NEW YORK, May 24 (Reuters) - A long-awaited report on workplace wellness programs, which has still not been publicly released, delivers a blow to the increasingly popular efforts, Reuters has learned, casting doubt on a pillar of the Affordable Care Act and a favorite of the business community.

According to a report by researchers at the RAND Corp, programs that try to get employees to become healthier and reduce medical costs have only a modest effect. Those findings run contrary to claims by the mostly small firms that sell workplace wellness to companies ranging from corporate titans to mom-and-pop operations.

RAND delivered the congressionally mandated analysis to the U.S. Department of Labor and the Department of Health and Human Services last fall.

The report found, for instance, that people who participate in such programs lose an average of only one pound a year for three years.

In addition, participation "was not associated with significant reductions in total cholesterol level." And while there is some evidence that smoking-cessation programs work, they do so only "in the short term."

Most large U.S. employers believe the programs improve workers' health and reduce or at least keep the lid on medical spending. "Companies from the CEO on down feel that these programs are bringing value," said Maria Ghazal, a vice president at the Business Roundtable, the association of chief executives of big companies. "The criticism is surprising, because companies are not hearing that internally."

Some experts not involved with the new report say even the modest benefits RAND found need qualification.

"The strongest predictor of whether someone will lose weight or stop smoking is how motivated they are," said Al Lewis, founder and president of the Disease Management Purchasing Consortium International, which helps self-insured employers and state programs reduce healthcare costs. "Since the programs are usually voluntary, the most motivated employees sign up. That makes it impossible to credit the programs with success in smoking cessation or weight loss rather than the employees' motivation."

For its report, RAND collected information about wellness programs from about 600 businesses with at least 50 employees and analyzed medical claims collected by the Care Continuum Alliance, a trade association for the health and wellness industry.

Industry experts noted that whenever researchers analyze hundreds of programs, there are inevitably more effective and less effective ones.

"Traditional workplace wellness barely scratches the surface," said Keith Lemer, president of WellNet, which provides programs to Cumulus Media, Viking Range Corp and the Charlie Palmer Group of restaurants, among others. "Done right, (the program) requires the integration of clinical data, wellness, health coaching, and work flow." The initiatives succeed if they have "senior level support and a high-degree of employee engagement in healthy behaviors," he said.

SAVINGS OF $2.38 A MONTH

The report's conclusions about the financial benefits of workplace wellness programs are also grim. In theory, the programs should reduce medical spending as employees become healthier and thereby avoid expensive conditions such as heart disease, cancer and stroke.

In fact, workers who participated in a wellness program had healthcare costs averaging $2.38 less per month than non-participants in the first year of the program and $3.46 less in the fifth year. Those modest savings were not statistically significant, meaning they could have been due to chance and not to the program.

More surprisingly, workplace wellness did not catch warning signs of disease or improve health enough to prevent emergencies. "We do not detect statistically significant decreases in cost and use of emergency department and hospital care" as a result of the programs, RAND found.

The RAND report was mandated by the Affordable Care Act, the healthcare reform law known as Obamacare. Two sources close to the report expected it to be released publicly this past winter. Reuters read the report when it was briefly posted online by RAND on Friday before being taken down because the federal agencies were not ready to release it, said a third source with knowledge of the analysis.

FROM SUBISIDY TO PENALTY

Starting next year, the healthcare reform law allows employers to reward employees who participate in workplace wellness programs with subsidies equal to 30 percent of the cost of insurance premiums, or about $1,620 annually per worker.

If wellness programs do not reduce healthcare spending, some employees could suffer financially. If an employer is subsidizing employees who use its program but is not reaping lower healthcare costs, it has three choices. It can absorb the costs, perhaps figuring it helps recruit or retain valued employees. It can raise healthcare premiums across the board. Or it can raise costs only to workers who do not participate, through higher deductibles or premiums, by at least that $1,620.

Cost-shifting seems especially unfair if wellness programs don't deliver medically or financially, said senior counsel Dania Palanker of the National Women's Law Center, which generally supports the programs: "We've seen plans that appear to cost-shift, with wellness programs rolled out at the same time that premiums or deductibles are increased."

$6 BILLION INDUSTRY

Workplace wellness is a $6 billion industry in the United States, with an estimated 500 vendors now selling the programs. Fifty-one percent of employers with 50 or more workers offer one, the RAND report found. Medium-to-large companies now spend an average of $521 per employee per year on wellness incentives (gift cards for losing weight, for instance), double the $260 in 2009, according to a survey by Fidelity Investments and the National Business Group on Health released in February.

For many employers, wellness programs are a recruiting and retention tool, attracting the health-conscious employees they prefer. The programs also promise to control an employer's healthcare spending. By getting workers to stop smoking they should reduce expensive emphysema treatments, for instance, and by nudging workers to get annual physicals they are expected to help companies avoid such financial black holes as cancer treatment and stroke rehabilitation.

Although the RAND report's conclusions seem counterintuitive - how can wellness programs not improve health? - other recent studies agree.

This year researchers at the University of California conducted an analysis of dozens of existing studies of workplace wellness programs at the behest of the California state senate. Based on gold-standard studies, similar to those that evaluate a new drug, participating in work-based wellness programs does not lower blood pressure, blood sugar or cholesterol and rarely leads to weight loss, said Janet Coffman, a health policy expert at the University of California, San Francisco, Institute for Health Policy Studies.

"Even in studies that found statistically significant weight loss, it was not always sustained," she said.

Similarly, after years in which vendors and others claimed that the programs return $3, $9 and more for every $1 invested, rigorous studies have found the opposite, also providing support for the RAND findings.

Earlier this year, economist Gautam Gowrisankaran of the University of Arizona and colleagues found that employees who participated in the wellness program at BJC Healthcare, a St. Louis, Missouri-based hospital system, had fewer hospitalizations for illnesses such as heart disease and diabetes. But their overall spending did not decrease, the researchers reported in the journal Health Affairs.

The main reasons, said Gowrisankaran, were that employees who fill out company surveys assessing their health risks ("what is your blood pressure?") or get health screenings at company-sponsored health fairs ("you better see a doctor about that") led to more office visits and medication use. In-patient costs fell $22 per employee per month, on average, but other costs rose $19. The program cost $500,000 per year.

"The wellness program just didn't save money," Gowrisankaran said.

To understand how that can be, experts offer the example of what happens when a workplace wellness program identifies hypertension (by requiring participants to get a physical) in someone who never suspected she had it. That might keep her from having a stroke in 20 years, but in the meantime it leads to physician visits and drugs to manage a condition that had gone untreated - and that therefore had previously cost the company or its insurer nothing, explained Vik Khanna, a benefits consultant in St. Louis.

Employers told RAND they were "overwhelmingly" confident that workplace wellness reduces medical costs. Yet only 44 percent have actually evaluated their efforts, and only 2 percent had precise savings estimates. Most leave those calculations to companies that sell them the programs, or to consultants, opening the door to creative accounting, say skeptics.

Tom Emerick, president of Emerick Consulting and former vice president of global benefits at Walmart, is one of them: "Many of the vendors reporting savings are making it up."

Ghazal of the Business Roundtable acknowledged that calculating savings from wellness programs is tricky: "Sometimes the benefits are way down the road, when the person is not at that employer anymore."

On the bright side, the RAND report says healthcare costs and use of expensive medical services rose more slowly for program participants than nonparticipants. That offers hope "that a reduction in direct medical costs would materialize if employees continued to participate."

Chronic illnesses account for over 70% of all health care costs today – diseases like diabetes, heart failure, cancer, chronic lung disease and others. The best way to care for these chronic illnesses is with a good primary care physician and a multidisciplinary team approach. This is not the typical way our medical care delivery system is organized. We tend to have a system that relies on a single provider treating an illness – the internist gives an antibiotic for pneumonia and the surgeon cuts out the diseased gall bladder. But patients with chronic illnesses often need multiple providers. For example, the diabetic may need, in addition to a primary care physician, an endocrinologist, an exercise physiologist, a nutritionist, an ophthalmologist, a vascular surgeon, a nephrologist, etc. But this team needs a coordinator or quarterback and this is preferably the primary care physician. Good care coordination can direct the patient to the care he or she needs while reducing the number of unnecessary specialist visits, procedures, tests and imaging — with the result that the quality of care goes up and the cost of care goes down substantially.

The multi-disciplinary team care approach is new for most providers and the way our healthcare system is organized, it is difficult to arrange. Worse, the primary care physician is always short of time – time to listen, time to think, time to give really intense preventive care and time to coordinate the care of those with chronic illnesses. Time is the missing ingredient to optimum care.

This lack of time results in less than adequate care, less than adequate prevention and skyrocketing costs. Simply providing the PCP with sufficient time (i.e., the need to see fewer patients per day in return for the same total income) would vastly improve care and reduce overall costs.

Chronic illnesses not only last a lifetime and are difficult of manage but are also the diseases that are driving the high cost of care. These costs can be brought down and can be brought down quite substantially through a better approach to patient care, one that gives major attention to disease prevention and intensively coordinates the multidisciplinary team approach to care for those with chronic illnesses. But for this to happen, PCPs need more time with these patients.

Stephen C Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center. He is the author of The Future of Health Care Delivery- Why It Must Change and How It Will Affect You from which this post is partially adapted.

NEW YORK (Reuters Health) - Back pain, migraine and other types of chronic pain without a known physical cause - and therefore little prospect for relief - were associated with an increased risk of suicide in a new study of U.S. veterans.

But the researchers, who analyzed data on about five million patients in the U.S. Department of Veterans Affairs Healthcare System, found no link between suicide and arthritis, neuropathies or non-migraine headaches.

Dr. Mark Ilgen, the study's lead author, said the findings jibe with what he and his colleagues expected to see based on their own experiences and past research.

"I think we had the expectation that certain conditions - such as migraine and back pain - would be especially problematic when it came to suicide risk," Ilgen, from the VA Ann Arbor Healthcare System in Michigan, told Reuters Health.

That's because of differences in the origins, intensity and treatability of various chronic pain conditions, he said.

For example, there are treatments available for chronic pain brought on by arthritis, which is caused by joint inflammation. But fewer options are available for psychogenic pain - a diagnosis that literally means "originating in the mind" with no known physical cause.

"My sense is that the level of pain that they're seeing in arthritis is not as severe and debilitating as what people are seeing in the back pain group and psychogenic pain," said Dr. David Marks, a psychiatrist and pain medicine physician at the Duke University Medical Center in Durham, North Carolina.

Past research has focused mainly on links between chronic pain and so-called suicidal behaviors, such as suicidal thoughts and attempts, according to the researchers.

For their study, Ilgen and his colleagues write in JAMA Psychiatry that they wanted to look at possible links between specific pain conditions and completed suicides.

They used data on 4,863,036 patients receiving care in the VA health system between October 2004 and September 2005 and then looked to see how many with a chronic pain condition killed themselves between October 2005 and September 2008.

Over two million people were diagnosed with arthritis and about 1.1 million people were diagnosed with back pain, which made those conditions the most common. Only about 18,000 people had psychogenic pain, which made it the least common condition.

About 5,000 people committed suicide over the next three years.

After taking into account the patients' ages, sex and other physical and psychiatric conditions, the researchers found that back pain, migraine and psychogenic pain were the only chronic pain conditions linked to suicide.

Back pain was linked to a 13 percent increased risk of committing suicide, compared to people without chronic pain. Migraines were linked to a 34 percent higher suicide risk and psychogenic pain was linked to a 58 percent increase in risk.

As far as how important these conditions are as risk factors for suicide, Ilgen said they "wouldn't be at the top of the list, but they still matter."

The findings also cannot prove these conditions are what caused the patients to commit suicide.

And Ilgen noted that the findings may not apply outside this specific population.

"I think the results probably generalize reasonably well to middle-aged males in the general population. If you want to apply the results to women, that's a little bit more challenging," he said.

Marks, who was not involved in the new research, said that despite the fact that only a minority of the people with chronic pain actually killed themselves, the study benefits doctors.

"It points out to pain providers that pain is a significant risk factor for suicide that needs to be screened for and taken into account," he said.

SOURCE: http://bit.ly/11fDWOF JAMA Psychiatry, online May 22, 2013.

This is just a simulation from medical education company CaseNetwork but it’s designed to mirror the kind of situations professionals are put in ever day. The idea is to help medical professionals collaborate and communicate with each other and with the patient. The CareCases simulator is designed to improve care coordination to help providers avoid the reimbursement penalties facing hospitals with higher than average readmission rates for chronic conditions like congestive heart failure, pneumonia and myocardial infarction.

CaseNetwork CEO and founder Dr. Jeffrey Levy is a Philadelphia area medical education entrepreneur.

“We are specialists in case-based problems, case-based decision-oriented learning using electronic media, and that really helps engage physicians,” said Levy in a phone interview. He observed that social media, technology advances and mobile devices have created ways to make the medical education experience more immediate.

The platform for mobile devices and computers simulates the readmission experience with patient encounters. It is designed to help different members of a care team understand their role. It evaluates and reports on individual and team readiness with immediate feedback.

Among the competencies it seeks to underline are discharge plans, disease management, medication reconciliation, care transition management and education. Theoretically a hospital administrator can look at a dashboard to evaluate how well  care team members are doing in these areas.

“This is an interdisciplinary team-based approach to medical education covering areas like discharge and transition issues. It is the entire team — not just the physician and not just the residents,” Levy said.

Additionally, the company is developing an education platform for residents as part of a move by the Accreditation Council for Graduate Medical Education in 2002 to require young physicians to demonstrate six core competencies: medical knowledge, patient care, practice-based learning and improvement, interpersonal and communication skills, professionalism and system-based practice. It’s about ensuring that patient care is compassionate, appropriate and effective for treating health problems, demonstrating professional ethics, investigating and evaluating their patient care practices.

The platform is packed with case studies, which are structured as decision-oriented learning modules that are also interactive. Users can watch videos of simulated encounters between healthcare professionals and patient actors and other healthcare professionals to develop and improve their communication skills with constant feedback for decisions made by the user. It also makes use of social media to encourage peer to peer collaboration. Big data is another feature it uses so users and resident administrators can see how they are performing in relation to other residents in the hospital.

The plan is to structure the platform around different practice areas. It expects to begin releasing these modules in July.

The FDA said full clinical information about the patients is still being gathered but it suggested that at least some of the problems were caused by infections and "at least one of these infections appears to be fungal in nature."

The steroid in question is same one - methylprednisolone acetate - that was linked to a meningitis outbreak last year that has killed some 53 people and sickened more than 700.

That outbreak was linked to the Framingham, Massachusetts-based New England Compounding Center. The FDA has since stepped up its oversight of pharmacies that compound drugs tailored to specific patient needs.

The FDA said it will work closely with the Centers for Disease Control and Prevention and the Tennessee Board of Pharmacy to investigate the reports.

"An investigation into the exact source of these adverse events is still ongoing," the FDA said, "but these cases are associated with a potentially contaminated medication."

It was not immediately clear how many patients have taken the drug, which is often given to ease back pain. The drug was distributed by Main Street Family Pharmacy LLC of Newbern, Tennessee, the FDA said.

(Reporting by Toni Clarke in Washington; Editing by Eric Beech)

NEW YORK (Reuters) - Canada's Valeant Pharmaceuticals International is nearing a deal to acquire eye care company Bausch & Lomb Holdings Inc from Warburg Pincus LLC for about $9 billion, a person familiar with the matter said on Friday.

Valeant shares reached their highest level since 2001 on the news and were up 10 percent at C$84.33 in Friday afternoon trading in Toronto.

The move comes after Valeant made an attempt last month to acquire generic drugmaker Actavis Inc in an all-stock deal that would have topped $13 billion, people familiar with the matter previously told Reuters. The talks broke down and Actavis ended up with a deal to buy pharmaceutical company Warner Chilcott Plc.

The person that spoke on Friday requested anonymity because the matter is not public. Valeant could not be immediately reached for comment. Bausch & Lomb and Warburg Pincus declined to comment.

The Wall Street Journal, which earlier reported on the talks, said a deal might come as soon as next week.

Valeant has been on the acquisition trail since its 2010 takeover by Biovail Corp, which assumed the Valeant name. It has been pursuing deals with strong cash flow in high-growth areas where big pharmaceutical companies have little presence, its Chief Executive Michael Pearson said earlier this month.

Bausch & Lomb filed with U.S. regulators for an initial public offering in March. A source had told Reuters that its private equity owner Warburg Pincus had been exploring an outright sale of the company at the same time.

(Reporting by Greg Roumeliotis in New York; Editing by Lisa Von Ahn and Phil Berlowitz)

It’s particularly problematic for individuals with chronic conditions, as a healthcare infographic from Health Literacy Innovations illustrates. These are patients that providers need to pay special attention to if they want to avoid penalties for unnecessary readmissions.

A recent Journal of American Medical Association article drew attention to the problem, according to Reuters. As much as people like to Google medical keywords, a lot of the information on medical association websites such as the American Psychiatric Association is geared to people with high school or college level reading and comprehension. But millions of Americans possess a fourth to sixth grade level. Language barriers can also pose challenges as well as basic literacy. In short — there’s too much jargon.

Some companies are also developing ways to reduce or eliminate medical jargon to improve patient engagement. From a longterm perspective, Florida startup Shadow Health developed a physical exam simulator for nursing school and medical school students which forces users to speak in conversational English. If they don’t, the patient says he doesn’t understand. Other companies such as Seamless Medical Systems,  Mana Health and Health Literacy Innovations are taking different approaches that integrate health literacy with patient engagement.

NEW YORK (Reuters Health) - More babies born via cesarean section grow up to be heavy kids and teens than those delivered vaginally, according to a new study of more than 10,000 UK infants.

Eleven-year-olds delivered by C-section, for example, were 83 percent more likely to be overweight or obese than their vaginally-born peers once other related factors - such as their mother's weight and how long they were breastfed - were taken into account.

The findings are in line with a recent review of nine earlier studies that also found a link between C-sections and childhood obesity (see Reuters Health story of December 12, 2012 here: http://reut.rs/TV6GwC).

With C-sections, "there may be long-term consequences to children that we don't know about," said Dr. Jan Blustein, who led the new study at the New York University School of Medicine.

The rate of C-sections in the U.S. has been rising, leading to concerns about possible complications for mothers and babies. According to the Centers for Disease Control and Prevention, C-sections accounted for almost 1 in 3 births in 2010 - up from 1 in 5 in 1996.

For women, the procedure increases the chance of bowel or bladder injuries as well as future pregnancy complications.

Blustein said the size of the obesity risk for kids is "not great," and shouldn't come into play for women who need a C-section for medical reasons.

But, "a woman who's considering C-section electively should probably know about those risks," she told Reuters Health.

The researchers analyzed data from babies born in Avon, UK in 1991 and 1992 who were followed through age 15. Just over 9 percent of the infants were delivered via C-section.

On average, kids delivered by C-section were born slightly smaller - by less than two ounces - than those who went through vaginal birth.

Starting at six weeks of age, however, C-section babies were consistently heavier than vaginally-born infants at almost all check-ins. That link was especially strong among children born to overweight mothers, Blustein and her colleagues report in the International Journal of Obesity.

Across the whole study group of children, rates of overweight and obesity ranged from 31 percent at age three to 17 percent at ages seven and 15.

Blustein said studies haven't been able to prove whether C-section, itself, is a reason some babies tend to gain more weight.

If it is, she speculates, it might have something to do with C-section babies missing out on important exposures to friendly bacteria during the trip through the birth canal.

"Generally, the early colonization and establishment of the intestine with bacteria seems very important. Yet, much more work is needed before we can explain the mechanisms of the early bacterial colonization," Teresa Ajslev, from the Institute of Preventive Medicine in Frederiksberg, Denmark, told Reuters Health in an email.

For example, there may be a specific type of bacteria that's protective, said Ajslev, a researcher and PhD student who has studied pregnancy-related impacts on childhood weight but wasn't involved in the new report.

Or bacteria imbalances could more generally disrupt intestinal function in a way that promotes obesity.

Either way, if the exact cause could be identified, it might be possible to give C-section babies doses of the missing gut bugs to restore balance.

But it's also possible bacteria have nothing to do with the obesity link to C-section births.

"The other possibilities are (that) these are children that would have been heavier anyway," Blustein said.

"Being heavy as a woman is a risk factor for C-section, so that's the problem with trying to figure out whether this is real or if it's simply a matter of selection," since overweight parents are more likely to have overweight children.

Her study was able to take a mother's weight into account, and did find the link between C-section births and child obesity was "weak" among kids born to normal-weight mothers.

But there could be other unmeasured factors that help explain the overall link between delivery method and a child's weight.

"This certainly is not the last word," Blustein said.

SOURCE: http://bit.ly/16UHXRJ International Journal of Obesity, online May 14, 2013.

GENEVA (Reuters) - The World Health Organization (WHO) said on Friday that it would help Saudi Arabia dig deeper into deadly outbreaks of a new SARS-like virus to draw up advice ahead of the annual haj pilgrimage, which attracts millions of Muslims.

The U.N. agency, which is not currently recommending any restrictions on travel to the kingdom or screening of passengers at airports or entry points, will sent a second team of experts in the coming weeks, WHO director-general Margaret Chan said.

The virus, which can cause coughing, fever and pneumonia, emerged in Saudi Arabia last year and has been found in 33 people there, killing 17. They are among 44 cases and 22 deaths worldwide, according to the WHO, which has called it the Middle East Respiratory Syndrome Coronavirus (MERS-CoV).

"Without that proper risk assessment, we cannot have clarity on the incubation period, on the signs and symptoms of the disease, on the proper clinical management and then, last but not least, on travel advice," Chan told the WHO's annual ministerial meeting in Geneva.

The WHO, which sent a first team to Saudi Arabia this month, will provide a fresh risk assessment ahead of this year's haj, which takes place in October.

"We need to get the facts clear and get the appropriate advice to all your countries where your pilgrims want to go to Mecca. It is something quite urgent," Chan said.

Millions flock to the Muslim holy cities of Mecca and Medina for the haj, although pilgrims come and go all year round.

CENTRED IN MIDDLE EAST

The virus has also been found in Jordan, Qatar, Tunisia, United Arab Emirates, while isolated cases have been exported to France, Britain and Germany by visitors.

Saudi Arabia said on Friday that tighter controls had helped to stamped out a MERS-CoV outbreak in a hospital in the eastern region of al Ahsa, which infected 22 people, killing 10.

"Certain infection control measures were applied because we thought there was some transmission happening in the areas where the patients were clustered. These included the ICU (intensive care unit) and the hemodialysis unit," Saudi Arabia's Deputy Health Minister Ziad Memish told the Geneva talks.

The measures included separating patients or increasing the distance between them, and reduction of direct contact.

Many questions remain about how the new virus spreads and what the vector may be, ranging possibly from animals to surface contamination. Saudi and WHO officials say there has been some contagion between people, but only where contact has been close and prolonged.

Saudi authorities have collected a large number of samples from bats, camels, sheep and cats for testing, Memish said.

Asked about the risk factors for contracting the disease, Memish said: "It seems like being a male is a risk factor, being old is a risk factor; having underlying diseases including diabetes, heart disease and renal failure seem to be putting people at risk."

(Reporting by Stephanie Nebehay; Editing by Kevin Liffey)

NORMAN -- In an effort to help local children process their emotions in the wake of tornadoes on Sunday and Monday, the University of Oklahoma's Center on Child Abuse and Neglect is offering a mental health clinic.

The clinic, a part of OU Health Sciences Center in Oklahoma City, is specifically designed to help children work through difficult emotional trauma associated with a natural disaster. For more information, call 271-8858.

Susan R. Schmidt, associate professor of research at the center, said children and adults often develop immediate emotional or behavioral reactions after traumatic experiences. These reactions often subside over time without needing professional intervention.

"Children whose reactions are impacting their daily life up to six weeks or more after the tornado may benefit from a trauma-focused assessment by a qualified therapist to determine if treatment is needed," Schmidt said.

Parents should watch for these reactions to help determine if professional attention is needed: worry about own safety or the safety of others; sensitivity to loud sounds or other reminders of the tornado; avoiding people, places or other reminders of the tornado or aftermath; physical symptoms like stomachaches or headaches, reduced appetite, bad dreams or sleep problems; strong, overwhelming feelings and/or frequent mood changes; increased activity level, decreased concentration and attention, and changes in school performance; increased irritability, defiance and angry outbursts; changes in activities; return of past behaviors like trouble separating from parents, bedwetting, baby talk or tantrums; and increase in teens' risky behaviors.

Parents can assist their children by focusing on listening, protecting and connecting, Schmidt said. Parents should let children know they are willing to listen and answer questions.

Re-establishing routine, communicating with children about how they are safe and limiting event media exposure can help children feel protected. Connecting children with people such as family, friends, community support organizations or mental health providers, can help.

Schmidt said Oklahoma Trauma-Focused Cognitive-Behavioral Therapy and National Child Traumatic Stress Network websites contain useful information for parents helping children process trauma. Visit the respective websites at oklahomatfcbt.org and nctsn.org.

Schmidt said parents should not neglect their own personal mental health.

Schmidt suggested parents wanting to learn more about adult trauma and effective treatments visit the National Center for Post-Traumatic Stress Disorder website, ptsd.va.gov/

public/pages/survivors_

disaster.asp.

Parents seeking information on qualified adult trauma treatment providers can call the 211 helpline or visit the Oklahoma Department of Mental Health and Substance Abuse Services website at ok.gov/odmhsas. ___

The developers view CytoSorb as having the potential to be an effective treatment against sepsis and prevent multiple organ failure, caused by the overreaction of the immune system in response to infection, referred to as cytokine storm or cytokine cascade.

The device uses porous polymer beads the size of a grain of salt. Here’s how it works. A temporary dialysis catheter would be inserted into a vein, and the filtration system would be connected to the dialysis machine. Blood would be pumped out of the body and through the filter. For each procedure a new filter cartridge would be used. The company maintains that it can reduce the amount of cytokines by at least 50 percent.

Although cytokine are proteins that help stimulate and regulate the immune system, an excessive amount can be harmful and lead to organ failure.

The target patient population is 65 years old and older since they are most vulnerable and have co-morbidities that make them more susceptible to sepsis, particularly pneumonia. About two thirds of sepsis cases are patients in this age range. Although it sees its device as being able to significantly reduce hospitalization costs caused by sepsis, and organ failures, it believes there are many other areas where it could be used sees its filter system as a way to tackle other medical issues such as pancreatitis, liver failure and for surgery.

Having received a CE Mark for its device in Europe in 2011, Cytosorbents  is in expansion mode there — it’s been marketing CytoSorb in Germany, Austria, Switzerland and most recently in the UK. Now it is seeking FDA clearance for the device. CEO Dr. Phillip Chan said it has an approved Investigational Device Examination to do a small sepsis trial in the U.S., and plans to convert that into a pivotal trial IDE. Then it would begin a Premarket Approval trial in 2014 — a move that would cost about $8 million to $12 million and take two to three years. “We are the only ones to have specific approval for a cytokine filter,” in Europe, Chan said.

Prior to starting the Monmouth Junction, New Jersey company, Chan served as the co-founder of Andrew Technologies and commercialized a lipoplasty device called HydroSolve which receive 510(k) clearance from the US Food and Drug Administration in 2010. He also is a former partner at NJTC Venture Fund where he led life science investments for five years. CytoSorbents s one of the fund’s portfolio companies, as is Andrew Technologies.

Last year CytoSorbents received a $3.8 million five year DARPA grant as part of its “Dialysis-Like Therapeutics” program to treat sepsis to remove cytokines and bacterial toxins. A few months later it was awarded a $1 million Phase 2 SBIR Trauma and Burn grant to research how its filter could be used to help burn victims vulnerable to infection.

European medical device companies have also been developing ways to address the cytokine storm that can cause multiple organ failure. Gambro‘s “dialyzer” to filter out cytokines called Nephral and Italian company Bellco’s CPFA devices are intended to counter the inflammation suffered in multiple organ failure.

The cost of treating sepsis was $14.6 billion in 2008, according to the Centers for Disease Control. Several companies are developing approaches to combat sepsis from therapeutics from BioAegis  Therapeutics to preventive measures to flag up vulnerable patients earlier.

A Florida company trying to make the practice of pill splitting safer and easier has raised at least $1 million in its latest round of funding.

According to a Form D filing, Accu-Break Pharmaceuticals Inc. could continue raising up to $1.5 million in equity, debt and other securities. The company’s vice president of business didn’t reply to an email request for comment, but it was noted in the filing that proceeds would be used for general expenses and R&D.

Accu-Break is the developer of technologies that enable oral drug tablets to be subdivided into smaller doses.  Its proprietary technologies involve use of a drug-free break layer inside of tablets.

The company seeks licensing agreements with pharmaceutical companies. Last year, it signed a licensing deal with New Delhi’s Alembic Pharmaceuticals Ltd , which said it would launch five generic drugs over two to three years using the technology.

The FDA generally advises against pill splitting unless it’s specified in a drug’s labeling, because it may result in inaccurate or inconsistent doses. But it’s commonly done in an effort to save money or make them easier to swallow.

[Pill bottle courtesy of flickr user prudencebrown21]

HONG KONG (Reuters) - The H7N9 bird flu virus may be capable of spreading from human to human and can be transmitted not only through direct contact but also through airborne exposure, researchers at the University of Hong Kong have found.

The researchers found in a study, presented at a news briefing on Friday, that three ferrets - the main animal used for research into human influenza - that were placed in close contact with ferrets injected with H7N9 contracted the virus.

One out of three that were kept in different cages became infected through airborne exposure.

The World Health Organization (WHO) has previously said it has no evidence of "sustained human to human transmission" of the virus, which has killed 36 people in China.

The WHO in China did not immediately respond to a request for comment on the study.

"The findings suggest that the possibility of this virus evolving further to form the basis of a future pandemic threat cannot be excluded," said the research team, led by bird flu expert and microbiologist Yi Guan.

The team also found that some infected animals did not develop fever and other clinical signs, indicating that asymptomatic infections among humans are possible. That would make the virus harder to detect and control.

The virus can also infect pigs, but could not be transmitted from pig to pig or from pigs to other animals, the study showed, although the team urged authorities to maintain surveillance to ensure the virus did not mutate into a more serious one.

The findings come just days after the WHO said the H7N9 virus appeared to have been brought under control in China thanks to restrictions at bird markets.

H7N9 has relatively mild clinical signs in ferrets, according to the study. All the animals infected with the virus in the experiments presented symptoms for no more than seven days and all recovered from the disease.

The researchers said that cases where humans died or became extremely ill were triggered by additional causes.

"All the deceased or seriously ill patients, (their illness) are due to other causes," said Dr Maria Zhu Huachen from the research team.

United Nations experts said this week the bird flu outbreak in China had caused some $6.5 billion in losses to the economy.

The H7N9 virus is known to have infected 130 people in mainland China since it emerged in March, but no cases have been detected since early May.

(Editing by Anne Marie Roantree and Ron Popeski)

COPENHAGEN, May 24 (Reuters) - Danish drug maker Novo Nordisk said it could launch obesity treatment liraglutide in the United States by the end of next year and rejected some analysts' doubts over the medicine's commercial potential.

The world's biggest insulin producer is hoping the treatment for severe obesity will help to at least partly offset the delay to its next generation insulin treatment Tresiba after U.S. regulators asked for more tests.

Novo said on Thursday a final stage clinical trial showed patients treated with 3 mg of liraglutide - which is already on sale as a treatment for type-2 diabetes under the brand name Victoza - had an average 8 percent weight loss.

But some analysts on Friday questioned whether the results were strong enough to secure the drug's success.

"The modest efficacy supports our hypothesis that the drug is unlikely to be a significant commercial success," Deutsche Bank analysts said, adding they were also concerned by the high price of the injectable drug.

Liraglutide is expected to cost around $25 per day as a treatment for obesity and could be a lifelong treatment. That compares with about $5 per day for rival Belviq, made by Arena Pharmaceuticals, and Qsymia from Vivus.

Novo Chief Scientific Officer Mads Thomsen told Reuters the higher price was justified because liraglutide was a better product than competitors.

He said the treatment was likely to be launched in the United States - the world's biggest drugs market - at the end of next year or the start of 2015.

Analysts who believe the drug will be a success estimate it could achieve peak annual sales of around $4 billion.

Sydbank's Soren Hansen said the key issue was whether liraglutide would qualify for reimbursement, which is when authorities help patients to pay for the cost of a drug.

"The study shows some good effects ... but whether that is enough to justify reimbursements, I am not sure," he said.

At 1000 GMT, Novo Nordisk shares were up 0.8 percent at 976.5 Danish crowns, compared with a 0.1 percent rise in the STOXX Europe 600 healthcare index.

Two interesting studies have come up over the past month on heart attacks. Scientists have found a temporary condition that can quadruple your chance of having a heart attack. Scientists have found that job stress leads to more heart attacks, but there is a treatment that can reduce job stress-related heart attacks by 50 percent.

Curious? The first study involved almost 4,000 patients, and was conducted at Harvard, with results published in the American Journal of Cardiology. The surprising condition that could lead to a quadrupling of heart attacks was anger. The researchers collected data from patients who were part of a study between 1989 and 1996 to determine what brought on their heart attacks.

A total of 1,484 participants reported having outbursts of anger in the previous year, 110 of whom had those episodes within two hours of the onset of their heart attacks. The researchers found that with each increment of anger intensity, the risk of heart attack in the next two hours rose.

That risk was 1.7 times greater after feeling "moderately angry, so hassled it shows in your voice"; and 2.3 times greater after feeling "very tense, body tense, clenching fists or teeth" and 4.5 times greater after feeling "enraged! lost control, throwing objects, hurting yourself or others."

Why does anger increase heart attacks? Anger induces a fight-or-flight response in the body, releasing chemicals epinephrine and norepinephrine that raise blood pressure, raise our heart rate, constrict blood vessels and promote stickiness in platelets. All these are not good for the cardiovascular system and can lead to a heart attack.

The second study looked at job stress and heart attacks, and found that the magical cure with a 50 percent success in reducing heart attacks from job stress was a healthy lifestyle. The study was published in the Canadian Medical Association Journal. In this study, researchers studied 102,000 men and women, ages 17 to 70, in the United Kingdom, France, Belgium, Sweden and Finland. Over 10 years, the rate of coronary artery disease was 18.4 per 1,000 for people with job stress and 14.7 per 1,000 for those without job stress

The lifestyles measured were smoking, alcohol consumption, exercise, inactivity and obesity. Those with a healthy lifestyle had no risk factors, while people with a moderately unhealthy lifestyle had one risk factor. Two or more risk factors was an unhealthy lifestyle.

What is fascinating is the extraordinary impact of lifestyle on the reduction of heart-attack risk with job stress: When lifestyle and work were factored together, the heart disease rate was 31.2 per 1,000 for people with job stress and an unhealthy lifestyle and decreased to 15 per 1,000 for those with job stress and a healthy lifestyle.

Take-home points? Anger is dangerous for the heart, and escalating expressions of anger _ far from being cathartic _ appear to hurt the body. And if you are at risk for heart disease and have job stress, you can decrease that risk by changing your lifestyle. Both of these studies help quantify the benefits of a holistic approach to your health _ in addition to seeing your doctor, do focus on mind/ body/spirit wellness.

___

(Drs. Kay Judge and Maxine Barish-Wreden are medical directors of Sutter Downtown Integrative Medicine program in Sacramento, Calif. Have a question related to alternative medicine? Email fitness@sacbee.com.)

LOS ANGELES (Reuters) - California unveiled prices on Thursday that consumers will pay for a selection of health plans offered through the state under the Affordable Care Act, providing a glimpse into how health care reform may look as it is rolled out across the nation.

Under the federal health care reform law, Californians who do not get or cannot afford health insurance through their jobs can buy coverage through an exchange, at a group rate negotiated by state regulators.

The cost to a 40-year-old who needs coverage would vary from about $40 to $300 per month for a mid-level plan, depending on the person's income. Some young adults, who are less expensive to cover, could pay nothing, depending on how much they earn.

The prices in California, along with those announced in Washington, Vermont and other states, show that premiums under Obamacare can be more affordable than had previously been thought. Consumer advocates welcomed the new exchange.

"It's a revolutionary improvement to move from a broken market where people are charged by how sick they are, to a competitive market where people pay what they can afford, based on a percentage of their income, on a sliding scale," said Anthony Wright, executive director of advocacy group Health Access.

"Most consumers buying coverage in the individual market will get financial help and see their premiums go down," he said.

The sweeping federal reform law known as Obamacare seeks to extend health insurance to many of the 49 million Americans without it, and alter how care is delivered so as to curb what has been an inexorable rise in healthcare spending.

Congressional Republicans who oppose the law had warned that high premiums would sink Obamacare as the uninsured would not be able to afford coverage even with federal subsidies.

Even the modest rates announced Thursday do not really signal that the program will work, said California Republican Assemblyman Dan Logue.

"This is like a shell game to me," said Logue, co-chair of the assembly health committee, who predicted that taxes would go up to pay for the subsidies, forcing other prices to rise.

"They're not going to tell you that you're going to pay for it in your gas or your food or going to the show," he said.

About a dozen states have set up these exchanges, or large group plans, which are a key element of the massive national health reform effort. Several have already released rates for monthly premiums, and most say the cost will not go up as high as skeptics had feared.

In California, a 40-year-old who makes less than four times the federal poverty level - that is, $95,000 for a family of four or $46,000 for an individual - would pay as little as $40 per month for a mid-level plan in which about 70 percent of medical costs and all preventive care is covered. This excludes additional costs to cover children or a spouse.

The same plan for a person who makes too much to qualify for a subsidy would run about $300 per month on average, the state said. In addition, the total amount consumers would have to pay each year for co-payments and other out of pocket costs would be limited to $6,350 or less, depending on income.

Patients could choose plans that offer lower co-pays if they wished, but would pay higher premiums. In some cases, particularly for low and moderate income workers in their 20s, the premiums are free once a federal subsidy is factored in.

PLAN OPTIONS

The exchange will also offer what it calls platinum plans, in which co-payments are very low or non-existent. These plans would cost $500 for those who do not qualify for subsidies, but as little as $300 per month for low-wage earners.

The biggest subsidies go to people who make less than 150 percent of the federal poverty level, or about $17,000 for a single person.

Peter V. Lee, a longtime health advocate recruited by the state to help set up and run its program, said costs had been expected to skyrocket because the Affordable Care Act requires health plans to offer more benefits and cover more people than they might otherwise have done.

For example, the plans must cover people with or without pre-existing conditions that would make their care more expensive. The actuarial firm Millman had predicted a 30 percent rise in the cost of monthly premiums for individuals in California under the new exchange.

But Lee said that did not happen. While rates without subsidies may be moderately higher for some consumers next year, most will pay less, he said. The rates announced on Thursday must still be approved by state regulators.

Democratic Congressman Henry Waxman, who backed the health reform act, said the program would protect millions from bankruptcy due to medical costs.

"Californians buying coverage on their own will now have access to the same quality coverage that people get through their employers at the same or lower rates," he said.

California's exchange will offer coverage from 13 insurers - down from more than 30 that had applied to participate.

Among them are some of the biggest names, including Anthem Blue Cross, Blue Shield and Kaiser Permanente. Coverage will also be offered by some companies that had previously limited their activity to the Medicare and Medicaid markets.

Paul Markovich, president of Blue Shield of California, which is offering coverage under the plan, said that to keep prices low, doctors and hospitals had lowered some of their rates. Some insurers also agreed to limit profits, Lee said.

The policies vary in their provider networks, but Lee said consumers would have access to about 80 percent of doctors in the state, and some of its premier medical centers.

Consumers will be able to begin signing up on October 1 for plans that will go into effect in January. Next month, the California exchange will reveal plans and prices for insurance that small business owners can purchase for their employees.

(Additional reporting by Caroline Humer and David Morgan; Editing by Cynthia Johnston and Richard Chang)

Aveo's shares were down about 13 percent in extended trade, after closing at $2.70 on the Nasdaq.

Astellas does not intend to fund any future studies of the drug, tivozanib, in renal cell cancer, Aveo said in a regulatory filing on Thursday. (http://r.reuters.com/caz38t)

Earlier this month, an advisory panel to the U.S. Food and Drug Administration decided in a 13-1 vote that an additional trial would be needed before tivozanib could be approved for renal cell cancer.

Staff reviewers for the FDA had previously noted that kidney cancer patients on tivozanib did not survive longer when compared with patients on Bayer AG and Onyx Pharmaceuticals' drug, Nexavar.

Following the advisory panel vote, Aveo and Astellas had said they would work with the FDA to address the issues raised by the panel.

Aveo said in Thursday that it was evaluating the effect of the Astellas decision on tivozanib's clinical and regulatory path going forward.

(Reporting by Pallavi Ail in Bangalore; Edoting by Anthony Kurian)

We often think of heart disease, cancer and stroke as the major causes of death and, as diseases that cause death, which is correct. But what if we go back further and look at what caused those diseases. The rank order of causes of death according to a study from the Centers for Disease Control in the Journal of the American Medical Association lists tobacco, poor nutrition, lack of exercise, alcohol to excess, infections, toxic agents, motor vehicle accidents, sexual behaviors and illicit drug use as the primary predisposing factors to the diseases that cause death. A look at that list shows that the ones at the top of the list and a number of others all relate to our behaviors.

The diseases that cause death have changed substantially over the decades (see “The Burden of Disease and The Changing Task of Medicine”.) At the beginning of the 1900’s it was infectious diseases that caused most deaths. Over time they came under reasonably good control with preventive techniques such as immunizations, sanitary sewer systems and clean water systems and then, of course, antibiotics. Meanwhile chronic illnesses such as coronary artery disease became much more prevalent. [See this graphic] Even though fewer people smoke than a few decades ago our obesity and our lack of exercise have led to rapid increases in diabetes, heart disease, stroke, high blood pressure and many other chronic illnesses that last a lifetime.

What we need in America today is a focus on health care meaning a greater focus on disease prevention and health promotion beginning in childhood and a recognition that our adverse behaviors or lifestyles are the major drivers of today’s chronic illnesses – the ones that will lead to our deaths.

Stephen C Schimpff, MD is an internist, professor of medicine and public policy, former CEO of the University of Maryland Medical Center. He is the author of The Future of Health Care Delivery- Why It Must Change and How It Will Affect You from which this post is partially adapted.

Who will win this year’s MassChallenge? The Boston accelerator is set to get its fourth session underway with the announcement of the 128 new startups that will participate. A quarter of them are life science or health IT companies, and some of them sound particularly promising.

Benevolent Technology for Health, for example, is focused on making an affordable, self-adjustable prosthetic device for the developing world. DS Labs Inc. is developing a discreetly worn breast pump. Sensulin LLC could have a glucose-responsive insulin for type 1/type 2 diabetes patients. And Vecoy Nanomedicines won the pitch contest at FutureMed with its nano-scale “virus traps” to kill infections.

The selected entrepreneurs will get four months of mentorship and office space at MassChallenge’s offices. At the end, they will pitch for $1 million in cash prizes. MassChallenge says it received 1,200 applicants from 40 countries and 30 states. Notably, a handful of the life science companies are from Israel.

Here’s the rest of the list:

• B.B.R. Medical Innovations Inc. (inline IV fluid sterilizer)
• Calista Therapeutics (cystic fibrosis drug)
• CONTINUUS Pharmaceuticals (continuous manufacturing for pharmaceuticals)
• Elegant Therapeutics
• Gentoo (compression vest for infusion pump equipment)
• Gweepi Medical (sensor-embedded adult diaper)
• HackCriticalCare
• Hemova Medical (access port for dialysis)
• Home Analytics
• INRFOOD (“personalized food GPS”)
• Integrative Enzymatics (drugs for metabolic disorders)
• iQuartic Inc. (EHR data mining)
• Keraderm (non-surgical wound healing)
• Little Sparrows Technologies (low-cost phototherapy for jaundice)
• MedAlert (data analysis to prevent prescription errors)
• MobiStine (mobile apps for new parents)
• Mofin Technologies (mobile tools for coordinating care)
• MouseHouse
• MyZooPets
• Neural Analytics (tool to measure intracranial pressure non-invasively)
• Noliva Therapeutics LLC (cancer drugs that block protein-protein interactions)
• QMedic (wearable sensor to monitor seniors)
• Quad Technologies LLC (dissolvable hydrogel for biologics purification and cell separation)
• Thompson SCI
• Veraquel Technologies Inc. (peptide purification)
• Verbal Applications (communication software for patients with speech limitations)
• Volvox Biologic Inc. (glycan detection tool for biologic drug development)
• WaveGuide (hand-held diagnostic tool for tuberculosis)

NEW YORK (Reuters Health) - A web-based decision-making tool that alerts heart doctors when diagnostic tests would not be useful for a specific patient can curb wasteful procedures, according to a new study.

"This educational tool helps doctors determine the best test for any particular patient," said lead author Dr. James Min, director of cardiac imaging research at the Cedars-Sinai Medical Center in Los Angeles.

Imaging tests help detect disease and motivate doctors to focus their care, but expensive diagnostic tests can be a financial drain if overused, experts said.

"Even if you didn't care about money, there are reasons not to be tested unnecessarily, including false positive tests and having something found that is not really relevant," said Dr. Gilbert Welch of The Dartmouth Institute for Health Policy & Clinical Practice in New Hampshire, who was not involved in the current study.

That kind of overtesting and overdiagnosis can also lead physicians to pursue treatments that are unnecessary and potentially dangerous for patients, according to Welch.

Researchers noted that in many cases overtesting comes from a physician's inability to keep up with the constantly changing world of diagnostic tools.

In an effort to reduce the use of unnecessary tests, Min and colleagues created an online questionnaire that helped doctors participating in the study to decide whether a test was appropriate.

Physicians took around two minutes to enter details into a web form, then the program gauged the appropriateness of the test against recommendations from the American College of Cardiology (ACC).

The study ran from mid-2010 to early 2011, and the researchers tracked doctors' decision-making at three large cardiology practices in St. Louis. All the patients involved had private insurance through United HealthCare, which agreed to suspend its usual prior authorization requirements to give the doctors free rein to decide which diagnostic tests to give their patients.

During the study, 100 physicians used the decision-aid for 472 heart patients, who were mostly middle-aged men with existing coronary artery disease.

The researchers focused on three common cardiac imaging tests: MRI, as a method to show heart muscle function; stress echocardiography, an ultrasound view of how the heart works when exercised and CT angiogram, a high-resolution X-ray that reveals blood vessel blockage.

Over an eight-month period, inappropriate tests decreased from 22 percent to 6 percent, according to the researchers. During the same period, studies deemed appropriate by ACC criteria increased from 49 percent to 61 percent, Min's team reports in the Journal of the American College of Cardiology.

Reducing unnecessary tests could save a lot of money for the cash-strapped U.S. healthcare system, experts noted. Two of the three heart tests monitored in the study together cost Medicare over $1 billion in 2008 in physician payments alone.

"It's a good study; it reinforces and replicates what others have shown in the same area of clinical decision support for imaging: it can be done and it works," said Dr. Chris Sistrom, a radiologist and health economist with Partners HealthCare, at the University of Florida.

Sistrom was not involved in the current study, but he found a similar trend when he studied a doctor feedback system at Massachusetts General Hospital. The number of inappropriate CT scans decreased from about 20 percent to around 10 percent within a month.

Welch said he expects hospital systems will adopt more of these real-time feedback systems as doctors increasingly use computers to store clinical information and order tests.

"It becomes very useful to have algorithms help physicians," he told Reuters Health.

But he cautioned that such tools will have to strike a balance between giving doctors useful feedback and becoming another time vacuum for busy physicians.

"The balance is not to nickel and dime and overwhelm the physicians with algorithms in the process of what's already a busy job," Welch said.

Dr. Elliot Fishman, professor of radiology, surgery and oncology at Johns Hopkins Hospital, said he sees potential for wider application of decision support tools integrated right into the electronic forms doctors use to order diagnostic tests for a patient.

They would operate something like the feedback and recommendations that pop up when a customer orders a product on Amazon.com, only the programs would guide doctors towards the most appropriate test, Fishman said.

The ideal is always to be able to talk with other doctors for advice, Fishman told Reuters Health, but when that's not possible, technology can be helpful.

"If I'm the patient, anything the physician can do to help me get the right study as fast as possible is a great thing," he said.

SOURCE: http://bit.ly/ZxVjdo Journal of the American College of Cardiology, May 21, 2013.

SAN FRANCISCO — The Affordable Care Act, aka health care reform, aka Obamacare, is spurring a massive creation of new business opportunities.

So says Bryan Sivak, the chief technical officer and entrepreneur-in-residence at the Department of Health and Human Services, the cabinet-level agency that regulates the $2.8 trillion U.S. health care market. Sivak joined the HealthBeat conference here, which VentureBeat is producing, via a video conference (see photo above).

Just one of the areas that’s becoming fertile ground for entrepreneurial innovation: the health insurance exchanges mandated by the law.

These exchanges bring a level of transparency and openness to the insurance market that hasn’t been easy to find until now, Sivak said. The new exchanges will be large, consumer-facing marketplaces, and the insurance industry hasn’t been exactly nimble about embracing the latest consumer tech trends — so there will be lots of opportunities for startups to bridge the gap.

They’ll increase competition, because people will be able to see and compare insurance plans more easily. Now, any qualified, licensed insurer will have access to a market of potential customers via the exchanges.

Also, he said, the act will bring 30 million to 50 million more people into the ranks of the insured, creating a new pool of customers to market to. And there will be lots of data

“You have no idea what’s possible, and you have no idea what people are going to come up with, so that’s what I’m really looking forward to,” Sivak said.

Apart from the ACA, Sivak also said that government has an important role to play in facilitating health care innovation.

Government can help spur technology in three ways, he said:

• Facilitation: ”Governments at all levels are interested in seeing citizens do great things.” At the federal, state, and local levels, he said, there’s a lot of interest in helping people create new ventures, improve existing health care systems, or create new systems.
• Convening: “We’re really, really good at getting people together,” Sivak said. So if a big problem needs tackling, governments are well-positioned to gather people to talk about it.
• Incentivizing: Governments can be very effective at spurring change through relatively small incentives or through mandates. For example, he said, the adoption of electronic medical records (EMRs) stagnated until it was mandated by the Affordable Care Act in 2012.

“Just think about that: A small government intervention has caused EMR adoption to go from under 15 percent to over 70 percent,” Sivak said.

What’s more, government sits on top of a lot of data. Sivak estimates that HHS has about 1,000 data sets, 400 of which have been catalogued on the agency’s HealthData.gov website. Some of the datasets aren’t free, though HHS is working to bring the costs down. So there’s a long way to go, still.

Sivak, a former entrepreneur who cut his teeth in San Francisco during the dot-com days, says his attitude toward government’s role is a new perspective for him.

“The only time I interacted with government was when I needed to file my incorporation paperwork with the State of California,” Sivak said of his experience in the 1990s — not atypical of many tech entrepreneurs.

But if he’s right, techies — at least those who want to do business in the health care field — would do well to pay a lot more attention to what’s going on in government.

This article originally appeared on VentureBeat

Nurses are the unsung heroes of the hospital who navigate crappy software on outdated hardware to keep you healthy — and it needs to stop.

Executives from Cedar’s-Sinai and Kaiser Permanente explained at VentureBeat’s HealthBeat conference that technology innovators need to start focusing on new, consumer-like user experiences and better end-to-end communications software and hardware. Otherwise, nurses are going to start using their own devices, which creates obvious issues in privacy and data management.

“We’ve done a lot of ethnographic research of our nursing areas. … It’s still amazing when you walk into that environment that there’s still a tremendous amount of inefficiency, redundancy.” said Julie Vilardi, a registered nurse, as well as the executive director of Kaiser Permanente’s clinical informatics and strategic projects. “User experience it’s really critically important. Because of the consumer experience now is pretty slick, when you get into the walls of the hospital [consumer-grade experiences are] beginning to be the expectation, and we so don’t deliver it right now.”

She explained how nurses manage everything having to do with your hospital stay from the medication you’re prescribed, to food you eat, and the baths you take. They typically have four or so patients who may not even be in the same area of the hospital. These nurses often have to tote around workstations on wheels, and clunky communications devices that simply aren’t effective, but because of their ability work in a chaotic environment, they’re making due.

Darren Dworking, the chief information officer for Cedar’s Sinai Medical Center, said the center recently deployed 800 iPhones to its staff. He thought clinicians were going to shy away from using texting for communications, but he was wrong.

“A lot of our clinicians are beginning to use technology in other aspects of their life … they want to know how come they can’t have a healthcare version of that,” said Dworking. “Giving them something akin to a cordless phone isn’t going to do it for communications.”

Vilardi says she hopes to see developers create a consumer-grade iPhone experience for patient management and electronic medical records (EMR). She wants to be able to push an icon to get a patient assessment, and believes we’re very close to that reality. Dworking, however, encourages innovators to look beyond the EMR, which he says the window has closed on. Instead, he hopes that people will find a new way of displaying data and improving communications.

According to Vilardi, iOS phones and tablets really are the devices of choice in hospitals today. This is because vendors in general are taking more advantage of iOS than Android. She explained that Kaiser is looking for ways to integrate Android, however.

Nurses, speak up! We want to hear from you about your experiences with workstations on wheels, apps, and more. Send us an email at tips@venturebeat.com or e-mail me directly at meghan@venturebeat.com.

This article originally appeared on VentureBeat

NEW YORK (Reuters Health) - People who had used marijuana in the past month had smaller waists and lower levels of insulin resistance - a diabetes precursor - than those who never tried the drug, in a new study.

The findings, based on surveys and blood tests of about 4,700 U.S. adults, aren't enough to prove marijuana keeps users thin or wards off disease. And among current pot smokers, higher amounts of marijuana use weren't linked to any added health benefits, researchers reported in The American Journal of Medicine.

"These are preliminary findings," said Dr. Murray Mittleman, who worked on the study at Beth Israel Deaconess Medical Center in Boston.

"It looks like there may be some favorable effects on blood sugar control, however a lot more needs to be done to have definitive answers on the risks and potential benefits of marijuana usage."

Although pot smoking is a well-known cause of "the munchies," some previous studies have found marijuana users tend to weigh less than other people, and one suggested they have a lower rate of diabetes. Trials in mice and rats hint that cannabis and cannabinoid receptors may influence metabolism.

The new study used data from a national health survey conducted in 2005-2010. Researchers asked people about drug and alcohol use, as well as other aspects of their health and lifestyle, and measured their insulin and blood sugar levels.

Just under 2,000 participants said they had used marijuana at some point, but not recently. Another 600 or so were current users - meaning they had smoked or otherwise consumed the drug in the past month.

Compared to people who had never used pot, current smokers had smaller waists: 36.9 inches versus 38.3 inches, on average. Current users also had a lower body mass index - a ratio of weight to height - than never-users.

When other health and lifestyle measures were taken into account, recent pot use was linked to 17 percent lower insulin resistance, indicating better blood sugar control, and slightly higher HDL ("good") cholesterol levels.

However, there was no difference in blood pressure or blood fats based on marijuana use, Mittleman's team found.

A CAUSAL LINK?

Mittleman said that in his mind, it's still "preliminary" to say marijuana is likely to be responsible for any diabetes-related health benefits.

"It's possible that people who choose to smoke marijuana have other characteristics that differ (from non-marijuana smokers)," and those characteristics are what ultimately affect blood sugar and waist size, he told Reuters Health.

Dr. Stephen Sidney from the Kaiser Permanente Division of Research in Oakland, California, said he wonders if cigarette smoking may partially explain the association. Marijuana users are also more likely to smoke tobacco, he told Reuters Health.

"People who use tobacco oftentimes tend to be thinner," said Sidney, who has studied marijuana use and weight but didn't participate in the new study. "So I really wonder about that."

Another limitation with this and other studies, Sidney and Mittleman agreed, is that all of the data were collected at the same time, so it's unclear whether marijuana smoking or changes in waist size and blood sugar came first.

"The question is, is the marijuana leading to the lower rate (of diabetes) or do they have something in common?" said Dr. Theodore Friedman, who has studied that issue at Charles R. Drew University of Medicine and Science in Los Angeles.

He and his colleagues think the link is probably causal. "But it's really hard to prove that," Friedman, who also wasn't involved in the new research, told Reuters Health.

One possibility is that the anti-inflammatory properties of marijuana help ward off diabetes, he said. But he agreed that more research is needed to draw out that link.

"I want to make it clear - I'm not advocating marijuana use to prevent diabetes," Friedman said. "It's only an association."

SOURCE: http://bit.ly/10Ty3La The American Journal of Medicine, online May 16, 2013.

AxoGen

The grant will support the development and expansion of nerve regeneration technologies. The program at Vanderbilt Medical School will be led by Dr. Wesley Thayer, an assistant professor at Vanderbilt University’s Department of Plastic Surgery and Curt Deister of AxoGen.

AxoGen has three cleared nerve repair technologies on the market. Its Avance Nerve Graft is used to bridge gaps in peripheral nerves with grafts sourced from human donors. Its Nerve Protector is used to wrap and isolate nerve tissue during healing. Its Nerve Connector is used to approximate nerve endings.

In financial year 2013, the orthopedic research program allocated $30 million for grants. In financial year 2011, improving limb  injuries using nerve repair was one of three areas where funding was allocated. It also funded the prevention and treatment of post-traumatic osteoarthritis and the development of a modular, interoperable prosthetic wrist.

The Congressional Directed Medical Research program provided nearly $500 million in financial year 2012 with $30 million allocated for orthopedic research grants.

[Photo from Flickr user Virginia Guard Public Affairs]

Nephosity said it receive 510(k) clearance for use of its app in situations where a clinician doesn’t have access to the traditional means of viewing CT scans, MRIs and X-rays.

A radiologist, for example, who’s on call but steps outside the hospital to get dinner could still make a diagnosis from an image using MobileCT Viewer, said co-founder and CEO Michael Pan, a former product engineer at DreamWorks. Nephosity’s app communicates directly with a hospital’s picture archiving and communication system (PACS) to retrieve images, and it allows the physician to pan and zoom while looking at the images.

Pan said the Nephosity team is now working on tying up any the loose ends on product development before making the diagnostic version of the app available. “We’ve found that if doctors try something and they find one little piece of it they don’t like, they won’t want to use it again,” he said.

Meanwhile, Nephosity’s cloud-based platform, Jack Imaging, is in private beta. This platform allows medical images to be uploaded and stored in the cloud, so that they be shared any time.

If that platform were to be cleared by the FDA and integrated with MobileCT Viewer, doctors could collaborate on a remote diagnosis. That would be a compelling differentiator when looking at other apps that have been cleared for diagnostic viewing, like Calgary Scientific’s ResolutionMD and MIM Software’s Mobile MIM.

The San Francisco-based startup was part of Rock Health’s second class last year.

[Image from Nephosity]