin E intake
critical during 'the first 1,000 days'
Amid conflicting reports about the need for vitamin E and how much is
enough, a new analysis suggests that adequate levels of this essential
micronutrient are especially critical for the very young, the elderly, and
women who are or may become pregnant.
A lifelong proper intake of vitamin E is also important, researchers said,
but often complicated by the fact that this nutrient is one of the most
difficult to obtain through diet alone. It has been estimated that only a
tiny fraction of Americans consume enough dietary vitamin E to meet the
estimated average requirement.
Meanwhile, some critics have raised unnecessary alarms about excessive
vitamin E intake while in fact the diet of most people is insufficient, said
Maret Traber, a professor in the College of Public Health and Human Sciences
at Oregon State University, principal investigator with the Linus Pauling
Institute and national expert on vitamin E.
"Many people believe that vitamin E deficiency never happens," Traber said.
"That isn't true. It happens with an alarming frequency both in the United
States and around the world. But some of the results of inadequate intake
are less obvious, such as its impact on things like nervous system and brain
development, or general resistance to infection."
Some of the best dietary sources of vitamin E â nuts, seeds, spinach, wheat
germ and sunflower oil - don't generally make the highlight list of an
average American diet. One study found that people who are highly motivated
to eat a proper diet consume almost enough vitamin E, but broader surveys
show that 90 percent of men and 96 percent of women don't consume the amount
currently recommended, 15 milligrams per day for adults.
In a review of multiple studies, published in Advances in Nutrition,
Traber outlined some of the recent findings about vitamin E. Among the most
important is the significance of vitamin E during fetal development and in
the first years of life; the correlation between adequate intake and
dementia later in life; and the difficulty of evaluating vitamin E adequacy
through measurement of blood levels alone.
Findings include: Inadequate vitamin E is associated with increased
infection, anemia, stunting of growth and poor outcomes during pregnancy for
both the infant and mother; Overt deficiency, especially in children, can
cause neurological disorders, muscle deterioration, and even cardiomyopathy;
Studies with experimental animals indicate that vitamin E is critically
important to the early development of the nervous system in embryos, in part
because it protects the function of omega-3 fatty acids, especially DHA,
which is important for brain health. The most sensitive organs include the
head, eye and brain.
Traber said she recommends a supplement for all people with at least the
estimated average requirement of vitamin E, but that it's particularly
important for all children through about age two; for women who are
pregnant, nursing or may become pregnant; and for the elderly.
Merck's new tool
in cancer fight
Merck & Co. said on Sept. 4 that the Food and Drug Administration approved
what Merck said was a groundbreaking cancer treatment that it hopes will
cure many patients and generate billions of dollars in revenue. On the same
day, Bristol-Myers Squibb said bunk to that, alleging patent infringement in
a lawsuit in federal court in Delaware, where both global pharmaceutical
giants are registered.
Bristol-Myers, whose version of that type of cancer drug was approved in
Japan in July, hoped the legal move would thwart Merck in the industry race
to sell expensive cancer medicine.
Merck chief executive officer Ken Frazier used his opening remarks in his
Tuesday appearance at the Morgan Stanley Global Healthcare Conference to say
that the first U.S. approval of this type of cancer medicine was vindication
of his 2013 strategy of narrowing the company's focus. That strategy
involved selling what Frazier viewed as noncore divisions, such as consumer
products, and eliminating 16,000 jobs, cuts that are being implemented
"We said that we're going to focus on those areas where we thought we could
lead, and that's what we have been doing in terms of investing in our
internal pipeline and programs like Keytruda," Frazier said, referring to
the brand name given to the anti-PD-1 cancer drug that has the chemical name
The drug is one of the so-called immunotherapy medications that try to
unlock the body's immune system to fight cancer. Merck's FDA approval was
only for patients who have tried other medications to fight a type of
melanoma. It's not a huge group of people. Merck says it hopes to get FDA
approval for use in other cancers but won't say that it hopes doctors
prescribe Keytruda for those other cancers without waiting for the FDA.
Read more at the Philadelphia Inquirer.
Hospital stay ups
risk of multidrug-resistant infection
Each day of hospitalization increases the likelihood of the individual
acquiring a multidrug-resistant infection, says an alarming study. âOur
findings emphasize one of the risks of being in the hospital is acquiring a
multidrug-resistant infection,â said co-author John Bosso from the Medical
University of South Carolina in the US.
For the study, the researchers gathered and analyzed historical data from
949 documented cases of Gram-negative bacterial infection at their academic
medical center in the US. In the first few days of hospitalization, the
percentage of infections associated with Gram-negative bacteria, classified
as multidrug-resistant, was about 20 percent and rose fairly steadily until
four or five days, then jumped dramatically, peaking at over 35 percent at
10 days. Statistical analysis suggested an additional one percent risk per
day of hospitalization.
On any given day, about 1 in 25 hospital patients has at least one
healthcare associated infection and over a third of these infections are
caused by Gram-negative bacteria, many of which are resistant to one or more
classes of antibiotics, the study noted.
Visit the Healthsite for the report.
introduces new Sparkle Disposable Air/Water Syringe tips
Crosstex International has introduced Sparkle Disposable Air/Water Syringe
tips, the latest addition to the companyâs Patientâs Choice treatment
accessories product line.
Sparkle tips stand out among currently available disposable air/water
syringe options because they include a four-part âQuad Coreâ air channel
that keeps water and air flow separate and distinct for specific procedures.
The tips connect directly to all air/water syringe handpieces without the
need for an adapter, so tips can be changed out quickly and easily. The tips
feature a beveled edge on each end; on the patient facing side, the beveled
edge increases comfortâwithout it, the blunt hard plastic tip can be
uncomfortable for patients, potentially even leaving scratches in the oral
The rounded edge, on the side of the tip that gets locked into the unit,
helps prevent O-ring instrument damage. Additionally, the tipsâ rigid
construction assists with cheek retraction.
The tips are available in a series of translucent colors and/or clear,
allowing clinicians to clearly see water flow (and potential blockages) in
the water chamber. And all of the plastic tips are recyclable.
Single-use tips allow staff to completely eliminate any risks associated
with reprocessing reusable metal tips, which have been found to harbor
deposits which canât be seen or removed. And another important advantage of
single-use tips are that since no cleaning is required, clinicians save time
and increase workflow productivity.
Visit Crosstex for more information.