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Archive for April, 2010

The healthcare reform law has included an amendment to the Fair Labor Standards Act (FLSA) according to which, the employers should provide reasonable unpaid break time to nursing mothers during the working hours to express milk to babies till the baby is one year old. The employer is also required to provide a clean and private area for the employee, other than rest room for this. The amendment is documented in the Section 4207 of the Patient Protection and Affordable Care Act.

Breastfeeding benefits both the mother and baby. It protects babies from sudden Infant Death Syndrome, asthma, juvenile diabetes etc and builds up the baby’s resistance to infections. Mothers are protected from diseases like diabetes, breast cancer, ovarian cancer and postpartum depression.

Interest in the study has been raised with the results of a new study published in the April 2010 issue of the ‘Pediatrics’ journal which states that if ninety percent of mothers in the United States breast feed their babies, the lives of upto 900 babies can be saved each year and save around $13 billion in health care costs per year.

While most women knows the benefits of breast feeding, working mothers are usually unable to do so from busy work schedules and lack of time in between. Lack of a private and hygenic place is also forbidding it and often women has to depend on public restrooms or their cars.

Even when the government has recognized the benefits and amended the FLSA to provide breaks for expressing breast milk, confusions exist regarding the law. The law has not defined how many breaks or how much time is alloted for the breaks and these breaks are not compensated. Employers with less than 50 employees are not required to furnish these reqirements if it causes undue hardship or financial burden to the employer. The law has also not defined any punishment to the employer who does not comply.

But even after considering these shortcomings, if the law is implemented, it can reduce the number of women leaving jobs after child birth and among working women, it eases tension, improves job productivity. It can also reduse illness among infants as well as mothers and thus reduce healthcare costs.

Dr. David Blumenthal, National Coordinator for Health Information Technology, recently announced that ONC has awarded $60 million in research grants through the Strategic Health IT Advanced Research Projects (SHARP) program to four renowned institutions.

The research grants worth $60 million were awarded to Mayo Clinic of Medicine, Harvard University, University of Texas Health Science Center at Houston,  and University of Illinois at Urbana-Champaign  through the SHARP program.

Dr. David Blumenthal said , “The Office of the National Coordinator for Health Information Technology (ONC) has created a solid foundation of programs and initiatives to support health care practitioners and hospitals in implementing meaningful use of certified EHR technology, but we are admittedly at the beginning of our journey. ONC is keenly aware that technology needs to continuously advance, bringing new solutions that will make it even more beneficial. While I’m proud of what ONC has achieved so far, I’m humbled by the size of the task still in front of us.”

The research projects in these institutions will be set to identify solutions – long-term as well as short-term – to address the fundamental challenges which include -

Researchers, the technology industry, and health care providers will be leading the multidisciplinary teams, and these teams are supposed to conduct these projects. The results of the team work will be practiced by producing innovative health IT solutions, so they can be deployed nationwide.

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius wrote to governors and independent insurance commissioners of each state asking about their interest in participating in the temporary high risk pool program (which is part of the healthcare reform law).

The temporary high risk pool program is part of the new health insurance reform law and it addresses the people who could not be insured due to pre-existing medical conditions.

The letter, dated April 2, 2010, asks the states to express their interest in participating in the program and how they want to involve in it.

Sebelius announced that implementing the temporary new high risk pool program is amomg the initial tasks to be done in the new healthcare reform law and that the HHS will work closely with the states to clear their doubts regarding this.

A sum of $5 billion is allocated towards this program in the new insurance reform law, which will be available from July 1^st , as it is the start of the fiscal year in many states, till January 1, 2014. The amount disbursed to each state depends on its population and costs. Unissued funds will be reallocated after two years.

States can participate in this program through multiple options which includes:

• They can form a new high risk pool along with a current state high risk pool
• They can establish a new high risk pool if they don’t have one
• If they have a different program, states can build upon their existing one.
• States can also contract with a current HIPAA carrier to cover eligible individuals.

The letter asks the states to let their intentions be known by April 30^th. The letter also states that a conference call will be held in mid-April to enable learning additional details about the of the program, application requirements, as well as to respond to any questions regarding this program.

A study published by the Journal of the American College of Cardiology suggests that Brain Magnetic Resonance Imaging (MRI) along with Transfemoral Aortic-valve Implantation (TAVI) detects emboli, an abnormal particle, probably an air bubble or part of a clot circulating in the blood, that usually goes undetected.

For patients with high surgical risk, a TAVI device have to be approved by the FDA, but still, some surgeons are using this method instead of surgery, in low-risk patients.The CoreValve and Edwards Sapien TAVI devices are widely used in Europe.

The study was conducted by Dr Alexander Ghanem and colleagues of University of Bonn, Germany. They found that when compared to conventional MRI, the incidence of clinically silent cerebral embolic lesions on MRI images after TAVI was high, but the incidence of persistent neurological impairment was low.

30 patients undergoing TAVI approach for the implantation of a CoreValve aortic-valve prosthesis were evaluated by Ghanem and his colleagues for the study. Out of them, 22 were evaluated with cerebral diffusion-weighted-MRI scans thrice – before, directly after and three months after – evaluating with TAVI.

It was found that there were three patients with neurological impairment following the TAVI, and only one with a permanent neurological impairment. Around 75 lesions were found in 16 patients, where scans were taken immediately after TAVI. 59 out of the 75 lesions were in the supratentorial region of the brain, which contains cerebrum and rest were in the infratentorial region, the part of the brain containing cerebellum. In 16 patients, MRI taken after three months of TAVI showed an infarcted tissue in the area of a lesion that had appeared in the scan right after TAVI.

According to the study, emboli appears on scans of those patients who already had cerebral events and cerebrovascular disease, and the patients with the emboli had a tendency of having worse renal function.

Ghanem said,

The study raises awareness of potential cerebral embolism, which most often stays clinically silent. This end point is a sensitive surrogate parameter for future neuroprotective approaches.