Rituxan + Chemo Helps Fight Leukemia

Patients with relapsed Chronic Lymphocytic Leukemia (CLL) can benefit from a combination of treatment through fludarabine and cyclophosphamide chemotherapy along with Rituxan, a drug sold by Genetech Inc. and Biogen Idec Inc. The combination treatment has proven to raise the survival rate for patients with CLL and warded off the progression of the cancer.

Recently, a study called REACH—the second to evaluate the success of combination treatment with Rituxan and chemotherapy as a fight against CLL—showed great success. According to the American Cancer Society, CLL is the most common form of adult leukemia and will affect around 15,000 people this year. Leukemia, which means "white blood," is a broad term that represents a range of diseases. It is a cancer that attacks a patient’s blood and bone marrow where blood cells are made.

Rituxan is approved for several uses. Its initial purpose was to treat non-Hodgkin’s lymphoma, which it was approved to treat in 1997. Since then it has been approved for other uses including rheumatoid arthritis. During the study REACH, researchers evaluated 552 random study patients that were previously unsuccessfully treated for CLL. REACH compared the results from patients treated with the combination treatment of Rituxan and chemotherapy, and those only treated with chemotherapy, to see which group reached greater results at increasing progression free survival. Based on the study, those patients treated with the combination of Rituxan and chemotherapy improved their progression free survival rates more than those patients treated with only chemotherapy.

Based on the successful results of REACH, the makers of Rituxan hope to gain approval from the FDA for another treatment option for CLL. The President of Research and Development with Biogen Inc, Cecil Pickett stated “REACH results are promising, and pending confirmation of the results by independent review, we look forward to submitting an application to the FDA for Rituxan’s potential approval in this indication.”

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Medicare to Cease Payment for Hospital Error

It’s official—starting tomorrow, Wednesday October 8th, Medicare will no longer pay hospitals for additional care for patients who acquire “reasonably preventable” conditions while hospitalized. Institutions also will be banned from charging the patients directly, meaning the hospitals must absorb the costs for their own mistakes. Officials say the new rule will not save much money at first, perhaps $21 million a year, but as the conditions are expanded and more insurers follow their lead, the savings could become substantial. However, the most important benefit could come if hospitals are persuaded to work harder to prevent errors and improve the quality of care for their patients.

The rule, proposed over a year ago, covers 10 conditions for which Medicare will no longer reimburse hospitals for. They include: injuries from falls, severe bedsores, urinary tract and vascular infections that result from improper use of catheters, poor blood sugar control, and infections after certain surgeries. In addition, the rule covers three “never events”: incompatible blood transfusions, objects left in the body during surgery and air embolisms. Medicare reports that in 2007 more than 250,000 people had a serious bedsore while hospitalized, for which the hospitals were paid approximately $43,000 for each case.

This move could mark the beginning of a growing trend, as many private insurance companies intend to follow suit. And many states are considering or have implemented a similar policy for Medicaid patients. In the past year, at least four state Medicaid programs announced that they will not pay hospitals for as many as 28 “never events,” and several large insurers, including Aetna, Cigna, Blue Cross Blue Shield and WellPoint plans in seven states, have issued similar rules. Under a law passed in 2005, Medicare-participating hospitals are required to report on 42 quality measures. At least 20 states have also passed laws requiring hospitals to report clearly preventable medical errors caused by hospital workers or preventable infections publicly.

So far, the policy only focuses on hospitals, not doctors. If a surgeon leaves an object in a patient and has to perform a second operation to retrieve it, the hospital will not be paid for the second procedure but the surgeon will be. However, Medicare intends to add conditions to the no-pay list in 2009 which may begin to address this inequity.

In another development, federal officials last week approved a new company to begin inspections as part of its hospital accreditation program—DNV Healthcare. DNV becomes the first new accreditor in more than 30 years, according to the Houston-based company. Until recently, the Joint Commission on the Accreditation of Healthcare Organizations has effectively held a monopoly on the hospital reviews, which are a requirement in order to participate in Medicare. “We’re ready to go,” said DNV’s President, Yehuda Dror. “Our role is to be a leader in hospital accreditation, not just to offer another option.”

Patients can go to www.medicare.gov for Medicare’s hospital quality data.

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Childbirth and Postpartum Cardiomyopathy (PPCM)

Pregnancy and the anticipation of new life is a time of excitement for most women. The gestation period is also tinged with some anxiety about the health of the child, and a safe delivery. Most pregnancies are relatively trouble-free, but there are those pregnancies which do not evolve as planned. Take a woman in her late thirties and pregnant for the third time. Previous pregnancies and deliveries were fairly routine and uncomplicated. Until today, this pregnancy was as normal as pregnancies ever are. Labor starts and after 30 some hours the doctor decides that a cesarean delivery is advisable. The operation proceeds normally and within the hour a new baby has arrived. The balance of the hospital stay meets the criteria established for release from the hospital and the new mother and baby go home. Within three days the mother is having problems breathing and relatives start to take her to the emergency room, but en route she cannot breathe at all and it is necessary to call for emergency transportation to complete the trip. The local hospital transfers the patient to a regional hospital that specializes in heart disorders.

The patient has been diagnosed with PPCM (peripartum cardiomyopathy). PPCM is a rare form of dilated cardiomyopathy in which a weakened heart is diagnosed in the final month of pregnancy or within a few months after delivery. Cardiomyopathy is considered peripartum when there is absence of heart disease prior to the pregnancy and no other cause can be found. As with all forms of heart problems the heart cannot effectively support the body and the condition affects the lungs, liver and other body systems. In this country, PPCM is a complication of 1 in every 2,000 - 4,000 deliveries. It can occur in any race, at any age during reproductive years, and during any pregnancy.

Symptoms can include difficulty breathing while lying flat, shortness of breath with exertion, edema, cough, frequent night-time urination, and heart palpitations. Patients as well as health care professionals frequently dismiss symptoms as part of normal pregnancy. Early detection and treatment are extremely important to the PPCM patient. Delays in treatment are associated with increased mortality.
PPCM has no known cause. Researchers are investigating viruses, auto immune system problems, nutrient or mineral deficiencies and genetics as possibilities that contribute to or cause PPCM.

The Internet Journal of Anesthesiology, 2007, Volume 12 Number 1 lists case histories of patients with PPCM and the treatments that were used for these patients. The underlying theme of this and other research is that both the patients and health care providers need to be more aware of the symptoms. Patients need to be persistent when seeking treatment if they exhibit any of the symptoms usually associated with PPCM.
In 2000 the National Heart, Lung, and Blood Institute and Office of Rare Disease (National Institutes of Health) Workshop Recommendations and Review concluded: "Peripartum cardiomyopathy is a rare lethal disease about which little is known.

Diagnosis is confined to a narrow period and requires echocardiograph evidence of left ventricular systolic dysfunction. Symptomatic patients should receive standard therapy for heart failure, managed by a multidisciplinary team. If subsequent pregnancies occur, they should be managed in collaboration with a high-risk perinatal center. Systematic data collection is required to answer important questions about incidence, treatment, and prognosis. "

A Mother's Heart is a non-profit online organization found at www.amothersheart.org dedicated to providing up-to-date medical information regarding the disease. It also provides the largest online support group for PPCM world-wide. Access to the support group is http://www.amothersheart.org/members/index.php

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Seniors Report Having Satifsying Sex Lives After 70

Sex after 70 is better than ever, according to a group of Swedish researchers. Contrary to popular belief, there are an increasing number of people age 70 and older that are having good quality sex more often, with senior women particularly satisfied with their sex lives.

Nils Beckman and colleagues from the University of Gothenburg in Sweden studied four groups of men and women totaling more than 1,500 people aged 70 and older about their attitude toward sex later in life. Study participants were surveyed in the periods of 1971-1972, 1975-1977, 1992-1993 and 2000-2001 regarding information about their sex lives such as sexual dysfunction, marital satisfaction, and sexual activity.
Participants who reported having sex within the past year were considered sexually active and more seniors interviewed in the latest survey were reporting being sexually active and having a happy relationship with a positive attitude toward sex compared those interviewed in earlier surveys. According to Beckman and his colleagues, "Most elderly people consider sexual activity and associated feelings a natural part of later life."

The study shows that over the last thirty years the number of 70 year olds having sexual intercourse has increased. The percentage for married men increased from 52% to 68%, with married women's percentage jumping from 38% to 56%. The increase for unmarried men rose from 30% to 54%, with the percentage for unmarried women grew from 0.8% to 12%.

It was also found that the number of women reporting high sexual satisfaction has increased, with more women reporting having an orgasm during sex and fewer reporting never having had an orgasm. On the flip side, more men are reporting low sexual satisfaction. The research team suggests that this could be due to the fact that it is now more acceptable for men to admit failure regarding the aspects of sex. Both men and women hold men responsible when they stop having sex, which remains consistent with the results of other studies done in the 1950s and 2005-2006.
Other findings show that the number of men reporting erectile dysfunction has decreased while the percentage reporting ejaculation dysfunction has increased, but the proportion reporting premature ejaculation remains unchanged.

Though the reason for the increase in senior sexual activity is not clear, researchers suggest that factors such as society's changing attitudes toward sex, better overall health, more education, and higher incomes may all play a part.
Until now, information regarding the sexual behavior of older seniors has mainly been limited to sexual problems with little known about the normal aspects of their sex life. The results of this study may be what health professionals need to motivate them to ask people of all ages about the health of their sex life. Beckman noted, "I think it's very important for older people to know that it's quite normal to have sexual feelings, and it's important for health professionals to know that they are sexually active or would like to be, and they should take that into consideration."
The study was published on the British Medical Journal Online First website.

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Can Our Mental Skills Fade Before Old Age?

When it comes to getting older, is there a certain point when our mental skills start to fade? If this is true, is there anything we can do about it?

To test this theory, researchers gathered 288 people, 126 men and 162 women, from one community in Sweden to get the answers. When this study first began, none of the participants had any form of dementia. The participants were test approximately 12 times from the age of 70 until the day of their death and researchers gauged how well they did in three particular categories.

They were measured in the following three areas:

* Perceptual Speed: This is how fast they were able to match certain figures that were in a line of other figures.
* Verbal Ability: This tested how well they were able to understand ideas expressed in words with synonyms.
* Spatial Ability: This was tested by using two-colored blocks to build a replica of a model design that they were shown.

The results of these test when those three skills started to decline are as follows:

* Perceptual Speed: The difference was seen almost 15 years before their death.
* Verbal Ability: The participants showed a "change point" for a decline almost 7 years before their death.
* Spatial Ability: This ability changed approximately 8 years before their death.

The studies lead author, Valgeir Throvaldsson of Gotenberg University in Sweden, said, "These changes are different and separate from the changes in thinking skills that occur as people get older. We found that accelerated changes in people's mental skills that indicated a terminal decline phase years before death."

Is there anything that we can do about this? Are there any particular reasons why this may be happening to us?

Thorvaldsson stated that our health conditions could contribute to this decline. He also said that cardiovascular conditions like dementia or heart disease that is too early for detections could also be factors.

He claims that "increased health problems and frailty in old age often lead to inactivity, and this lack of exercise and mental stimulation could accelerate mental decline." He also speculates that doctors may want to watch for the changes in verbal ability, like being able to stay sharp at recognizing ideas expressed by words, as a warning sign of a decline in health since the study found that the verbal skills took a sharper fall in the years before death.

If you would like to further information on this research, the findings of this study appears in the August 27th online edition of Neurology.

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Surgical Cosmetic Procedures Continue to Gain Popularity

Would you like to look years younger? Maybe you would like to be a bit slimmer, have a more prominent chin, or even more voluptuous? It seems many Americans would love to have some form of plastic surgery or cosmetic procedure to improve their appearance. In fact, 85 percent of adult Americans would partake of facial plastic surgery if given the opportunity.

The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), which represents over 2,700 facial plastic and reconstructive surgeons around the world, recently reported on a study revealing that 80 percent of those surveyed prefer only a certified facial plastic surgeon to perform procedures on their face, neck or head.

Even if you plan to use a specialist in cosmetic alterations, it is very important to gather all the information you can in regards to a cosmetic procedure you are considering, as well as research on the doctor and facility you plan to use for the procedure.

In a perfect society, those less fortunate in the looks category wouldn’t fall short behind those better looking, when interviewing for a job, choosing a sole mate, or even making friends. However, looks do matter in our society and it does play a role in many situations. It is probably the main reason that cosmetic procedures continue to gain popularity. While some procedures may be necessary for children under the age of 18, most cosmetic operations are not recommended until adulthood. Many of those who endured years of humiliation by their school peers may opt to alter their looks when they become adults. Surgical and non surgical procedures that are most often performed as luxuries, rather than from necessity, have increased 27 percent in both men and women over the last eight years.

Based on the research performed by Kelton Research for the AAFPRS, if patients were given a free service their first choice would be to have an eyelift. Many aging men and women may begin recognizing that their eyelids have begun to sag. At some point, saggy eyelids may begin to hinder your vision. In this case, your insurance company may cover the costs of the operation! Other popular procedures noted by the study were neck surgeries, nose jobs, face-lifts, and breast enhancements. Nose jobs ranked #1 among men. The study also showed that the demand for Botox® and collagen treatments continue to rise.

Whether it is a mother wanting her pre-motherhood figure back, a maturing adult who would like to erase years of aging or hard work, or a women hoping for a fuller chest, the number of cosmetic procedures continue to rise. In fact, there is now a new surgery on the market called, “bra line back lift”. You probably have noticed where rolls of skin may come over the top of a lady’s bra, underneath the bra, or even both, on a lady’s back. These bra rolls could be history, with the new procedure, and the scars are hidden by the bra line.

If given the opportunity to erase lines from years of aging or to move parts of the body that decided to move south back in their appropriate place; would you do it? Most say “yes”. In fact, even with the hard economic times, there was $13 billion spent on cosmetic procedures last year. Make sure to do your research before having any surgical procedure and don’t rush yourself. Take your time and be informed of all aspects

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