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The Numbers: Hospital Mortality for Four Key Conditions Continues Downward

Hospital mortality rates for heart failure, pneumonia, myocardial infarction, and stroke continue to trend downward, according to data from the U.S. Agency for Healthcare Research and Quality.

Among the findings:

• Between 1994 and 2007, inpatient mortality rates for heart failure dropped by 60%; for pneumonia, 55%; for MI, 47%; and for stroke, 35%.
• The midwestern states had the greatest decreases in mortality for all four conditions.
• Nationally, in 2000 the poorest communities had lower rates of inpatient mortality for heart failure and pneumonia than the richest communities, but by 2007 the groups had switched their relative rankings.

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FDA Rejects Approval of Another Diet Drug, Qnexa

Qnexa, a combination of phentermine and topiramate, has not been granted approval by the FDA, according to a New York Times report. Earlier this month the FDA refused approval for another diet drug, lorcaserin.

According to the report the agency has asked Vivus, Qnexa's developer, "to provide a thorough evaluation of the drug's potential for causing birth defects and heart problems." In a statement on its website, Vivus said that new studies may be required if the FDA's concerns are not addressed by existing data, which it plans to submit by year's end.

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Heavy Smoking in Midlife Linked to Increased Dementia Risk Decades Later

Heavy smoking in midlife is associated with more than a doubling of risk for dementia in older age, according to an Archives of Internal Medicine study.

An ethnically diverse group of some 21,000 adults aged 50 to 60 were interviewed about their smoking habits between 1978 and 1985. Researchers then assessed the participants' medical records from 1994 to 2008 and found that a quarter had developed dementia, Alzheimer disease, or vascular dementia.

In fully adjusted analyses, the risk for dementia rose as the amount of smoking increased. In particular, participants who smoked more than two packs a day in midlife had more than twice the risk for dementia, AD, or vascular dementia two decades later, compared with those who'd never smoked.

Commenting on the potential reason behind the association, the authors write: "It is well recognized that smoking augments oxidative stress and inflammation, which are also believed to be important pathophysiologic mechanisms in AD."

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Guidelines for Preventing Recurrent Stroke Issued

Updated guidelines on preventing recurrent ischemic stroke have been issued by the American Heart Association and the American Stroke Association.

The document, published in Stroke, offers recommendations in a variety of areas, for example, management of risk factors such as smoking and obesity. The use of antithrombotic therapy after an intracranial hemorrhage also receives much attention.

There are several new strong recommendations, based on high levels of evidence. Among them:

• Although the utility of screening patients for metabolic syndrome has not been established, the dyslipidemic and hypertensive features of the syndrome should be singled out for preventive care.
• In addressing glycemic control and hypertension in diabetes, targets in existing U.S. guidelines should be used.

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Dabigatran Approved for Stroke Prevention in Atrial Fibrillation

Dabigatran Approved for Stroke Prevention in Atrial Fibrillation

The FDA has approved the oral anticoagulant dabigatran (Pradaxa) to prevent stroke and blood clots in patients with atrial fibrillation.

Approval follows the RE-LY trial, in which dabigatran was noninferior to warfarin in terms of a combined endpoint of stroke or systemic embolism. There were also fewer hemorrhagic strokes with dabigatran.

"Unlike warfarin, which requires patients to undergo periodic monitoring with blood tests, such monitoring is not necessary for Pradaxa," the director of the FDA's Division of Cardiovascular and Renal Products said in an FDA news release.

The drug, a direct thrombin inhibitor, will come with a medication guide to warn patients of the potential for serious bleeding. Other side effects include gastrointestinal symptoms.

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PS...docs have been waiting for this medication's approval for a long time...if you are on coumadin, you know what I mean...

Botox Approved for Chronic Migraine

Botox Approved for Chronic Migraine

The FDA has approved onabotulinumtoxinA (Botox) for prophylaxis of chronic migraine (more than 14 migraine days monthly).

Treatment involves injections into several areas of the head and neck, about every 12 weeks. Botox was already frequently used off-label for migraine.

In studies, Botox recipients had significantly fewer days with migraine, but not fewer episodes, than placebo recipients, the New York Times reports. It is unclear exactly how the drug prevents migraine. The drug is estimated to cost between $1000 and $2000, analysts tell the Times.

Botox carries a boxed warning, saying that the drug can spread beyond the treatment sites and cause symptoms of botulism, but so far, no serious adverse events have been reported with the regimen used for migraine.

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Chest Compressions Emphasized in New Heart Association Guidelines on CPR

Chest Compressions Emphasized in New Heart Association Guidelines on CPR

The American Heart Association has updated its 2005 guidelines on cardiopulmonary resuscitation and emergency cardiac care. For CPR, the guidelines newly emphasize chest compressions because of their importance for survival. Among the changes, published in Circulation:

• The order of CPR is now C-A-B (compressions, airway, breathing) instead of A-B-C for everyone except newborns. The first cycle should include 30 compressions before rescue breaths.
• "Look, listen, and feel" is no longer recommended.
• Compressions for adults should be at least (instead of up to) 2 inches and performed at a rate of at least 100 per minute.
• Untrained bystanders should perform compression-only CPR (previous guidelines did not address untrained bystanders separately).
• Emergency cardiac treatments no longer recommended include routine atropine for pulseless electrical activity/asystole, cricoid pressure (with CPR), and airway suctioning for all newborns (exception for those with obvious obstruction).
• New sections address post-arrest care, care for children with cardiac arrest and specific congenital heart defects, and follow-up for children or young adults with sudden, unexplained cardiac death.

Link

Social Media

FDA Says Bisphosphonates Might Increase Femoral Fracture Risk, Orders Label Change

FDA Says Bisphosphonates Might Increase Femoral Fracture Risk, Orders Label Change

In contrast with earlier reassurance that there was no "clear connection" between use of bisphosphonates and atypical femoral fractures, the FDA now says labeling changes are needed.

Changes to the warnings section of all bisphosphonates given for osteoporosis will highlight the potential risk for subtrochanteric and diaphyseal femoral fractures. In addition, manufacturers will need to include a medication guide for use by patients.

The FDA says that the fractures being reported "may be related to use of bisphosphonates for longer than five years." Consequently, physicians are being asked to reevaluate the need for the drugs if their patients have been using them longer than that.

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What's Happening To Your Health Plan?

Employers already are passing on a bigger share of their health-care costs to employees than they have over the previous decade, according to data from the Kaiser Family Foundation. The Menlo Park, Calif.-based nonprofit found this year that family premiums for firms went up 3% in 2010, but workers' share of those costs rose 14%.

This so-called cost-shifting trend appears to be intensifying. When Zurich Insurance Services Inc., a property and casualty firm in Jacksonville, Fla., conducted its open enrollment last month, it asked employees to pay 10% of their premiums for the first time. The company always has paid 100%, but "we reached the breaking point," says Ryan Schwartz, senior vice president of corporate affairs, citing higher costs generated by the new health-law provisions.

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Weight Loss Medication Pulled from Market

Meridia (sibutramine): Market Withdrawal Due to Risk of Serious Cardiovascular Events

[Posted 10/08/2010]

AUDIENCE: Primary Care, Consumers

ISSUE: Abbott Laboratories and FDA notified healthcare professionals and patients about the voluntary withdrawal of Meridia (sibutramine), an obesity drug, from the U.S. market because of clinical trial data indicating an increased risk of heart attack and stroke.

BACKGROUND: Meridia was approved November 1997 for weight loss and maintenance of weight loss in obese people, as well as in certain overweight people with other risks for heart disease. The approval was based on clinical data showing that more people receiving sibutramine lost at least 5 percent of their body weight than people on placebo who relied on diet and exercise alone. FDA has now requested market withdrawal after reviewing data from the Sibutramine Cardiovascular Outcomes Trial (SCOUT). SCOUT is part of a postmarket requirement to look at cardiovascular safety of sibutramine after the European approval of the drug. The trial demonstrated a 16 percent increase in the risk of serious heart events, including non-fatal heart attack, non-fatal stroke, the need to be resuscitated once the heart stopped, and death, in a group of patients given sibutramine compared with another given placebo. There was a small difference in weight loss between the placebo group and the group that received sibutramine.

RECOMMENDATION: Physicians are advised to stop prescribing Meridia to their patients, and patients should stop taking this medication. Patients should talk to their health care provider about alternative weight loss and weight loss maintenance programs.

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Iphone to Launch on Verizon

http://online.wsj.com/article/SB10001424052748703735804575536191649347572.html?mod=WSJ_hp_mostpop_read

AT&T Inc. is about to lose its lock on the iPhone.

Apple Inc. is making a version of its iPhone that Verizon Wireless will sell early next year, according to people familiar with the matter, ending an exclusive deal with AT&T and sharpening the competition with Google Inc.-based phones.

While Apple is on track to sell 40 million iPhones across the globe this year, the touchscreen handset is facing pressure in the U.S. from phones running Google's Android software, which have been heavily promoted by Verizon Wireless, the biggest U.S. carrier by subscribers.

Apple plans to begin mass producing the new iPhone by the end of the year, and it would be released in the first quarter of 2011, these people said. The phone would resemble the iPhone 4 currently sold by AT&T, but would be based on an alternative wireless technology used by Verizon, these people said.

Data on Clopidogrel and Omeprazole Offer 'Reassurance' on Cardiovascular Risk, Researchers Say

Patients on dual antiplatelet therapy showed no increase in cardiovascular events while receiving omeprazole to lower risks for gastrointestinal bleeding, according to a New England Journal of Medicine study.

In a double-blind trial, 3700 patients were randomized to receive the proton-pump inhibitor (PPI) omeprazole or placebo, while taking both aspirin and clopidogrel. The study had two primary endpoints: gastrointestinal bleeding or pain, and cardiovascular events, such as cardiovascular death, MI, or ischemic stroke. (Cogentus Pharmaceuticals, the manufacturer of the clopidogrel-omeprazole combination pill, designed and sponsored the trial, but the company is now defunct.)

Over the course of a median follow-up of 106 days, gastrointestinal events were significantly less frequent with clopidogrel-omeprazole. Cardiovascular event rates were also less frequent, but not significantly so (4.9% vs. 5.7%).

The authors say the outcome "provides reassurance that there is no clinically significant cardiovascular interaction between PPIs and clopidogrel."

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Compression-Only CPR by Bystanders Raises Rates of Survival

Compression-only CPR by lay rescuers modestly increases survival over conventional resuscitation, a JAMA study finds.

Researchers prospectively studied rates of survival to hospital discharge in some 4400 adult victims of out-of-hospital cardiac arrest not witnessed by emergency medical personnel. All episodes occurred over a 5-year period in Arizona during a public campaign to encourage bystander intervention with compression-only CPR.

Among the principal findings:

• The overall annual rate of bystander CPR increased during the 5-year period, from 28% to 40%.
• Compression-only CPR increased from 20% to 76%.
• Overall survival increased from 4% to 10%; survival was 13% in the compression-only group.
• Good neurological status at discharge, however, did not differ significantly between those getting compression-only versus conventional CPR.

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McDonald's May Drop Health Plan

http://online.wsj.com/article/SB10001424052748703431604575522413101063070.html?mod=WSJ_hps_LEFTWhatsNews

McDonald's Corp. has warned federal regulators that it could drop its health insurance plan for nearly 30,000 hourly restaurant workers unless regulators waive a new requirement of the U.S. health overhaul.

McDonald's warned federal regulators that it could drop its health insurance plan for nearly 30,000 workers unless regulators waive a new requirement of the U.S. health overhaul. Janet Adamy discusses.

The move is one of the clearest indications that new rules may disrupt workers' health plans as the law ripples through the real world.

Trade groups representing restaurants and retailers say low-wage employers might halt their coverage if the government doesn't loosen a requirement for "mini-med" plans, which offer limited benefits to some 1.4 million Americans.

The Name of God

God makes himself known to us in various ways...sometimes through that "small inner voice", sometimes through the Loudspeaker of Tragedy, sometimes He just stamps his name on a map...

Jeremiah 7:12 (God Speaking) "But go now to my place which was in Shiloh where I set my Name at the first."

Jeremiah 7:12 in the Hebrew Language:

The Name of God "My Name" in Hebrew (Jeremiah 7:12) - take a gook look at the verses written in Hebrew - the word for God's Name - where my finger is pointed to:

God "set His Name" in Shiloh...

Where is Shiloh?

Now...This is the City of Shiloh in Israel. Take a look at Shiloh on a map:

Now, check out the Satellite Photograph of Jerusalem and the Beth-El/Shilo Region, the Shilo region is located in the Yellow Rectangle Box - see it?)

Do you recognize anything?

The area photographed is the Biblical site of the Tabernacle. The hills and valleys in the area form the Divine Name in Hebrew.

"...But go now to my place which was in Shilo where I set my Name at the first..."

Jeremiah 7:12

Daddy's Day

Daddy's Poem


Her hair was up in a pony tail,

her favorite dress tied with a bow.
Today was Daddy's Day at school,
and she couldn't wait to go.



But her mommy tried to tell her,
that she probably should stay home
Why the kids might not understand,
if she went to school alone.



But she was not afraid;
she knew just what to say.
What to tell her classmates
of why he wasn't there today.

But still her mother worried,
for her to face this day alone.
And that was why once again,
she tried to keep her daughter home.

But the little girl went to school
eager to tell them all.
About a dad she never sees a dad
who never calls.

There were daddies along the wall in
back, for everyone to meet.
Children squirming impatiently,
anxious in their seats.

One by one the teacher called
a student from the class.
To introduce their daddy,
as seconds slowly passed.

At last the teacher called her name,
every child turned to stare.
Each of them was searching,
a man who wasn't there.



"Where's her daddy at?"
She heard a boy call out.
"She probably doesn't have one,"
another student dared to shout.

And from somewhere near the back,
she heard a daddy say,
"Looks like another deadbeat dad,
too busy to waste his day."

The words did not offend her,
as she smiled up at her Mom.
And looked back at her teacher, who
told her to go on.



And with hands behind her back,
slowly she began to speak.
And out from the mouth of a child,
came words incredibly unique.



"My Daddy couldn't be here,
because he lives so far away.
But I know he wishes he could be,
since this is such a special day.

And though you cannot meet him,
I wanted you to know.
All about my daddy,
and how much he loves me so.

He loved to tell me stories
he taught me to ride my bike.
He surprised me with pink roses,
and taught me to fly a kite.

We used to share fudge sundaes,
and ice cream in a cone.
And though you cannot see him.
I'm not standing here alone.

"Cause my daddy's always with me,
even though we are apart
I know because he told me,
he'll forever be in my heart"



With that, her little hand reached up,
and lay across her chest.
Feeling her own heartbeat,
beneath her favorite dress.

And from somewhere there in the crowd
of dads, her mother stood in tears.
Proudly watching her daughter,
who was wise beyond her years.

For she stood up for the love
of a man not in her life.
Doing what was best for her,
doing what was a right.

And when she dropped her hand back
down, staring straight into the crowd.
She finished with a voice so soft,
but its message clear and loud.

"I love my daddy very much,
he's my shining star.
And if he could, he'd be here,
but heaven's just too far.



You see he is an American Soldier
and died just this past year
When a roadside bomb hit his convoy
and taught Americans to fear.

But sometimes when I close my eyes,
it's like he never went away."
And then she closed her eyes,
and saw him there that day.



And to her mother's amazement,
she witnessed with surprise.
A room full of daddies and children,
all starting to close their eyes.

Who knows what they saw before them,
who knows what they felt inside.
Perhaps for merely a second,
they saw him at her side.



"I know you're with me Daddy,"
to the silence she called out.
And what happened next made believers,
of those once filled with doubt.

Not one in that room could explain it,
for each of their eyes had been closed.
But there on the desk beside her,
was a fragrant long-stemmed pink rose.



And a child was blessed, if only for
a moment, by the love of her shining star.
And given the gift of believing,
that heaven is never too far.

FDA Announces New Restrictions on Rosiglitazone, Europe Suspends the Drug

The FDA has restricted use of the diabetes drug rosiglitazone (Avandia), while the European Medicines Agency has recommended suspending use of the drug entirely over concerns about increased cardiovascular risk.

The FDA says that the manufacturer, GlaxoSmithKline, will develop a risk evaluation and mitigation strategy (REMS) and that access to the drug will be limited to new patients whose diabetes is not controlled by other treatments and who cannot tolerate pioglitazone. Current U.S. users may continue taking rosiglitazone if they appear to benefit and understand the risks.

Simultaneously, the European Medicines Agency recommended suspending sales of rosiglitazone in Europe.

The actions affect Avandia as well as the combination drugs, Avandamet (metformin/rosiglitazone) and Avandaryl (glimepiride/rosiglitazone; marketed as Avaglim in Europe).

Link

Lower 10-Year Incidence of Stroke After Endarterectomy

Successful carotid endarterectomy reduces 10-year stroke risks in asymptomatic patients, a Lancet study finds.

In an international study, researchers randomized 3100 asymptomatic patients with at least 60% stenosis either to immediate endarterectomy or to indefinite deferral of any procedure. In the 30-day perioperative period, the risk for stroke or death was 3%.

When perioperative events and non-stroke deaths were excluded, patients undergoing immediate endarterectomy had lower stroke risks at 5 and 10 years. When the perioperative risks were included, net stroke risks were still lower at 10 years (13% vs. 18%).

Commentators write that the results "confirm the superiority of immediate [endarterectomy] versus medical therapy," and they conclude that endarterectomy "remains the first choice of revascularization therapy for an asymptomatic carotid lesion."

Link

First Oral Drug Approved to Reduce Relapses in MS

The FDA has approved fingolimod (Gilenya), the first oral drug used to treat relapsing forms of multiple sclerosis.

The once-daily, 0.5-mg capsules "can slow the progression of disability and reduce the frequency and severity of symptoms in MS," according to the agency's Center for Drug Evaluation and Research. The drug works by preventing lymphocytes from exiting lymph nodes, which keeps them from migrating to the brain and spinal cord.

The most common adverse effects of fingolimod include elevated liver enzymes, influenza, headache, back pain, cough, and diarrhea. In clinical trials leading to the drug's approval, some patients experienced macular edema and herpes infections. Patients should initially be monitored for decreased heart rate.

Link

Possible Replacement for Coumadin (Warfarin)

Dabigatran Recommended by FDA Advisers

An FDA advisory committee voted on Monday to recommend approval of dabigatran etexilate, an anticoagulant, to prevent strokes in patients with atrial fibrillation.

In December, the New England Journal of Medicine published a study showing that dabigatran is as effective as warfarin in treating venous thromboembolism.

Link

Use of Multiple Antithrombotic Drugs in Atrial Fibrillation Increases Bleeding Risk

In patients with atrial fibrillation, adding multiple-drug therapy to prevent thromboembolism can greatly increase the risk for major bleeding, according to an Archives of Internal Medicine study.

Investigators used Danish national databases to follow bleeding outcomes in some 80,000 patients with a discharge diagnosis of first-time atrial fibrillation. All patients had at least one postdischarge prescription for warfarin, aspirin, or clopidogrel. After a follow-up averaging 3.3 years, the relative risks associated with various regimens for fatal and nonfatal bleeding, relative to warfarin monotherapy, were as follows:

• Aspirin, 0.96
• Clopidogrel, 1.45
• Clopidogrel + aspirin, 1.91
• Warfarin + aspirin, 1.75
• Warfarin + clopidogrel, 3.57
• Warfarin + clopidogrel + aspirin, 4.03

The authors conclude that "combination therapy should be carefully considered and should be given only for a short time when treatments are mandatory."

Link

First Gymnastic Meet

Today is the First set of "Meets" - gymnastic competitions. After today the meets are every 2 weeks through November. Gonna be busy.

The competing teams line up...

National Anthem Sung

Igette's First Routine was the Beam

Second Routine was Floors

Then comes the Vault

And Lastly the Bars

She had "issues" at the bars...the rubberband for her "grips" (gloves) broke and unravelled at the beginning and she couldn't hold on...she managed to finish the routine anyways!

Won 3 Medals, not bad for first timer

Igette and Shadow

Coaches

Team Huddles

Little Iggy with the Laptop

Little Iggy and I ready to watch competition

I managed to sneak out after the Meet and watched a movie with Shadow

I've Been up for the last 36+ hours. Last night was in the ER. The bed is finally calling...

9/11 - We Will Rebuild

Health Insurers Plan Hikes

Health insurers say they plan to raise premiums for some Americans as a direct result of the health overhaul in coming weeks, complicating Democrats' efforts to trumpet their signature achievement before the midterm elections.

Aetna Inc., some BlueCross BlueShield plans and other smaller carriers have asked for premium increases of between 1% and 9% to pay for extra benefits required under the law, according to filings with state regulators.

These and other insurers say Congress's landmark refashioning of U.S. health coverage, which passed in March after a brutal fight, is causing them to pass on more costs to consumers than Democrats predicted.

Link

Israel Palestinian Peace Talk Update

President of Palestinian Authority says he "will not recognize Israel as a Jewish State" - there goes the "peace" talks

Link:


http://bit.ly/c3Vr1d

Meat-Based Low-Carb Diet Linked to Higher Mortality Risk

A low-carbohydrate diet heavy on animal protein and fat is associated with greater long-term mortality, while a plant-based low-carbohydrate diet is linked to lower mortality, according to an Annals of Internal Medicine study.

Researchers analyzed food frequency questionnaires from 85,000 women from the Nurses' Health Study and 45,000 men from the Health Professionals' Follow-Up Study. Among the findings over roughly 20 years' follow-up:

• People who had the highest scores for an animal-based low-carbohydrate diet were at increased risk for all-cause and cardiovascular mortality.
• Those with the highest plant-based low-carbohydrate diet scores had a reduced risk for all-cause and cardiovascular mortality.
• Men who more closely followed any low-carbohydrate diet had a higher cancer mortality risk.

Editorialists see flaws in the study and observe that "no one can legitimately claim that a low-carbohydrate diet is either harmful or safe with any degree of certainty" in the absence of a large-scale randomized study.

Link

New Study Links Oral Bisphosphonates to Esophageal Cancer

New Study Links Oral Bisphosphonates to Esophageal Cancer

A case-control study in BMJ finds that oral bisphosphonates are associated with increased risk for esophageal cancer, thus contradicting a recent JAMA study finding no such link.

In the current study, British researchers used a national database to identify nearly 16,000 adults diagnosed with esophageal, stomach, or colorectal cancer over a 10-year period, and matched them with some 78,000 controls without cancer. Prescriptions for bisphosphonates were then assessed for the 7.5 years before diagnosis.

Bisphosphonate prescriptions were associated with a 30% increase in risk for esophageal cancer, with the elevated risk largely limited to patients with 10 or more prescriptions. The drugs did not appear to increase risk for stomach or colorectal cancer.

The researchers, noting that the contradictory JAMA study used the same database, say the disparate result may be due, in part, to the longer follow-up and greater number of controls in the current study.

Link

New IPhone App: embedding slideshow with video

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Can you guess the location of these photographs?

If, in spite of the economic crisis and media coverage, you have managed to travel lately - maybe you can guess where these photographs were taken.

Scroll down for the answer!

Answer:

Gaza...Hometown of Hamas