January 14, 2016

Junior doctors’ strike in England disrupts care for thousands

LONDON — Hospital doctors in England staged their first strike in four decades on Tuesday, disrupting treatment for thousands of patients in the National Health Service and escalating political tensions over a publicly funded healthcare system so revered that it was once likened to a national religion.

Operations were postponed and appointments canceled in a bitter dispute over pay and working hours between employers and junior doctors, a term that covers medical professionals with as much as a decade of experience.

With the junior doctors offering only emergency care, about 3,500 operations had been affected by Tuesday afternoon, including routine procedures for knee and hip replacements — prompting a warning from Prime Minister David Cameron that the labor action would create “real difficulties for patients, and potentially worse.”

Yet the dispute over the health system carries risks for the government. The National Health Service, which is funded by taxes and payroll deductions but has faced years of financial strain, delivers most treatment without charge. Despite regular funding crises, there has been no similar strike since 1975.

NHS has a significant presence in national life, employing 1.6 million people which, it says, puts it in the top five of the world’s largest work forces, alongside the United States Defense Department, McDonald’s, Walmart and the Chinese People’s Liberation Army.

Weekend shifts are at the heart of the current dispute. A proposed new contract would increase basic pay but would reduce the number of hours for which junior doctors receive added compensation for work, particularly on Saturdays.

The government argues that this would improve treatment by creating a genuine seven-day service, and the health secretary, Jeremy Hunt, highlighted the elevated mortality rates recorded for some medical conditions on weekends, when hospitals have fewer staff.

The doctors counter that their stand against excessive working, and the strain it puts on them, makes them the guardians of safety in hospitals. Officially, junior doctors are required to work a 48-hour week, but that is calculated over a 26-week period, and they can end up working long stretches, particularly over weekends.

The government insists that doctors would not be worse off under the new contract, but that is disputed by the British Medical Association, which represents more than 37,000 of the country’s 55,000 junior doctors and which describes the proposed conditions as “unsafe and unfair.”

The National Health Service has been praised for providing universal access while being cost-effective, while the American system, despite the introduction of the Affordable Care Act in 2010, is still so expensive that many people cannot afford treatment.

Although British doctors can operate private practices, most participate in the National Health Service, making them subject to the government workplace rules that the junior doctors are now protesting.

In the United States, doctors are more likely to work in for-profit practices, with health insurers’ payment menus setting the rules.

The British system is well regarded internationally by some measures, despite its stretched resources. A 2013 survey of 11 industrialized nations by the Commonwealth Fund, a nonpartisan health policy research group in the United States, ranked Britain No. 1 overall and at the top in categories including quality of care, patient access and efficiency.

The United States was ranked at the bottom over all, despite having the costliest care per capita ($8,508), compared with Britain’s lowest cost by this measure ($3,405).

Visit the New York Times for the story.

Company bets on catching cancer with 'Liquid Biopsy'

Gene sequencing company Illumina is betting it can diagnose cancer in people long before they have any symptoms at all with a blood test called a liquid biopsy. The San Diego-based firm launched a spinoff company Sunday named Grail, with obvious references to the "Holy Grail."

"The holy grail in oncology has been the search for biomarkers that could reliably signal the presence of cancer at an early stage," said Dr. Richard Klausner, a former director of the National Cancer Institute who's a member of the new company's board of directors.

The plan is to use Illumina's super-fast genetic sequencing technology to look for genetic material from tumor cells in peoples' blood long before they have any evidence of cancer. The test would check for genetic mutations known to be found in tumors.

Something similar is already done sometimes in people who already have cancer. The liquid biopsies are used to see how well cancer treatment is working.

Some big names in investing and cancer researcher are signing on for the enterprise. They include Amazon founder Jeff Bezo's Bezos Expeditions, Microsoft co-founder Bill Gates and Sutter Hill Ventures. Klausner; Dr. Jose Baselga, physician in chief at Memorial Sloan Kettering Cancer Center and president of the American Association of Cancer Research; and Dr. Brian Druker, director of the Oregon Health & Science University, have signed on to the advisory board.

It will be years before any such test could be designed, and it would have to be tested in thousands of people before regulators could consider approving it. Right now one of Illumina's whole-genome tests costs about $1,000, so it would be a pricey cancer screening test unless that cost can be brought down.

And while tumors are known to drop bits of genetic material into the blood, cancer experts caution that some early cancers may not secrete DNA fragments and require other types of detection.

The American Cancer Society projected that cancer would be diagnosed in close to 1.7 million Americans this year and that it would kill nearly 600,000. Most deaths are of people whose cancer had already spread before it was treated.

Visit NBC News for the report.

Researchers closer to better treatment for leading cause of hospital-acquired diarrhea

Researchers at Vanderbilt University Medical Center have obtained the crystal structure of a toxin from the bacterium Clostridium difficile ("C. diff") -- the leading cause of hospital-acquired diarrhea in the United States.

Reporting in Nature Microbiology, they also found that zinc is required to unleash the toxin's damaging effects in the colon. The discoveries are aiding efforts to develop vaccines and other novel therapies to prevent the potentially fatal consequences of C. diff infection.

Like anthrax, diphtheria and botulism, C. diff infection is a toxin-mediated disease. The bacterium actually produces two similar toxins, toxin A and toxin B. But unlike the other infections, there is as yet no vaccine or other treatment that can effectively block C. diff toxins.

Meanwhile, C. diff has become a major public health menace. In 2011, the bacterium caused nearly half a million infections in the United States, and approximately 29,000 people died from intestinal complications, including a form of colitis, within a month of the initial diagnosis.

At Argonne National Laboratory outside Chicago, the researchers bounced a highly focused X-ray of a specific wavelength off the crystal. The resulting diffraction pattern was then converted using computational methods into a model of the toxin.

They found that one small section of the toxin is "highly conserved," meaning that its sequence of amino acids is identical to the same sequence in other Clostridium species.

This "suggests that antibodies specific for this conserved region could provide protection against multiple toxin-mediated clostridium infections and points to a generalizable strategy for generating safe vaccine antigens for this class of toxins," they concluded.

Visit Medical News Today for the report.

Common painkiller may also be powerful cancer killer

The painkiller diclofenac, a common painkiller used to treat migraine, fever and rheumatoid arthritis, may hold significant anti-cancer properties, according to new research.

Diclofenac is a non-steroidal anti-inflammatory drug, or NSAID, a type of painkiller that has shown promise to prevent cancer, however researchers in Belgium and the United States report the drug could play an important role in treating cancer based on previous studies and in-progress clinical trials. The drug, sold as Voltaren, Zipsor, Solaraze, and Cambia, among other names, is cheap and widely available.

Researchers said excitement over the drug's potential use for cancer is based on its effects on the immune system and on angiogenesis, the development of blood vessels that move oxygen and nutrients to tissues.

For the study, researchers analyzed previous studies dating back to 1983 that showed the drug could have anti-tumor effects against fibrosarcoma, colorectal cancer, neuroblastoma, ovarian cancer and several others.

Retrospective analysis of medical records for patients with a range of cancers who were treated with diclofenac before surgery to remove tumors showed the drug had a statistically significant impact on the risk of metastasis and reduced mortality.

There are currently four clinical trials investigating diclofenac's effects on cancer, including three that use the painkiller as part of TL-118, an experimental four-drug combination.

Visit UPI for the study.

Kindred Healthcare to pay $125 million to end Medicare fraud probe

Kindred Healthcare Inc agreed to pay $125 million to settle government allegations that the largest U.S. nursing home therapy provider knowingly caused skilled nursing facilities to submit false or fraudulent Medicare reimbursement claims.

The U.S. Department of Justice said the accord resolves claims under the federal False Claims Act against Kindred and contract therapy providers RehabCare Group Inc and RehabCare Group East Inc, which Kindred bought in June 2011.

RehabCare was accused of having since January 2009 engaged in schemes that permitted the submission of Medicare reimbursement claims for rehabilitation therapy services that were unreasonable, unnecessary, unskilled or nonexistent.

The government said these schemes included reporting extra therapy to boost reimbursements, scheduling therapy that patients' treating therapists thought superfluous, and providing skilled therapy to patients who were asleep.

U.S. Attorney Carmen Ortiz in Massachusetts said RehabCare and its nursing facility customers engaged in a "systematic and broad-ranging" scheme focused on boosting reimbursements instead of patients' clinical needs.

Four skilled nursing facilities using Kindred and RehabCare will pay $8.23 million to settle related claims, the Justice Department said.

Kindred said RehabCare denied engaging in illegal activity, and agreed to settle without admitting wrongdoing to "provide clarity" to shareholders, customers and regulators.

The Louisville, KY-based company also said it previously set aside money for the accord, and intends to record a related tax benefit in last year's fourth quarter.

Visit Reuters for the story.

New bird flu virus kills woman in China

A Chinese woman has died from an infection with H5N6 bird flu virus, the China News Service said Wednesday.

A second woman is in critical condition with the virus, which only very rarely infects people — but kills most of them when it does. Both cases were reported in China's southern Guangdong province.

The H5N6 strain is one of several avian influenza viruses circulating in poultry in China and elsewhere and occasionally infecting people. It killed one woman last July, according to the World Health Organization, and two others in 2014 and 2015.

WHO says 683 laboratory-confirmed cases of H7N9 bird flu have been reported and the virus has killed 275 of those people. The H5N1 bird flu virus, circulating since 2003, has infected at least 844 people and killed 449 of them.

Scientists are keeping an eye on both to make sure they do not turn into strains that people can pass easily from one to another. That could cause a new pandemic of influenza if it happened. There's a milder virus occasionally infecting people, too, called H9N2. It's only been detected in four patients so far.

"This virus does not seem to transmit easily between humans and tends to result in mild clinical disease, therefore the current likelihood of community-level spread and public health impact of this virus is considered low," WHO says.

Visit GCONew for the alert.

CMS launches new Medicare Drug Spending Dashboard

The Center for Medicare and Medicaid Services (CMS) has released a new online dashboard with information on prescription drugs for both Parts B and D of Medicare with high spending on a per user basis, high spending for the program overall, and those with high unit cost increases in recent years. This list of medications contributes to sharing of information about drug spending, and enhances and elevates the discussion around the rising costs of drugs.

Visit here to access the Medicare Drug Spending Dashboard.

New clear totes and dividers for storage

Akro-Mils, announces the expansion of its 6-inch-tall ShelfMax and 8-inch-tall ShelfMax8 plastic shelf bins with the addition of new clear plastic width dividers for all bin models.

Made of ultra-clear polystyrene, these new dividers are extremely durable and crack-resistant. The clear material provides maximum visibility to identify items in multiple compartments in the bin. For more information, visit Akro-Mils.

In addition Akro-Mils also announces the expansion of its line of plasticNest & Stack Toteswith the addition of new Clear totes and lids.
Available in nine sizes, Akro-Mils’ Nest & Stack Totes are a solution for storage, transfer and shipping applications. The totes stack with or without optional lids and nest when empty to conserve space. The totes’ high-density, industrial-grade polymers will not bend out of shape even when fully loaded. Its heavy-duty construction provides a longer service life, resulting in lower replacement costs than alternative products.
In addition to the new Clear option, Nest & Stack Totes are available in Red, Blue and Gray. For more information,visit here.