Posts Tagged ‘medical’

Coffee and Cancer

May 19th, 2011

Several years ago, at the Clinical Breast Care Project’s (CBCP) offsite retreat with the physicians from Walter Reed Army Medical Center, our biomedical informatics group had prepared a demonstration for the CBCP’s Scientific Advisory Board, a group of distinguished scientists, breast cancer consultants and physicians.

Colonel Craig D. Shriver, MC Director, Clinical Breast Care Project Program Director and Chief, General Surgery Walter Reed Army Medical Center

COL Craig D. Shriver, MC Director, Clinical Breast Care Project (CBCP), Program Director & Chief of General Surgery, Walter Reed Army Medical Center

As the 7:00 PM meeting time approached, it was obvious that there was not going to be a quorum present to start the formal meeting.  The two additional members had called in and we sat waiting patiently for the remainder of this august body to join us; fifteen minutes passed, then twenty and finally at about 7:25 PM, the group burst apologetically into the conference room to begin the call.

In case you’re wondering what would have caused such a delayed response from an otherwise very prompt group of individuals, it was the introduction provided by the biomedical informatics group of how this data repository’s capabilities could be explored.  The advisory group was so captivated by the power of this tool that they literally became lost in the excitement of the demonstration.

This form of science was fascinating to me, because having trillions of pieces of data available from thousands of women allowed the queries to be guided by the data itself.  When this power was coupled with the normal questioning generated by the intellectual curiosity of the individual scientists, the outcomes were beyond fascinating.

For example, you could ask the question, “How many of you drink coffee?” The thousands of participants whose biopsies – both malignant and benign – were being stored in the tissue repository at our research institute had agreed to answer over 500 demographic questions relating to their very personal and now anonymous lives. A graph appeared showing the proportion of women who were coffee drinkers. When I then asked, “How many cups a day do you drink?”a new graph appeared with that information as well. My final question was, “How many of you were diagnosed with breast cancer?” This resulted in an interesting fusion of information. The women who consumed the most coffee had the least amount of breast cancer. Of course, that general assumption needed to be researched, confirmed and proven in numerous ways, but there it was, way back in about 2005.

A report that touched on this topic was released during the second week of May, and it was fascinating. It was a Harvard study that followed almost 50,000 male health professionals for more than two decades.  Over 5,000 of the participants got prostate cancer – 642 of them the most lethal form. “For the men who drank the most coffee, their risk of getting this bad form of prostate cancer was about 60 percent lower compared to the men who drank almost no coffee at all,” says Lorelei Mucci, an epidemiologist at the Harvard School of Public Health and an author of the study. The same group reported about a 50 percent reduced risk of dying from prostate cancer among men who took two or three brisk walks a week. As a part of our funding, similar studies performed by the Preventative Medicine Research Institute under the direction of Dr. Dean Ornish also confirmed this exercise theory of risk reduction for prostate cancer.

The new study shows that a 60 percent reduction in risk of aggressive prostate cancer requires at least six cups a day. However, men who drank only three cups a day still had a 30 percent lower chance of getting a lethal prostate cancer, and that’s not bad. Earlier research also suggests coffee reduces the risk of diabetes, liver disease and Parkinson’s.

But here is best part of this story. Just last week, Swedish researchers reported that women who drink at least five cups of coffee a day have nearly a 60 percent lower risk of a particularly aggressive breast cancer that doesn’t respond to estrogen.

Epidemiologist Mucci says more research is needed before officially urging people to drink coffee for its health benefits. Meanwhile, she says, “there’s no reason not to start drinking coffee.

So, all of these years later, the National Cancer Institute is using about 200 of these CBCP biopsies from that same tissue repository to map the Human Breast Cancer Genome, and everyday new reports are emerging that confirm the value of this research. All of this from a little coal mining town in Western Pennsylvania – the location of the research institute and hospital where I served as President and CEO – just three seconds in air miles from where Flight 93 went down.

Now that’s a story.

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Posted in Diet, Healthcare, Public Health, Science

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Excerpts and Opinions on “What Makes a Hospital Great?”

March 17th, 2011

Dr. Pauline W. Chen’s March 17th New York Times article answers the question, “What Makes a Hospital Great?” In this article, Dr. Chen finds:

Dr. Pauline W. Chen - surgeon & New York Times contributor - Nick Jacobs, FACHE

Pauline W. Chen, MD | Blog: paulinechen.typepad.com

“Hospitals have long vied for the greatest clinical reputation. Recent efforts to increase public accountability by publishing hospital results have added a statistical dimension to this battle of the health care titans. Information from most hospitals on mortality rates, readmissions and patient satisfaction is readily available on the Internet. A quick click of the green ‘compare’ button on the ‘Hospital Compare’ Web site operated by the Department of Health and Human Services gives any potential patient, or competitor, side-by-side lists of statistics from rival institutions that leaves little to the imagination. The upside of such transparency is that hospitals all over the country are eager to improve their patient outcomes. The downside is that no one really knows how.”

I’ve written often about the failed promise of technology alone, and this is reaffirmed in Dr. Chen’s findings:

“…hospitals have made huge investments in the latest and greatest in clinical care — efficient electronic medical records systems, ‘superstar’ physicians and world-class rehabilitation services. Nonetheless, large discrepancies persist between the highest and lowest-performing institutions, even with one of the starkest of the available statistics: patient deaths from heart attacks.”

As she asks why this is,  the answers have become relatively clear from a study that was released in the Annals of Internal Medicine this very week. This research indicated that it was not the expensive equipment, the evidence-based protocols, or the beautiful Ritz Carlton-like buildings. It was, instead, the culture of the organization.

Hosptials in both the top and bottom five  percent in heart attack mortality rates were queried by the study team. One hundred fifty interviews with administrators, doctors and other health care workers found that the key to good (or bad) care was “a cohesive organizational vision that focused on communication and support of all efforts to improve care.”

Elizabeth H. Bradley, Phd, Yale School of Public Health

Elizabeth H. Bradley, Phd, Yale Global Health Leadership Institute

“It’s how people communicate, the level of support and the organizational culture that trump any single intervention or any single strategy that hospitals frequently adopt,” said Elizabeth H. Bradley, Senior Author and Faculty Director of Yale University’s Global Health Leadership Institute.

So, it wasn’t the affiliation with an academic medical center, whether patients were wealthy or indigent, bed size, or rural vs. urban settings that mattered in hospital mortality rates. Rather, it was the way that patient care issues were challenged that made the difference. The physicians and leaders at top-performing hospitals aggressively go after errors. They acknowledge them, and do not criticize each other. Instead, they work together to identify the sources of problems, and to fix them.

One of the most telling findings in this study was that relationships inside the hospital are primary, and the physicians and staff must be committed to making things work. Dr. Bradley said. “It isn’t expensive and it isn’t rocket science, but it requires a real commitment from everyone.”

So, the next time that you select a hospital, look up its statistics, and I guarantee you that you will be surprised. When it comes to outcomes, to nurturing or even competent care, the biggest is not always the best.

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Posted in Healthcare, Hospital, patient-centered care

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Veratherm

February 3rd, 2011

For the past 25-plus years, my personal commitments, both intellectually and emotionally, have been directed toward helping to make positive changes in the healthcare system worldwide. It’s been my great pleasure to have had the opportunity to connect with such organizations as Planetree, and to work with them to enhance and promote their philosophy of integrative medicine and human touch. We have watched them grow from three to more than 600 affiliated hospitals. It has also been exciting to have had the chance to work with organizations like the American Board of Integrative Holistic Medicine (ABIHM), a truly transformational healing organization. Their laser-focused goal is to reach more and more physicians worldwide to assist them in becoming certified in the techniques of holistic and integrative healing arts.

Along with these high-touch organizations, I’ve also been privy to advancements and discoveries made within the research field. As a former hospital CEO, and Founder of a medical research institute, I have been exposed to both the peaks of promise created by medical technology and the valleys of disappointment that have evolved from those unfilled expectations generated by the promises of that same technology.

Veratherm - ThermalTherapeutic Systems, Inc. - Nick Jacobs, FACHE

The subject matter to be addressed in this next blog segment is not a false promise. This particular medical device, the VERATHERM™ system was designed, patented and FDA-cleared as a portable hyperthermic perfusion system. There are two other FDA-cleared devices that have been used for this procedure – one which has been retrofitted and the other is somewhat outdated. There are also experimental-type devices that have been pieced together for use in some research facilities and academic medical centers, but they are not FDA-cleared and cannot be marketed.

What VERATHERM™ does provide is a very real opportunity for surgeons and perfusionists to not only standardize hyperthermic perfusion in the treatment of cancer but, potentially, to help to significantly extend the lives of those patients touched by these surgeons and the use of this technology. Most recently, I have had an opportunity to not only see this medical device but also to work with the extremely passionate individual who is in charge, Raymond Vennare, CEO of Thermal Therapeutic Systems, Inc. Raymond has helped to develop and bring to market this compact and mobile perfusion system that, I believe, will contribute to helping literally hundreds of thousands of people worldwide. In my exploration of hyperthermic perfusion, however, I have discovered that only a tiny fraction of those patients who could be helped by the technique that is enabled through the use of this device have any idea that it even exists. Hence, the reason for this blog. VERATHERM™ not only does exist, but the procedure performed by these surgeons and perfusionists can also have a dramatic impact on certain types of cancers.

Please understand that my interest in hyperthermic perfusion in the treatment of cancer revolves around a commitment to those individuals – people like my father, and Raymond’s father, mother and brother who, because products like this were not available, were all lost prematurely due to different types of devastating cancers.

How does this work? After complex surgery for the removal of the tumors in specific body cavities, such cancers as the colon, appendix, stomach, lung and even some types of metastatic breast cancer, the appropriate fluids can be heated in order to perform an intraperitoneal or intrathoractic lavage. These heated fluids then are circulated through the impacted body cavity as needed to help eradicate any remaining cancer cells. Sensors and probes built directly into the VERATHERM™ Console and Disposable Kit efficiently monitor temperature, pressure and flow of heated and unheated sterile solutions while protecting the patient, physician and profusionist.

Let me close by saying one more time that, due to the procedure enabled by this medical device, the lives of many patients have been extended by as much as three-to- five years. It’s not technically impossible to do, but, as a patient, you have to know about it to request it, and only a handful of cancer centers in the entire country have begun to even look at the creative re-use of profusion equipment for non-traditional surgical lavages such as this.

You read it here first!

The Parable of the Starfish

One morning an elderly man was walking on a nearly deserted beach. He came upon a boy surrounded by thousands and thousands of starfish. As eagerly as he could, the youngster was picking them up and throwing them back into the ocean. Puzzled, the older man looked at the young boy and asked, “Little boy, what are you doing?” The youth responded without looking up, “I’m trying to save these starfish, sir.” The old man chuckled aloud, and queried, “Son, there are thousands of starfish and only one of you. What difference can you make? Holding a starfish in his hand, the boy turned to the man and, gently tossing the starfish into the water, said, “It will make a difference to that one!”

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Posted in Healthcare, Hospitals, Integrative Health

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Making Sense of Tucson

January 11th, 2011

It was 1991 when one of  my professors at Carnegie Mellon University began discussing health policy in the United States.  He told us about Arizona, where the state government had decided to stop paying for transplants.  Then he went on to explain that desperate families were moving from Arizona to Pittsburgh, just so they could establish residency in Pennsylvania, and their loved one could receive a transplant.

At around that same time, an outspoken politician from Colorado, former Governor Richard Lamm, who ran for President of the United States on the Reform Party, described the travesty of Medicare vs. Medicaid.   He described the older generation as committing “generational murder” because, even though many times there was no hope  for their survival, for extending their life or for having any quality to their life, we, as a nation, spend 60% of our Medicare dollars on the last  30 or so days of life.  He advocated being honest and allowing people to decide if they wanted palliative care.

What he also pointed out was that, as a country, we continue to have one of the highest infant mortality rates in the industrial world. The reason, he theorized, was because the seniors voted and the young mothers didn’t and no politician would dare vote against that senior coalition.  (This is not about death panels, it is about honesty in healthcare. It is about transparency and explaining the facts to the families so that they could make rational decisions.) None of his words were well received, but nevertheless, they were filled with candor and embraced very difficult ethical views.

Giffords Tucson tragedy - Nick Jacobs, FACHE - Healing Hospitals

The bottom line?  It is a very sad situation when we have to, in effect, sentence people to death at any age because resources are not available to save them, but this is emphatically not about rationing of care, because rationing infers giving everyone a little less.  This is about making a government decision to take away everything. So, this is about making rational  resource allocation, not based upon the number of votes needed to get re-elected, but based on the value of a life at any and all ages.

Finally, the elephant in the room?  Those people killed and wounded in Arizona were killed and wounded because of a man who is most likely mentally ill.  We, as a country, must begin to address this mental health issue with parity, with commitment and without judgment.  No family is without some member who is suffering from some mental health issue, but  this discussion is still ignored, hidden or buried.

So, when the pundits ask if it is about the rhetoric? We don’t know. When they ask if it is about the availability of weapons and ammunition?  The answer seems to fall under that same category. BUT, when the question is properly directed toward mental health?  The answer seems to be absolutely, yes without a doubt.

During this time of reflection, let’s get serious about the very real and very big challenges that this nation faces. We must, as a nation, take these challenges head-on and deal with “problem solving,” and if this Congress does not begin to take action and begin to solve problems, then we must vote again in May and November to continue to make our voices heard.

Unless we can begin to talk with each other with dignity and respect, we will not make progress.  Until we begin to respect the other person’s point of view and understand that debates are healthy again, we will not make progress. Our leaders need to debate, but at the end of that debate, it is essential that they walk out of the room together and agree that they are all here to do a job, and that job is to solve problems.

My heart goes out to all of those families who were impacted by this awful tragedy.

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Posted in Current Affairs, Healthcare, Medicine

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Carrots or Sticks?

January 30th, 2010

When you do the math, you can rather quickly determine that, as the aging process continues with the Boomer generation, federal funding for health care and Social Security will become more and more scarce. At the same time, we have all read the sobering national statistics regarding unnecessary deaths from hospital missteps. The CMS (Center for Medicare and Medicaid Services) previously introduced a form of pay for performance, or –more accurately– no pay for performance, which has already caused a great deal of change in the American Healthcare System.

As is widely known by now, CMS has decided to literally stop paying for the treatment costs of preventable medical complications.  This actually may seem like an intelligent idea. This approach is referred to by some as visibility for good care, and there is no doubt that it will represent the beginning of a stampede from the third-party insurance payers to follow the CMS “Big Dog.”  In fact, several companies have already announced that they will not be reimbursing hospitals for similar errors, as well.  The truth of the matter, however, is that this step does not even begin to address the problem.

The problem is not about penalizing hospitals, it’s about creating an incentive system that is not disease and sickness based.  Until the pyramid is flipped, we will not see the necessary changes to halt this financial slide to economic oblivion.

Sanjay Saint, MD, MPH

About 9% of U.S. hospitals presently use daily reminders to help physicians remember which patients have urinary catheters in place.  According to the University of Michigan’s Sanjay Saint, a professor of internal medicine, about 74% of hospitals don’t keep tabs on how long the catheters are in place.  But the real issue is that about 98% of hospitals and physicians don’t completely address issues of wellness and prevention that can allow us to remain well until we die because there is little or no incentive to do so.

Logic would dictate that because financial reimbursements will be connected to these hospital-created mistakes, infections or injuries, someone will surely pay more attention to the current misses.  But what if the entire system was based on keeping people healthy?  What if all of our focus was on exercise, appropriate food consumption, and stress management?

Unfortunately – or fortunately, depending upon your perspective – the United States has become the most proficient country in the world when it comes to capitalism, and much of capitalism is based on manipulating people to get them to consume what will bring the financial success and rewards to the corporations.  If you doubt this, just go to Eastern Europe to see what is happening in an environment with unregulated tobacco advertising.  The circle has started all over again.

In the old carrot-and-stick arrangement, there will be plenty of hits.  Wouldn’t it have been interesting, though, to reward hospitals where mistakes are almost nonexistent so that the less successful medical centers might line up to learn from them, or to reward docs and hospitals for helping to keep people healthy all the time. Carrots work, too, and with much less grief.

Carrots and (Celery) Sticks

What’s the old line?  “We’re going to beat the troops until morale improves.”

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Posted in Boomers, medical errors, Wellness

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HIMSS

April 15th, 2009

HIMSS, Healthcare, IT, health, information technology

If you’re interested in finding about everything that happened at the HIMSS 2009 Conference and Expo, don’t read on, because I’m just going to focus on four or five companies that captured my imagination there. There were hundreds and hundreds of vendors attempting to do business in the massive McCormick Convention Center in Chicago, and most of the participants were clearly interested in attracting some bailout money. My host for the week-end was Apptis, and a special thanks must go out to them for allowing me to grace their exhibit as an observer.

Genova Technologies
The companies that grabbed my attention were rather unique; neither the largest, nor the most aggressive. Not the end all and be all of IT, but niche players that had their acts together. Dawn Ainger, the President and COO of Genova Technologies was the first to garner my complete attention. She and her people had come up with a software platform that is uniquely positioned to change the entire concept of Continuing Medical Education. Just log onto their product for somewhere around $100 a month, and voila, everytime you research a patient’s ailment online you get CME credits backed by a major university. Next, she plans to expand to nursing education as well. My oh my, will that change plenty of lives? Our typical employed physician used to get an automatic $4,000 a year stipend for CME in our little rural hospital and never got credit for the work they were already doing. Nice job, Dawn.

logo_aclaim
Not that all of the products that captured my attention were produced by companies run by women, but a-claim was, and their President and CEO Mary Dees Griffith had come up with a similarly low cost solution to a major, ongoing problem. Get your a-claim software, and prequalify your patients on line, have them sign the authorization prior to being seen, and then ask them for their check or credit card for the co-pay that you now know will be approved. Nice job, Mary. Every physician’s office in the world should spend $100 or so a month for that one, because it could virtually eliminate their accounts receivables.

logo_lifelinks
As I was walking by Lifelinks, I noticed a butterfly logo and was curious as to what they did. Once again, their basic, get-you-in-the-door fee was about $100 a month, and that will get you access to live human beings on your lap top who can perform sign language interactively with your patients, or, if need be, Lifelinks will get you live and online someone who speaks whatever language your patient needs. Okay, so that’s probably not a big problem in a small town in Western Pennsylvania, but I’m sure it’s perfect for those offices in highly diverse regions of our country. More importantly, their literature pointed out a case in New Jersey where a physician had been sued and the patient won $400,000 because the doc told her he couldn’t afford a translator. Good job, guys. Wesley Waite, the COO, actually hit the keyboard, and a woman came up on the screen to interact with me personally in sign language. Amazing.

Gemalto, health, security, Netherlands
Gemalto, a Dutch based company really grabbed my attention in the world of cyber security on a small, simple scale. Well, okay, not so small I guess. They have over 100 million of their devices already in use in the EU, but not too many in the US yet. The Gemalto team took us happily through the safety and security they can build into their smart cards to keep you from being hit with a major civil and/or criminal penalty for compromised information.

voalte_iphoneThe wildest display tucked in the back corner of one of the exhibit halls was a lime green and pink booth with the word, voalté across the top of their exhibit. A really nice guy named Oscar in pink scrubs and a black voalté teeshirt was my tour guide through I-phone heaven for nurses, techs, and other hospital professionals. What they have created with this system can only be described as remarkable. It shimmies, it shakes, it crawls on its belly like a reptile. Seriously, paging, messaging, dosing, you name it can all be communicated to your staff via the Apple iphone. No more overhead pages, no more, “I didn’t get that message,” no more I’m busy because if you are, that page keeps being passed along until someone isn’t busy. This Sarasota company is fresh, fun, exciting, and competent.

So that’s my little trip down HIMSS lane. Oh yeah and I got to have lunch with the brilliant Tony Chen of both HospitalImpact.org and SavvyDaddy.com fame. I encouraged Tony to follow his dreams, and he told me today in an E-mail that he is going to do just that. You go, Tony. And Neil Versel, the very talented free lance writer, journalist, and U2 fan nearly knocked me over at the entrance. I met Neil a few years back at a Web 2.0 conference in Chicago, and there were at least two or three other people there I had worked with over my 22 years in Healthcare Management. The biggest outcome?

My feet are still killing me.

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Posted in Events, Healthcare, Information Technology

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