New Biomarker for Metastatic Prostate Cancer?
Sources: Medical News Today; Thomas Jefferson University
An inter-institutional team effort, initiated by Thomas Jefferson Unversity’s Michael A. Augello of the Department of Cancer Biology at Thomas Jefferson University, has found a potential biomarker for determining who will get the metastatic (and lethal) form of prostate cancer, which is usually contained or containable if caught in early stages.
Cyclin D1b regulates a large gene network, the researchers found, which was shown to cooperate with androgen receptor (AR) signaling to fuel metastatic progression in multiple models of prostate cancer. Studies have shown that Cyclin D1b expression is elevated in early stages of prostate cancer (in up to 30% of primary disease), and researchers have now demonstrated that this occurs more frequently in late stage castration-resistant prostate cancer: up to 80%.
The group found that Cyclin D1b, a variant of the cell cycle regulator Cyclin D1a, functions independently of the cell cycle to promote metastasis in both early and late stage prostate cancer. “Numerous clinical and pre-clinical studies have effectively demonstrated that AR signaling is critical for progression to metastatic disease, but our knowledge of AR targets which can induce metastatic phenotypes is limited,” said Dr. Knudsen, who assisted in the research. ”Our data describe how cross talk between the cell cycle and AR can rewire the AR signaling axis to enhance the expression of genes which elicit metastasis in both early and castration resistant prostate cancer models.”
Metastatic resistant prostate cancer represents the most lethal form of the disease, which arises when AR is reactivated despite continued hormone therapy. Soft tissue metastasis (spread) to the liver and lung represents a particularly aggressive form of prostate cancer, whose presence predicts for decreased survival time in prostate cancer patients. There is little knowledge as to how these metastatic events occur, and identification of pathways and biomarkers of this lethal event could greatly benefit prostate cancer patients.
Have you or a loved one been diagnosed and treated for prostate cancer? Contact the Lewis Law Firm for a free consultation.
Hospital Malpractice 1 in 10 Patient’s Readmitted in 30 Days
Source: Journal of the American College of Surgeons, Volume 215, Issue 3 , Pages 322-330, September 2012
Hospital Malpractice
Hospital Malpractice continues to be a problem. An article published recently in the Journal of the American College of Surgeons sheds some rare light on hospital care and legislation aimed at reimbursing Medicare and Medicaid for the additional expenses of readmission and treatment caused by hospital malpractice.
Study Design
Using standard National Surgical Quality Improvement Project protocol, preoperative, intraoperative, and postoperative outcomes were collected on patients undergoing inpatient general surgery procedures and merged with an institutional clinical data warehouse to identify unplanned 30-day readmissions. Demographics, comorbidities, type of procedure, postoperative complications, and ICD-9 coding data were reviewed for patients who were readmitted.
Results and reasons for readmission
1,442 general surgery patients were reviewed. 163 or (11.3%) were readmitted within 30 days of discharge. The most common reasons for readmission were gastrointestinal problem/complication (27.6%), and surgical infection (22.1%), accounting for nearly 50% of all readmission reasons. Postoperative occurrences leading to increased risk of readmission were blood transfusion, postoperative pulmonary complication, wound complication, sepsis/shock, urinary tract infection, and vascular complications. Multivariable analysis demonstrates that the most significant independent risk factor for readmission is the occurrence of any postoperative complication (odds ratio = 4.20; 95% CI, 2.89–6.13).
Procedures
Patients undergoing a pancreatectomy had the highest readmission rate (17.9%) for any procedure at our institution, followed by patients undergoing colectomy with or without colostomy (12.6%), small bowel resection (11.8%), gastrectomy (11.4%), and ventral hernia repair (11.0%). Procedures with low 30-day readmission rates in our analysis included parathyroidectomy (7.7%), thyroidectomy (2.9%), and mastectomy (2.0%).
Conclusions
Postoperative complications appear to drive readmissions in surgical patients. Taking appropriate steps to minimize postoperative complications will decrease postoperative readmissions.
The Lewis Law Firm represents patients and their families who are victims of hospital malpractice resulting in serious injury and death. If you or a loved one were the victim of hospital or physician malpractice, contact the Lewis Law Firm for a FREE consultation and case review today.
Tort Reform -The Big Lie
Source: Public Citizen Report -Congress Watch Division (Public Citizen is a national non-profit consumer organization with more than 300,000 members and supporters).
Medical malpractice payments were at their lowest level on record in 2011
In contrast to the hundreds of thousands of annual avoidable adverse events (and tens or hundreds of thousands of deaths) that major studies attribute to medical mistakes, only 9,758 medical malpractice payments were made on behalf of doctors in 2011. However, policymakers and leaders of physician groups have spent the past two decades championing efforts to restrict patients’ legal rights, calling for Tort Reform and arguing of a crisis. There is no evidence that patients have received any benefits in exchange for ceding their legal remedies. Instead, the evidence suggests that litigation restrictions have suppressed meritorious claims, forcing malpractice victims and ordinary patients to absorb the costs of treating injuries caused by uncompensated medical errors.
Despite suggestions by those seeking to reduce patients’ legal rights that medical malpractice lawsuits are largely “frivolous,” the vast majority of payments compensate for extremely serious harms. 80% of the money paid for medical negligence in 2011 compensated victims or their surviving family members for harms defined by the NPDB as significant permanent injuries; major permanent injuries; quadriplegia, brain damage, or injuries requiring lifelong care; or death. The latter two categories (quadriplegia, brain damage, or injuries requiring lifelong care; and death) accounted for 44 percent of the dollars spent to compensate victims of medical malpractice.
Declines in Litigation Do Not Translate into Lower Costs for Consumer
Between 2000 and 2011, the value of medical malpractice payments fell 11.9 percent while healthcare spending nearly doubled, increasing 96.7 percent (both calculations in unadjusted dollars). These figures debunk claims that medical malpractice litigation is responsible for rising healthcare costs, as well as promises that patients should expect savings from litigation restrictions.
There Is No Evidence that the Decline in Medical Malpractice Payments Is Due to Safer Medical Care
For years, observers of healthcare safety issues referred to the 1998 Institute of Medicine (IOM) report, “To Err Is Human,” for guidance on the prevalence of medical errors. That study concluded that 44,000 and 98,000 patients were dying every year because of avoidable medical errors. In 2010 and 2011, three major studies reached conclusions on medical errors at least as shocking as those in the IOM report. The administrator of the Centers for Medicare and Medicaid Services (CMS), found that the number of adverse events could be 10 times greater than originally thought.
Comparing the well-recognized prevalence of medical errors with the relatively small numbers of malpractice payments leads to the inescapable conclusion that the overwhelming majority of medical errors do not lead to litigation. Harvard School of Health’s Michelle M. Mello and her co-authors in 2007 wrote in analysis of existing literature that only “2 to 3 percent of patients injured by negligence file malpractice claims … The findings of our analysis indicate that the overwhelming proportion of the costs of hospital medical injures are shifted to parties other than the hospital.”15
Uncompensated Medical Errors Are Costing Both Victims and Taxpayers Significantly
To put this figure in perspective, the total number of payments made in 2011 equaled only a little more than 1 percent of the number of Medicare patients that the Department of Health and Human Services estimates to suffer serious, avoidable injuries in a given year—and that’s just Medicare patients. This demonstrates that the vast majority of medical malpractice errors are not resulting in malpractice compensation payments for patients.
Conclusion
The juxtaposition of declining medical malpractice payments, skyrocketing medical costs, and consistent findings of rampant medical errors discredit the underlying promises of those who have campaigned to reduce patients’ access to legal remedies. The only sensible response is for policymakers and physicians to dedicate themselves to pursuing patient safety measures with the same vigor they have applied to limiting patients’ legal rights. That is a solution we could all live with.
The Lewis Law Firm has a long history of standing up for injured patients and their families. If you or a loved one have been the victim of physician or hospital malpractice, please contact the Lewis Law Firm for a FREE consultation and case review, today.
~Posted by: Gayle R. Lewis, Esquire
Novel Approach, Say You’re Sorry.
Sources: sorry works! coalition; Healthcare Providers Insurance Exchange; National Institutes of Health; National Institute of Medicine
It seems obvious to most of us but the importance of making an early an honest disclosure to a patient could mean the difference between no litigation at all or an expedient an amicable settlement. Contrast that with the lack of empathy, avoidance or flat out denial and obfuscation so typical of our health care system and you have all but guaranteed protracted and acrimonious litigation. We try to make all of our clients understand that we can’t make them or their loved ones whole again, or undo the physical and emotional suffering endured, that it isn’t personal -except it often is.
Groups such as the Sorry Works! Coalition have been advising hospitals, physicians and risk managers of the value of early and honest disclosures regarding medical errors for several years. It seems that the medical malpractice insurance industry is finally catching on as well. We’ve long recognized the value of this as among the most frequent complaints we hear from clients is that the doctor, nurse or hospital “didn’t acknowledge” that they had done something wrong, “didn’t seem to care” about the outcome and “didn’t even say they were sorry” that things went unexpectedly wrong.
Instead doctors find themselves in an antagonistic relationship with their own patients. The medical malpractice insurance industry would have you believe it’s all because of “frivilous lawsuits” and the “fear of litigation” brought about by Plaintiff trial attorneys. The reality is that apologies can cost insurance companies money in the form of settlements. This runs contrary to their traditional model of dragging out litigation for as long as possible, making it an expensive proposition for the patient and their attorneys to discourage otherwise valid lawsuits. This further allows medical malpractice insurance companies to keep their money in the bank longer, knowing that they will raise the premiums of their insured at the conslusion of litigation to offset any loss in profit.
So why not simply let the doctors and hospitals and Joint Commissions and Physician Boards take care of their own? Because they don’t do a very good job of it. The National Institute of Medicine estimates that 120 patients die every day in US hospitals as a direct result of medical errors. We may have one of the best healthcare systems in the world, but it still isn’t good enough for the 120 patients on any given day. Preventable occurrences such as wrong site surgeries (operating on wrong part of body) continue to be one of the largest categories of error. Patient falls and medication errors are a close second and third. Add to this the shortage of staffing from doctors to nurses to technicians and it’s clear to see that another approach may be needed.
What’s wrong with letting patients and their families know that something went wrong? (hint: they already know that) Better still, let them know how the error likely happened, what the doctor and hospital plan to do for the family now that it has occurred and what they plan to do in the future to ensure that it is not likely to happen again. Contrary to what the medical malpractice insurance industry spends a great deal of money advertising, “tort reform” doesn’t address the issues. Preventing preventable medical errors before they occur, and being open and honest with patients and their families when they do occur, is the real answer to the problem.
If you or a loved one were the victim of a preventable medical error and the doctor and hospital have not given you answers, much less an apology, contact the Lewis Law Firm for a free consultation.
Posted by: Gayle R. Lewis, Esquire
Men Over Age 50 are being Victimized by Overly Agressive Surgery!
Sources: Duke Medical School, International Journal of Radiation Oncology, Biology, Physics, Vol. 82, Issue 5, 1 April 2012, p. 781; NCCN Guidelines for Prostate Cancer; National Institute for Health & Clinical Excellence; James Buchanan Brady Institute at Johns Hopkins Memorial Hospital; Sloan Kettering Memorial Hospital
Editorial
After 30 years of Medical Malpractice Litigation, I have come to recognize that medicine has patterns of treatments falling in and out of vogue every 10-20 years. Over 20 years ago, women were almost routinely given hysterectomies for a wide range of post menopausal symptoms including bleeding and cramping. Women with Breast Cancer invariably underwent radical mastectomy, the standard of care in the 1980′s. Did our Mothers, Sisters, Wives and Girlfriends require these surgeries? The emergence of a number of non-surgical treatment options that have been just as effective lead one to question the wisdom of the times. I used to think it was a function of women utilizing medical services 3x more than men or that it was simply bad luck to have been born a woman in modern society. Perhaps there was simply way too much money involved in surgeries, operative times, anesthesia times and inpatient postoperative stays for the US healthcare system to slow itself down and reflect?
Lately, a good portion of my practice, has focused upon men and their healthcare experiences. It has been my observation that there is a significant amount of prostate surgery, stemming from the overly agressive approach to prostate cancer treatment. All too often surgeries are scheduled for men with prostate cancer at such an early stage that it does not represent a life-threatening condition. Add to this the reports of misread biopsies, mis applied PSA scores and overly read scans and the results are a staggering amount of radical prostatectomies. Of course there are those who will blame the Medical Malpractice trial lawyers for creating a climate of fear among physicians, leading them to suggest surgery. This argument makes little sense. Cancer is a lot like being pregnant, either you’re positive or you aren’t. And why is there a disproportionate amount of surgery in the male 50 to 80 years of age group? If one lives long enough, they will get prostate cancer -currently affecting 1 out of 6 men. This is actually more prevalent than breast cancer, which affects 1 out of 8 women. However, studies following autopsy have demonstrated that even where prostate cancer is present, it has not been the cause of death in 90% of men. Prostate cancer tends to be slow growing (indolent) and non-recurrent.
So why all the surgery? And what does this mean for men age 50 and older? First, be very careful with your choice of a Urologist. A competent urologist is most likely to obtain a good biopsy sample of the prostate. Be aware that the Pathologist who interprets the biopsied tissue may make an error as well leading to our Second recommendation. Get a second opinion. In most cases you will basically feel healthy. Make sure you aren’t being misdiagnosed or overly diagnosed. Look at the stock market lately. The company which pioneered robotic sugery, originally for women and now for the prostate, is at an all time high. The Global Market for surgical robotics is expected to exceed 5 billion by 2015. Most metropolitan and now suburban hospitals have invested considerable amounts of capital in robotic and minimally invasive surgeries to bring more patients through their doors and into their operating rooms. This is not a train that is easily derailed.
I am certainly not against new technology and constantly push hospitals and physicians to move toward more state-of-the-art practices in the cases I bring on behalf of my clients. I am simply warning that not all surgeries are indicated and that prostatectomy -no matter how robotic or “minimally-invasive” involves the disconnection and reconnection of vital structures and nerve endings which can and does result in temporary (and sometimes permanent) loss of sensation, erectile dysfunction and incontinence. Consider your options carefully and make well informed choices.
Have you or a loved one been diagnosed and treated for prostate cancer? Contact the Lewis Law Firm for a free consultation.
Posted by: Gayle R. Lewis, Esquire
New Jersey Same Day Surgery Center’s Reviewed
Source: NJ Department of Health and Senior Services (NJ DHSS)
What are Ambulatory Surgery Centers?
Ambulatory Surgery Centers or “Same Day Surgery Centers” are facilities where patients can undergo certain types of surgery or medical procedures, recover and go home the same day. Eye, knee and shoulder surgery, cosmetic surgery, and procedures such as colonoscopy screening for colon cancer are examples of services these centers provide.
How many Ambulatory Surgery Centers are there in New Jersey?
There are 133 DHSS-licensed centers in the state. Another 116, though not DHSS-licensed, are certified by the federal Centers for Medicare and Medicaid Services as meeting CMS standards of care. Many other centers come under the authority of the New Jersey state Board of Medical Examiners, which regulates private physician practice.
Patient Safety in New Jersey
DHSS inspects licensed ambulatory surgery centers every three years. Hospitals and ambulatory surgery centers must report to New Jersey’s confidential Patient Safety Reporting System when a serious preventable adverse event occurs. Facilities must conduct a root cause analysis to find the underlying causes of the medical error, and develop and implement a plan to prevent future errors. DHSS, working in conjunction with the Centers for Medicare and Medicaid Services, temporarily curtailed admissions at some ambulatory surgery centers for deficiencies in meeting standards related to infection control, safety, sanitation, medication control, patient safety and other issues. Each of these centers was allowed to reopen after correcting the problems identified.
To learn more, visit the NJ DHSS Patient Safety web site. The Annual Reports contain data on errors and their underlying causes, and track statewide trends in the effort to improve patient safety. By way of example, from the 2009 survey the following issues continue to be problematic:
Falls (preventable) are the largest recurring category of issues in NJ Hospitals and Same Day Surgery Centers
Pressure Ulcers and “Care Management Other” continue to be the next largest subcategories
There has been an increase in the number of reportable device malfunctions, wrong patient/wrong site/wrong procedure events and suicide/attempted suicide in 2009.
The number of retained foreigh objects (RFOs) (things left inside of patients during surgery) remained roughly constant from 2008 to 2009, 27 to 25 RFOs.
If you or a loved one were injured at a New Jersey Hospital or Same Day Surgery Center contact the Lewis Law Firm for a free consultation and opinion. The Lewis Law Firm is committed to improving the quality of medical and hospital care for New Jersey residents.
Posted by: Gayle R. Lewis, Esquire
Prostate Cancer -Get the Facts
Sources: US Centers for Disease Control & Prevention (CDC), Cancer.org
Other than skin cancer, prostate cancer is the most common cancer Amercian men will face. 1 in 6 men will be diagnosed with prostate cancer. The American Cancer Society 2012 estimates for prostate cancer in the United States are:
- 241,740 new cases of prostate cancer will be diagnosed
- 28,170 men will die of prostate cancer
The average age at the time of diagnosis is about 67. Prostate cancer is the second leading cause of cancer death in men, behind only lung cancer. 1 in 36 men will die from prostate cancer. However a good percentage of men diagnosed with prostate cancer will survive:
- The relative 5-year survival rate is nearly 100%
- The relative 10-year survival rate is 98%
- The 15-year relative survival rate is 91%
A note on survival rates: The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is diagnosed. Some will live longer and some will only live 5 more years after a diagnosis. Keep in mind that 5-year survival rates are based on patients diagnosed and first treated more than 5 years ago, and 10-year survival rates are based on patients diagnosed more than 10 years ago. Modern methods of detection and treatment mean that many prostate cancers are now found earlier and can be treated more effectively. If you are diagnosed this year, your outlook may be better than the numbers reported above. These survival rates are based on previous outcomes of large numbers of men who had the disease, but they cannot predict what will happen in any particular man’s case.
Risk Factors
Not all men with these risk factors will develop prostate cancers, but more will than not.
- Age -More thatn 65% of prostate cancer diagnoses are made over age 65
- Race -African Amercian Males are 60% more likely to be diagnosed than Caucausians and have 2.5x more mortality. Asian men (living in Asia) have the lowest risk
- Genetics -Family history is important. Having a father or brother with prostate cancer increases the risk 2x
- Geography -Men who live North of Philadephia PA (40 degrees latitute) have the highest risk of death from prostate cancer. The theory is that inadequate sunlight for 3 months every year decreases vitamin D
- Smoking -While a risk factor for ALL cancers, smoking has been linked with more aggressive prostate cancer
- Diet -A lack of leafy green vegetables is associated with more aggressive prostate cancer
- BMI (Body Mass Index) -Obesity is linked with more aggressive prostate cancer
Signs of Prostate Cancer
These are just some of the symptoms associated with prostate cancer. Some men have no symptoms at all : Weak or interrupted flow of urine; Frequent urination (especially at night); Trouble urinating; Pain or burning during urination; Blood in the urine or semen; Pain in the back, hips, or pelvis; Painful ejaculation; Elevated PSA (prostate specific antigen).
Treatment of Prostate Cancer
Although treatment options vary depending upon the stage of prostate cancer, these are the most common current treatment options for men:
- Watchful waiting -That’s correct. The most common treatment is doing nothing but waiting until the cancer reveals itself on testing or scanning
- Radical prostatectomy -Surgery to remove the prostate, with newer robotic guidance it may be possible to remove the prostate without damaging nerves that are necessary for an erection
- External-beam radiation therapy -Directed to the prostate and any areas of potential spread
- Implant radiation therapy -With radioactive “seeds”
- High-intensity focused ultrasound -Designed to break up the tumor to facilitate removal
- Experimental treatment
If you or a loved one have been diagnosed with prostate cancer and you believe there was a delay in the diagnosis, contact the Lewis Law Firm for a free consultation and opinion. The Lewis Law Firm has a history of litigating cases of delayed diagnosis of prostate cancer.
Posted by: David M. Schwadron, Esquire
How Healthy is your County in New Jersey?
Sources: The US Centers for Disease Control & Prevention (CDC), the Dartmouth Health Atlas, the U.S. Census Bureau
The 2012 County Health Rankings report, the third annual, is out today and measures each of the 3,005 counties in the U.S. The report, which draws on data from the CDC, the Dartmouth Health Atlas, the U.S. Census Bureau and other sources, is user-friendly and free. The project, is a collaboration of the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. Their aim is to help local leaders and residents see not only where they rank on factors that determine health, but also specific ways to improve. So how healthy is your county?
The Lewis Law Firm is committed to doing our part to improve the quality of health and healthcare delivery in your county. If you or a loved one were injured by medical malpractice, please contact the Lewis Law Firm for a free consultation.
Posted by: Gayle R. Lewis, Esquire
A Cheap Plastic Ring May Prevent Premature Birth
Sources: The Lancet online, BBC Health
They aren’t entirely new, however, in one of the first radomised and controlled studies, women with a short cervix (identified by transvaginal ultrasound at 20-23 weeks) had a simple silicon pessary device inserted to determine if this might reduce the risk of preterm labor.
A Brief Background
Being born prematurely (before 34 weeks) during pregnancy is linked to a host of health problems, including: breathing problems; blindness or poor vision; infection; and, death. Over 13 million babies are born prematurely every year. One reason for premature births is a short cervix, defined as a length of 25 mm or less. Physiologically, a short cervix does not accomodate a growing baby to term.
The Study
The Pesario Cervical para Evitar Prematuridad (PECEP) trial followed 11,875 pregant women (aged 18-43) in five hospitals in Spain. The women were randomly assigned to have a cervical pessary placed or to continue their pregnancy without one. Unlike placebo studies, the control and study groups were known.
Results
Spontaneous delivery before 34 weeks of gestation was significantly less frequent in the pessary group than in the expectant management group. How significantly? In the group of women without the pessary, 27% of babies were born prematurely. In the group with the pessary. the rate of premature birth was 6%. No serious adverse effects with the use of a cervical pessary were reported.
Of course, the usual caveats apply, it is thought that only a small portion of women have a short cervix and “more studies are needed.”
If you or a loved one had a child born prematurely and you beleive that you were not provided with appropriate obstetrical care, contact the Lewis Law Firm for a free consultation. The Lewis Law Firm is committed to the health of women and children.
Posted by: Gayle R. Lewis, Esquire
Medicaid Cuts to Impact Nursing Home Care in NJ?
Source: The Record
This Summer, New Jersey officials voted to move to a reimbursement system that would allow homes that care for the patients with greater medical needs to be paid at a higher daily Medicaid reimbursement rate. However the negative impact upon revenues for homes which care for healthy patients prompted a slow adoption process. During the course of this wrangling, Governor Christie’s budget for the state called for some $75 million in Medicaid spending reductions. The Christie plan was for a 3% cut across homes but was applied disporportionally.
The result? One nursing home in Wyckoff, which three years ago opened a 68-bed, post-acute care unit to accommodate sicker patients, saw its daily per-Medicaid-patient reimbursement rate drop from $198 to $187, although the new rate system had previously promised to raise that figure to $225. The state notified nursing homes of the revised Medicaid rates in early October, more than three months into the current fiscal year, meaning some facilities would have to pay back a portion of reimbursements already received.
Since then, nursing home advocates have been lobbying the Christie administration and lawmakers for some relief from cuts they say could in time force them to cut staff or services. Advocates say county-operated nursing homes also could be among the most hurt by the rate changes as they tend to serve patients who are predominantly on Medicaid. State Sen. Loretta Weinberg, D-Teaneck, outgoing chairwoman of the Health, Human Services and Senior Citizens committee, said she is discussing potential solutions with other legislative leaders but doubts anything could be done in the current fiscal year to roll back cuts, as some nursing home operators are hoping.
“I think these cuts are harmful, and they are harmful to the most vulnerable of populations,” Weinberg said. “We need to hear from the people who are affected. We need their voices on this.”
”There is a lot of uncertainty,” said Larry Lane, vice president for government relations at Nursing Home Giant -Genesis Health Care, a national chain that operates 30 nursing homes and three assisted living centers in New Jersey alone, which together will lose between $6 and $7 million in Medicaid cuts. On the labor side, Service Employees International Union Local 1199, which represents 7,000 long-term care workers in New Jersey, is already concerned that some homes are not staffed adequately, nor trained well enough, to care for these sicker patients, said Milly Silva, executive vice president. “No one wants to see a tragedy where somebody ends up injured because of a lack of staff,” Silva said. No indeed.
Posted by: Gayle R. Lewis, Esquire