Better stent surgery stats needed: heart doctors

By Andrew M. Seaman

NEW YORK (Reuters Health) - Publicly reported statistics about how patients fare after a common heart procedure often are inaccurate, says a new study that suggests publishing the poor quality numbers may do more harm than good.

The proportion of patients who die within 30 days of a medical procedure is sometimes used to gauge the effectiveness of the treatment, or of the hospital or doctor administering it.

After analyzing thousands of patient records at one U.S. hospital, researchers found that less than half of the deaths following percutaneous coronary intervention (PCI) - also known as coronary angioplasty - were related to the procedure.

That's far fewer than the number of deaths usually attributed to the surgery, which involves clearing a narrowed artery then inserting a mesh tube called a stent to prop the vessel open.

"I think what this really points out is that (with) the clinical complexity of medicine (it) can be tough to get a policy that's sort of one size fits all," said Dr. Karen Joynt, a cardiologist at Brigham and Women's Hospital in Boston.

Joynt, who was not involved with the new study but has done similar research, said there are a number of factors that determine whether or not a person dies after PCI - many of them unrelated to the actual procedure.

About 500,000 angioplasties are performed in the U.S. every year. It's often used in emergency situations, for instance to stop heart attacks caused by blocked blood vessels.

New York State first reported the number of people who died after PCI in its hospitals in 1991. Since then, Massachusetts and Pennsylvania started to report that figure as well.

According to the new study's authors, the U.S. Centers for Medicare and Medicaid Services have also proposed using the number as a quality measure, in the hope of improving patient care.

For the new study, researchers led by the Cleveland Clinic's Dr. Mehdi Shishehbor used patients' medical records to see whether deaths following PCI could be blamed on the procedure.

Out of 4,078 PCIs performed between January 2009 and April 2011 at one U.S. hospital, they found 81 deaths within 30 days of the surgery, representing 2 percent of patients who had the procedure.

Forty-seven, or about 60 percent, of those 81 patients died of a heart-related problem, but only 34, or 42 percent, of the deaths resulted from a complication of the procedure itself.

Previous research has attributed up to 60 percent of deaths following PCI to the procedure, but those figures were often based on causes of death listed on death certificates, which are frequently inaccurate, according to Shishehbor and his colleagues.

In the current study, based on close reading of every patient's chart, many of the deaths were among patients who were very sick when they got to the hospital and might have died with or without PCI, the researchers report in the Journal of the American College of Cardiology.

Fifty eight percent of the patients who died arrived in cardiac arrest, cardiogenic shock or with the most lethal type of heart attack, the authors point out.

But Joynt said doing PCI on these patients may have given them a better chance of survival, even though they ultimately died.

"That's the kind of overuse (of PCI) that we're probably willing to accept in many cases," she said.

However, Joynt's own research has suggested that hospitals avoid doing PCI in the sickest patients when their states start reporting the number of 30-day deaths.

In 2012, her study found that hospitals in Massachusetts, New York and Pennsylvania performed fewer PCIs - especially among the sickest patients who could possibly have benefited the most.

"Public reporting is a good thing and needs to be done, but when done incorrectly there are a lot of downstream consequences, such as denying patients treatment," said Dr. Duane Pinto, head of interventional cardiology at Boston's Beth Israel Deaconess Medical Center, who wrote an editorial accompanying the new study.

"We have to recognize and adapt to the unintended consequences of public reporting and fix them when we identify them," Pinto said.

SOURCE: http://bit.ly/10L9DPz Journal of the American College of Cardiology, online May 7, 2013.

Source: http://news.yahoo.com/better-stent-surgery-stats-needed-heart-doctors-201557408.html

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How the GOP Can Win Back the Values Debate?and How Dems Could Lose It (Atlantic Politics Channel)

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Source: http://news.feedzilla.com/en_us/stories/politics/top-stories/304849046?client_source=feed&format=rss

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Heat, Bulls both looking for Game 2 improvements - seattlepi.com

MIAMI (AP) ? The Miami Heat have been in this less-than-ideal spot before.

They trailed Indiana in the Eastern Conference semifinals last season, needed to win a pair of elimination games against Boston in the East finals and then dropped Game 1 of the NBA Finals to Oklahoma City. And when it was all said and done, the Heat walked away with the title.

So that might explain why there was no sense of panic in Heat land on Tuesday, and not even much of a sense of anger. Dropping Game 1 of the East semifinals to the Chicago Bulls on Monday night was hardly what the Heat wanted, though could end up serving as a wake-up call for a team that made it through a 66-win regular season without many rough patches.

"We haven't lost in a while, so it was very different to come in here and deal with a loss and to deal with it in the playoffs at home," Heat guard Dwyane Wade said after a video-and-practice session. "It was different from the standpoint of what we've been used to lately, but not anything different from what we've been used to as a team. We've been in tough moments. We've lost games before."

Chicago's 93-86 win in the series opener was filled with statistical anomalies, such as Miami shooting just under 40 percent (its second-worst showing in 87 games overall this season) and the Bulls scoring 35 points in the fourth quarter ? matching the most the Heat allowed in the final 12 minutes of regulation all season.

Still, the Heat know some things still need to change, and in a hurry, or else the reigning champions could be in a gigantic amount of trouble.

"Playoffs are all about revealing who you are," Heat coach Erik Spoelstra said. "It's either a win or a loss, and so we lost the first game. We have to figure it out, somehow, some way, to win the next game. And that's all it is.

"We have to fight for our playoff lives right now, to play a much harder and much more committed game together tomorrow night."

Oddly, the same sentiments were being uttered a few miles south of where Spoelstra was standing, with the Bulls saying many of the same things after reviewing tape at their hotel.

Chicago's lineup isn't expected to change for Game 2. Luol Deng, who needed a spinal tap to rule out meningitis last week, still is not with the team, and coach Tom Thibodeau said a decision about flying him to Miami likely wouldn't be made until Wednesday morning ? so, barring a seismic change in thinking, there is no way he would play Wednesday night. And guard Kirk Hinrich was limping when the team exited the conference room it used for meetings, suggesting that the calf injury he's dealing with could keep him out of a fifth straight game.

Then again, the Bulls showed on Monday ? again ? that even their depleted crew is more than good enough to win. Nate Robinson scored 27 points in the opener, even after needing 10 stitches during the game to close a nasty cut on his chin. He came into Monday averaging 9.6 points in 25 previous appearances against Miami.

That's how good it's going for Chicago right now.

"We're not satisfied," Bulls center Joakim Noah said. "We've been getting some big victories the last couple games, but we're not satisfied. We're going to stay hungry, make our adjustments and try to play even better."

The Bulls haven't won three straight road games since mid-January. They have a chance to pull that off Wednesday, coming off a Game 7 win in Brooklyn on Saturday and then stunning Miami in Game 1 two nights later.

If this keeps up, Chicago might struggle to keep the underdog status that it somehow converts into fuel.

"The outside shouldn't matter. It really shouldn't," Thibodeau said. "The only thing that matters, really, is what we think. So whether it's praise or criticism from the outside, that's not important. It's what we think on the inside. So we know if we do the right things that go into winning, we're going to have a chance to win and that's all we want to focus in on. All the other stuff, I think, just gets you distracted."

Noah said he was planning to sit in the sunshine on Tuesday, sip water, maybe squeeze a nap or a massage into his afternoon agenda. In other words, he was basically going to have a mini-vacation.

Make no mistake, though. The Bulls are taking this opportunity super-seriously. That's why the theme of their meetings on Tuesday was about ways to get better.

"Everything," guard Jimmy Butler ? who has played all 48 minutes in three straight games ? said when asked about which areas where Chicago needs to see improvement in Game 2. "We made a lot of mistakes in our offense, our defense. They missed a lot of open shots and we made some shots. I feel that we can execute better, and we will."

There's no arguing Miami can execute better. Or at least, shoot better.

The tape confirmed what the stat sheet, their eyes, and the eyes of everyone else who watched Game 1 said: Miami missed tons of open shots on Monday night. So while there will be adjustments to make, the simplest way for the Heat to get back on track is just make more shots, easy as that sounds.

"It ain't about Xs and Os in this series," Heat forward and four-time NBA MVP LeBron James said. "It's about will and determination to win the series, for both teams. ... We want our shooters to shoot and they will continue to shoot because we will continue to find them. We've got the utmost confidence in them."

Source: http://www.seattlepi.com/sports/article/Heat-Bulls-both-looking-for-Game-2-improvements-4496418.php

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Was Christie's surgery political? (CNN)

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'Iron Man 3': Behind The Movie's Biggest Twist

A Marvel expert reacts to the 'unusual' surprise that no one saw coming.
By Kevin P. Sullivan

Robert Downey Jr. in "Iron Man 3"
Photo: Marvel/Disney

Source: http://www.mtv.com/news/articles/1706795/iron-man-3-twist.jhtml

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New device can extract human DNA with full genetic data in minutes

May 6, 2013 ? Take a swab of saliva from your mouth and within minutes your DNA could be ready for analysis and genome sequencing with the help of a new device.

University of Washington engineers and NanoFacture (http://nano-facture.com/), a Bellevue, Wash., company, have created a device that can extract human DNA from fluid samples in a simpler, more efficient and environmentally friendly way than conventional methods.

The device will give hospitals and research labs a much easier way to separate DNA from human fluid samples, which will help with genome sequencing, disease diagnosis and forensic investigations.

"It's very complex to extract DNA," said Jae-Hyun Chung, a UW associate professor of mechanical engineering who led the research. "When you think of the current procedure, the equivalent is like collecting human hairs using a construction crane."

This technology aims to clear those hurdles. The small, box-shaped kit now is ready for manufacturing, then eventual distribution to hospitals and clinics. NanoFacture, a UW spinout company, signed a contract with Korean manufacturer KNR Systems last month at a ceremony in Olympia, Wash.

The UW, led by Chung, spearheaded the research and invention of the technology, and still manages the intellectual property.

Separating DNA from bodily fluids is a cumbersome process that's become a bottleneck as scientists make advances in genome sequencing, particularly for disease prevention and treatment. The market for DNA preparation alone is about $3 billion each year.

Conventional methods use a centrifuge to spin and separate DNA molecules or strain them from a fluid sample with a micro-filter, but these processes take 20 to 30 minutes to complete and can require excessive toxic chemicals.

UW engineers designed microscopic probes that dip into a fluid sample -- saliva, sputum or blood -- and apply an electric field within the liquid. That draws particles to concentrate around the surface of the tiny probe. Larger particles hit the tip and swerve away, but DNA-sized molecules stick to the probe and are trapped on the surface. It takes two or three minutes to separate and purify DNA using this technology.

"This simple process removes all the steps of conventional methods," Chung said.

The hand-held device can clean four separate human fluid samples at once, but the technology can be scaled up to prepare 96 samples at a time, which is standard for large-scale handling.

The tiny probes, called microtips and nanotips, were designed and built at the UW in a micro-fabrication facility where a technician can make up to 1 million tips in a year, which is key in proving that large-scale production is feasible, Chung said.

Engineers in Chung's lab also have designed a pencil-sized device using the same probe technology that could be sent home with patients or distributed to those serving in the military overseas. Patients could swab their cheeks, collect a saliva sample, then process their DNA on the spot to send back to hospitals and labs for analysis. This could be useful as efforts ramp up toward sequencing each person's genome for disease prevention and treatment, Chung said.

The market for this device isn't developed yet, but Chung's team will be ready when it is. Meanwhile, the larger device is ready for commercialization, and its creators have started working with distributors.

A UW Center for Commercialization grant of $50,000 seeded initial research in 2008, and since then researchers have received about $2 million in funding from the National Science Foundation and the National Institutes of Health. Sang-gyeun Ahn, a UW assistant professor of industrial design, crafted the prototype.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/~3/h-_EnMAFYVk/130506132100.htm

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Newtown board mulls plans for Sandy Hook school

NEWTOWN, Conn. (AP) ? Newtown, Conn., officials are meeting to discuss what to do with the elementary school where 20 first-graders and six educators were shot to death in December, but they might not vote.

A consultant for the town said a task force of 28 local elected officials likely wouldn't make a decision Friday night and will return for another meeting next week.

Residents have expressed mixed opinions on what should be done with Sandy Hook Elementary School.

The task force has narrowed a list of choices to renovating or rebuilding on the school site or building a new school on property down the street.

The 430 surviving students are attending a renovated school renamed Sandy Hook Elementary School in the neighboring town of Monroe.

Source: http://news.yahoo.com/newtown-board-mulls-plans-sandy-hook-school-002903689.html

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