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Adult Cancer Survivors At Increased Risk Of Psychological Distress
Long-term survivors of cancer that developed in adulthood are at increased risk of experiencing serious psychological distress, according to a report in the July 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
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Parents Fear Errors During Children's Hospitalization
Nearly two-thirds of parents reported they felt the need to watch over their child"s care to ensure that medical errors are not made during their hospital stay, according to a study led by Beth A. Tarini, M.D., M.S., assistant professor of pediatrics at the University of Michigan Medical School.
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Washington Post Examines Lobbying Efforts Of Health Information Technology Industry
The Washington Post on Saturday examined the role of the Healthcare Information and Management Systems Society in lobbying for the national adoption of health information technology as part of health reform efforts. According to the Post, HIMSS has collaborated with various allies, including technology vendors and research groups, "in a sophisticated, decade-long campaign to shape public opinion and win over Washington"s political machinery."HIMSS in the early part of this decade forged a "strategic alliance" with the Center for Information Technology Leadership, a not-for-profit health IT research group in Massachusetts, to develop and distribute data reports on the cost efficiency and benefits of health IT, the Post reports. CITL also had sponsorship ties with several health and technology companies, including Google, Microsoft, Kaiser Permanente and Siemens Medical Solutions. In 2004, CITL issued a report that concluded in part that a national health IT system could reduce spending by as much as $77.8 billion by limiting drug prescribing errors and notifying providers of more cost-effective drug alternatives.According to the Post, the findings of the report were used by the Obama administration in developing the $787 billion federal economic stimulus package, which included billions in new spending for the creation and adoption of health IT systems. Although a Congressional Budget Office report found that the assumptions of CITL report were "overly optimistic" -- a follow-up CBO analysis projected that electronic health records would reduce health care spending by $17 billion over 10 years -- the health IT measures in the stimulus package "represented a triumph" for HIMSS, "whose members now stand to gain billions in taxpayer dollars," the Post reports. The Post notes that HIMSS" "sudden success shows how the economic crisis created a remarkable opening for a political and financial windfall: the enactment of a sweeping new policy with no bureaucratic delays and virtually no public debate about an initiative aimed at transforming a sector that accounts for more than a sixth of the American economy" (O"Harrow, Washington Post, 5/16).Please note: The Kaiser Family Foundation is not associated with Kaiser Permanente or Kaiser Industries.
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Government Focus On Acute Stroke May Compromise Other Areas Of Stroke Care

The focus on acute stroke in the UK government"s national stroke strategy may distract attention and res from other important elements of stroke care, warn experts in a paper published on bmj.com today. In 2005, the National Audit Office (NAO) report on stroke services outlined improvements for reducing death, disability and recurrent stroke, along with costs. Its recommendations led to the publication of the national stroke strategy in 2007. But it has been suggested that the NAO report overemphasised the benefits and cost savings to be gained from intravenous thrombolysis (giving anti-clotting drugs within three hours of an acute stroke) and underestimated the gains from comprehensive care in a stroke unit. Now senior doctors at the University of Edinburgh warn that the report"s strong focus on hyperacute stroke care (the first 72 hours), and on greatly increasing the proportion of patients being given intravenous thrombolysis, could mean that the many other effective components of a comprehensive stroke service might not receive as much attention. They examined the current performance of stroke services in England, Wales and Northern Ireland against three proven interventions for acute stroke: organised stroke unit care, early administration of aspirin, and intravenous thrombolysis. According to the 2008 national sentinel stroke audit, 68% of patients admitted to hospital with an acute stroke spent more than half of their admission on a specialist stroke unit, 85% of eligible patients received early aspirin, and 1.4% of eligible patients received intravenous thrombolysis. Based on these figures, the authors estimate that, at present, in a notional UK population of one million people, intravenous thrombolysis is preventing two patients from having a poor outcome (death or disability) each year, while stroke unit care and aspirin are preventing 37 and 24 poor outcomes respectively. More optimistically, if 5% of all stroke patients could be treated with intravenous thrombolysis within three hours (a greater than fivefold increase in what is currently being achieved UK-wide, and an improvement even on the highest rates in the UK), then 11 would avoid a poor outcome, while increased rates of stroke unit admission and early aspirin administration would lead to 59 and 29 patients avoiding a poor outcome respectively. These calculations clearly show that the numbers of patients benefiting at current or realistic target levels are far larger for stroke units and aspirin than for intravenous thrombolysis, and they remain higher even at optimistic target levels, say the authors. Achieving a higher rate of thrombolysis will also require radical changes to local systems. But they warn "we must be careful that the emphasis on developing hyperacute stroke care, mainly to allow delivery of thrombolysis to the small proportion who may benefit, does not distract attention and res from the other proved interventions." They conclude: "Although it is important to give intravenous thrombolysis in an appropriate setting to as many eligible patients as possible, it is crucial that this should not be at the expense of any of the other parts of a comprehensive stroke service. All elements of effective stroke care must be properly joined up, and funded, from hyperacute care to long term community support." Link to paper British Medical Journal


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