viernes, 17 de octubre de 2014

DLPSS|HEALTHCARE NEWS|October 16, 2014 ▲ Division of Laboratory Programs, Standards, and Services (DLPSS)


Healthcare News

A Weekly Compilation of Clinical Laboratory and Related Information 
from The Division Of Laboratory Programs, Standards And Services


October 16, 2014

  • Novel Culture System Replicates Course of Alzheimer's Disease, Confirms Amyloid Hypothesis
  • Unlocking the Non-Coding Half of Human Genome
  • CDC Develops Faster Test for Enterovirus D68
  • Fast and Simple Diagnostic Test Solution Specific to the 2014 Ebola Outbreak Developed
  • New Push for Standard Approach to Critical Values
  • PHI Test Included in Updated NCCN Guidelines
  • Scientists Reverse Autoimmune Disease Progression With Naturally Occurring Molecule
  • The Nanoscopy Nobel
  • Diagnosing Ebola
  • Infection Prevention and Control Recommendations for Hospitalized Patients With Known or Suspected Ebola Virus Disease in U.S. Hospitals
  • Some EHR Vendors Tweak Systems to Cope With Ebola
  • ONC Report Confirms Struggles on EHR Interoperability


View Previous Issues - Healthcare News Archive


Leading News

Novel Culture System Replicates Course of Alzheimer's Disease, Confirms Amyloid Hypothesis
An innovative laboratory culture system has succeeded, for the first time, in reproducing the full course of events underlying the development of Alzheimer's disease. Using the system they developed, investigators from the Genetics and Aging Research Unit at Massachusetts General Hospital (MGH) now provide the first clear evidence supporting the hypothesis that deposition of beta-amyloid plaques in the brain is the first step in a cascade leading to the devastating neurodegenerative disease. They also identify the essential role in that process of an enzyme, inhibition of which could be a therapeutic target. 
"Originally put forth in the mid-1980s, the amyloid hypothesis maintained that beta-amyloid deposits in the brain set off all subsequent events - the neurofibrillary tangles that choke the insides of neurons, neuronal cell death, and inflammation leading to a vicious cycle of massive cell death," says Rudolph Tanzi, PhD, director of the MGH Genetics and Aging Research Unit and co-senior author of the report receiving advance online publication in Nature. "This new system - which can be adapted to other neurodegenerative disorders - should revolutionize drug discovery in terms of speed, costs and physiologic relevance to disease," says Tanzi 

Unlocking the Non-Coding Half of Human Genome 
The game-changing discovery was part of a study led by Texas A&M biology doctoral candidate John C. Aldrich and Dr. Keith A. Maggert, an associate professor in the Department of Biology, to measure variation in heterochromatin. Aldrich's findings, published in the online edition of the journal PLOS ONE, showed that differences in the heterochromatin exist, confirming that the junk DNA is not stagnant as researchers originally had believed, and that mutations which could affect other parts of the genome are capable of occurring. The uncharted genome sequences have been a point of contention in scientific circles for more than a decade, according to Maggert, a Texas A&M faculty member since 2004. It had long been believed that the human genome -- the blueprint for humanity, individually and as a whole -- would be packed with complex genes with the potential to answer some of the most pressing questions in medical biology. Now, thanks to Aldrich's and Maggert's investigation of heterochromatin, the groundwork has been laid to study the rest of the genome. Once all of it is understood, scientists may finally find the root causes and possibly treatments for many genetic ailments. 

CDC Develops Faster Test for Enterovirus D68 
The Centers for Disease Control and Prevention (CDC) has begun using a new and faster laboratory test to identify enterovirus D68 (EV-D68), which has sent hundreds, if not thousands, of children to the hospital this summer and fall with breathing problems, and has killed several of them, the agency announced today. In a news release, the CDC said it developed a reverse transcription polymerase chain reaction (rRT-PCR) test that will allow it to process 180 specimens a day compared with 40 specimens a day with the previous technology. The agency cautioned that accelerated testing will cause the number of confirmed cases to shoot up. The rapid increase should not be construed as a real-time change or worsening of the EV-D68 outbreak, they noted. More information on [the] announcement is available on the CDC website.
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Laboratory Testing / Diagnostics

Fast and Simple Diagnostic Test Solution Specific to the 2014 Ebola Outbreak Developed 
High-tech British company Primerdesign Ltd, a spin-off company from the University of Southampton, has developed a fast and simple diagnostic test solution specific to the 2014 Ebola outbreak. The kit detects the DNA finger print of the Ebola Virus. It means that even minute quantities of the disease can be detected in the early stages allowing for pre-emptive healthcare intervention. Primerdesign Ltd, which is part of the university business incubator collaboration SETsquared, has finished development work in the last few days and is meeting with the World Health Organisation to discuss plans to possibly put large numbers of these tests in to the front line in West Africa as quickly as possible. 

New Push for Standard Approach to Critical Values
The new data from European labs were presented during a session at the American Association for Clinical Chemistry’s Annual Meeting and Clinical Expo in Chicago (“Critical Result Management Practices: Global Perspectives and Recommendations for Best Practices”). The session also provided a preview of a forthcoming draft guideline from the Clinical and Laboratory Standards Institute that represents the organization’s first formal attempt to advise laboratories around the world on critical values reporting.
“It’s rather convincing that critical result management practices are really greatly varied. This means both within and between countries,” Eva Ajzner, MD, PhD, said at the session. Dr. Ajzner, from the Teaching Hospital of the University of Debrecen Medical and Health Science Center in Hungary, is chair of the EFLM group that conducted the survey. The major shortfall in European labs comes in the development of critical alert lists, thresholds, and auditing practices, Dr. Ajzner tells CAP TODAY. Less than half of European labs ask doctors about critical value thresholds, but among laboratories in Norway and the Netherlands, 72 percent and 88 percent, respectively, do involve clinicians in these decisions. That compares with 73 percent in the U.S. (Howanitz PJ, et al. Arch Pathol Lab Med. 2002; 126[6]:663–669).
Andrew N. Young, MD, PhD, another speaker at the AACC session, echoed this point in an interview with CAP TODAY. Dr. Young is medical director of Quest Diagnostics’ Pittsburgh office and heads the CLSI’s document development committee on reporting critical results. The CSLI’s draft guideline also is likely to caution against routinely repeating a test on the same specimen that yields a critical value, Dr. Young says. “Simply repeating the test on the specimen has a low rate of finding analytical error,” he notes. A 2008 CAP Q-Probes found that 56 percent of the 121 labs participating repeated testing for all critical results, and 31 percent repeated testing for some results (Valenstein PN, et al. Arch Pathol Lab Med. 2008;132[12]: 1862–1867). The initial draft guideline has been submitted to the CLSI document development committee for review, which was scheduled to be completed by Sept. 3, according to Marcy Hackenbrack, MCM, M(ASCP), senior standards project manager at the institute. Dr. Young says he hopes the guideline will be finalized and published in late spring 2015.

PHI Test Included in Updated NCCN Guidelines
Beckman Coulter’s Prostate Health Index (PHI), which is offered in the U.S. by GeneNews’ (TSX:GEN) Innovation Diagnostic Lab (IDL) joint venture, has been recommended by the National Comprehensive Cancer Network (NCCN) as a blood test to improve specificity for prostate cancer detection in its recently updated Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Prostate Cancer Early Detection. Inclusion in the NCCN Guidelines recognizes the benefit and clinical utility of PHI for better prostate cancer diagnosis and for the reduction of unnecessary biopsies. Approved for use by the FDA in men with PSA values between 4 and 10 ng/mL, PHI is a simple, non-invasive blood test that is three times more specific in detecting prostate cancer than PSA alone, decreasing the need for many men with elevated PSA levels to undergo a biopsy in order to achieve a reliable diagnosis.

Quantifying Physical Changes in Red Blood Cells as They Mature in the Bloodstream
During their approximately 100-day lifespan in the bloodstream, red blood cells lose membrane surface area, volume, and hemoglobin content. A study publishing this week in PLOS Computational Biology finds that of these three changes, only the observed surface-area loss can be explained by RBCs shedding small hemoglobin-containing vesicles budding off their cells' membrane. Variation in mean volume and hemoglobin content is associated with many important clinical conditions, but we do not understand the mechanisms controlling these physical characteristics of red blood cells. The study required a multidisciplinary team with expertise in applied mathematics, engineering and medicine. 

A Call for Population-Based BRCA1 and BRCA2 Screening
The researcher who first identified cancer predisposition genes BRCA1 and BRCA2 says that all women should get screened for these gene mutations—not just those with personal or family histories of breast and ovarian cancers. “Many women with mutations in these genes are identified as carriers only after their first cancer diagnosis because their family history of cancer was not sufficient to suggest genetic testing,” wrote Mary-Claire King, PhD, in a commentary published in the Journal of the American Medical Association. In her view, this “is a failure of cancer prevention.” King, a professor of Genome Sciences and Medicine at the University of Washington School of Medicine in Seattle, suggests that all women starting at age 30 should receive genetic screening for BRCA1 and BRCA2 as part of routine medical care.

New Technique Yields Fast Results in Drug, Biomedical Testing
A new technique makes it possible to quickly detect the presence of drugs or to monitor certain medical conditions using only a single drop of blood or urine, representing a potential tool for clinicians and law enforcement. The technique works by extracting minute quantities of target molecules contained in specimens of blood, urine or other biological fluids, and then testing the sample with a mass spectrometer. Testing carried out with the technology takes minutes, whereas conventional laboratory methods take hours or days to yield results and require a complex sequence of steps, said Zheng Ouyang (pronounced Jung O-Yong), an associate professor in Purdue University's Weldon School of Biomedical Engineering.
The method, called "slug flow microextraction," could be used to detect steroids in urine for drug screening in professional sports and might be combined with a miniature mass spectrometer also being commercialized. Findings are detailed in a paper appeared online Oct. 5 in the research journalAngewandte Chemie International Edition

New Validation Study Shows Genomic Health Prostate Cancer Test Can Assess Biochemical Recurrence
Genomic Health's multi-gene expression prostate cancer test assesses adverse pathology at the time of surgery and is an independent predictor of increases in prostate cancer antigen after surgery, researchers last week announced at a major European medical conference. The prostate cancer test measures the expression of 17 genes across four biological pathways involved in prostate cancer progression. The test yields a score for patients between 0 and 100, and this result may be combined with clinical factors to inform the risk of prostate cancer ahead of treatment. This study on the prostate cancer test is in line with other recently published validation data. The company published three studies a few months ago in European Urology – two development trials and a third validation study conducted with Cleveland Clinic and the University of California, San Francisco. 

Elevated Cholesterol and Triglycerides May Increase the Risk for Prostate Cancer Recurrence
Higher levels of total cholesterol and triglycerides, two types of fat, in the blood of men who underwent surgery for prostate cancer, were associated with increased risk for disease recurrence, according to a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research. Emma Allott, PhD, postdoctoral associate at Duke University School of Medicine in Durham, North Carolina. For every 10 mg/dL increase in high density lipoprotein (HDL; known as “good” cholesterol) among men with abnormal HDL (below the desirable value of 40 mg/dL), the risk for prostate cancer recurrence was lowered by 39 percent.

Marketing OK’d for Test to Spot Yeast Pathogens
The Food and Drug Administration recently announced that it is allowing marketing of the first direct blood test for detection of five yeast pathogens that cause bloodstream infections: Candida albicansand/or Candida tropicalisCandida parapsilosisCandida glabrata and/or Candida krusei.
FDA based its review on a clinical study of 1,500 patients, in which T2Candida correctly categorized nearly 100 percent of the negative specimens as negative for the presence of yeast. In a separate clinical study of 300 blood samples with specific concentrations of yeast, T2Candida correctly identified the organism in 84 to 96 percent of the positive specimens.
Source: Web Site Icon


Research and Development

Scientists Reverse Autoimmune Disease Progression With Naturally Occurring Molecule 
Type 1 diabetes, ulcerative colitis, and multiple sclerosis are among the more well-known autoimmune diseases. But according to the AARDAExternal Web Site Icon  [American Autoimmune Related Diseases Association], there are more than 150 rare autoimmune diseases, which affect around 50 million Americans. Even with this large number, scientists are still in the dark regarding interventions that can help cure these diseases. But this might change with the discovery of a molecule called NAD+ that has the potential to reverse autoimmunity. This new research conducted by Brigham and Women's Hospital (BWH) has identified NAD+ (Nicotinamide adenine dinucleotide), a naturally occurring molecule in living cells, plants, and food that has the potential to turn “destructive” cells that attack healthy tissues into “protective” cells. The molecule has also been found to reverse disease progression by restoring tissue damaged by the autoimmunity process.

The Nanoscopy Nobel
A trio of researchers has been awarded this year's Nobel Prize in Chemistry for their work developing nanoscopy. The Max Planck Institute for Biophysical Chemistry's Stefan Hell, Eric Betzig from the Howard Hughes Medical Institute's Janelia Farm, and Stanford University's William Moerner are being honored "for the development of super-resolved fluorescence microscopy,” according to the Nobel committeeExternal Web Site Icon. Such microscopy enables researchers to examine, for instance, cellular structures at the molecular level, beyond the limit of optical microscopy.

Researchers Find RNA Molecules in Urine and Tissue That Detect Prostate Cancer
Researchers at Sanford-Burnham Medical Research Institute have identified a set of RNA molecules that are detectable in tissue samples and urine of prostate cancer patients but not in normal healthy individuals. The study sets the stage for the development of more sensitive and specific noninvasive tests for prostate cancer than those currently available, which could result in fewer unnecessary prostate biopsies with less treatment-related morbidity, according to a new study in The Journal of Molecular Diagnostics. Since most men with prostate cancer have indolent (nonaggressive) disease for which conservative therapy or surveillance is appropriate, the clinical challenge is not only how to identify those with prostate cancer, but also how to distinguish between those who would benefit from surgical or other aggressive treatment from those who would not. Prostate cancer is primarily detected and monitored by testing for high concentrations of prostate-specific antigen (PSA) in blood samples. High PSA levels are often followed by a biopsy to confirm the presence of cancer and whether it is slow growing or aggressive. The researchers believe that they have identified a group of RNA molecules - known as long noncoding RNAs (lncRNAs) - that hold the potential for serving as better prognostic markers for prostate cancer. 

Scripps Research Institute Team Receives $6.6 Million to Investigate Deadly Lassa Virus 
Scientists from The Scripps Research Institute (TSRI) have been awarded $6.6 million from the National Institutes of Health (NIH) to lead an investigation of Lassa fever virus, the most prevalent virus-induced hemorrhagic fever disease in Africa. The study aims to understand how Lassa fever virus causes disease and why some patients die, while others survive the inflection. “The ultimate goal is for researchers to understand the basic mechanism of how Lassa fever virus causes disease and develop new treatments to be used by clinicians to fight this malady,” said TSRI Professor Michael Oldstone, principal investigator of the new grant. Lassa fever is spread by rodents and is common in West Africa, where it kills an estimated 30,000 to 40,000 people every year—approximately 10 to 15 percent of those infected. The virus can pass from human to human, causing devastating outbreaks of a hemorrhagic disease similar to Ebola virus. 

Tissue Chip to Screen Neurological Toxins
A multidisciplinary team at the University of Wisconsin-Madison and the Morgridge Institute for Research is creating a faster, more affordable way to screen for neural toxins, helping flag chemicals that may harm human development. The National Institutes of Health (NIH) announced on Sept. 23, 2014, that the UW-Madison and Morgridge team is among 11 universities receiving support to continue the promising work as part of the Tissue Chip for Drug Screening program. The team will receive approximately $7 million over the three-year project. The next phase of the NIH program aims to improve ways of predicting drug safety and effectiveness. Researchers will collaborate to refine existing 3-D human tissue chips and combine them into an integrated system that can mimic the complex functions of the human body. These stem cell-based models could replace current animal testing for fast and accurate toxicity screens, he says, potentially dramatically reducing the number of animals used in research.

New 'Lab-on-a-Chip' Could Revolutionize Early Diagnosis of Cancer
Scientists have been laboring to detect cancer and a host of other diseases in people using promising new biomarkers called “exosomes.” Indeed, Popular Science magazine named exosome-based cancer diagnostics one of the 20 breakthroughs that will shape the world this year. Exosomes could lead to less invasive, earlier detection of cancer, and sharply boost patients’ odds of survival. “Exosomes are minuscule membrane vesicles — or sacs — released from most, if not all, cell types, including cancer cells,” said Yong Zeng, assistant professor of chemistry at the University of Kansas. Now, Zeng and colleagues from the University of Kansas Medical Center and KU Cancer Center have just published a breakthrough paper in the Royal Society of Chemistry journal describing their invention of a miniaturized biomedical testing device for exosomes. Dubbed the “lab-on-a-chip,” the device promises faster result times, reduced costs, minimal sample demands and better sensitivity of analysis when compared with the conventional bench-top instruments now used to examine the tiny biomarkers.

Researchers Discover Gene That Can Predict Aggressive Prostate Cancer at Diagnosis
Researchers at The University of Texas MD Anderson Cancer Center have identified a biomarker living next door to the KLK3 gene that can predict which GS7 prostate cancer patients will have a more aggressive form of cancer. The results reported in the journal of Clinical Cancer Research, a publication of the American Association of Cancer Research, indicate the KLK3 gene -- a gene on chromosome 19 responsible for encoding the prostate-specific antigen (PSA) -- is not only associated with prostate cancer aggression, but a single nucleotide polymorphism (SNP) on it is more apparent in cancer patients with GS7.

Testosterone Promotes Prostate Cancer in Rats
A researcher who found that testosterone raised the risk of prostate tumors and exacerbated the effects of carcinogenic chemical exposure in rats is urging caution in prescribing testosterone therapy to men who have not been diagnosed with hypogonadism, according to a new study published in the Endocrine Society's journal Endocrinology. The study, "Testosterone Treatment is a Potent Tumor Promoter for the Rat Prostate," was published online, ahead of print. "This research demonstrates that testosterone on its own is a weak carcinogen in male rats," said the study's author, Maarten C. Bosland, DVSc, PhD, of the University of Illinois at Chicago. "When it is combined with cancer-causing chemicals, testosterone creates a hospitable environment for tumors to develop. If these same findings hold true in humans, there is serious cause for public health concern." "Since the growth of testosterone therapy is relatively recent and prostate cancer is a slow-moving disease, there are at present no data to determine if testosterone could heighten the risk of prostate cancer in humans," Bosland said. 

NIH Provides $29M in Fiscal 2014 to Investigate Rare Diseases
The National Institutes of Health today announced it awarded $29 million in fiscal 2014 to expand the Rare Diseases Clinical Research Network (RDCRN). As a result of the funding, researchers at 22 consortia will collaborate with representatives of 98 patient advocacy groups to further clinical research and investigate new treatments for patients diagnosed with rare diseases, which affect about 25 million Americans.

Could Honeysuckle Tea be Used to Combat Flu Viruses?
Honeysuckle has been used for more than a century within traditional Chinese medicine, often consumed in the form of tea. Researchers have now identified a molecule within the plant that directly targets influenza A viruses, a family of viruses that includes Spanish flu and avian flu. The study was conducted by a team from Nanjing University, China, and is published in the journal Cell Research. The team believes the findings could be important in offering a novel therapeutic strategy for combating rapidly evolving influenzaExternal Web Site Icon A viruses (IAV).
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Public Health and Patient Safety

Diagnosing Ebola
Diagnosing Ebola in a person who has been infected for only a few days is difficult, because the early symptoms, such as fever, are nonspecific to Ebola infection and are seen often in patients with more commonly occurring diseases, such as malaria and typhoid fever. However, if a person has the early symptoms ( ) of Ebola and has had contact with the blood or body fluids of a person sick with Ebola, contact with objects that have been contaminated with the blood or body fluids of a person sick with Ebola, or contact with infected animals, they should be isolated and public health professionals notified. Samples from the patient can then be collected and tested to confirm infection. Laboratory tests used in diagnosis include:

Timeline of Infection
Diagnostic Tests Available
Within a few days after symptoms begin
  • Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing
  • Polymerase chain reaction (PCR)
  • Virus isolation
Later in disease course or after recovery
  • IgM and IgG antibodies
Retrospectively in deceased patients
  • Immunohistochemistry testing
  • PCR
  • Virus isolation

Infection Prevention and Control Recommendations for Hospitalized Patients With Known or Suspected Ebola Virus Disease in U.S. Hospitals
Standard, contact, and droplet precautions are recommended for management of hospitalized patients with known or suspected Ebola virus disease (EVD). Note that this guidance outlines only those measures that are specific for EVD; additional infection control measures might be warranted if an EVD patient has other conditions or illnesses for which other measures are indicated (e.g., tuberculosis, multi-drug resistant organisms, etc.). Though these recommendations focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting. In this guidance healthcare personnel (HCP) refers all persons, paid and unpaid, working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or aerosols generated during certain medical procedures. HCP include, but are not limited to, physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual personnel, home healthcare personnel, and persons not directly involved in patient care (e.g., clerical, dietary, house-keeping, laundry, security, maintenance, billing, chaplains, and volunteers) but potentially exposed to infectious agents that can be transmitted to and from HCP and patients. 
This guidance is not intended to apply to persons outside of healthcare settings.
As information becomes available, these recommendations will be re-evaluated and updated as needed. These recommendations are based upon available information (as of July 30, 2014) and the following considerations:
  • High rate of morbidity and mortality among infected patients
  • Risk of human-to-human transmission
  • Lack of FDA-approved vaccine and therapeutics
For full details of standard, contact, and droplet precautions see 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Setting. For information on symptoms of Ebola Virus Disease infection and modes of transmission, see the CDC Ebola Virus Disease Website(

Do-it-yourself Flu Vaccine? Study Shows it Works
It could happen. Military folks who squirted vaccine up their noses were as well-protected as others who got it from health workers, a study found. There's no reason civilians couldn't do the same, especially for children who might be less scared if vaccine was given by mom or dad, the study leader said "A parent could easily administer it. You can't go wrong," and having a DIY option might improve vaccination rates, said Eugene Millar of the Uniformed Services University of the Health Sciences in Rockville, Maryland. So far, only health professionals are allowed to give MedImmune's FluMist, the only flu vaccine sold as a nasal spray. The government says it's the preferred method for healthy kids ages 2 to 8 if it's available; it's approved for ages 2 through 49. In an epidemic or rapid deployment, there might not be enough health workers to give vaccine quickly enough to protect troops in crowded barracks, so Millar's study tested DIY as a practical solution.

Vaccination, Early Flu Treatment Critical for Pregnant Women
Pregnant women who developed 2009 H1N1 influenza were sicker and their infants had worse outcomes, according to data from the 2009 H1N1 influenza pandemic and the 2013-2014 influenza season. In a perspective piece publishedExternal Web Site Icon in the October 9 issue of the New England Journal of Medicine, Sonja A. Rasmussen, MD, and Denise J. Jamieson, MD, MPH, both from the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, present current recommendations for vaccinating and treating pregnant women at risk for influenza.
"Pregnant women with 2009 H1N1 influenza were at substantially higher risk for hospitalization than the general population, and they accounted for approximately 5% of deaths from 2009 H1N1 influenza that were reported to the [CDC], even though pregnant women make up only about 1% of the population." Infants born to mothers who had been severely ill with influenza also were at increased risk for poor outcomes, including preterm birth and small size for gestational age. Before 2009, pregnant women with influenza were only treated if they had other high-risk medical conditions or severe illness. In 2009, in a significant change in antiviral treatment guidance, the CDC recommended that pregnant women suspected of having 2009 H1N1 influenza "receive prompt antiviral therapy regardless of risk factors, severity of illness, history, or the results of diagnostic testing," the authors write. "During the pandemic, we learned that treating pregnant women with such a medication makes a difference."

Infection Rates in Nursing Homes on the Rise: Study
Infection rates within U.S. nursing homes are on the rise, and that trend will continue until better hygiene practices are put in place, a new study suggests. "Infections are a leading cause of deaths and complications for nursing home residents and, with the exception of tuberculosis, we found a significant increase in infection rates across the board," study author Carolyn Herzig, of the Columbia University School of Nursing, said in a school news release. Her team analyzed data submitted by nursing homes to the U.S. Centers for Medicare and Medicaid Services between 2006 and 2010. They found rising rates of pneumonia, urinary tract infections, viral hepatitis, septicemia (blood infection), wound infections and multiple drug-resistant bacterial infections such as methicillin-resistant Staphylococcus aureus (MRSA).

Investigating the TB-Diabetes Link: Increasing Type 2 Diabetes Rates in Low- and Middle-income Countries Could Affect Efforts to Limit the Spread of TB
Increasing type 2 diabetes rates in low- and middle-income countries could affect efforts to decrease and eliminate tuberculosis worldwide, finds a new study, published in The Lancet Diabetes & Endocrinology​. The two conditions can raise the risk of adverse outcomes for those who have both, since TB can negatively affect blood sugar levels, and having diabetes is tied to a poorer prognosis for TB. About 15%, or more than 1 million cases of TB in adults, can be attributed to diabetes. “If diabetes rates continue to rise out of control, the present downward trajectory in global TB cases could be offset by 8% (i.e., 8% less reduction) or more by 2035,” according to a summary of the research.
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Health IT

Some EHR Vendors Tweak Systems to Cope With Ebola
Russ Branzell, CEO of the College of Healthcare Information Management Executives, said he's hearing from health system chief information officers around the country that they are making EHR tweaks rather than major changes in their record systems to address the issue. He noted that when outbreaks of communicable diseases occur, the CDC typically recommends that providers follow standard procedures to identify potential patients with the disease. In response, CIOs typically tweak the documentation process in their EHRs, then make sure their healthcare providers are working in harmony with the changes. “The real key is to make sure everyone's doing them the same way, and that people are entering data appropriately in the record,” he said. 
Branzell cites his own recent experience as an example. After traveling to Abu Dhabi, he developed a respiratory cold that he was worried was Middle East respiratory syndrome. On his return to the U.S., he was pleased to find out that his doctor's office had an intake system that had been modified to ask about travel history because of a CDC alert on MERS.

ONC Report Confirms Struggles on EHR Interoperability
Healthcare information-sharing is largely stuck in neutral, according to the Office of the National Coordinator for Health Information Technology's annual report on electronic health-record adoption, released Thursday. 
“Electronic health information is not yet sufficiently standardized to allow seamless interoperability, as it is still inconsistently expressed through technical and medical vocabulary, structure, and format, thereby limiting the potential uses of the information to improve health and care,” the report (PDF) Adobe PDF fileExternal Web Site Icon said.
Information-sharing is particularly problematic when attempting to share with post-acute-care and behavioral health providers, and long-term-care institutions. Those providers were not included in the federal EHR subsidy program and therefore have lower rates of adoption, the report noted. 

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Providers Underwhelmed by Interoperability
It may not come as any surprise: Electronic health record vendors don't play well with others. At least that's according to healthcare providers who say, in the lion's share of cases, their EHR is not interoperable with others. So finds a new report put out by health IT research firm KLAS, which underscores a less than ideal reality: In excess of $25 billion in EHR incentives has been paid out to providers and hospitals to subsidize these behemoth EHR systems, which, in most cases, don't talk to each other. In fact, less than half of providers say their EHR vendor is interoperable with other vendors, according to the KLAS data. "There has been a lot of public discussion about the lack of interoperability among (EHR) vendors," said report author Colin Buckley, in an Oct. 7 press statement announcing the report. "The truth is that most providers feel at least moderately successful with interoperability today, but most say that success is due to their own efforts. They wonder how well prepared their vendor will be for the future."

Can We Talk: Creating a Common Language for Cybersecurity
Experts are hopeful that a new framework released by the National Institute of Standards and Technology will give agencies a method to evaluate the security of their computing environments against their peers. With a variety of security options available, public-sector agencies often are deploying tools and using strategies that utilize different terminology and principles. These differences can lead to frustration when trying to compare cybersecurity programs and address the latest digital threats across agencies or jurisdictions. Without a standardized language, it’s difficult to gauge how strong another organization’s cybersecurity is. State chief information security officers (CISOs) say the effort to integrate the 41-page federal initiative — officially called the Framework for Improving Critical Infrastructure Cybersecurity — will deliver significant benefits for government agencies in the years ahead. If the majority of organizations adopt the framework’s principles, they’ll be speaking the same language and have an easier time contracting with one another and protecting against cyberthreats. 

EHR Incentive Programs: Eligible Hospitals and Requirements for CEHRT to Participate in 2015
The 2015 program year for the Electronic Health Record (EHR) Incentive Programs begins on October 1, 2014 for eligible hospitals. Medicare eligible hospitals beyond their first year of participation have a 365-day EHR reporting period. All eligible hospitals are required to have 2014 Edition certified EHR technology (CEHRT)External Web Site Icon to be able to successfully participate in 2015. 
Public Health Objectives Flexibility 
Some objectives require a test for the first demonstration, and then require ongoing submission. These objectives give eligible hospitals 60 days from the start of the reporting period to allow time for things like successfully registering, onboarding with the registry, and submitting a test. This inherently provides some flexibility for getting their 2014 Edition CEHRT in place later and submit ongoing from that point forward:
If the eligible hospital meets the threshold during the reporting period, it meets the measure whether or not the function was in place for the full year.  

Health IT Oversight Requires Legislative Action, Groups Argue
Close to 60 health IT stakeholders--including the American Medical Informatics Association and Health IT Now--want to see congressional involvement in clarifying appropriate risk-based oversight of health IT. In a letter sent to Congress on Oct. 7, 58 organizations said that now is the time for legislation "that achieves the complementary goals of protecting patients, ensuring safe and effective care and fostering innovation in the rapidly growing health IT field." The groups outline four reasons for legislative action, including:
  1. The potential of health IT to boost efficiency and quality of care
  2. Regulatory uncertainty, which "stifles" innovation
  3. The need for a risk-based framework for health IT
  4. Broad support on both sides of the political isle
Source: Web Site Icon

Other News

Five U.S. Airports to Enhance Screenings for Ebola
Travelers from West Africa arriving at five large airports in the U.S. will have their temperature taken and face questions about their health in an effort to prevent the spread of Ebola, federal officials said Wednesday. Customs and Border Protection will begin the stricter screening Saturday [Oct.11] at New York's John F. Kennedy Airport and next week at New Jersey's Newark, Washington's Dulles, Chicago's O'Hare and Atlanta's Hartsfield-Jackson. Travelers from Ebola hot spots in Liberia, Sierra Leone and Guinea will receive greater scrutiny. Josh Earnest, a White House spokesman, said the airports receive about 150 travelers per day from the three countries. The five airports receive 94% of the travelers from those West African countries, he said.

Bacterial Protein Implicated in Eating Disorders
Eating disorders such as anorexia nervosa, bulimia, and binge eating disorder affect approximately 5-10% of the general population, but the biological mechanisms involved are unknown. Researchers at Inserm Unit 1073, "Nutrition, inflammation and dysfunction of the gut-brain axis" (Inserm/University of Rouen) have demonstrated the involvement of a protein produced by some intestinal bacteria that may be the source of these disorders. Antibodies produced by the body against this protein also react with the main satiety hormone, which is similar in structure. According to the researchers, it may ultimately be possible to correct this mechanism that causes variations in food intake. These results are published in the journal Translational Psychiatry, in the online issue of 7 October 2014. "We are presently working to develop a blood test based on detection of the bacterial protein ClpB. If we are successful in this, we will be able to establish specific and individualized treatments for eating disorders," say Pierre Déchelotte and Sergueï Fetissov, authors of this study. 

Fecal Capsules Resolve Clostridium Difficile Infection in 90% of Patients
A preliminary study published in JAMA demonstrates the potential of treating recurrent Clostridium difficile infection with frozen encapsulated fecal matter administered orally. Clostridium difficile (C. difficile) is a bacterium that affects the digestive system and can lead to severe swelling of the bowel and inflammation of the colon. Recurrent Clostridium difficile infection (CDI) is considered a major cause of illness and death globally, with a recent significant increase in the number of both adult and child patients affected. 

Rats and Their Alarming Bugs
Recently, a team of pathogen hunters at Columbia University went on an expedition closer to home. They conducted a survey of the viruses and bacteria in Manhattan’s rats, the first attempt to use DNA to catalog pathogens in any animal species in New York City. “Everybody’s looking all over the world, in all sorts of exotic places, including us,” said Ian Lipkin, a professor of neurology and pathology at Columbia. “But nobody’s looking right under our noses.” Dr. Lipkin and his colleagues published their initial results in the journal mBio. First, the scientists looked for disease agents previously found in rats. They discovered bacteria that caused food poisoning, such as Salmonella and a strain of E. coli known to cause terrible diarrhea. They also found pathogens that caused fevers, such as Seoul hantavirus and Leptospira. Then the scientists searched the rats for new species of viruses. So far, they have identified 18 unknown species related to viruses already shown to cause diseases in humans. Two of the new species, were similar to the virus that causes hepatitis C. Dr. Lipkin and his colleagues are now collaborating with the New York City Department of Health and Mental Hygiene and the Centers for Disease Control and Prevention to look for signs of infection from some of the rat pathogens in the blood samples of New Yorkers.The study should alert New York to monitor rats and control them better, Dr. Lipkin said.
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