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Digital Medicine: Health Care In The Internet Era
With more than $19 billion in new spending planned for health information technology, the Obama administration is taking serious steps toward modernizing the U.S. health care system. Implementing health IT can reduce both costs and errors, but it requires extensive information infrastructure upgrades. Few hospitals, clinics or private practices have the funds to pay for new technology. The new Brookings Institution Press book Digital Medicine: Health Care in the Internet Era investigates the factors affecting digital technology"s ability to remake health care.
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Evidence Challenges Effectiveness Of Embryo Screening For Older Women
There is growing evidence that a procedure for identifying chromosomal abnormalities in embryos prior to in vitro fertilization is ineffective at helping older women become pregnant, the Wall Street Journal reports. The procedure -- known as pre-implantation genetic screening, or PGS -- is performed in dozen of U.S. fertility clinics and sometimes marketed to older women as a way to increase the odds of a healthy live birth. PGS involves extracting a single cell from a six-cell embryo and inspecting it for chromosomal abnormalities known as aneuploidies; unaffected embryos can then be implanted through IVF. Women older than age 35 have a higher risk of aneuploidies, in which embryos have fewer or more than the usual number of 23 pairs of chromosomes. Aneuploidies can trigger early miscarriage or certain genetics conditions, such as Down syndrome. Most medical experts agree that embryo screening is capable of significantly reducing the risk of Down syndrome and other serious chromosome-related illnesses. However, evidence from several studies increasingly suggests that the procedure does not increase older women"s chances of healthy live births. The American Society for Reproductive Medicine released an initial opinion about PGS in 2007, saying that available evidence does not support the use of embryo screening to increase live birth rates in older women. Andrew La Barbera, scientific director of the society, said, "Since that time, there have been several more trials that have reached the same conclusion." Another shortcoming is that most clinics can only test for fewer than half of the 23 chromosomes, meaning that many defects can go undetected. However, medical experts say that the use of PGS has increased in the two years since ASRM issued its recommendations. According to the Journal, PGS can add more than $2,000 to the roughly $10,000 cost of one IVF cycle. Very few health insurers cover PGS, though some pay for IVF. Some experts contend that studies showing a lack of clinical benefit from PGS do not use more efficient biopsy techniques that can prevent damage to the embryo. Santiago Munne, scientific director for Reprogenetics, said that the treatment is "effective." In a 2007 study, Munne and colleagues used PGS to reduce the rate at which patients miscarried. However, the chances of a woman getting pregnant largely were unchanged, which the authors said could be attributed to the small number of study participants (Naik, Wall Street Journal, 6/1).
News of the day
Two Drug-Related Legislative Plans Pose Problems For Stakeholders
"The Senate dealt a blow to the drug lobby Thursday by voting to permit people in the United States to order lower-cost drugs from Canada over the Internet," the Associated Press/Arizona Republic reports. The drugs in question are often made in the U.S., and then sold abroad for lower prices than at home because because of government policies in many other countries. The bill would make it legal to re-import those drugs more readily. The drug provision passed as an amendment to a Department of Homeland Security funding bill and was introduced by Republican Louisianna Sen. David Vitter (Taylor, 7/9).
Medical Devices

Geriatrician Available To Discuss New Research On Falls In Older Adults

Each year in this country, one of every three people over age 65 suffers a fall, resulting in nearly 16,000 deaths. The federal government estimates that 1.8 million older adults who fall are treated each year in hospital emergency rooms for nonfatal injuries - including bruises, fractures and head trauma - and that 433,000 of those individuals need to be hospitalized because of their injuries. Research published this month in the Journal of the American Geriatrics Society has found that a significant number of those falls - an average of 129 per day - involve the use of walkers and canes, the very devices on which millions rely to help them avoid the dangers posed by falling. "Falls are a particularly serious health hazard for the elderly," said Dr. Anita Chopra, a geriatrician and the director of the New Jersey Institute for Successful Aging at the UMDNJ-School of Osteopathic Medicine. "When an older person falls, there is a 20 to 30 percent chance of an injury that could result in an extended period of convalescence or limit that person"s ability to live independently." Noting that the study found that more than half (56 percent) of the falls that caused injury occurred in the home, Chopra said that having an assistive device like a cane or walker isn"t enough to ensure safety from falling. "There are many falling hazards in the home," she said. "Clothing that is too long, shoes or slippers that don"t provide good support, clutter, loose rugs or poorly lit rooms can all contribute to falls." According to Chopra, falling is not an inevitable part of aging. "As we grow older, the likelihood of a fall increases, as does the chance that the fall will cause some sort of injury," she said. "Taking proactive steps - including exercise to improve balance and strength, being aware that some medications can affect balance, getting regular vision checks and getting prompt medical attention for any pain or difficulties with your ears - will help to keep falls out of your life as you age." The UMDNJ-School of Osteopathic Medicine is dedicated to providing excellence in medical education, research and health care for New Jersey and the nation. Working in cooperation with Kennedy Memorial Hospitals-University Medical Center, its principal affiliate, the UMDNJ-School of Osteopathic Medicine places an emphasis on primary health care and community health services that reflect its osteopathic philosophy, with centers of excellence that demonstrate its commitment to developing clinically skillful, compassionate and culturally competent physicians from diverse backgrounds, who are prepared to become leaders in their communities. The University of Medicine and Dentistry of New Jersey


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