Archive for November, 2010

7th lawsuit against MN nursing home filed in SD

SIOUX FALLS, S.D. — A seventh lawsuit has been filed in federal court in South Dakota over alleged elder abuse at a Minnesota nursing home.

The latest lawsuit claims like the others that the Sioux Falls-based Evangelical Good Samaritan Society failed to properly oversee employees at the home in Albert Lea.

A Minnesota Health Department investigation in May 2008 concluded that several nursing assistants mistreated dementia and Alzheimer’s patients. The Argus Leader reports that one woman has been sentenced to three months in jail in the case and another is to be sentenced in December.

In Minnesota, liability claims die with the victim. In South Dakota, families of victims can pursue civil claims on their behalf.

The Good Samaritan Society has sought to have the lawsuits filed in South Dakota dismissed.


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Illinois Truck Accident Lawsuit Settled For $6.5M


The family of an Illinois woman killed in an accident caused by a truck driver who was high on marijuana, will receive $6.7 million to settle a wrongful death and personal injury lawsuit.  

The truck accident lawsuit was filed by the family of Tabitha Carroll, 32, who was killed on Halloween 2008. The accident occurred in Huntley, Illinois, when Jeffrey Repec, driving a tractor trailer for Geils Farms, rear-ended the pickup truck Carroll was riding in with her husband, Randy, and their three-year-old son, Gabriel. 

The family was on its way to a nearby pumpkin patch at the time of the accident. Tabitha Carroll was pronounced dead at the scene, Randy Carroll suffered a broken spine, respiratory failure and facial fractures, and Gabriel suffered two broken legs and head injuries, as well as lacerations. 

The settlement with Geils Farms, approved last month in Kane County court, awards the family $4.7 million for Carroll’s death, $1.5 million for injuries to Randy Carroll and $300,000 for injuries to Gabriel. Repec, who was said to be driving at a high rate of speed while under the influence of marijuana, is currently serving a 45-month prison sentence after pleading guilty to aggravated driving under the influence of drugs. 

According to a press release (PDF) issued by the family’s attorneys, it was discovered as the lawsuit developed that Geils Farms had failed to conduct random drug tests of its drivers, as required by law, and failed to perform background checks on its drivers. Repec’s tractor trailer that day was also found to be legally overloaded and weighed 80,000 pounds at the time of the crash.

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WSJ(10/26)Smoking In Your 50s, 60s Increases Risk Of Dementia


Need another reason not to smoke? Heavy smoking in middle age more than doubles the risk of dementia later in life, according to a study published Monday.

The study counters previous evidence suggesting that smoking might actually have a protective effect against Alzheimer’s disease.

Researchers followed 21,000 patients in the Kaiser Permanente health system for more than 20 years and found those who smoked more than two packs of cigarettes a day in middle age had a 157% greater risk of developing Alzheimer’s compared with nonsmokers. And they had a 172% greater risk of vascular dementia, the second-most common form and one that is associated with stroke and other conditions affecting blood supply to the brain.

The increased risk of dementia was more muted in less-heavy smokers: Those who smoked one to two packs a day had a 44% greater risk of developing dementia compared with nonsmokers, while those who smoked a half to one pack a day had a 37% increased risk.

About 25% of the sample developed dementia in older age, according to the results published in the journal Archives of Internal Medicine.

“It’s a pretty clear picture that heavy smoking . . . elevates your risk of dementia,” said Rachel Whitmer, a study author and scientist at the research division of Kaiser Permanente in Oakland, Calif. “If you are a heavy smoker and you’re lucky enough to make it to old age, you’re not in the clear. You’re still at risk for dementia.”

The researchers say they think smoking’s role in the development of Alzheimer’s and vascular dementia may include possible negative effects on brain blood vessels and brain cells.

“We know smoking compromises the vascular system by affecting blood pressure and elevates blood-clotting factors, and we know vascular health plays a role in risk of Alzheimer’s disease,” Dr. Whitmer said.

Previous studies had raised questions about whether smoking provided a protective effect. Some research in the early 1990s indicated that smoking reduced the risk of cognitive impairment and dementia, and a recent study showed that smoking appears to improve current cognitive performance, probably because of the effects of the stimulant nicotine.

There also is evidence to suggest that smokers are less likely to get Parkinson’s disease. Why this would be the case is “a big question mark,” but would likely involve how nicotine affects brain chemicals such as dopamine, according to Miia Kivipelto, deputy head of the Aging Research Center at the Karolinska Institute in Stockholm.

Earlier studies suggesting protective effects of smoking were biased, due to the likelihood that a higher proportion of heavy smokers died before developing Alzheimer’s disease, said Lenore Launer, chief of the neuro-epidemiology section at the National Institute of Aging who conducted some of the previous research but wasn’t involved in the current study.

Several other large-scale studies that followed patients over time have shown that smoking is a risk factor for dementia.

In the current study, researchers asked patients, who were 50 to 60 years old at the start of the study, whether they smoked or not — unlike previous studies of individuals in their 70s and 80s, who were asked to recall health habits from years ago. People often incorrectly remember information from years ago, or they may already be suffering from some type of mild cognitive impairment, Dr. Whitmer said.

Significantly, former smokers — those who had reported having quit by the start of the study — didn’t have an increased risk of dementia. That finding dovetails with other work to suggest “that if you quit smoking after seven to 10 years, especially at a young age, there is a lot of evidence you could be OK,” Dr. Whitmer said.

“The silver lining is that this risk factor is completely modifiable,” said William Thies, chief medical and scientific officer of the Alzheimer’s Association.

“For anyone who is contemplating ending a smoking habit, this study’s findings provide yet another excellent reason to do so,” he said.

In the recent study, the length of time that people smoked, and how long ago they’d quit, couldn’t be determined.

Dr. Whitmer is currently conducting a study to examine the long-term risk for dementia for people who began smoking in young adulthood.

“The brain is not immune to the long-term consequences of smoking,” she said.

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Sepsis: A deadly disorder you’ve never heard of

Sepsis: A deadly disorder youve never heard of Doctors say greater awareness, faster treatment will improve survival rates
DECATUR, Ga. (MarketWatch) – Sepsis is a leading cause of death in American hospitals, but ask most people what sepsis is, and theyll give you a blank stare.

About 750,000 Americans get sepsis every year at a cost of $17 billion to the U.S. health-care system, and about 200,000 die from it, according to the Global Sepsis Alliance, a coalition of 250,000 intensive- and critical-care physicians.

But 60% of Americans are unfamiliar with sepsis, and 30% who have heard the word cant define it, according to a recent poll commissioned by the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System in Manhasset, N.Y.

Sepsis is a global medical emergency with 18 million cases internationally every year, according to 150 medical professionals, researchers and policymakers from 18 countries, who attended the Merinoff Symposium, an international sepsis conference, in September.

As a key first step to increasing public familiarity of sepsis, the group ratified a new definition of the disease. Its a major problem when the leading killer cant even be described, said Dr. Kevin J. Tracey, president of the Feinstein Institute, which hosted the symposium. People need to know what it is in order to incite the response necessary to cure it.

Tracey urges doctors, media and other stakeholders around the globe to use this definition routinely: Sepsis is a life-threatening condition that arises when the bodys response to an infection injures its own tissues and organs.

That is, you contract another disorder, such as flu, pneumonia, cancer, bladder infection, appendicitis, skin infection, trauma, or any other bacterial, viral or fungal infection, including MRSA and other hospital-acquired infections, but its the bodys severe protective reaction to that infection, not the infection itself, which may lead to septic shock, multiple organ failure and death.

Complicating and often delaying diagnosis, initial symptoms of septic patients resemble those for other disorders, including low blood pressure, fever or chills, trouble breathing and general weakness.

Surgical patients who develop an infection and then sepsis stay in the hospital almost 11 days longer, at a cost of $32,900, and one in five die, according to a study of 1998-2006 discharge records reported in the September 2010 issue of Infection Control Today.

At Ohio State University Medical Center, one third of the patients on the intensive care unit at any given time have sepsis, said James M. OBrien, an ICU doctor at the Columbus hospital and a board member of the Global Sepsis Alliance. More public awareness of sepsis can only improve doctor-patient communication, he said.

A big part of my job is giving people bad news and telling them that their loved one is dying or has died, he said. Its difficult in all circumstances, but its even more difficult when their loved one is dying of something that the family has never heard of.

Chances are someone you know has had sepsis, but even the patient may not know because many physicians avoid the term, OBrien said.

A 2004 survey of 1,000 physicians in Europe and U.S. found agreement that sepsis is a leading cause of death in critical-care units and that similar symptoms to other conditions may lead to under-reporting. However, only 10% called the diagnosis sepsis when speaking to patients relatives, while 85% referred to sepsis as a complication of another condition.

You may be more susceptible to sepsis if you have a weakened immune system due to an illness such as cancer or AIDS or because of medical treatments such as chemotherapy, steroids or an organ transplant. Seniors and babies, whose immune systems are not fully developed, are also at greater risk.

But healthy people of all ages contract sepsis, OBrien said. In all honesty, we dont know why when you take 10 people and expose them to an infectious agent, [such as] a bacteria, some of them never get the bacteria, some get the infection and get better, and some develop sepsis and die from it, he said.

A year ago, Jennifer Ludwin, a 23-year-old Ohio State University graduate student, ran daily and was completely healthy. Then in October 2009, she developed a severe sore throat and high fever and began coughing up blood.

On her first emergency room visit, Ludwin received fluids and was sent home. A few days later, when her symptoms worsened, she returned and was admitted with H1N1 flu so severe her body triggered septic shock.

Ludwin remained hospitalized for 100 days. Her sepsis was so invasive and fast-spreading that to halt its progress, surgeons had to remove her gall bladder, perform a thoracotomy on her left lung, and amputate her legs below her knees, all her fingers on her left hand and partial digits on her right hand. She has had 18 surgeries to date with more to come.

Its a weird feeling because you realize you came so close to dying, but you have no memories of it, Ludwin said. In a way you dont believe it. My parents even had to discuss funeral arrangements for me.

Research studies have found that hospital deaths from sepsis could be reduced significantly by the simple practice of administering antibiotics and fluids sooner, OBrien said.

With septic shock, delays of antibiotics by even 30 minutes can prevent someone from dying, he said. The chance of dying goes up 8% per hour of delayed antibiotics.

At Ohio State University Medical Center, an investigation of antibiotic orders by emergency physicians found an up-to-four-hour delay between prescription and patient delivery. Now if a patient comes into the emergency room with low blood pressure, a key indicator for septic shock, antibiotic orders default to a high priority category for immediate dispensing, OBrien said.

Attendees of the Merinoff Symposium issued a statement calling for initiating antibiotics, fluids and other emergency actions within one hour of suspicion of sepsis. Meanwhile several large U.S. health-care systems are speeding up procedures for patients with sepsis symptoms, including North Shore-LIJ, which operates 28 facilities and services in New York state.

North Shore-LIJs program launched last year and already the system saw its mortality rate for septic patients drop to about 19% in June 2010 from 26% in 2008, said Dr. Kenneth J. Abrams, the health systems associate chief medical officer.

His dream is that soon early intervention for sepsis will be as routine as that for heart attacks. Today, a patient feels chest pain, self-administers an aspirin at home, then oftentimes therapy begins with an EKG transmitted to the hospital from the ambulance, Abrams said. A team is waiting to care for the patient upon hospital arrival and hes in the cath lab within 60 to 90 minutes.

About $100 million in U.S. research dollars is spent on sepsis annually, compared to about $700 million for breast cancer and about $300 million for stroke or prostate cancer, according to National Institutes of Health data.

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Dramatic drop in SoCal hospital overcrowding

LOS ANGELES — There’s been a dramatic drop in emergency room overcrowding at Los Angeles County-University of Southern California Medical Center.

County health officials told the Board of Supervisors on Tuesday that “dangerously overcrowded” conditions in the 600-bed hospital’s emergency room have dropped from an average 16 hours each day in August to five hours a day last month.

Health department chief network officer Carol Meyer says a new “rapid early medical evaluation” area in the emergency room has also eased treatment delays. Patients now see a doctor or nurse within an hour of arrival.

The Los Angeles Times says that since August, the number of people who left the emergency room without being seen has been halved and County-USC is now handling 400 more patients a month.

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Roche Shares Jump On Positive Multiple Sclerosis Drug Data

ZURICH (Dow Jones)–Roche Holding AG (ROG.VX) Friday said mid-stage trials of a experimental multiple sclerosis medicine ocrelizumab showed the drug to significantly reduce disease activity in patients with relapsing-remitting multiple sclerosis, raising hopes the medicine could make it to the market and eventually turn into a blockbuster.

Developed by U.S.-based Biogen Idec Inc (BIIB) and Roche unit Genentech, ocrelizumab was recently abandoned in treating patients suffering from rheumatoid arthritis due to an unfavorable risk profile, raising concerns the drug could be discarded in other indications, a step that would have weakened Roche’s pipeline.

Shares in Roche rose after news of the positive trial results, as a potential approval could turn the drug into a blockbuster. At 1348 GMT, the stock was up 2.8%, or CHF3.8, at CHF142.2. Still, Roche’s share price has fallen some 20% so far this year due to a series of setbacks, which have prompted management to launch a restructuring program that will entail job cuts and cost reductions.

Roche said that a 24 week phase II trial showed a substantial reduction of brain lesions and the relapse rate of multiple sclerosis patients. When administered at a dose of 2,000 milligrams, the reduction of brain lesions was 96% and at 89% at a dose of 600 milligram when compared to placebo.

“These efficacy results are amongst the most remarkable seen in a phase II … study, and show that ocrelizumab may have the potential to offer benefits to patients with this disease,” said Professor Ludwig Kappos, lead investigator of the study, from the Department of Neurology, University Hospital Basel, Switzerland.

The study involved 220 patients, comparing ocrelizumab to placebo in patients with relapsing-remitting multiple sclerosis, the most common form of this autoimmune disease that affects around 1.3 million people worldwide.

“We are strongly encouraged by these data and the possibility that ocrelizumab could become a new option for patients with multiple sclerosis,” said Hal Barron, Roche’s Chief Medical Officer. “We believe in the potential of ocrelizumab and look forward to exploring it further in the final phase of clinical development.”

Given these study results, chances for a potential approval are rising and could give Roche a sizable stake in the $10 billion multiple-sclerosis market even though ocrelizumab is administered via infusions, albeit only about twice a year depending on the treatment methodology. Earlier this year, cross-town rival Novartis AG (NVS) received approval to market its multiple sclerosis drug Gilenya, which is administered orally in pill form.

Given this easy regime, Gilenya is expected to reach peak sales of more than $ 3 billion, and could, according to analysts, give Novartis a lead over competitors such as Irish drug maker Elan Corp. PLC (ELN), U.S.-based Biogen Idec Inc. (BIIB) and Germany’s Merck KGaA (MRK.XE), whose drugs have to be administered more often via injections and infusions.

“The data still lacks a few missing pieces, but if it is what it looks like … ocrelizumab has a … strong efficacy profile, especially in relapse rates,” said Vontobel pharma analyst Andrew Weiss.

-By Goran Mijuk, Dow Jones Newswires, +41 43 443 80 47;

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