Dr. Mark Gendreau flew from Boston to Orlando, Fla., recently and didn't like what he saw.

An emergency medicine specialist at Lahey Clinic and Tufts University, he was dismayed by what his fellow passengers weren't doing, in light of swine flu's spread around the world.

"I was horrified to see that most of my fellow passengers failed to periodically wash or sanitize their hands," he writes in an op-ed article in the New York Times. "Keeping our hands clean is critical, because aside from being directly coughed or sneezed upon by an infected passenger, we are most likely to catch a virus by touching a hand or an object like a seat, an overhead bin or plastic seatback tray that is contaminated with invisible droplets full of microorganisms (the bugs can survive there for many hours), and then touching our own mouth, nose or eyes."

Hand-washing is more practical than screening air passengers, but people need help to do it, he writes. And passenger cabin air quality should also be improved, he adds.

"Airports and airline personnel should be fully trained in infection control measures, and alcohol-based gel hand sanitizers should be available throughout airports and aboard aircraft," he says. "The cruise ship industry has been doing this for years."

Patient satisfaction and aggressive care don't necessarily go hand in hand, according to new hospital ratings prepared by Consumer Reports.

Drawing on government surveys compiled on the Hospital Compare web site and the Dartmouth Atlas of Health Care intensity index, the consumer ratings publisher has ranked the nation's more than 3,000 hospitals on its online health site, using the same red and black blobs familiar from ratings of cars or digital cameras.

Patient satisfaction covered eight categories, from cleanliness to communication, and intensity was measured by the number of tests conducted, doctors' visits made, procedures performed, and days spent in the hospital. Consumer Reports reverses how Dartmouth reports intensity, instead presenting aggressive care at the low end and conservative care at the high end of a spectrum from 1 to 100.

The top 28 teaching hospitals -- those that ranked significantly above the national average in patient satisfaction -- on average practiced more conservative medicine than 59 percent of hospitals, according to Dartmouth benchmarks for chronic care.

Brigham and Women's Hospital and Massachusetts General Hospital, the only two hospitals in the state to make the highest performers' list, were among the exceptions. The Brigham's Dartmouth score says it is more conservative than 29 percent of hospitals and Mass. General is more conservative than 18 percent on a spectrum where aggressive scores are low and conservative scores are high.

That stands in contrast to the Dartmouth-affiliated Mary Hitchcock Memorial Hospital in Lebanon, NH. Its overall patient satisfaction score of 81 is one point ahead of the Brigham and one point below Mass. General, but its Dartmouth score says its care is more conservative than 88 percent of hospitals.

"Mass. General does very well and so does the Brigham among better-performing hospitals. They are more toward the aggressive end of the spectrum, but what we try to communicate to folks is a more conservative approach doesn't lessen patient satisfaction," Dr. John Santa, director of the Consumer Reports Health Ratings Center, said in an interview. "It actually appears to be associated with a better experience."

Two Boston hospitals make US News & World Report's latest Best Hospitals rankings look a little like "Partners and Everyone Else," to borrow a phrase from former Globe business columnist Steve Bailey.

That's because Partners stalwarts Massachusetts General Hospital and Brigham and Women's Hospital are the only ones in the state to crack the magazine's 19-member Honor Roll. The distinction signifies hospitals that scored at or near the top in at least six of the list's 16 specialties. Pediatrics will have its own ranking in the fall.

Not that other hospitals didn't perform well. Our medical mecca's reputation is still intact with Beth Israel Deaconess Medical Center, Dana-Farber Cancer Institute, Massachusetts Eye and Ear Infirmary, McLean Hospital, and Spaulding Rehabilitation Hospital all finishing in the top 10 of various specialties.

Massachusetts hospitals today are revealing the rates of pressure ulcers their patients have acquired during their hospital stays, another in a series of statistics made public by the Massachusetts Hospital Association on its Patients First web site. Falls by patients in the hospital and nurse staffing plans were previously posted.

The data on pressure ulcers, better known as bedsores, was gathered on two days in March and September 2007 when nurses did full-body examinations of their patients. Pressure ulcers are a particular danger to certain patients, such as diabetics with circulation problems, paraplegics, or trauma patients immobilized on ICU ventilators.

Pressure ulcers are a good measure of nursing and hospital quality, Carol Haraden, vice president of the Cambridge-based Institute for Healthcare Improvement, said in an interview. The sores can become serious after skin breaks down from pressure, moisture, or abrasion, later destroying muscle and bone.

“In people who are prone to them, their ability to heal from them is often impaired,” making prevention critical, she said.

The Lahey Clinic Medical Center, North Shore, broke ground yesterday for a $50 million expansion in Peabody.

A new three-story wing will add 63,500 square feet to the current 162,000 square-foot space off Route 128. Its cancer center, orthopedic surgery and emergency departments will be enlarged and sleep disorders, spine and pain units will be added. About 25 doctors and 125 nurses, technical and clerical workers will be hired. The project is expected to be completed in spring of 2009.

By Elizabeth Cooney, Globe Correspondent

Certain diabetes drugs should be used with caution in people who have heart disease or a history of heart failure, researchers from the Lahey Clinic report after analyzing previous studies, a finding they hope will clarify the debate on treatment.

Dr. Richard W. Nesto and his colleagues reviewed the results of seven randomized clinical trials that enrolled a total of 20,000 patients to study Actos and Avandia, two drugs from the class called thiazolidinediones, or TZDs, that lower blood sugar. Their article in tomorrow’s Lancet concludes that while TZDs do increase by 72 percent the relative risk of heart failure in people who have type 2 diabetes or are close to it, the drugs do not raise the risk of cardiovascular death. The risk of heart failure was already known.

"I view this as helpful information because if doctors want to use this drug even despite the recent debate about it, they can more appropriately select patients for the drugs in whom the risk of heart failure would be very, very low," Nesto, who is Lahey’s chair of cardiovascular medicine, said in an interview.

Beth Israel Deaconess Medical Center has taken over the cardiothoracic surgery program at St. Vincent Hospital previously run by Tufts-New England Medical Center and is starting a transplant referral program at the Worcester hospital, the hospitals said.

BIDMC physicians already staff the 348-bed medical center's emergency and radiation oncology departments. The change in cardiothoracic surgery took place July 1, when Dr. Robert M. Bojar, a surgeon based at St. Vincent, switched from Tufts-NEMC to BIDMC. Bojar and Dr. David C. Liu, another BIDMC surgeon, now operate in Worcester.

Tufts-NEMC spokeswoman Brooke Tyson Hynes said yesterday the cardiothoracic surgery change came about because of BIDMC's new surgical residency program at St. Vincent. On July 1, seven surgical residents began the first BIDMC rotations at the Worcester hospital, a year after University of Massachusetts Medical School and its clinical partner, UMass Memorial Medical Center, ended their surgical residency programs at St. Vincent.

By Liz Kowalczyk, Globe Staff

The Board of Registration in Medicine has disciplined two physicians, Dr. Matthew Cushing Jr. and Dr. Douglas M. Katz.

The board revoked Cushing's license, following a similar action by the California Medical Board in 2004 over his treatment of a patient who later died of an overdose. No Massachusetts office was listed for Cushing, whose specialty is internal medicine.

The board reprimanded Katz, a 1987 graduate of the School of Medicine, State University of New York, for "engaging in communication" with a patient whose tattoo he removed "designed to foster a personal relationship beyond the boundaries of a doctor/patient relationship."

Katz, who is board certified in internal medicine, practices in Peabody and is affiliated with Lahey Clinic and Union Hospital.

Three Massachusetts hospitals have been named among the country's top 100 integrated health networks -- hospital systems that operate as a unified group.

Baystate Health System in Springfield was ranked 31st, Cambridge Health Alliance came in 49th and Lahey Clinic in Burlington finished 85th in the ratings released by Verispan. There were 587 hospital networks considered.

The healthcare information company said it surveyed health systems about patient access, clinical quality, physicians and the use of technology.

Dr. Desmond H. Birkett of Lahey Clinic has been named president-elect for 2007 of the Massachusetts chapter of the American College of Surgeons.

Birkett is the chair of general surgery at Lahey and a clinical professor of surgery at Tufts University School of Medicine.