VA Medical Centers
The VA New England Healthcare System announced today that it plans to ask the national office to move the Bedford VA Medical Center under the umbrella of the Boston system.
The Bedford network, which includes the Edith Nourse Rogers Memorial Veterans Hospital and four outpatient clinics, would join three veterans medical centers that have been integrated since the late 1990s: Brockton, West Roxbury, and Jamaica Plain. Dr. Michael Mayo-Smith, New England network director, said the proposal would bring the Boston area in line with other major metropolitan VA networks, which typically have one system that serves the entire region.
For years, the VA has been looking for ways to consolidate services at the four medical centers. Mayo-Smith said the proposal would not shutter any facilities and is aimed not at downsizing but at creating better integrated care. Demand for services in Bedford has grown in recent years, though Mayo-Smith could not provide numbers this evening.FULL ENTRY
John Overcash of Ayer was already a believer. Acupuncture had relieved the pain from a longstanding wrist injury. When the opportunity came up to enter an acupuncture study for people who served in the Gulf War, the 21-year Army veteran jumped at it.
Overcash, 55, had never thought of the pain in his knees and ankles as the product of Gulf War illness, defined by a broad set of symptoms, including fatigue, joint and muscle pain, headaches, and indigestion, affecting people who have served in the Gulf. The illness is difficult to pinpoint and harder to treat. In more than a decade of study, researchers have not been able to find a cause.
Lisa Conboy, a health researcher at the New England School of Acupuncture, knew that acupuncture was effective in relieving many of those symptoms. So in 2009, she applied for and won a $1.2 million grant to study its effects on service members from the first Gulf war. Convincing the Department of Defense that an alternative treatment like acupuncture could work was the easy part. Getting veterans to enroll is a different story.FULL ENTRY
A look at the morning's top health industry news.
Vermont health bill now law: Governor Peter Shumlin yesterday signed a bill to put in motion plans to create a publicly financed, consolidated state health system, often referred to as "single-payer." The change won't happen immediately, Nancy Remsen of the Burlington Free Press reports. Instead the law calls for dozens of studies and creates a new regulatory board to lay the groundwork.FULL ENTRY
A look at the morning's top health industry news.
Court rebukes Veterans Affairs on handling of mental health: Scott Hensley of the National Public Radio Shots blog notes that, while much of the national health coverage yesterday was dominated by the Virginia appellate hearing of the federal health law, another appeals court was busy scolding the Department of Veterans Affairs for "unchecked incompetence" in the handling of soldiers' mental health. The strongly-worded ruling is striking in how it lays out the case against the department and points the finger at the president and Congress for not acting sooner.FULL ENTRY
Dave Duerson suspected brain damage. When the 50-year-old former Chicago Bears safety shot himself in the chest in February, he left a note asking that his brain be studied.
Boston researchers yesterday confirmed Duerson’s suspicions. Dr. Ann McKee, a director of the Boston University Center for the Study of Traumatic Encephalopathy, said Duerson had a “moderately advanced” case of the degenerative disease caused by repeated head trauma.
Duerson brings to 15 the number of NFL players studied by the center for signs of chronic traumatic encephalopathy, or CTE. All but one were confirmed to have had the disease, identifiable by the buildup of an abnormal protein in the brain.
With so few examples of the disease and so little known about it, every case matters, said Robert Stern, an associate professor of neurology at Boston University and also a director at the center. Duerson’s is unique because of the self-awareness he displayed.
“This is the first time that anyone really felt ahead of time that they had this disease,” Stern said.FULL ENTRY
A group of doctors is questioning recent research by Boston-based scientists who concluded that athletes with multiple head injuries may be prone to developing a disabling neurological disease similar to amyotrophic lateral sclerosis, also known as ALS or Lou Gehrig's disease.
The doctors said the study by researchers from Boston University School of Medicine and the Veterans Administration Hospital in Bedford lacked clinical evidence to conclude that three athletes, believed to have died from ALS, actually died from a different disease, known as CTE, or chronic traumatic encephalopathy.
The doctors' comments are published today in an editorial in the journal Muscle & Nerve.
"Their 3 patients with CTE and ALS most likely had two different diseases, namely CTE and ALS," wrote lead author Dr. Stanley H. Appel, chairman of the department of neurology at the Methodist Hospital in Texas.
The Boston researchers said in a study published in August that they pinpointed evidence of a new disease that mimics ALS in the brains of two former National Football League players previously thought to have died of ALS. They also found the new disease in the brain of a deceased professional boxer who was a military veteran.
They also speculated that athletes and some others previously diagnosed with ALS actually had the related syndrome - perhaps even Gehrig himself, the New York Yankees star who is the iconic ALS sufferer.
Appel and his colleagues said that those comments were perhaps the most troubling.
"What is most disconcerting to our ALS patients is the implication that they may have been misdiagnosed," he wrote. "They also want our input as to whether Lou Gehrig really had ALS."
It's a mystery that will never be solved, because Gehrig's body was cremated.
Dr. Robert Cantu, a co-author of the Boston study and co-director of the Center for the Study of Chronic Encephalopathy at Boston University, said the group stands by its work. He said their study did not conclude Gehrig did not die from ALS.
“We did say that he did have a history of five recorded concussions because he played football at Columbia, where he took a lot of subconcussive brain traumas," Cantu said. "Nobody really knows for sure if this was ALS or CTE because his spinal cord was never studied."
Boston doctors have some reassuring news for people who take blood-thinning drugs because they have heart disease.
Clopidogrel, better known by its brand name Plavix, is widely prescribed for people who have a heightened risk of dying from a heart attack or stroke. These patients may also be taking aspirin because both drugs prevent blood clots, but at a price: They can cause bleeding in the stomach or esophagus.
Doctors commonly put patients taking blood thinners on heartburn drugs known as proton-pump inhibitors because research has shown that these drugs, including omeprazole (sold as Prilosec), lower the risk of gastrointestinal bleeding. But recent observational studies have raised concerns that the heartburn drugs were blunting the effectiveness of blood thinners.
Dr. Deepak Bhatt of the Veterans Affairs Boston Healthcare System and Brigham and Women’s Hospital led a large, randomized clinical trial comparing heart patients who began taking the blood thinners clopidogrel and aspirin plus the heartburn drug omeprazole to people who began taking both blood thinners and a placebo. The researchers tracked how many patients had gastrointestinal bleeding or pain, including ulcers, and cardiovascular problems, such as heart attacks or stroke.
After six months, patients who took both blood thinners and the heartburn drug had significantly fewer instances of gastrointestinal bleeding -- 39 vs. 68 patients -- compared to patients on placebo, but they had no more cardiovascular problems than the placebo group.
The trial, which included more than 3,700 patients at almost 400 sites in 15 countries, is considered more scientifically rigorous than previous studies, whose design did not allow researchers to draw conclusions about cause-and-effect. But the new trial, published online this week in the New England Journal of Medicine, does have an important limitation. It was ended early because its sponsor, Cogentus Pharmaceuticals, lost its funding and is now defunct. The trial data was analyzed and reported independently of the sponsor.
"I think the data are certainly reassuring for patients," Bhatt said in an interview. "We didn't see harm but in fact we did see a benefit in reduced GI bleeding."
Patients and doctors may think doctors' visits are shrinking, as dwindling numbers of primary care physicians are pressured to do more. But not only are appointments lasting a little longer, Boston researchers say, their quality is also higher than a decade ago.
A team from the Veterans Affairs Boston Healthcare System analyzed national data gathered from 1997 through 2005. They tracked how long people spent with their doctors and whether recommended screening or counseling took place. They compared certain medical conditions to see if there were differences in time and quality of care. Prescriptions were reviewed to see if they complied with national guidelines.
At the beginning of the study period, overall visits averaged 18 minutes. Almost 10 years later, the average time increased to 20.8 minutes. Some visits grew more than others: general medical exams lasted 3.4 minutes longer, diabetes visits were 4.2 minutes longer, hypertension visits were 3.7 minutes longer, and visits for joint diseases were 5.9 minutes longer.
Counseling or screening -- two factors considered signs of high quality -- lengthened the visits by 2.6 to 4.2 minutes, the study found. Providing appropriate medications did not take more time. Together, all three were more likely to occur later in the study period than earlier.
"We found no evidence for the commonly held belief that physicians are spending less time with their patients or that quality of care has diminished," the authors write in the Archives of Internal Medicine, also noting that the number of primary care visits rose 10 percent during the study period. "In fact, patients spent more time with their primary care physicians during office visits in 2005 than they did almost a decade earlier, and overall they received better care."
Boston engineers are joining forces with the nation's largest healthcare system to incorporate lessons learned from other industries into daily patient care, including ways to prevent the kind of safety lapses that could expose patients to potential infection.
Northeastern University will lead one of four collaborations with the Veterans Affairs healthcare systems designed to make care more safe, effective, efficient, and reliable. Through the New England Healthcare Engineering Partnership, engineers from Northeastern will work with the eight hospitals and 37 outpatient clinics that make up the New England Veterans Affairs healthcare system. Grants and matching funds of $3.4 million per year from the VA will support the New England effort, which is based in Boston, for an initial three-year period. MIT and Worcester Polytechnic Institute will also participate.
"Industrial engineers work on improving processes," partnership executive director James Benneyan said. He is a professor of industrial and mechanical engineering at Northeastern and a fellow at the Institute for Healthcare Improvement in Cambridge. "We're the guys doing Six Sigma at GE and the Toyota Production System. The VA already has one of the best healthcare systems and certainly the best information and electronic medical records systems. This is a huge opportunity."FULL ENTRY
An experimental device designed to help paralyzed people control computer cursors, robotic arms, or even wheelchairs just by thinking about moving them will be tested in a new hospital trial after its private-sector sponsor's withdrawal.
The pilot BrainGate 2 trial, funded by federal grants and led by doctors at Massachusetts General Hospital working with scientists at Brown University and the Providence VA Medical Center, is recruiting up to 15 participants who have become quadriplegics after a spinal cord injury, a brain stem stroke, or because of ALS, muscular dystrophy, or another neurological disorder, the collaborative said today.
The researchers hope to learn more about a system whose preliminary trial, supported by the former Cyberkinetics Inc. of Foxborough, showed promise in translating thoughts into movement. The system works by decoding brain signals detected by a sensor implanted in the motor cortex, the part of the brain that governs movement. Signals are then sent to an external device, such as a computer cursor, which then moves in response.FULL ENTRY
About white coat notes
|White Coat Notes covers the latest from the health care industry, hospitals, doctors offices, labs, insurers, and the corridors of government. Chelsea Conaboy previously covered health care for The Philadelphia Inquirer. Write her at firstname.lastname@example.org. Follow her on Twitter: @cconaboy.|
Gideon Gil, Health and Science Editor
Elizabeth Comeau, Senior Health Producer