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Health & Fitness (230)

WASHINGTON (AP) -- Michael Lee knew he was still in bad shape when he left the hospital five days after emergency heart surgery. But he was so eager to escape the constant prodding and the roommate's loud TV that he tuned out the nurses' care instructions.

"I was really tired of Jerry Springer," the New York man says ruefully. "I was so anxious to get out that it sort of overrode everything else that was going on around me."

He's far from alone: Missing out on critical information about what to do at home to get better is one of the main risks for preventable rehospitalizations.

"There couldn't be a worse time, a less receptive time, to offer people information than the 11 minutes before they leave the building," said readmissions expert Dr. Eric Coleman of the University of Colorado in Denver.

Hospital readmissions are miserable for patients, and a huge cost - more than $17 billion a year in avoidable Medicare bills alone - for a nation struggling with the price of health care.

Now, with Medicare fining facilities that don't reduce readmissions enough, the nation is at a crossroads as hospitals begin to take action.

"Patients leave the hospital not necessarily when they're well but when they're on the road to recovery," said Dr. David Goodman, who led a new study from the Dartmouth Atlas of Health Care that shows different parts of the country do a better job at keeping those people at home.

The Dartmouth study was commissioned by the Robert Wood Johnson Foundation, which then invited the AP as a partner to explore through focus groups it organized what happens at the hospital level that makes readmissions so difficult to solve.

In Portland, Ore., nurses at Oregon Health & Science University start teaching heart failure patients what they'll need to do at home on their first day in the hospital, instead of just on their last day.

In Salt Lake City, a nurse acts as a navigator, connecting high-risk University of Utah patients with community doctors for follow-up treatment and ensuring both sides know exactly what's supposed to happen when they leave the hospital.

Some techniques are emerging as key, Coleman said: Having patients prove they understand by teaching back to the nurse. Role-playing how they'd handle problems. Finding a patient goal to target, like the grandmother who wants her heart failure controlled enough that her feet don't swell out of her Sunday shoes.

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You'd be mad at having to return your car to the mechanic within a month, yet rehospitalization after people get their hearts repaired too often is treated as business as usual, laments Dr. Ricardo Bello, a cardiac surgeon at New York's Montefiore Medical Center.

Heart surgeons try to prevent that by re-examining patients two to three weeks after they go home. But Montefiore patients tend to be readmitted sooner than that.

So last fall, Bello's team began a special clinic where nurses check heart surgery patients about a week after they go home, at no extra charge - and have a chance to re-teach those discharge instructions when people are more ready to listen.

Plus, for that first month at home, patients are supposed to wear a bracelet with a phone number to reach Montefiore's cardiac unit 24 hours a day with any worries.

"It changed my conception of dealing with a doctor," said Michael Lee, 60.

Montefiore surgeons repaired a life-threatening crack in Lee's aorta, the body's main blood vessel, but his recovery derailed days after getting home. He quit some medications. He was scared to wash the wound that ran from chest to navel, an infection risk. He developed a scary cough and called that special clinic in a panic.

It turned out the cough was a temporary nuisance - but nurses discovered a real threat: Lee's blood pressure was creeping up, a risk to his healing aorta. Those pills Lee quit were supposed to keep it extra low, a message he'd missed. And some hands-on instruction reassured Lee that he could handle his wound without tearing it.

Without the clinic, "he's definitely somebody we would have been called to see in the emergency room," said physician assistant Jason Lightbody.

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In heart failure, a weakly pumping heart allows fluid to build up until patients gasp for breath. Spotting subtle early signs like swelling ankles or creeping weight gain is crucial. But at the Oregon Health & Science University, nurse practitioner Jayne Mitchell spied as patients were told what to watch for as they were discharged - and they barely paid attention.

The new plan: Learn by doing.

Every morning, hospitalized patients weigh themselves in front of a nurse, record the result and get quizzed on what they'd do at home. Gained 2 pounds or more? Call the doctor for fast help. Lots of day-to-day fluctuation? A weekly log can help a doctor tell if a patient is getting worse or skipping medication or having trouble avoiding water-retaining salty food.

Step 2: These patients need a check-up a week after they go home. The hospital makes the appointment with a primary care doctor before they're discharged, to ensure they can get one.

And for some high-risk patients who live too far away to easily track, Mitchell is pilot-testing whether a high-tech option helps them stick with care instructions.

During that first vulnerable month at home, those patients record their morning weight, blood pressure and heart rate on a monitor called the Health Buddy. It automatically sends the information back to Mitchell's team at OHSU and also will flash instructions to the patient if it detects certain risks.

In Sun River, Ore., Richard W. Pasmore's phone rang one morning. Nurses three hours away in Portland saw that his weigh-in was high and adjusted his medications over the phone.

The 67-year-old Pasmore thinks it prevented a return to the hospital: "It kept them totally abreast of everything that was happening with me." And by the end of the month, he says he'd gotten in the habit of his morning heart failure checks.

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At the University of Utah, nurse Stephanie Wallace links high-risk patients to the outside care that could keep them from returning. And she's the one whose phone rings when that care falls through.

Consider the single mother who couldn't afford post-hospital blood tests to make sure her blood-thinning medication was working properly, or time off work to get them and didn't speak enough English to seek help. When the woman missed her lab appointment, Wallace pieced together the trouble, helped her enroll in a program for low-income patients - and stressed the importance of sticking with this care.

"It's not that they don't understand why they're sick. They don't grasp the importance of why they need follow-up," Wallace said.

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The customized programs reflect the Dartmouth study's findings that there's great geographic variability in hospital readmissions.

In Miami, for example, more than a quarter of Medicare patients with heart failure returned to the hospital within a month in 2010, the latest data available. That's double the readmission rate for those patients in Provo, Utah.

In Dearborn, Mich., the readmission rate for pneumonia was 20 percent, twice that of hospitals in Salt Lake City.

"Every place is different and faces different challenges in terms of improving care after patients are discharged from the hospital," Goodman said.

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Online:

Care About Your Care: HTTP://WWW.CAREABOUTYOURCARE.ORG

Dartmouth Atlas of Health Care: HTTP://WWW.DARTMOUTHATLAS.ORG

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Monday, 11 February 2013 09:42
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NEW YORK (AP) -- Researchers have discovered the first U.S. cases of whooping cough caused by a germ that may be resistant to the vaccine.

Health officials are looking into whether cases like the dozen found in Philadelphia might be one reason the nation just had its worst year for whooping cough in six decades. The new bug was previously reported in Japan, France and Finland.

"It's quite intriguing. It's the first time we've seen this here," said Dr. Tom Clark of the Centers for Disease Control and Prevention.

The U.S. cases are detailed in a brief report from the CDC and other researchers in Thursday's New England Journal of Medicine.

Whooping cough is a highly contagious disease that can strike people of any age but is most dangerous to children. It was once common, but cases in the U.S. dropped after a vaccine was introduced in the 1940s.

An increase in illnesses in recent years has been partially blamed on a version of the vaccine used since the 1990s, which doesn't last as long. Last year, the CDC received reports of 41,880 cases, according to a preliminary count. That included 18 deaths.

The new study suggests that the new whooping cough strain may be why more people have been getting sick. Experts don't think it's more deadly, but the shots may not work as well against it.

In a small, soon-to-be published study, French researchers found the vaccine seemed to lower the risk of severe disease from the new strain in infants. But it didn't prevent illness completely, said Nicole Guiso of the Pasteur Institute, one of the researchers.

The new germ was first identified in France, where more extensive testing is routinely done for whooping cough. The strain now accounts for 14 percent of cases there, Guiso said.

In the United States, doctors usually rely on a rapid test to help make a diagnosis. The extra lab work isn't done often enough to give health officials a good idea how common the new type is here, experts said.

"We definitely need some more information about this before we can draw any conclusions," the CDC's Clark said.

The U.S. cases were found in the past two years in patients at St. Christopher's Hospital for Children in Philadelphia. One of the study's researchers works for a subsidiary of Johnson & Johnson, which makes a version of the old whooping cough vaccine that is sold in other countries.

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JournaL: HTTP://WWW.NEJM.ORG

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Thursday, 07 February 2013 06:21
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NEW YORK (AP) -- Opponents are pressing to delay enforcement of the city's novel plan to crack down on supersized, sugary drinks, saying businesses shouldn't have to spend millions of dollars to comply until a court rules on whether the measure is legal.

With the rule set to take effect March 12, beverage industry, restaurant and other business groups have asked a judge to put it on hold at least until there's a ruling on their lawsuit seeking to block it altogether. The measure would bar many eateries from selling high-sugar drinks in cups or containers bigger than 16 ounces.

"It would be a tremendous waste of expense, time, and effort for our members to incur all of the harm and costs associated with the ban if this court decides that the ban is illegal," Chong Sik Le, president of the New York Korean-American Grocers Association, said in court papers filed Friday.

City lawyers are fighting the lawsuit and oppose postponing the restriction, which the city Board of Health approved in September. They said Tuesday they expect to prevail.

"The obesity epidemic kills nearly 6,000 New Yorkers each year. We see no reason to delay the Board of Health's reasonable and legal actions to combat this major, growing problem," Mark Muschenheim, a city attorney, said in a statement.

Another city lawyer, Thomas Merrill, has said officials believe businesses have had enough time to get ready for the new rule. He has noted that the city doesn't plan to seek fines until June.

Mayor Michael Bloomberg and other city officials see the first-of-its-kind limit as a coup for public health. The city's obesity rate is rising, and studies have linked sugary drinks to weight gain, they note.

"This is the biggest step a city has taken to curb obesity," Bloomberg said when the measure passed.

Soda makers and other critics view the rule as an unwarranted intrusion into people's dietary choices and an unfair, uneven burden on business. The restriction won't apply at supermarkets and many convenience stores because the city doesn't regulate them.

While the dispute plays out in court, "the impacted businesses would like some more certainty on when and how they might need to adjust operations," American Beverage Industry spokesman Christopher Gindlesperger said Tuesday.

Those adjustments are expected to cost the association's members about $600,000 in labeling and other expenses for bottles, Vice President Mike Redman said in court papers. Reconfiguring "16-ounce" cups that are actually made slightly bigger, to leave room at the top, is expected to take cup manufacturers three months to a year and cost them anywhere from more than $100,000 to several millions of dollars, Foodservice Packaging Institute President Lynn Dyer said in court documents.

Movie theaters, meanwhile, are concerned because beverages account for more than 20 percent of their overall profits and about 98 percent of soda sales are in containers greater than 16 ounces, according to Robert Sunshine, executive director of the National Association of Theatre Owners of New York State.

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Follow Jennifer Peltz at HTTP://TWITTER.COM/JENNPELTZ

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Wednesday, 06 February 2013 06:23
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CHICAGO (AP) -- Commonly used steroid shots may worsen tennis elbow in the long run and increase chances that the painful condition will reappear, a small study found.

By contrast, patients who got dummy injections alone or with physical therapy were more likely to completely recover after a year and much less likely to have a recurrence than those given steroids.

While the Australian study results echo previous findings, injections of cortisone or similar steroids are still widely recommended by doctors to treat tennis elbow and similar conditions, probably because they can provide short-term pain relief.

The results from this study and others show that steroid shots shouldn't be the main treatment for tennis elbow, said researcher and co-author Bill Vicenzino the University of Queensland.

His study appears in Wednesday's Journal of the American Medical Association.

So-called tennis elbow is caused by repetitive activity or overuse of the arm, which can cause small tears in tendons that attach to the elbow bone. Rest, applying ice, and over-the-counter pain medicine can help relieve symptoms.

The study involved corticosteroids, often used medically to reduce inflammation. These are different from hormone-related anabolic steroids used to treat certain diseases but which are banned in many professional sports because they can build muscle and improve performance..

The researchers enrolled 165 adults aged 18 and older; each had tennis elbow in one arm for longer than six weeks. They were divided into four treatment groups: a single steroid injection; a shot of a dummy liquid; a steroid shot plus about eight weekly half-hour sessions of physical therapy; or a dummy injection plus physical therapy,

After four weeks, steroid patients fared best, but after one year, those who didn't get a steroid shot did better. All the patients who had physical therapy without steroids and 93 percent who got just dummy injections reported complete recovery or much improvement, versus about 83 percent of those who had steroids with or without physical therapy. A recurrence of tennis elbow was reported by about half of the patients in both steroid groups, compared with just 5 percent of the physical therapy patients and 20 percent in the placebo group.

Despite the differences, more than 80 percent of patients in each group were much better or recovered after one year, showing that tennis elbow generally improves over time regardless of treatment.

One reason steroid injections aren't always the best choice is that they reduce the pain without fixing the underlying problem, so patients are more likely to resume activity too soon, said Dr. Michael Perry, a sports medicine specialist at Northwestern Memorial Hospital in Chicago.

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Online: JAMA: HTTP://WWW.JAMA.COM Tennis elbow: HTTP://TINYURL.COM/BVZG7CN © 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Wednesday, 06 February 2013 06:21
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DENVER (AP) -- It was a startling assertion that seemed an about-face from church doctrine: A Catholic hospital arguing in a Colorado court that twin fetuses that died in its care were not, under state law, human beings.

When the two-year-old court filing surfaced last month, it triggered an avalanche of criticism - because the legal argument seemed to plainly clash with the church's centuries-old stance that life begins at conception.

But it is also now fueling an already raging debate in Colorado and beyond about whether fetuses should have legal rights and, if so, what kind.

On Monday, the hospital and the state's bishops released a statement acknowledging it was "morally wrong" to make the legal argument.

News of the wrongful death lawsuit came as Colorado lawmakers weigh how far they should go in penalizing acts that harm a fetus, and some worry that the case could diminish the Catholic Church's credibility in advocating more rights for the unborn.

Miguel De La Torre, a professor at the Iliff School of Theology in Denver, noted that the church often argues for laws recognizing a fetus as a human being.

"If that legislation was to come up again, how could the Catholic Church argue we should protect the rights of a fetus?" he said.

Indeed, last week Colorado's bishops met with executives at Catholic Healthcare Initiatives, a branch of the church that operates the hospital at the center of the case, to review how the lawsuit was handled. The two released separate statements Monday saying CHI executives had been unaware of the legal arguments and pledging to "work for comprehensive change in Colorado's law, so that the unborn may enjoy the same legal protections as other persons."

Spurred on by advancing medical technology that makes fetuses more viable and more visible, states have been expanding some rights to fetuses, sometimes in conjunction with anti-abortion groups and the Catholic Church.

State laws vary widely. It's difficult to quantify how many states allow wrongful death lawsuits on behalf of unborn children because each state has different case law and judicial interpretation. A report from the anti-abortion Americans United for Life estimates that 38 permit such lawsuits.

According to The Guttmacher Institute, which tracks reproductive health issues, 37 states allow some form of prosecution for killing a fetus. A federal law also makes it a crime to harm a fetus while committing other federal crimes.

The debate over such measures has been especially heated in Colorado, which has long battled over the legal status of unborn children. For example, Colorado has been ground zero for the "personhood" movement, which pushes laws that give fertilized eggs all the legal rights of human beings. Opponents warn that such laws would outlaw all forms of abortion and some types of birth control. Voters here so far have overwhelmingly rejected such proposals.

In 1986, a federal court ruled that fetuses are indeed people for purposes of wrongful death lawsuits in Colorado, but state courts have offered conflicting views. This latest case further calls the matter into question.

The case centers on St. Thomas More Medical Center in Canon City, a few hours south of Denver, and a wrongful death lawsuit filed by a husband who lost his pregnant wife.

Lori Stodghill was 28 weeks into her pregnancy when, on New Year's Day 2006, she began vomiting and feeling short of breath, according to court papers. Her husband, Jeremy, took her to the emergency room of St. Thomas More, where Stodghill collapsed and went into cardiac arrest.

Doctors and nurses tried to revive her, but she was declared dead from a pulmonary embolism. No one tried to remove the fetuses via an emergency cesarean section, and they perished, too, court papers said.

Jeremy Stodghill sued the hospital, some doctors and Catholic Healthcare Initiatives, which owns the company that operates Thomas More. Attorneys for CHI in 2010 filed court papers asking a judge to dismiss the case because the plaintiffs couldn't prove negligent care killed Lori Stodghill and her fetuses. They also argued that "under Colorado law, a fetus is not a `person,' and Plaintiff's claims for wrongful death must therefore be dismissed."

The trial judge agreed, finding that previous state cases required a fetus to be "born alive" to have a legal claim. An appellate court upheld the dismissal on other grounds. Stodghill's attorneys are now asking the state Supreme Court to hear the case.

The arguments were first reported on Jan. 23 by The Colorado Independent and Westword and set off a firestorm because of Catholic health groups' past stances on such issues. The trade group representing Catholic Hospitals opposed a provision of the federal health care law mandating that birth control be covered by insurance.

In their Monday statement, Denver Archbishop Samuel J. Aquila, Colorado Springs Bishop Michael Sheridan and Pueblo Bishop Fernando Isern said: "Catholic healthcare institutions are, and should, be held to the high standard of Jesus Christ himself."

They and CHI pledged not to argue against fetal personhood further in the case. They also said they and CHI sympathize with the Stodghill family.

Attorney Timms Fowler, who wrote a brief on behalf of the Colorado Trial Lawyers Association in the case, doesn't believe that allowing lawsuits over wrongfully killed fetuses leads to giving them the same rights as human beings. He said there is a difference between "the duty owed by a stranger to the mother and the unborn child" and the mother's own decisions about the fetus' future.

"To die by the wrongful conduct of a stranger, you don't have to be a walking, talking, full person," Timms said, stressing he was speaking for himself and not the association.

Last Monday, no church representatives testified as a state legislative committee considered a proposal to make it a crime to kill a fetus. Republican Rep. Janak Joshi said his measure was not meant to wade into abortion politics but rather enable prosecutors to file additional charges in cases like the Aurora movie theater shooting. One victim was so severely wounded during the July massacre that she miscarried, but prosecutors could not file murder charges on her unborn child's behalf.

Witness Heather Surovik told the committee about how a drunken driver injured her last year and killed her 8 1/2-month-old unborn son, Brady. At the hospital, the emergency staff removed him from her body and dressed his corpse in infant clothes. Prosecutors could not file vehicular manslaughter charges because Brady was not legally a person.

Democrats and an attorney for Planned Parenthood argued that Joshi's measure, as written, could enshrine legal rights for fetuses in state law and lead to an abortion ban. The committee voted it down, but Democrats later unveiled their own bill that would make it a crime to kill a fetus during a criminal act committed against a pregnant woman. That measure specifically states that the intent is to neither outlaw abortions nor give unborn children additional rights.

A hearing on that proposal is scheduled later this month.

© 2013 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Tuesday, 05 February 2013 07:43
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