US says Legionnaire's cases triple over decade (AP)

ATLANTA � Cases of Legionnaire's disease have tripled in the last decade, U.S. health officials said Thursday, but the risk of dying from it is lower because of more effective treatment.

Legionnaire's most often strikes the elderly and can cause deadly pneumonia. The germ spreads through mist or vapor from contaminated water or air conditioning systems.

The Centers for Disease Control and Prevention reports 3,522 cases in 2009, the most since Legionnaire's was first identified in 1976. There were only 1,110 cases in 2000. CDC officials think the increase may be partly because there are more old people.

To be sure, Legionnaire's remains uncommon. Just 8 percent of its victims died in the last decade, compared to 20 percent in the 1980s and 1990s. But it still kills hundreds of Americans each year, and leaves an estimated 8,000 to 18,000 hospitalized.

The increase in cases is worrisome, said study co-author Dr. Lee Hampton, a CDC epidemiologist. "We need to minimize the risk of people dying from this," he said.

The disease got its name from an outbreak at a Philadelphia convention of the American Legion in 1976 when more than 200 people were sickened and 34 died. The outbreak drew intense media coverage, and months later health investigators fingered the bacterial cause. The germ apparently had spread through the convention hotel's air-conditioning system.

Early signs of the disease can include high fever, chills and a cough. Fortunately, some of the drugs most commonly used against pneumonia are first-line treatments against Legionnaire's.

Cases of the disease held relatively steady in the 1980s-90s, but rose since 2000.

The CDC relies on doctors, hospitals and state health departments to report cases when they occur, and agency officials believe the national case count is an underestimate.

___

___

Online:

Report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6032a3.htm?s_cidmm6032a3_w

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials

Study: Only 1 in 5 medical malpractice cases pay (AP)

ATLANTA � Only 1 in 5 malpractice claims against doctors leads to a settlement or other payout, according to the most comprehensive study of these claims in two decades.

But while doctors and their insurers may be winning most of these challenges, that's still a lot of fighting. Each year about 1 in 14 doctors is the target of a claim, and most physicians and virtually every surgeon will face at least one in their careers, the study found.

Malpractice cases carry a significant emotional cost for doctors, said study co-author Amitabh Chandra, an economist and professor of public policy at the Harvard Kennedy School of Government

"They hate having their name dragged through the local newspaper and having to go to court," he said.

The study might seem to support a common opinion among doctors that most malpractice lawsuits are baseless, but the authors said the truth is more complicated than that.

They noted influential earlier research in New York state concluding that just a tiny fraction of the patients harmed by medical mistakes actually file claims.

Trial lawyers say cost is a barrier to bringing a claim to court. There are very high up-front costs for hiring expert witnesses and preparing a case. Doctors, hospitals and their insurers often have significant money and legal firepower. Some states also have caps on malpractice awards. So, usually, only very strong cases with high expected payouts are pursued.

Given the expense and other difficulties involved in winning, it's doubtful most claims are filed on a greedy whim, the researchers said.

"A lawyer would have to be an idiot to take a frivolous case to court," Chandra said.

The study was published online Wednesday by the New England Journal of Medicine.

The research team turned to one of the nation's largest national malpractice insurers, analyzing data for about 41,000 physicians who bought coverage from 1991-2005. The researchers could only get the data by signing an agreement not to identify the insurer, so they wouldn't disclose the name of the company.

The insurer represents only about 3 percent of the nation's doctors, but it operates in all 50 states. The average payouts were about the same as seen in the government-created National Practitioner Data Bank, which records payouts but doesn't record all claims filed.

The study found:

_About 7.5 percent of doctors have a claim filed against them each year. That finding is a little higher than a recent American Medical Association survey, in which 5 percent of doctors said they had dealt with a malpractice claim in the previous year.

_Fewer than 2 percent of doctors each year were the subject of a successful claim, in which the insurer had to pay a settlement or court judgment.

_Some types of doctors were sued more than others. About 19 percent of neurosurgeons and heart surgeons were sued every year, making them the most targeted specialties. Pediatricians and psychiatrists were sued the least, with only about 3 percent of them facing a claim each year.

_When pediatricians did pay a claim, it was much more than other doctors. The average pediatric claim was more than $520,000, while the average was about $275,000.

"Jurors' hearts cry out for injured patients, especially when kids are involved," Chandra said. The amount attached to a pediatric case also rises because many more years of suffering are involved than if the victim is middle-aged or elderly, experts said.

The study was funded by the RAND Institute for Civil Justice. Chandra also received funding from the National Institute on Aging, which has been interested in malpractice as a possible driver of health-care costs.

The study echoes earlier research on which specialists get sued most often, said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, a Washington, D.C.-based consumer advocacy group.

"The thing that's disappointing about their study is they don't focus on what can be done to prevent people from being injured," said Wolfe, who has pushed for more aggressive policing of doctors by state medical licensing boards.

___

Online:

New England Journal: http://www.nejm.org

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials

FDA approves gene-targeting skin cancer drug (AP)

WASHINGTON � The Food and Drug Administration has approved a first-of-a-kind drug to treat the deadliest form of skin cancer by targeting a particular genetic mutation found in about half of patients.

The pill called Zelboraf, made by Roche, is the first treatment for melanoma that targets a specific gene found in skin-cancer tumors. The FDA said Wednesday it also approved a test to screen patients for the mutation.

Melanoma is the fastest-growing form of cancer in terms of new diagnoses. Researchers attribute the acceleration to longer life expectancies among the elderly and increased indoor tanning by the young.

About 68,000 people in the U.S. were diagnosed last year and 8,700 died, according to the American Cancer Society.

Melanoma has long been considered one of the toughest cancers to treat, with few drug options. In March the FDA approved a Bristol-Myers Squibb drug that was the first drug shown to prolong survival in patients with advanced skin cancer.

Zelboraf will provide a second option for melanoma patients with a mutated form of a protein called BRAF that helps with cell growth when working normally. Zelboraf works by blocking the mutated form of the protein, slowing tumor growth.

The FDA approved the drug based on a 675-patient study in which patients received either Zelboraf or a chemotherapy drug. The study is ongoing, but 77 percent of people on Zelboraf are alive compared with 64 percent of those taking the older drug, according to the FDA.

Despite the higher survival rate, melanoma adapts quickly, and patients saw their tumors resume growth after seven months, on average.

A six-month course of Zelboraf will cost about $56,400.

Side effects with the drug included skin rashes, joint pain, fatigue, diarrhea and hair loss. About 26 percent of patients developed a less serious form of skin cancer.

Melanoma patient advocates praised the FDA for clearing the drug well ahead of an Oct. 28 target date to complete its review.

"The FDA's quick action on this drug approval is important because it gives melanoma patients a new way to fight this deadly disease," Timothy Turnham, director of the Melanoma Research Foundation, said in a statement.

In June, Roche's Genentech agreed to study Zelboraf in combination with Bristol-Myers' Yervoy, the only other melanoma drug shown to extend life.

Zelboraf was co-developed by Roche's Genentech unit, based in South San Francisco, Calif., and Daiichi Sankyo, a Japanese drugmaker. The companies will co-promote the drug in the U.S.

Roche said Wednesday the drug would be available within two weeks.

The drug is under review in the European Union and more than a half-dozen other countries around the world.

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials

Studies show 15 minutes of daily exercise can help (AP)

LOS ANGELES � Don't despair if you can't fit in the recommended 30 minutes of daily exercise. Growing evidence suggests that even half that much can help.

It's still no excuse to slack off. Regular exercise strengthens muscles, reduces the risk of some diseases and promotes mental well-being. The more exercise, the better.

But not everyone has the time or willpower. So researchers set out to find the minimum amount of physical activity needed to reap health benefits. The findings by a study in Taiwan suggest just 15 minutes of moderate exercise a day can lead to a longer life.

This "may convince many individuals that they are able to incorporate physical activity into their busy lives," Dr. Anil Nigam of the University of Montreal said in an email. Nigam had no role in the research but wrote an editorial accompanying the Taiwan study published online Monday in The Lancet.

Fitness guidelines by the World Health Organization, the U.S. and other countries recommend that adults get at least a half-hour of moderate workout most days of the week. This can include brisk walking, bike riding and water aerobics.

Realizing that it might be difficult for some to break a sweat, health groups have suggested breaking it down into smaller, more manageable chunks of time such as three 10-minute spurts a day on weekdays.

The latest study, a large one led by researchers at the National Health Research Institutes in Taiwan, sought to determine if exercising less than the recommended half-hour was still helpful.

The researchers noted that east Asians � including China, Japan and Taiwan � are generally less physically active than their Western counterparts and their workouts tend to be less intense.

About 416,000 Taiwanese adults were asked how much exercise they did the previous month. Based on their answers, they were put into five groups of varying activity levels from inactive to highly active. Researchers kept track of their progress for eight years on average and calculated projected life expectancy.

The study found those who exercised just 15 minutes a day � or 90 minutes a week � cut their risk of death by 14 percent and extended their life expectancy by three years compared with those who did no exercise. Both men and women benefited equally from the minimum activity.

Each additional 15 minutes of exercise reduced the risk of death by another 4 percent compared with the inactive group. Researchers did not report how additional exercise affected life expectancy.

There were some limitations. Answers were self-reported. The study, though large, was observational, which means the health benefits may not be entirely due to exercise. But researchers said they took into account other factors that might affect health such as smoking and drinking. And outside scientists said the findings are in line with other studies.

For the sedentary, the key is this: Some exercise is better than none.

"Get off the couch and start moving," said I-Min Lee of the Harvard School of Public Health.

In a study published in Circulation earlier this month, Lee and colleagues found that people who engaged in 15 minutes a day of moderate physical activity had a 14 percent lower risk of heart disease compared with inactive people.

That research, combining the results of nearly three dozen studies of people from North America and Europe, also found that the benefit increased with more activity and may provide more motivation to the physically fit.

People should strive to do the recommended level of exercise, but should not be discouraged if they can't achieve it right away. Start slow and gradually build up.

"As inactive persons start moving, they may very well find that they become more fit" and reaching their exercise goal becomes easier, Lee said.

Until a year ago, Bernadette O'Brien, a retired principal who lives in northern New Jersey, did not make time for exercise. She would occasionally walk around her neighborhood and swim in the pool at her local gym, but she did little else.

After the 80-year-old was diagnosed with diabetes, she decided to change her habits. Now O'Brien exercises between 15 and 45 minutes a day, five days a week. She mixes up her routine with water aerobics and strength training so she won't get bored.

"I feel healthy and energetic. And my balance is pretty good," she said.

___

Online:

Lancet journal: http://www.thelancet.com

U.S. guidelines: http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html

WHO guidelines: http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/index.html

__

Follow Alicia Chang's coverage at http://twitter.com/SciWriAlicia

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials

Do-it-yourself battlefield medicine saves lives (AP)

CHICAGO � When Army Ranger Leroy Petry's hand was blown off by a grenade as he was saving his comrades in battle, he knew just what to do. He used his remaining hand to twist a tourniquet around his arm to avoid bleeding to death.

Sgt. 1st Class Petry, awarded the Medal of Honor last month, was with a regiment trained in do-it-yourself battlefield treatment. That kind of quick care on the field led to a 92 percent survival rate for the regiment over more than seven years, a study found.

Of the 32 deaths, just one had wounds considered potentially survivable, in this case massive bleeding. That Ranger died from post-surgery complications.

The study found a 3 percent death rate from potentially survivable causes in the 75th Regiment between October 2001 and April 2010. That compares with a 24 percent rate in a previously reported set of U.S. military deaths in Iraq and Afghanistan, which included troops who didn't have the Ranger-style training, the study authors said.

Petry "is a prime example of how this works," said lead author Dr. Russ Kotwal of the Special Operations Command at Fort Bragg, N.C. President Barack Obama awarded Petry his medal in a ceremony where he shook the Ranger's new robotic hand.

Historically, about 90 percent of combat-related deaths have occurred in the field, before troops reached a medical facility. Mindful of that, the Rangers adopted a new approach more than a decade ago, focusing on certain types of injuries, after a review of casualties in previous wars.

The idea is straightforward: There aren't enough doctors or medics to treat battlefield wounds, so Rangers must be equipped with their own first aid devices and trained to use them.

"If you can't do it to yourself, then you grab somebody to do it for you," Kotwal said.

The study, published Monday in Archives of Surgery, details the Rangers' approach, which also has been adopted in some other parts of the military.

The Rangers are part of the Army's Special Operations Command. They undergo training over a couple of days in how to treat battlefield wounds.

The focus is immediately treating the three main types of "potentially survivable" injuries: extreme bleeding from arms or legs, collapsed lungs from chest trauma, and airway blockage, including blood or tissue caught in the throat.

Soldiers are equipped with tourniquets, special wound dressings and needles used to treat major chest injuries. Their medical training is considered "as important as shooting," said Dr. John Holcomb, the study's senior author.

"To really inculcate this training and mentality into the entire regiment takes a couple of years," Holcomb said.

Master Sgt. Harold Montgomery, a medic, said he's "an absolute believer" in the approach.

He said he has seen non-medics administer treatment without qualms. "The one time you see them flustered" is treating severe chest wounds, which can cause air to fill the chest cavity and collapse the lungs. Treatment "is sticking a big needle into somebody's chest" to deflate the air build-up. "It can quickly save a life," but non-medics sometimes seek assurance from more medically experienced comrades about when it's really needed, Montgomery said.

Causes of injuries and deaths examined in the study included explosive devices and gunshot wounds, which accounted for half of the deaths. Most battlefield treatment focused on controlling bleeding and non-medical personnel applied 42 percent of the tourniquets.

The approach studied teaches soldiers "to take a deep breath" in the middle of combat and "fall back on a basic set of concepts and maneuvers shown by this study to increase survival of those wounded," said Dr. Todd Rasmussen, an Air Force surgeon who is the deputy commander of the U.S. Army Institute of Surgical Research in San Antonio, Texas.

It is being adopted in some military settings and by police in nonmilitary settings, "to overcome the chaos of these types of events, whether it is an explosion on the battlefield or a live shooter at a mall," Rasmussen said. He was not involved in the study.

___

Online:

Archives of Surgery: http://www.archsurg.com

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials

CDC looks for 15 passengers of flight with bat (AP)

ATLANTA � Health officials are still looking for 15 passengers who were on a flight in which a bat flew inside the airplane's cabin so they can protect them against the possibility of rabies.

Danielle Buttke (buht-KEE') of the Centers for Disease Control and Prevention said Saturday they have contacted 35 of the 50 passengers on the Aug. 5 Delta Air Lines flight 5121 that was operated by Atlantic Southeast Airlines.

She says none of the passengers they've spoken with required treatment.

The plane was flying from Madison, Wis., to Atlanta when the bat emerged. No one knows if the bat had rabies because it escaped. The CDC wants to talk to the plane's passengers to make sure they didn't have close contact with it, putting them at risk.

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement | WordPress Tutorials