All members of the household need to be treated for trachoma in order to prevent rapid re-infection, according to a new study published in PLoS Neglected Tropical Diseases.

Trachoma is an infectious eye disease, and the leading cause of the world’s infectious blindness. Globally, 84 million people suffer from active infection and nearly 8 million people are visually impaired as a result of this disease.

Community-wide administration of antibiotics is one arm of a four-pronged strategy in the global initiative to eliminate blindness due to trachoma. The potential impact of more efficient, targeted treatment of infected households depends on the relative contribution of community and household transmission of infection, which have not been previously estimated.

A research team which included a number of scientists from the London School of Hygiene & Tropical Medicine, together with colleagues from Imperial College London, Johns Hopkins (US) and the Wilmer Eye Institute, studied prevalence data from four endemic populations in The Gambia and Tanzania. They found the rate of transmission of trachoma within households to be higher than the rate in communities, leading to persistent transmission of the infection within households. In all populations, individuals in larger households contributed more to the incidence of infection than those in smaller households.

David Mabey, one of the authors of the paper, comments: ‘We have known for many years that cases of trachoma tend to cluster within households. This paper is the first to compare rates of transmission within and between households. We have shown that within-household transmission is far more efficient, and accounts for almost three quarters of new infections across the four communities we studied. Failure to treat all infected members of a household during the mass administration of antibiotics is likely to lead to the rapid re-infection of that household, followed by a more gradual spread across the community. It is important to achieve high treatment coverage of infected households in mass treatment campaigns.’

Isobel Blake, the lead author of the study from Imperial College London, said: “Trachoma can be a very debilitating disease – it is difficult for people in the developing world to work and get on with their everyday lives if they lose their sight. Our research shows that the bacterial infection which causes trachoma can spread really easily within a household. This happens through contact with an infected person’s hands, or with objects like towels and clothing that have picked up the bacteria, or with flies, which transfer the bacteria from person to person. If control programmes make sure they treat everyone who is living with an infected person, they can greatly reduce the spread of the infection.”

London School of Hygiene & Tropical Medicine (LSHTM)
lshtm.ac

A study published by the Public Library of Science (PloS) One found that three out of five DDT-resistant Aedes aegypti mosquitoes, carriers of human diseases like dengue and urban yellow fever, avoided huts sprayed with DDT. The chemical’s unique spatial repellent action, combined with its moderate irritant and toxic properties, reduced the risk of disease transmission by nearly three-quarters.

The study authors looked at huts sprayed inside with three different residual insecticides – DDT, alphacypermethrin and dieldrin. Dieldrin’s toxic effect killed 92% of mosquitoes that made contact. Alphacypermethrin worked by both killing and irritating mosquitoes making contact, prompting them to rapidly exit, providing a composite 61% transmission protection. DDT’s spatial repellency kept almost as many mosquitoes from even entering the huts. By combining all three modes of action, DDT provided 73% protection.

“A toxic chemical like dieldrin kills almost all of the mosquitoes that land on it, but also increases the chance for rapid build up of resistance,” said Dr. Donald Roberts, study author and Professor of Tropical Disease at the US Uniformed Services University of the Health Sciences. “Since toxicity is dieldrin’s only chemical action, resistance completely eliminates its usefulness. Unlike dieldrin, DDT’s spatial repellency acts like a chemical screen, keeping 59% of the mosquitoes out of the hut at the outset. By comparison, alphacypermethrin and dieldrin did not deter the study mosquitoes from entering huts.”

According to the study results, DDT is the only World Health Organization (WHO)-recommended chemical that provides all three levels of protection if the disease-carrying mosquito is not resistant. Even where resistance to its toxic action exists, DDT still provides protection through its repellent and irritant actions. These findings have implications for controlling malaria, the biggest killer of African children. Most malaria infections are acquired when Anopheles mosquitoes enter homes at night and bite people. Anopheles mosquitoes are known to exhibit stronger behavioral responses to DDT and other chemicals than Aedes aegypti, so the transmission protection DDT provides against malaria is likely to be greater than 73%.

“The findings of this study support WHO’s recommendation to use DDT for indoor residual spraying,” says Dr. Roberts. “DDT’s repellent action makes it a powerful public health tool. It also explains why DDT remains effective against malaria-carrying mosquitoes in India, where mosquitoes developed resistance to its limited toxic action.”

The study authors propose a new classification scheme for public health insecticides that takes into account the multiple modes of action described by the study. They further urge researchers to look beyond toxicity in the search for alternative public health insecticides.

“By limiting our focus on insecticidal action to one-dimension, toxicity, we have missed opportunities to optimize insecticides against malaria,” says Richard Tren, Director of Africa Fighting Malaria, a non-profit advocacy group. “Vector resistance is a major threat to malaria control, but a poorly funded and barely understood subject. The Gates Foundation is the only organization investing in new public health insecticides, and broadening its focus to include all modes of chemical action on disease vectors.”

The study cited is Grieco, J. P., Achee, N. L., Chareonviriyaphap, T., Suwonkerd, W., Chauhan, K., Sardelis M. R., and Roberts, D.R., A New Classification System for the Actions of IRS: Chemicals Traditionally Used for Malaria Control. Public Library of Science One, Published online August 8th, 2007. This study is attached as a PDF along with background information on malaria and the applicability of the study results to malaria control.

fightingmalaria

If style is the main objective when you select shoes, your feet may suffer, especially as you age.

Over time, your feet become wider and longer and the natural padding under your heel and forefoot thins. Years of use also flatten your arches and stiffen your feet and ankles.

If you often wear shoes that are too short or too narrow, you may develop foot deformities such as bunions, calluses or corns, hammertoes or pinched nerves between your toes. Wearing better-fitting shoes reduces your chances of developing deformities or making them worse.

The July issue of Mayo Clinic Women’s HealthSource offers these tips when selecting shoes:

– Try on shoes later in the day. Feet can swell as the day wears on.

– Fit shoes to your largest foot. Your feet aren’t equally matched, so have both measured.

– Make sure there’s at least a half-inch for your longest toe at the end of each shoe when you’re standing. You should be able to wiggle all toes.

– Make sure your heel doesn’t ride up and down when you walk.

– Leave too-tight shoes behind. There’s no such thing as a break-in period.

– Look for shoes that are solidly constructed, conform to your feet and have cushioned soles that absorb the shock of hard surfaces.

– Try a lace-up style. A shoe that ties can be adjusted for better comfort and support.

– Look for a natural material, such as leather, on the upper portion of the shoes because it’s usually softer and provides more flexibility than a man-made material.

If you have diabetes, osteoporosis, rheumatoid arthritis or other conditions that put you at risk of foot problems, ask your doctor what other precautions are recommended.

This is a highlight from the July issue of Mayo Clinic Women’s HealthSource. You may cite this publication as often as you wish. Mayo Clinic Women’s HealthSource attribution is required. Also, you may reprint up to four articles annually without cost. More frequent reprinting is allowed for a fee. Include the following subscription information as your editorial policies permit: Call toll free for subscription information, 800-876-8633, extension 9PK1.

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Today Allergy & Asthma Network Mothers of Asthmatics (AANMA), the leading patient advocacy group for allergy and asthma, provided guidelines for people with asthma to prevent H1N1, often referred to as swine flu, and prepare themselves in the event they contract this virus that is threatening to become a global pandemic.

Although those with asthma are not necessarily more prone to coming down with H1N1 flu, their symptoms can be worse due to their compromised immune systems.

Influenza attacks the respiratory system, which means that those with asthma, chronic obstructive pulmonary disease (COPD) and related respiratory conditions are also at higher risk of developing complications from the virus. As a result, prevention and preparation are essential.

Nancy Sander, President and Founder of AANMA, said, “If symptoms occur, early intervention is critical. Just because we are at greater risk of serious flu complications doesn’t mean we can’t be well-armed and weather the storm. The best insurance plan is to have a written asthma action plan consistent with the federally funded, evidence-based National Asthma Education and Prevention Program (NAEPP)’s Guidelines for the Diagnosis and Management of Asthma. Access to inhaled corticosteroids and other appropriate medications, annual flu shots and specialty care are among top recommendations that, when followed, eliminate death and suffering and reduce direct costs as high as $37 billion each year.”

AANMA offers the following tips:

– Make sure you have an up-to-date, written asthma-management plan from your physician, as detailed by the NAEPP Guidelines.

– Make sure you have a fresh, full supply of medications.

– Practice good hygiene, especially hand washing.

– Stock up on food and entertainment (movies, books, games) to minimize time spent in public places.

Symptoms of H1N1 flu include:

– fever

– extreme tiredness

– lack of appetite

– coughing

Some people with the virus have also reported a runny nose, sore throat, nausea, vomiting and diarrhea.

People with asthma are also advised to steer clear of Relenza, an antiviral medication sometimes prescribed for the flu instead of Tamiflu. Some patients using Relenza have had bronchospasm (wheezing) or serious breathing problems. Many but not all of these patients had previous asthma or COPD. Relenza has not been shown to shorten the duration of influenza in people with these diseases.”

Sander continued, “The key is to treat symptoms early according to the written asthma action plan. Although the NAEPP Guidelines are federally funded and proven to save lives, reduce suffering and save money many Medicaid children and disabled adults do not have access to this level of care and necessary medications. For this reason, on May 6, 2009, we are asking Congress to ensure that all patients, including those who receive federal and state health assistance, have access to NAEPP Guidelines care. By making this goal a reality, we can eliminate suffering and death due to asthma and greatly reduce direct costs associated with poorly managed symptoms.”

About AANMA

Founded in 1985, Allergy & Asthma Network Mothers of Asthmatics is the leading national nonprofit family organization dedicated to eliminating suffering and death due to asthma, allergies and related conditions. AANMA’s core areas of expertise are education, advocacy and outreach.

On May 6, 2009, the organization will host its 12th annual Asthma Awareness Day Capitol Hill to support disease-specific and patient-centric healthcare reform initiatives that will save lives and money. Members of Congress and the media will attend a breakfast briefing to meet families whose life-and-death stories demonstrate need for action, healthcare experts whose programs currently save lives and money in America’s lowest income, hardest hit populations, and nonprofit organizations who provide free quality services to patients. According to the Centers for Disease Control and Prevention (CDC), asthma affects 23 million Americans and causes 3,884 deaths a year.

Source: Allergy & Asthma Network Mothers of Asthmatics

View drug information on Relenza; Tamiflu capsule.

A team of researchers at MIT and the University of California at San Diego has shown how cell division in a type of bacteria known as cyanobacteria is controlled by the same kind of circadian rhythms that govern human sleep patterns.

Previous studies have shown that even though cyanobacteria do not “sleep” in the same way that humans do, they cycle through active and resting periods on a 24-hour schedule. Cyanobacteria depend on sunlight for photosynthesis, so they are most active during the day.

The researchers demonstrate, for the first time, how the circadian clock regulates the bacteria’s rate of cell division (their method of reproduction) in single cells. “These cells have to keep dividing, and the circadian oscillator regulates when they divide,” says Bernardo Pando, an MIT graduate student in physics and one of the lead authors of a paper describing the findings in the March 18 online edition of Science.

In multicellular animals, including humans, cell division is critical for renewal and repair, while out-of-control cell division leads to cancer, so “understanding how cells are dividing is really of fundamental importance,” says Susan Golden, professor of molecular biology at the University of California at San Diego and an author of the paper.

Cyanobacteria maintain their circadian rhythms even when isolated from the naturally occurring daily light-dark cycles of the sun, just as humans do. The researchers found that under conditions of moderate constant light, the cyanobacteria undergo cell division about once per day, and the divisions take place mostly at the midpoint of the 24-hour cycle

To figure out how the cell division cycle is coupled to the circadian clock, the researchers sped up the cell cycle by boosting the intensity of light, enabling the cells to photosynthesize more, which increases the amount of energy available to them. The cells did start to divide more frequently, but in a pattern still linked to the circadian clock – they divided once a quarter of the way into the cycle, and again three-quarters into the cycle.

The team also showed that the cyanobacteria enter a resting phase about 19 hours into the circadian cycle, after which they will not divide until the next cycle begins.

How they did it: The researchers tracked single cells over a weeklong period. Proteins that govern the circadian clock were tagged with yellow fluorescent protein, so each cell’s position in the 24-hour cycle could be pinpointed. Cells were also photographed every 40 minutes, so researchers could see when they divided.

This is the first time researchers have studied how cell cycle and circadian rhythms are coupled in individual bacterial cells. “You can only do this by looking at single cells,” says Alexander van Oudenaarden, MIT professor of biophysics and senior author of the paper.

Next steps:
The same experimental setup could be used to study the relationship between circadian clocks and any other cell function that oscillates periodically. Yeast and mammalian cells are logical targets for such studies, says van Oudenaarden. Golden is planning further studies into how the circadian clock and proteins that control cell division in cyanobacteria are linked.

Source: “Circadian Gating of the Cell Cycle Revealed in Single Cyanobacterial Cells,” Qiong Yang, Bernando Pando, Guogang Dong, Susan Golden, Alexander van Oudenaarden. Science, March 19, 2010.

Funding: National Science Foundation, National Institutes of Health.

Source:
Jen Hirsch
Massachusetts Institute of Technology

The Centers for Medicare & Medicaid Services (CMS) issued a final rule that will change how Medicare pays for dialysis services for Medicare beneficiaries who have end-stage renal disease (ESRD). CMS also issued a proposed rule that would establish a new quality incentive program (QIP) to promote high quality services in dialysis facilities by linking a facility’ s payments to performance standards. The QIP is the first pay-for-performance program in a Medicare fee-for-service payment system.

“The new payment system and quality incentive program for dialysis services have significant potential to improve patient outcomes and promote efficient delivery of health care services,” said CMS Administrator Donald Berwick, M.D. “In addition, for the first time in any of our payment systems, the quality of care facilities furnish to patients will be reflected in their payment rates.” Currently, facilities only report on whether they have complied with quality measures.

The final rule establishing the new prospective payment system (PPS) provides for a payment adjustment for home dialysis training when clinically appropriate. This adjustment, which CMS adopted in response to public comments on the ESRD PPS proposed rule that strongly supported home dialysis, will help ensure that ESRD patients are learning the skills and techniques they need to properly receive their dialysis treatment at home.

Both the new prospective payment system and the proposed QIP were required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). The law requires the ESRD PPS to pay dialysis facilities a single bundled rate for renal dialysis services and home dialysis, while the proposed QIP promotes quality of service furnished by these facilities by creating payment incentives for them to take steps to improve patient outcomes.

ESRD was the first category for Medicare eligibility based on a specific diagnosis, without regard to the age of the patient. Patients are diagnosed with ESRD when their kidneys are no longer able to perform the function of removing excess fluids and toxins from their blood. The only cure for ESRD is a kidney transplant, but in the absence of a transplant, the patient must rely on dialysis to filter his/her blood. There are more than 330,000 individuals in the United States with ESRD, of whom the great majority are Medicare beneficiaries.

Currently, Medicare pays for certain dialysis services under a partial bundled rate, referred to as the composite rate. Payments for these composite rate services represent about 60 percent of total Medicare payments to ESRD facilities. The remainder of Medicare spending for dialysis services is for separately billable items such as drugs, supplies and non-routine laboratory testing. In 2007, there were about 600 hospital-based and 4,330 freestanding ESRD facilities furnishing outpatient maintenance dialysis services to nearly 330,000 Medicare patients. Total Medicare payments for these services were $9.2 billion including the dialysis treatments and other ESRD-related items such as drugs.

The new ESRD PPS provides a single bundled case-mix adjusted payment to dialysis facilities for renal dialysis services such as dialysis treatments and supplies, certain ESRD-related drugs, and ESRD-related clinical laboratory tests beginning on Jan. 1, 2011. Although CMS has determined that the definition of renal dialysis services includes ESRD-related oral drugs without injectable equivalents (or other forms of administration), CMS is delaying paying for those drugs under the ESRD PPS until Jan. 1, 2014.

The final rule sets a base payment rate of $229.63 for each dialysis treatment. This payment rate includes payment for the services in the current composite rate, as well as most items and services that are currently paid separately. The base rate was derived from 2007 claims data for both composite rate and separately billable services and updated to reflect projected 2011 prices.

The base payment rate would be adjusted for case-mix factors including patient’s age, body size, and time on dialysis. By accounting for more characteristics of patients, the new PPS will target payments more appropriately, paying higher rates to those facilities with the most costly dialysis patients. Separate case-mix adjustments will apply to pediatric patients. In the final rule, CMS also adopts facility level adjustments including a geographic wage index and an adjustment for low-volume facilities that furnish fewer than 4,000 dialysis treatments and meet certain other criteria. The final rule also includes an outlier payment policy that will pay facilities more for patients whose care is significantly more costly than the Medicare payment amount.

In the ESRD PPS final rule, CMS also has reduced the number of case-mix co-morbidity adjustments. In addition, at this time, CMS is not finalizing a case-mix payment adjustment based on the patient’s sex, race or ethnicity. CMS has been reviewing and updating its processes for collecting and validating patient-level race and ethnicity data from dialysis facilities, which will ensure that CMS has the most accurate information possible for the races and ethnicities of all patients with ESRD. As this work continues, CMS will assess whether this effort will position the Agency to incorporate such an adjuster for payment in the future. CMS plans to continue studying the issue to ensure that all beneficiaries with ESRD have access to quality care, and in the meantime, plans to implement an active monitoring program to respond to concerns about disparities in access to care.

In addition to finalizing the ESRD PPS payment policies and rates for calendar year 2011, CMS issued a proposed rule that would establish performance standards and a scoring methodology for the Quality Incentive Program required by MIPPA to ensure quality of care for patients with ESRD.

“The ESRD QIP is a critical tool for encouraging and supporting dialysis facilities to focus their energies thoroughly on the quality of the dialysis care they provide to Medicare beneficiaries,” said Berwick.

In the ESRD PPS final rule, CMS adopted the three quality measures that will be used in the initial implementation of the QIP. Two of these measures reflect whether patients are receiving appropriate treatment for anemia – that is, whether the amount of iron in the blood is neither too low, nor too high. The third measure captures patients’ urea reduction ratio, which indicates how well dialysis treatments are removing wastes from patients’ bodies. The law requires CMS to reduce the payment rates to a dialysis facility by up to 2.0 percent if that facility fails to meet or exceed the established performance scores with regard to performance standards established for each quality measure.

Facilities failing to meet or exceed specified total performance scores will receive reduced reimbursement for dialysis services furnished on or after Jan. 1, 2012.

The QIP proposed rule also discusses options for making individual facility performance scores available both to dialysis patients and to the general public as required by the law.

CMS will accept comments on the QIP proposed rule until Sept. 24, 2010, and will respond to them in a final rule to be issued later this year.

To view the ESRD PPS Final Rule and the QIP Proposed Rule, see here.

Source:

Centers for Medicare & Medicaid Services

A new approach to stimulating immune cells enhances their anticancer activity, resulting in a powerful anti-tumor response in mice, according to a study by researchers at the National Cancer Institute, a part of the National Institutes of Health. This work represents an important advance in the development of immunotherapy for cancer and appears online June 14, 2009 in Nature Medicine.

Researchers found that a subset of immune cells, T lymphocytes called CD8+ memory stem cells, were capable of mediating strong anti-tumor immune response. These potent cells were generated in the laboratory by stimulating anti-tumor T cells in the presence of drugs designed to mimic an important signaling pathway called Wnt, which is a complex network of proteins whose interactions are essential during development and stem cell maintenance. Under the influence of Wnt, T lymphocytes acquired stem-cell-like properties of multipotency and self renewal; that is, they generated differentiating daughter cells while regenerating themselves when transferred back to mice from the lab. These stem-like qualities enabled tiny numbers of T cells (about 40,000 cells) to trigger the destruction of large melanoma tumors (containing about one billion malignant cells).

This therapy, in which mice received CD8+ T memory stem cells together with a tumor vaccine and an immune system stimulant known as interleukin 2, improved the survival of treated mice compared with similar treatment using other types of memory T cells.

“This new category of lymphocytes is superior to T cells used in earlier experiments because they have the enhanced ability to renew themselves, to proliferate, to differentiate and ultimately to kill tumor cells,” said NCI lead author Nicholas P. Restifo, M.D., an investigator in the Surgery Branch at the Center for Cancer Research.

Current clinical immunotherapies, based on the transfer of tumor-specific T cells generated and expanded in the laboratory, rely on the use of large numbers of tumor-specific T cells and have had beneficial but sometimes limited success.

If confirmed in humans, the use of tumor-reactive CD8+ memory stem cells could reduce the numbers of tumor-specific T cells needed for successful immunotherapy, thus making this type of therapy easier to develop so that more patients could benefit.

These findings mark the latest advance in the field of cancer immunotherapy using tumor-specific T cells, which is moving from proof-of-concept to a promising treatment for patients with metastatic cancer.

The research was led by Luca Gattinoni, M.D., and Nicholas P. Restifo, M.D., NCI.

Reference: Gattinoni L, Zhong XS, Palmer DC, Ji Y, Hinrichs CS, Yu Z, Wrzensinski C, Boni, A, Cassard L, Garvin LM, Paulos CM, Muranski P, and Restifo NP. Wnt signaling arrests effector T cell differentiation and generates CD8+ memory stem cells. Nature Medicine. Online June 14, 2009.

For more information on Dr. Gattinoni’s research, please go to ccrncer/staff/staff.asp?profileid=7289. For more information on Dr. Restifo’s research, please go to ccrncer/staff/staff.asp?profileid=5762.

NCI leads the National Cancer Program and the NIH effort to dramatically reduce the burden of cancer and improve the lives of cancer patients and their families, through research into prevention and cancer biology, the development of new interventions, and the training and mentoring of new researchers. For more information about cancer, please visit the NCI Web site at cancer or call NCI’s Cancer Information Service at 1-800-4-CANCER (1-800-422-6237).

Source
The National Institutes of Health (NIH)

Dr. J. Francois Eid has performed more internal penile implant surgeries than anyone in the world and has built a reputation for excellence in the treatment of erectile dysfunction (ED). After examining the latest generation of Inflatable Penile Prosthesis (IPP) and Artificial Urinary Sphincter (AUS) technologies from American Medical Systems (AMS) and Coloplast Corporation, reviewing pertinent studies, and drawing on his 20 years of experience performing penile prosthesis surgery and overseeing his patients’ recuperation and subsequent training in operating the devices, Dr. Eid has high praise for the recent improvements. Updates have been made to the IPP pumps offered by both AMS and Coloplast, as well as to the CX and LGX cylinders offered by AMS. Also, AMS has added an antibiotic coating to its AUS.

Momentary Squeeze (MS) Pump – AMS

AMS’s Momentary Squeeze (MS) Pump was first introduced nearly two years ago, and Dr. Eid has implanted it with great success in patients suited to the CX-cylinder and LGX-cylinder versions. (The LGX model offers the potential for increased penile length in patients complaining of penile shortening after radical prostatectomy.) Both cylinders now feature redesigned proximal ends. At only 9.5mm in diameter, the ends allow for significantly easier insertion for patients with fibrotic proximal corporal bodies.

The MS Pump’s advantages include a smaller profile (which enables a more discreet placement) and one-touch deflation. However, this quality can result in operational difficulties with inflation (more difficult to get a hold of within the scrotum) and deflation (small button can initially be difficult to find). In addition, its new lockout valve has the advantage of preventing auto-inflation (potentially embarrassing and/or painful), but can at times make it difficult to initiate inflation. For these reasons, Dr. Eid recommends this pump for the younger patient with an average-sized penis.

Tactile Pump (700 CX Series) – AMS

“The AMS 700 CX Series with the Tactile Pump remains my prosthesis of choice for the older patient where pump concealment is not an issue,” says Dr. Eid. “This pump is large, easily palpable, remains the softest to inflate and has a very large deflation footprint, which is quickly recognized by the patient.” The Tactile pump is not available with the LGX cylinders.

Titan Pump – Coloplast

The FDA approved the improvements to the pump component of the Coloplast Titan prosthesis in July 2008. Although the cylinders and reservoir remain the same as the previous model, the pump now features a one-touch-release (OTR) deflation valve — easy for patients to locate and operable with one hand. In addition, the pump offers a non-bulky, low-profile size; enhanced silicone for higher threshold “tear strength” (likely to result in increased product durability, an issue with previous versions); and an overall simplicity likely to decrease repeat office visits, phone calls, and repeat training time. From a hospital standpoint, intraoperative prep of the device provides for easier priming of the implant system (the removal of excess air prior to filling) and may reduce slightly the overall intraoperative time.

“This remains a great device for the patient with a larger penis,” says Dr. Eid, “as these are the only cylinders that will expand to 22mm girth.” In addition, only Titan cylinders are available in lengths of 24cm, 26cm and 28cm.

Although the pump is easily identified and operated by patients, the small size of the deflation valve sometimes requires a longer learning curve.

In a recent study (“Evaluation of Three Penile Prosthesis Pump Designs in a Blinded Survey of Practitioners,” Urologic Nursing, 2008), 32 medical professionals, all familiar in teaching the operation of penile implants to patients, reviewed currently available penile pumps. The blindfolded reviewers, examining the pumps under time constraints through mock scrotal sacs, were asked to rate device:

– ease of location of deflation valve
– ease of inflation
– ease of deflation, and
– anticipated ability to train patients in clinical setting.

The Titan OTR pump design performed very well and “consistently demonstrated a significant advantage in subject preference.” (Quallich, Ohl & Dunn, 2008, p. 5).

Artificial Urinary Sphincter – AMS

AMS has improved the AUS by coating the device surface with inhibizone. This is the same antibiotic coating (Rifampin and Minocin) currently available on the IPP that has dramatically reduced infection rates since its introduction in 2001. In combination with Dr. Eid’s self-developed “no-touch” surgical technique, which eliminates direct and indirect contact between the prosthesis and the patient’s skin (the origin of most infections), he believes the new coating will offer additional protection against the most common pathogens responsible for sphincter infections.

Dedicated to Patient Education

Dr. Eid has developed a website UrologicalCare dispelling common misconceptions about penile implant surgery. Having performed over 3,000 penile implant surgeries (the most worldwide), Dr. Eid knows what a remarkable and positive difference the treatment can make in a man’s life. Between retaining a normal penis look and feel, employment of multiple techniques for preventing infection, and steady diminishment of pain until it is completely gone within 2-4 weeks, penile implant surgery has proven to be an effective treatment for many men, resulting in normal, healthy and productive lives.

About J. Francois Eid, M.D, and UrologicalCare

Dr. Eid is the director and founder of Advanced Urological Care in New York City. He is also a Clinical Associate Professor of Urology at Cornell University. Dr. Eid is one of the foremost specialists in urological prosthetic reconstruction and performs over 300 internal penile implants per year. Dr. Eid leads workshops on penile prosthesis surgeries worldwide. More information about Dr. Eid and his expertise with erectile dysfunction treatment, penile prosthesis implantations and artificial urinary sphincters can be found on his website, UrologicalCare.

UrologicalCare

U.S. residents are becoming increasingly concerned that they will be unable to save enough money to live comfortably during their retirement as a result of rising health care costs and the slowing economy, according to the Employee Benefit Research Institute’s annual survey, the AP/San Francisco Chronicle reports. For the survey, research firm Mathew Greenwald & Associates conducted telephone interviews with more than 1,320 people ages 25 and older. The survey had a margin of sampling error of plus or minus three percentage points. The survey found:
61% of respondents said they are “very confident” or “somewhat confident” of having enough money for retirement, the lowest percentage since 2001 and down from 70% in 2007;

Respondents who said they are “very confident” decreased from 27% last year to 18% this year, the largest decrease in the 18-year history of the survey;

22% of respondents currently working said they are concerned about not having enough savings to cover medical expenses during retirement, while 27% are concerned about long-term care costs;

15% of retired respondents said they are worried they did not have enough savings to cover medical expenses, and 28% said they are concerned they did not have enough savings to pay for long-term care (Alt Powell, AP/San Francisco Chronicle, 4/8);

33% of respondents currently working said they expect to have access to employer-paid health insurance in retirement, compared with 41% in 2007(Greene, Wall Street Journal, 4/9); and

About 50% of workers have saved less than $25,000 for their retirement, 24% have saved $25,000 to $99,999, 15% have saved $100,000 to $249,999 and 12% have saved $250,000 or more, not including the value of primary residences or pensions.

Reaction
Jack VanDerhei, a Temple University business professor and a co-author of the study, said, “I think more workers are beginning to factor in all the various information they’ve been given, especially the need for additional retirement funds just for the health care component” (AP/San Francisco Chronicle, 4/8). VanDerhei added that the presidential campaign likely is contributing to the results. “It’s the first time in at least four years you’re getting the constant drumbeat (in the media) that health expenses are going to be a problem going forward,” he said, adding, “The candidates are talking about the future solvency of Medicare and employers’ cutting down on retiree health coverage” (Wall Street Journal, 4/9).

EBRI President Dallas Salisbury said, “The economy and health costs are major concerns,” adding, “If there is a silver lining, it’s that Americans finally may be waking up to the realities of being able to afford retirement” (AP/San Francisco Chronicle, 4/8).

According to the St. Petersburg Times, researchers say the drop in confidence “may not be a bad thing.” VanDerhei said that in the past, “people were relatively confident they’d have enough money, but if you looked at what assets they had, it was just pathetically low,” adding, “The good news is that false optimism has started to evaporate. The bad news is that it hasn’t translated into a lot of increased retirement savings.”

According to the Times, “Confidence levels have been affected by the downturn in the economy, particularly the decline in home values and stock prices and the rise in unemployment,” with workers becoming “more aware of problems in their traditional safety nets.” In addition, fewer workers “expect Social Security and Medicare to provide them with the same level of benefits current retirees receive,” the Times reports (Huntley, St. Petersburg Times, 4/9).


An executive summary of the survey is available online.

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

A team approach to treating depression in older adults, already shown to improve health, can also cut total health-care costs, according to a new study led by the University of Washington. The study appears in the February issue of the American Journal of Managed Care.

Clinical depression affects about 3 million older adults in the United States and is associated with 50 to 70 percent higher health-care expenses, mostly due to an increased use of medical, not mental health, services. In this study, researchers found that adults over 60 who received a year of team care for depression had lower average costs for all of their health care over a four-year period — about $3,300 less than patients receiving traditional care, even when the cost of the team care treatment is included.

Over the past several years, a multi-center research team has been studying a team care approach called IMPACT (Improving Mood – Promoting Access to Collaborative Treatment for Late Life Depression). The treatment model features a nurse, social worker or psychologist serving as a depression-care manager. This depression-care manager works with the primary care physician and a consulting psychiatrist to care for depressed patients in their primary care clinic.

Previous studies have shown that the IMPACT program provides powerful health benefits, including significantly decreased depression and chronic physical pain, improved physical functioning and better overall quality of life. In this cost evaluation study, 551 IMPACT participants from two large health-care organizations, Group Health Cooperative of Puget Sound and Kaiser Permanente of Southern California, were followed for four years to examine long-term effects of team care on medical costs.

“Study participants assigned to the IMPACT program saw significantly lower total health care costs over four years than patients receiving standard care, and our research shows that this difference was almost certainly due to the IMPACT team-care model,” said Dr. Jurgen Unutzer, professor and vice-chair of psychiatry and director of the IMPACT Implementation Center at the UW. “This research, combined with our other work showing how team care for depression has significant health benefits for older adults, illustrates how important it is for health organizations to consider implementing evidence-based collaborative models of depression care, such as IMPACT.”

The cost of using the IMPACT model of depression care treatment is only about $500 per year for each patient – a modest investment compared to the total medical costs of about $8,000 per year for an older adult with depression. When spread out over an entire population of older adults, the cost of offering IMPACT as a health care benefit amounts to about $1 per person per month.

Based on its high effectiveness and cost-effectiveness, several major health organizations have already implemented the IMPACT model for depression care, including Kaiser Permanente of Southern California, which serves more than 3 million people in its 12 regional medical centers. In the Seattle area, Virginia Mason Medical Center will begin rolling out IMPACT to patients in their primary care clinics over the next few months. The John A. Hartford Foundation is supporting the efforts of Unutzer and his colleagues to help these and other health-care systems around the country adapt and implement IMPACT.

A cheaper, more effective method of treating clinical depression in older adults has become more important in recent years, as physicians have learned that the condition affects not only the mental health but also the physical health of millions of patients and helps drive up health-care costs. Studies estimate that 5 to 10 percent of older adults seen in primary care suffer from clinical depression. The condition is associated with a bevy of other medical problems, including more suffering and physical pain, decreases in physical ability and self-care of chronic illnesses, and a high potential for suicide. It also can significantly increase medical costs.

Unfortunately, many older adults don’t seek treatment for depression, and when they do, physicians can sometimes inadvertently delay diagnosis or misdiagnose the condition. Doctors and their patients often share the misconception that depression is a natural consequence of aging. When the condition is successfully diagnosed, patients often do not receive effective, evidence-based treatment with medication, psychotherapy, or a combination of the two. With a team-care program, like IMPACT, may of these barriers can be overcome.

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Background: IMPACT

The IMPACT study, which began in 2001, randomly assigned 1,801 depressed older adults from 18 diverse primary care clinics in eight cities in the United States to usual depression care or to the IMPACT program. In IMPACT care, a depression-care manager (a nurse or psychologist) with consultation from a psychiatrist and an expert primary care physician helped patients and their primary care doctors treat depression in the primary care setting. The care managers helped educate patients about depression, closely tracked depressive symptoms and side effects, helped make changes in treatment when necessary, supported patients on anti-depressant medications, and offered a brief course of psychotherapy to help patients make changes in their lives.

The IMPACT program did not replace the patient’s regular primary care physician, but instead supported these physicians to help them provide higher quality depression care. An independent evaluation of the study outcome was done at baseline 3, 6, 12, and 24 months to compare IMPACT to usual care.

The 18 study sites that were part of the IMPACT Project are located at Duke University, South Texas Veterans Health Care System, Central Texas Veterans Health Care System, San Antonio Preventive and Diagnostic Medicine Clinic, Indiana University School of Medicine, Health and Hospital Corporation of Marion County in Indiana, Group Health Cooperative of Puget Sound in cooperation with the University of Washington, Kaiser Permanente of Northern California, Kaiser Permanente of Southern California, and Desert Medical Group in Palm Springs, CA.

The IMPACT study was supported primarily by a grant from the John. A. Hartford Foundation with support from the California Healthcare Foundation, Hogg Foundation, and the Robert Wood Johnson Foundation. The John A. Hartford Foundation (jhartfound/) is dedicated to improving health care for older Americans.

The IMPACT Implementation Center, where physicians and health care professionals can learn more about implementing the IMPACT model in their organizations , can be found at: impact-uw/

Source: Justin Reedy

University of Washington