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Protesters Disrupt Democrats' Best-Laid Plans For Health Reform 'Conversations'
Over the weekend, a series of protests at Democratic events meant to promote health reform "organized by loose-knit coalition of conservative voters and advocacy groups, were a raucous start to what is expected to be weeks of political and ideological clashes over the health care overhaul," the New York Times reports. "Republicans said that the protests were just the beginning of spontaneous opposition to the health care proposals and that they would only gain momentum as Americans learn more about the legislation." But Democrats said they were only an effort to block discourse, and were anything but a grass-roots campaign. "This is a very coordinated effort," said one Democratic Congressman who was confronted by protestors at a grocery store (Herszenhorn and Stolberg, 8/3).
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Misdiagnosis Of Disorders Of Consciousness Still Commonplace
A sixteen-month study of consensus-based diagnosis of patients with disorders of consciousness has shown that 41% of cases of minimally conscious state (MCS) were misdiagnosed as vegetative state (VS), a condition associated with a much lower chance of recovery. Researchers writing in the open access journal BMC Neurology have demonstrated that standardized neurobehavioral assessment is more sensitive than diagnoses determined by clinical consensus.
News of the day
New Jersey Senator Proposes Plan To Avert HIV/AIDS Drug Copayments
New Jersey state Sen. Joseph Vitale (D) -- chair of the Senate Health, Human Services and Senior Citizens Committee -- earlier this week proposed a plan to temporarily reduce rebate checks to senior citizens earning $100,000 to $150,000 in an effort to alleviate the effects of possible budget cuts on certain populations, the Newark Star-Ledger reports. Vitale"s proposal also would avert planned $6 to $15 prescription drug copayments for people living with HIV/AIDS in the state (Livio, Newark Star-Ledger, 5/12). The copayments are part of Gov. Jon Corzine"s (D) $29.8 billion spending proposal for the state"s new fiscal year and would collect $1.36 million by creating copayments for HIV/AIDS drugs based on a sliding scale determined by income. The copayments would affect 9,000 people living with HIV/AIDS who have obtained no-cost medicine from the state because they do not qualify for other assistance programs. Advocates said that the copayments will hurt patients who are already struggling because of the poor economy (Kaiser Daily HIV/AIDS Report, 4/23). According to the Star-Ledger, Vitale"s proposal would save the state $15.7 million, including $9.7 million needed to allow 17,000 low-income families to enroll in the state"s health insurance program, FamilyCare. Senate Budget Committee Chair Barbara Buono (D) said that she does not believe it is possible to restore program cuts "given the collapse of revenues." According to the Office of Legislative Services, the current deficit for this year"s budget, which ends June 30, is at least $1.2 billon. Vitale said, "Our convictions are going to be tested as we come to terms with the fact that we simply don"t have enough money to fund all of the state"s priorities." He added, "But unless funding is restored for programs like NJ FamilyCare, Medicaid drug benefits and the AIDS Drug Distribution Program, I will be voting against the" fiscal year 2010 budget (Newark Star-Ledger, 5/12).
Diagnostics

Evaluating More Lymph Nodes May Not Improve Identification Of Late-Stage Colorectal Cancer

Surgically removing and evaluating an increasing number of lymph nodes does not appear to identify a greater number of patients with stage III colorectal cancer, according to a report in the July issue of Archives of Surgery, one of the JAMA/Archives journals. Colorectal cancer is the third most common type of cancer and the third leading cause of cancer-related death in the United States, according to background information in the article. More than 80 percent of newly diagnosed colorectal cancer patients will have locoregional disease (limited to a small region) and will be offered surgery that may cure their illness. The status of lymph nodes near the cancer has been recognized as the most powerful prognostic factor for recurrence and survival in these patients. "Accurate lymph node staging also is important for determining prognosis and the need for adjuvant chemotherapy," the authors write. "In addition, lymphadenectomy [lymph node removal] may be therapeutic; several studies have shown a positive association between the number of lymph nodes removed and survival for patients with negative and positive lymph nodes." In 1990, the World Congress of Gastroenterology first proposed a minimum threshold of 12 lymph nodes to be removed during surgery for colorectal cancer. This benchmark has since been adopted as a quality measure for surgical practice by multiple organizations. Sachin S. Kukreja, M.D., and colleagues at Rush North Shore Medical Center (now Skokie Hospital, NorthShore University HealthSystem), Skokie, Ill., and Rush University Medical Center and Rush Medical College, Chicago, in late 2004 began a multidisciplinary institutional initiative to increase the number of lymph nodes removed during colorectal cancer surgery. The effort involved discussing unacceptably low lymph node counts and reviewing the rationale for increased lymph node evaluation at multidisciplinary cancer committee meetings, along with a program of institutional awareness of the issue and a change in pathologists" lymph node assessment technique. The researchers then evaluated 701 consecutive colorectal cancer cases treated with surgery from 1996 through 2007. The initiative appeared successful in increasing the numbers of lymph nodes removed-when patients operated on in January 2005 or after were compared with those who had surgery before the initiative began, both the average number of lymph nodes removed (17.3 vs. 12.8) and the percentage of patients who had at least 12 lymph nodes removed (71.6 percent vs. 53 percent) increased. However, the proportion of patients diagnosed with stage III colorectal cancer did not change, with 204 of 553 (36.9 percent) of the earlier cases and 48 of 148 (32.4 percent) of the late cases having positive lymph nodes. "Overall, our improvement in lymph node yield demonstrates the value and impact of communication through a multidisciplinary initiative engaged in adherence to recommended standards and improving quality of care," the authors conclude. However, "our data suggest that mandatory harvest of a minimum of 12 lymph nodes as a quality indicator or performance measure appears unfounded." Arch Surg. 2009;144[7]:612-617. Archives of Surgery


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