Hospital Performance in Acute Myocardial Infarction

Patterns of Hospital Performance in Acute Myocardial Infarction and Heart Failure 30-Day Mortality and Readmission

Harlan M. Krumholz, MD, SM; Angela R. Merrill, PhD; Eric M. Schone, PhD; Geoffrey C. Schreiner, BS;Jersey Chen, MD, MPH; Elizabeth H. Bradley, PhD; Yun Wang, PhD; Yongfei Wang, MS; Zhenqiu Lin, PhD;Barry M. Straube, MD; Michael T. Rapp, MD, JD; Sharon-Lise T. Normand, PhD and Elizabeth E. Drye, MD, SM

From the Section of Cardiovascular Medicine (H.M.K., G.C.S., J.C., Y.W., Y.-F.W., E.E.D.) and the Robert Wood Johnson Clinical Scholars Program (H.M.K.), Department of Internal Medicine; Section of Health Policy and Administration (H.M.K., E.H.B.), School of Public Health, Yale University School of Medicine; and the Center for Outcomes Research and Evaluation (H.M.K., Y.W., Z.L.), Yale-New Haven Hospital, New Haven, Conn; Mathematica Policy Research, Inc (A.R.M., E.M.S.), Cambridge, Mass; Centers for Medicare & Medicaid Services (B.M.S., M.T.R.), Baltimore, Md; and the Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard School of Public Health (S.-L.T.N.), Boston, Mass.

Correspondence to Harlan Krumholz, MD, Yale University School of Medicine, 1 Church St, Suite 200, New Haven, CT 06510. E-mailharlan.krumholz@yale.edu

Background: In 2009, the Centers for Medicare & Medicaid Services is publicly reporting hospital-level risk-standardized 30-day mortality and readmission rates after acute myocardial infarction (AMI) and heart failure (HF). We provide patterns of hospital performance, based on these measures.

Methods and Results: We calculated the 30-day mortality and readmission rates for all Medicare fee-for-service beneficiaries ages 65 years or older with a primary diagnosis of AMI or HF, discharged between July 2005 and June 2008. We compared weighted risk-standardized mortality and readmission rates across Hospital Referral Regions and hospital structural characteristics. The median 30-day mortality rate was 16.6% for AMI (range, 10.9% to 24.9%; 25th to 75th percentile, 15.8% to 17.4%; 10th to 90th percentile, 14.7% to 18.4%) and 11.1% for HF (range, 6.6% to 19.8%; 25th to 75th percentile, 10.3% to 12.0%; 10th to 90th percentile, 9.4% to 13.1%). The median 30-day readmission rate was 19.9% for AMI (range, 15.3% to 29.4%; 25th to 75th percentile, 19.5% to 20.4%; 10th to 90th percentile, 18.8% to 21.1%) and 24.4% for HF (range, 15.9% to 34.4%; 25th to 75th percentile, 23.4% to 25.6%; 10th to 90th percentile, 22.3% to 27.0%). We observed geographic differences in performance across the country. Although there were some differences in average performance by hospital characteristics,there were high and low hospital performers among all types of hospitals.

Conclusions: In a recent 3-year period, 30-day risk-standardized mortality rates for AMI and HF varied among hospitals and across the country. The readmission rates were particularly high.

public health effect of economic crises

The public health effect of economic crises and alternative policy responses in Europe:
an empirical analysis

David Stuckler PhD a b, Sanjay Basu PhD c d, Marc Suhrcke PhD e f, Adam CouttsPhD g, Martin McKee MD b h

a Department of Sociology, Oxford University, Oxford, UK

b Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK

c Department of Medicine, University of California San Francisco, CA, USA

d Division of General Internal Medicine, San Francisco General Hospital, CA, USA

e School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK

f Centre for Diet and Activity Research (CEDAR), Cambridge, UK

g Oxford Department of Politics and International Relations, Oxford, UK

h European Observatory on Health Systems and Policies, Brussels, Belgium

The Lancet, Early Online Publication, 8 July 2009

doi:10.1016/S0140-6736(09)61124-7

Background http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61124-7/fulltext

There is widespread concern that the present economic crisis, particularly its effect on unemployment, will adversely affect population health. We investigated how economic changes have affected mortality rates over the past three decades and identified how governments might reduce adverse effects.

Methods

We used multivariate regression, correcting for population ageing, past mortality and employment trends, and country-specific differences in health-care infrastructure, to examine associations between changes in employment and mortality, and how associations were modified by different types of government expenditure for 26 European Union (EU) countries between 1970 and 2007.

Findings
We noted that every 1% increase in unemployment was associated with a 0·79% rise in suicides at ages younger than 65 years (95% CI 0·16—1·42; 60—550 potential excess deaths [mean 310] EU-wide), although the effect size was non-significant at all ages (0·49%, −0·04 to 1·02), and with a 0·79% rise in homicides (95% CI 0·06—1·52; 3—80 potential excess deaths [mean 40] EU-wide). By contrast, road-traffic deaths decreased by 1·39% (0·64—2·14; 290—980 potential fewer deaths [mean 630] EU-wide). A more than 3% increase in unemployment had a greater effect on suicides at ages younger than 65 years (4·45%, 95% CI 0·65—8·24; 250—3220 potential excess deaths [mean 1740] EU-wide) and deaths from alcohol abuse (28·0%, 12·30—43·70; 1550—5490 potential excess deaths [mean 3500] EU-wide). We noted no consistent evidence across the EU that all-cause mortality rates increased when unemployment rose, although populations varied substantially in how sensitive mortality was to economic crises, depending partly on differences in social protection. Every US$10 per person increased investment in active labour market programmes reduced the effect of unemployment on suicides by 0·038% (95% CI −0·004 to −0·071).

Interpretation
Rises in unemployment are associated with significant short-term increases in premature deaths from intentional violence, while reducing traffic fatalities. Active labour market programmes that keep and reintegrate workers in jobs could mitigate some adverse health effects of economic downturns.

EARLY PREDICTION OF WORLDWIDE BANKING CRISIS IGNORED

SAN FRANCISCO SENTINEL THURSDAY MORNING EDITION July 9 2009

8 July 2009

William White was predicteding the approaching financial crisis years before the subprime meltdown in 2007. Now the former chief economist at the Bank for International Settlements is suddenly back in demand.

BY BEAT BALZLI and MICHAELA SCHIESSL

William White predicted the approaching financial crisis years before 2007’s subprime meltdown. But central bankers preferred to listen to his great rival Alan Greenspan instead, with devastating consequences for the global economy.

Glutamic Acid May Lower Blood Pressure

By Kristina Fiore, Staff Writer, MedPage Today Published: July 08, 2009 Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

LITTLE FALLS, N.J., July 8 -- Dietary glutamic acid -- the amino acid abundant in vegetables -- may have blood pressure-lowering effects, researchers have found.

The amino acid had a consistent inverse relationship with blood pressure across several models, Jeremiah Stamler, MD, of Northwestern University, and colleagues reported in Circulation, Journal of the American Heart Association.

When glutamic acid intake comprised almost 5% of total dietary protein, systolic blood pressure averaged 1.5 to 3.0 mm Hg lower than then readings in people who consumed less glutamic acid. For diastolic, the reductions ranged from 1.0 to 1.6 mmHg

Cérebro: Afiado até o fim

Estudos revelam como o cérebro envelhece e sugerem estratégias para mantê-lo saudável durante toda a vida

Ricardo Zorzetto

Edição Impressa 161 - Julho 2009

Pesquisa FAPESP -

© Ernesto Rodrigues/Agência Estado/AE

Em plena atividade Tomie Ohtake, a artista plástica de 96 anos

Pesquisas concluídas recentemente – e outras ainda em andamento – no Brasil e no exterior vêm permitindo conhecer em detalhes alguns dos fenômenos químicos e biológicos característicos do envelhecimento, em especial do cérebro e de outros órgãos do sistema nervoso central que controlam a forma como percebemos o mundo e interagimos com ele. Realizados com pessoas e animais saudáveis, vários desses trabalhos devem contribuir para que nos próximos anos se consiga definir com mais precisão a fronteira que separa as alterações típicas do envelhecimento natural daquelas que caracterizam o princípio de enfermidades neurodegenerativas aniquiladoras como o mal de Alzheimer, que atinge cerca de 5% das pessoas com mais de 60 anos e se torna mais e mais comum à medida que a idade avança. Segundo alguns especialistas, hoje essa fronteira estaria mais para uma larga faixa do que uma linha./.../

NEWSEUM

From:The round.med.br: Fórum Médico Team.

Um dos links leva às manchetes de jornais de todo o mundo.

Newseum atrium. (Maria Bryk)

http://www.newseum.org/todaysfrontpages/flash/

Newseum Blends High-Tech With Historical

The Newseum — a 250,000-square-foot museum of news — offers visitors an experience that blends five centuries of news history with up-to-the-second technology and hands-on exhibits.

The Newseum is located at the intersection of Pennsylvania Avenue and Sixth Street, N.W., Washington, D.C., on America’s Main Street between the White House and the U.S. Capitol and adjacent to the Smithsonian museums on the National Mall. The exterior’s unique architectural features include a 74-foot-high marble engraving of the First Amendment and an immense front wall of glass through which passers-by can watch the museum fulfill its mission of providing a forum where the media and the public can gain a better understanding of each other.

The Newseum features seven levels of galleries, theaters, retail spaces and visitor services. It offers a unique environment that takes museumgoers behind the scenes to experience how and why news is made.

"Visitors will come away with a better understanding of news and the important role it plays in all of our lives," said Newseum Executive Director and Senior Vice President Joe Urschel. "The new Newseum is educational, inspirational and a whole lot of fun."

First patients receive cardiac stem cells for treatment of MI

July 6, 2009 | Lisa Nainggolan

Los Angeles, CA - Doctors in the US have injected autologous cardiac stem cells into patients for the first time, with two people out of a planned 24 having received the treatment following an MI [1].

"This is the first time we have injected cardiac-specific cells into a human," investigator Dr Raj R Makkar (Cedars Sinai Heart Institute, Los Angeles, CA) told heartwire. "These cells are destined to be heart-muscle cells, so this is attractive in that sense—we are trying to obtain cardiogenesis." Preclinical experiments suggest that the cells, known as cardiosphere-derived cells, do develop into cardiac myocytes, he noted./.../

Millennium Development Goals Report 2009

Millennium Development Goals Report 2009

Recent gains in eradicating hunger and poverty endangered by economic and food crises

UN Secretary-General calls on rich and poor countries to boost efforts and meet aid commitments

More than halfway to the 2015 deadline to achieve the Millennium Development Goals (MDGs), major advances in the fight against poverty and hunger have begun to slow or even reverse as a result of the global economic and food crises, a progress report by the United Nations has found. The assessment, launched by UN Secretary-General Ban Ki-moon in Geneva, warns that, despite many successes, overall progress has been too slow for most of the targets to be met by 2015.

• Full text of the Report
• Press Releases

Progenitor cells identified from human fetal hearts

July 1, 2009 | Fran Lowry

Boston, MA - Stem-cell researchers have identified a diverse set of human fetal islet-1 (ISL1⁺) cardiovascular progenitors that can differentiate into a family of cells that form the essential portions of the human heart. The discovery will allow the development of human models to study cardiovascular disease as well as new approaches for human regenerative cardiovascular medicine, they write in the July 2, 2009 issue of Nature [1].

Using two independent transgenic and gene-targeting approaches in human embryonic cell lines, the researchers, led by Dr Lei Bu (Massachusetts General Hospital, Boston, and Harvard Stem Cell Institute, Cambridge, MA), showed that the purified ISL1⁺ primordial progenitors are able to self-renew and expand before they differentiate into cardiomyocytes and smooth-muscle- and endothelial-cell lineages./.../

Projeto Home

(Thanks to Anne Schneider)

homeproject

2 de junho de 2009

HOME, filme da autoria do realizador francês Yann Arthus-Bertrand, é constituído por paisagens aéreas do mundo inteiro e pretende sensibilizar a opinião pública mundial sobre a necessidade de alter...

HOME, filme da autoria do realizador francês Yann Arthus-Bertrand, é constituído por paisagens aéreas do mundo inteiro e pretende sensibilizar a opinião pública mundial sobre a necessidade de alterar modos e hábitos de vida a fim de evitar uma catástrofe ecológica planetária.

Categoria: Filmes e desenhos

Palavras-chave:

HOME planeta Dia Mundial do Ambiente Yann Arthus-Bertrand Luc Besson Fnac PPR alertar informar sensibilizar.

O filme, com fundo "ambiental", tem cenas absolutamente sensacionais, com uma técnica de filmagem poucas vezes vista. O texto é narrado em portugues ( de Portugal).

O filme tem 1 hora e 58 minutos (passa direto, não precisa esperar para baixar). Então, quando começarem a ver é bom que tenham tempo, pois vão querer ver até o final.

Hospital: patients read physicians' notes

Electronic medical records and a push for consumer involvement make it more acceptable -- and imperative -- to release more information, say Beth Israel project backers.

By Pamela Lewis Dolan, AMNews staff. Posted July 6, 2009.

---

Tom Delbanco, MD, conducted an experiment in the 1970s in which he asked patients to take their own notes during clinical visits and compare them to their physicians' notes.

The experiment didn't last long, he said, because when patients asked other physicians for notes, "doctors thought the patients were crazy," he said. "They literally said, 'I am calling a psychiatrist.' "

Now, more than 30 years later, Dr. Delbanco, an internist at Beth Israel Deaconess Medical Center in Boston and professor of general medicine and primary care at Harvard Medical School, is trying again. He is one of the leaders of an experiment at Beth Israel that allows patients unfettered access to their doctors' notes made in relation to their visits. The idea is to see how granting real-time access to clinical notes will change the dynamic between physicians and patients./.../

Rise in Global Alcohol-Related Deaths

Stemming the Rise in Global Alcohol-Related Deaths

By Eben Harrell / London Monday, Jun. 29, 2009

Getty

• One in 25 deaths around the world is caused by alcohol consumption, and booze is now as damaging to global health as tobacco was a decade ago, according to a new study in the British medical journal the Lancet.

Economics as if people and planet mattered

THE HEALTHIEST, HAPPIEST COUNTRIES

nef (the new economics foundation) 3 Jonathan Street, London, SE11 5NH t: 020 7820 6300 Happy Planet Index Top Ten 1. Costa Rica, 2. Dominican Republic, 3. Jamaica, 4. Guetamala, 5. Vietnam, 6. Colombia, 7. Cuba, 8. El Salvador, 9. Brazil, 10. Honduras UK only 74th, but Costa Rica tops ‘Happy Planet Index’ The second global ranking of the ecological efficiency with which the world's nations deliver long and happy lives for the people who live there - the 'Happy Planet Index' - confirms a surprising picture of the relative wealth and progress of nations.

	Costa Rica lidera el "Índice del Planeta Feliz" pero el Reino Unido sólo alcanza la posición 74 Segunda clasificacin global de la eficiencia ecologica con la cual todas las naciones brindan vidas prolongadas y felices a sus ciudadanos, confirma una imagen muy diferente de la riqueza y el progreso relativos de estas.

	Easter Sunday, 12 April: the day Britain goes into ‘ecological debt’ 11.04.09 Britain has blown its yearly environmental budget earlier than ever before: consuming and polluting more than nature can manage.

International Network for the Rational Use of Drugs

• About INRUD
• ICIUM
• INRUD IAA
• Member Groups
• INRUD News
• Tools and Resources

INRUD-IAA Working to Improve Adherence to Antiretroviral Treatment in East Africa Although many countries are scaling-up antiretroviral therapy (ART) programs, no one has developed any practical approaches to monitor how well patients adhere to their treatment. Accepted wisdom is that if the ART adherence rate is less than 90–95 percent, treatment can fail, and the human immunodeficiency virus may become resistant to medicines. Therefore, the ability to accurately monitor treatment adherence and address problems immediately is crucial to the success of ART. The International Network for the Rational Use of Drugs Initiative on Adherence to Antiretrovirals (INRUD-IAA) is taking on the challenge./.../

Philosophiæ Naturalis Principia Mathematica

Newton's own copy of his Principia, with handwritten corrections for the second edition.

The Philosophiæ Naturalis Principia Mathematica (Latin: "mathematical principles of natural philosophy", often Principia or Principia Mathematica for short) is a three-volume work by Isaac Newton published on July 5, 1687. It contains the statement of Newton's laws of motion forming the foundation of classical mechanics, as well as his law of universal gravitation and a derivation of Kepler's laws for the motion of the planets (which were first obtained empirically). The Principia is widely regarded as one of the most important scientific works ever written. /.../

global movement to make cities healthier

Timing to prepare the next year World Health Day and to collaborate promoting health through citizenship initiatives.

É tempo de preparar o Dia Mundial da Saúde do próximo ano e colaborar promovendo a saúde através de iniciativas de cidadania.

World Health Day 2010

Be part of a global movement to make cities healthier

Sigfus Sigmundsson People cycle at the city centre in Brussels, Belgium on a car-free street day.

World Health Day 2010 will focus on urbanization and health. With the campaign "1000 cities - 1000 lives", events will be organized worldwide calling on cities to open up streets for health activities. Stories of urban health champions will be gathered to illustrate what people are doing to improve health in their cities.

The goal of the campaign is:

• 1000 cities – for 1000 cities to close off portions of streets to traffic for activities promoting better health.
• 1000 lives - to collect 1000 stories of urban health champions who have taken action to improve health in their cities.

:: Register your city/event!

About the theme

The theme for World Health Day 2010 was selected in recognition of the effect urbanization has on our collective health globally and for us individually. Embracing the positive side of urban health goes beyond the roles and responsibilities of government. It includes the contributions that civil society, community groups, architects, engineers, and responsible businesses can make.

The "1000 cities - 1000 lives" campaign is dedicated to bring communities together towards a common goal united around health – municipal authorities, community groups, and individuals. But it also represents an opportunity for people to enjoy exercise, music and being outdoors with friends and neighbours. Local businesses can enjoy increased sales, and all can enjoy the sense of community the day will bring.

Urbanization is associated with many health challenges related to water, environment, violence and injury, noncommunicable diseases (cardiovascular diseases, cancers, diabetes and chronic respiratory diseases) unhealthy diets and physical inactivity, harmful use of alcohol as well as the risks associated with disease outbreaks.