Medical care as well as Elegance every day therapeutic massage support

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Top rated Variables In which Produce Breast Cancer

Breast cancer is one of the subsequent almost all primary source of loss of life among women. Plastic surgeons believe a single girl is disapated with this disorder each thirteenth small on the globe. Currently, by making use of a great deal better screening process, enhanced consciousness along with brand-new therapies get presented, you possibly can command this kind of disorder along with fall the volume of death. Plastic Surgeons advice that becoming a girl, please note00 on the variables which might be the principle basic just for this challenging disorder. Given below are just some of danger variables providing climb for you to breast cancer:


Chest development or maybe enhancements:
Generally in most on the circumstances, many experts have identified in which chest treatments are among the major causes intended for cancers. As soon as the enhancements crack or maybe in the case of just about any complication, there are actually probability of breast cancer. You should make certain that merely FDA approved turfiste are generally injected from the treatments knowning that at the same time merely by way of a skilled and also qualified operating doctor.


Improving era
The most important chance component to the breast cancer could be the women maturing. Around 70 percent of the breast cancer diagnoses are produced throughout ladies are generally 60 or maybe elderly. Nevertheless this does not signify ladies are generally youthful to this particular era are definitely not afflicted by this kind of disorder. Ladies are generally youthful when compared with involving forty five bank account merely some. 8 pct involving breast cancer diagnoses.


Developing a genealogy and family history involving breast cancer
The other component that concerns the bigger possibility of creating breast cancer is caused by typically the essential contraindications, or maybe new mother, or maybe related or maybe little girl which may have visited while using disorder. Danger is usually enhanced when a girl possesses various close essential contraindications who have designed breast cancer with early age or maybe inside chests.


Currently being elderly with the birth and labor within your initial baby
Its typically discovered individuals ladies get their pleasurable initial baby with the beginning level or maybe the versions who have you are able to their baby receive closer to this kind of key disorder. Plastic surgeons believe individuals ladies rarely get married or maybe who have you are able to baby for the coffee lover, danger receives multiplied. In case the breastfeeding is usually effectively punctually, subsequently absolutely danger receives diminished.


Drinking alcohol
Drinking alcohol could function as a top chance component that is certainly linked to creating breast cancer. Drinking alcohol isn't only seen to produce typically the breast cancer quite considered typically the killer for your human body. Specifically the ladies, its encouraged not to ever take in mainly because it may well injury anyone plus your important limbs.


Currently being fat
Currently being fat present elevates a lot of the troubles along with outside of these people an example may be breast cancer. You've got being physically top fit and still have correct fat as outlined by your ex era. The ones who are generally fat but not continual on the frequent exercise, for the coffee lover, danger is usually larger to formulate this kind of disorder. Girls need to help it become some sort of practice for you to pick the standard routines which will help themselves to be healthy.

 Here by, Cervical Cancer for your enrichment of cancer

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Electronic Medical Records and Going For Broke: Jackson Health System's Financial Future Appears Grim

I have written on numerous occasions that health IT in its present form, often poorly designed and implemented under current IT leadership structures, is often a waste of precious healthcare resources. The resources might be better spent on essentials such as patient care for the poor or improved human staffing, until this experimental technology is perfected.

As at my site on health IT difficulties and mismanagement I observed:

Healthcare information technology (HIT) holds great promise towards improving healthcare quality, safety and costs. As we enter the second decade of the 21st century, however, this potential has been largely unrealized. A significant factor impeding HIT achievement has been mismanagement of the technology. Mismanagement of HIT is largely due to false assumptions and naïveté concerning the challenges presented by this still-experimental technology, and underestimations of the expertise essential to achieve the potential benefits of HIT. This results in mission-hostile HIT design, and HIT leaders and stakeholders operating outside (often far outside) the boundaries of their professional competencies. Until these issues are acknowledged and corrected, HIT efforts will waste precious healthcare resources, will not achieve claimed benefits for many years to come, and may actually cause harm. Numerous reports in the 2009 articles link corroborate this view, including those from the U.S. Joint Commission and National Research Council.

The following may bring my observations to life.

This from 2007:

RedOrbit.com/News
Jackson Memorial Hospital Uses State-of-the-Art Technology to Drive Improved Patient Outcomes for South Florida Families
Posted on: Thursday, 6 September 2007, 09:11 EDT
Jackson Memorial Hospital (JMH), part of Jackson Memorial Health System, South Florida's leading/largest healthcare provider, recently implemented 11 Cerner Millennium® solutions.

[Including EMR, nursing, pharmacy, radiology, HIM, Eligibility Management, Master Person Index, Registration Management, Scheduling Management, Emergency Department, etc. - ed.]
This marks the hospital's first step in a multi-stage healthcare information technology implementation. With Cerner Millennium® solutions, JMH clinicians now have access to real-time resources to better manage patient care with improved access to cross-department information, evidence-based clinical decision support and streamlined hospitals operations.
"Cerner is pleased to partner with Jackson Memorial Hospital, an institution continually ranked as one of the best hospitals in America," said Trace Devanny, Cerner -- president. "JMH's decision to implement a solution-oriented information technology system reinforces its vision to improve healthcare communitywide. Cerner worked together with JMH to implement multiple Cerner Millennium solutions specifically designed for various roles, venues and conditions that will ultimately improve the patient experience."

These implementations, a mere "first step" towards "streamlining operations," and their maintenance, modification, remediation, and staffing were undoubtedly multimillion-dollar expenses and are likely still ongoing. (See other examples of mass hospital IT expenditures here and here.)

Now, fast forward to 2010. This is stunning:

Jackson Health System's financial future appears grim
Miami Herald
BY JOHN DORSCHNER
Posted on Wednesday, 01.13.10

Looking forward and back, Jackson Health System's grim financial picture just keeps getting worse.

Members of the Public Health Trust, the system's governing board, are being told:

• Patient volume has dropped by 6.5 percent recently, meaning that with all the cost cutting and new revenue plans, Jackson is facing an $88 million loss this fiscal year, and this estimate is likely to get worse.

• The government system may have lost much more money last year than the $56 million it reported in unaudited statements. That loss could conceivably go as high as $150 million.

• Cash on hand to pay bills -- the measure of how the three-hospital system is doing at this moment -- continues to be awful. ``Perhaps a cash hemorrhage,'' PHT member Marcos Lapciuc called it.

The bad news came at PHT committee hearings late Tuesday afternoon. ``Very drastic measures need to happen'' to stem the growing losses, said Chief Executive Eneida Roldan. She said the losses were likely to increase, because considerable funding for poor patients comes from Tallahassee, and the Legislature is expected to cut back on healthcare funding programs as it deals with its own budget crisis.

``We're making very drastic decisions that no hospital wants to do,'' Roldan told the board, including ending contracts for 175 unfunded patients to receive dialysis at out-patient centers.

Ending contracts for unfunded patients to receive dialysis after spending tens of millions of dollars on IT to "streamline operations?" Could this be an example of "Blood for Computers?"

Board members were upset in particular about how the institution, with 12,000 employees and $1.9 billion in revenue, could be so uncertain about its financial performance last year.

The central issue appears to be the proper amount of accounts receivable -- money that the system expects to collect from insurers -- as contrasted with bad debts that are unlikely to be collected. As of Nov. 30, Jackson was listing its accounts receivable at $431.8 million.

``It just doesn't tie in,'' said board member Martin Zilber. ``We talk about $400 million or $500 million like it's buying lunch.''

Ernst & Young, Jackson's auditors, are expected to present the official audited returns within the next month. ``We know there's going to be a sizable adjustment,'' Chief Financial Officer Frank Barrett told the board. But he's uncertain how much.

Uncertain how much money will be "adjusted" in accounts receivable? Apparently all this computerization has not realized a ROI on basic financial management.

Could problems with the IT (e.g., mismanaged design, mission hostile user experience, bugs, etc.) and/or mismanagement of its implementation actually be responsible for the chaos, I ask?

... Perplexed board members heard several explanations. One is that the system has switched computer systems, and the old financial software may have been calculating bills as accounts receivable from years ago, when those items should be listed as uncollectable bad debts.

If that was the case (and I note the "may have", implying the organization is not even certain of this explanation), why was this discrepancy not noted before or during the transition? Who, exactly, was managing this project? This would be a stunning example of IT mismanagement making what happened at Yale some years ago look like a cakewalk, and on par with the mismanagement at another Miami hospital, Mt. Sinai, as I posted here.

... On Monday, the board was shown a presentation on bill collecting with a complex grid of flow charts and time lines. Still, some board members expressed concern about why Jackson's financial people didn't have a better handle on key measures of the system's condition.

A question arises regarding whether the massive IT implementations are causing data irregularities, confusion, or are not functioning properly in other ways affecting financial management.

``I don't totally understand the reasons,'' said [board member] Ernsto de la Fé.

... The fiscal 2009-2010 budget had calculated a loss of $6.5 million. Of that, $107 million was the baseline loss, reduced by $59.8 million in new revenue building ventures and $41.5 million in cost-cutting.

"Cost cutting" usually is synonymous with "layoffs." How many millions were spent on computing instead of jobs, I wonder?

Additional information on these financial difficulties are available at the Miami Herald:

• Jackson Health System faces more financial losses

Jackson Health System faces more financial losses

Looking forward and back, Jackson Health System's grim financial picture just keeps getting worse.
Members of the Public Health Trust, the system's governing board, are being told:
Patient volume has dropped by 6.5 percent recently, meaning that with all the cost cutting and new revenue plans, Jackson is facing an $88 million loss this fiscal year. This estimate is likely to get worse.

•Donna Shalala tries to mend fences with Jackson Health

Donna Shalala tries to mend fences with Jackson Health

While Jackson Health System's governing body struggled Tuesday to find more ways to cut costs and increase revenue, University of Miami President Donna Shalala made a rare appearance before the Public Health Trust to ``personally apologize for statements by members of the university leadership team last week.''
She was referring to UM Board of Trustees Chairman Phillip George's comments to Jackson leaders that he was disturbed about the quality of doctors that Jackson had been hiring in recent years. ``I wouldn't send my family to many of them,'' George said.
Shalala noted that the Jackson doctors, all fully credentialed, were often approved by UM department heads to practice at Jackson. ``If they are good enough for Jackson patients, let me tell you, they are good enough for me and my family.''

•Jackson Health System may close clinics, nursing homes

Jackson Health System may close clinics, nursing homes

Needing to present a balanced budget for Miami-Dade Commission's approval Thursday, the Jackson Health System is proposing to close two primary care centers, both of its nursing homes, outsource inmate healthcare and reduce support to other entities that care for the poor and uninsured.
``We are in an extremely unique position,'' Chief Executive Eneida Roldan said Wednesday. The public health system is having to cut services to meet an estimated budget deficit of $133 million for its next fiscal year at a time when the commission must also deal with filling a shortfall of more than $400 million in other county programs.
Some doctor services at Jackson Memorial may also be curtailed, Roldan said. ``Because Jackson has been forced to reduce its funding for the annual operating agreement with the University of Miami,'' she wrote in a message to employees, ``the university is also planning to reduce its services offered at our facilities.''

•Jackson Health System's cash pot falls to dangerous levels

Jackson Health System's cash pot falls to dangerous levels

Even after plans to reduce staff and close units, Jackson Health System is getting dangerously close to its bare minimum for cash-on-hand -- a key indication of financial health.
As of Oct. 31, Miami-Dade's public hospital system had 20.8 days of cash to pay its bills, including payroll and keeping the lights on. Its governing body, the Public Health Trust, has set 20 days as the lowest Jackson should go.
``When it gets below 20 days, that's when I declare an emergency,'' said Frank Barrett, chief financial officer. He said he is already talking to county administrators about getting an advance to fund payroll if the system runs out of cash.

•Jackson Health's finances continue to deteriorate

While IT is not a definite cause or contributor to these problems, I sense familiar patterns. Perhaps forensics related to hospital computing, the decisions to spend so many millions on the technology, and the actual impact of the implementations might shed additional light on the reasons for this apparent financial debacle.

Perhaps the hospital system would have better spent that money on buttressing its financial stability, and hiring smart people to have kept better track of its finances.

An analysis of these issues might likely provide a cautionary tale for hospital executives planning on massive new HIT expenditures to "streamline operations."

Addendum:

This is a good time to once again call attention to this paper by a perspicacious author from Down Under:

Pessimism, Computer Failure, and Information Systems Development in the Public Sector. (Public Administration Review 67;5:917-929, Sept/Oct. 2007, Shaun Goldfinch, University of Otago, New Zealand). Cautionary article on IT that should be read by every healthcare executive documenting the widespread nature of IT difficulties and failure, the lack of attention to the issues responsible, and recommending much more critical attitudes towards IT. link to pdf

Feb. 11, 2010 Addendum:

CFO at Miami health system resigns
MIAMI – Frank Barrett, chief financial officer and executive vice president at Miami's Jackson Health System, has resigned after five years in the position. The health system's board of directors criticized Barrett strongly last week after he reported miscalculated financial losses. Barrett had revealed to the board that Jackson Health lost $203.8 million in fiscal 2009, although he had originally reported a $46.8 million loss. The projected loss for fiscal 2010 rose $87 million to $229 million.

-- SS

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After Controversy Over Tobacco Money Funding Medical School, University President Steps Down

We have posted about the controversies arising from recently revealed research agreements between Richmond, Virginia based Virginia Commonwealth University (VCU) and tobacco company Philip Morris. These were first publicly discussed in May in a New York Times article. As we posted here, the main issues were that the research agreements themselves were secret; the agreements apparently gave Philip Morris control over all publications arising from the research, since they defined all products of the work as proprietary information belonging to Philip Morris; and that research for hire on behalf of a tobacco company, given that tobacco products have known severe health risks and no health benefits, seems to go against the mission of a medical school and academic medical center. We also noted that the university administration's apparent lack of qualms about its relationship with Philip Morris might have been related to its president's role as a leader of a tobacco company. (He sits on the board of Universal Corp, a tobacco buyer, processor, and distributor.) We later observed how little attention this subject has gotten in Richmond's major news outlet. Then, we noted that some university leaders were willing to open a public dialogue about the issue, thus exhibiting more transparency under criticism than has been shown by many other organizations. Most recently, we discussed how the Dean of the university's Medical School had allegedly actively sought grant support from Philip Morris for a center for research on women's health.

Today, the Richmond Times-Dispatch reported that VCU President Eugene Trani will step down next year. The article hailed Trani for his efforts to enlarge and expand the University. It also noted, however,

Trani was so intent on unifying the university in a shared mission that he forbid the mention of the Medical College of Virginia, renaming it the VCU Health System.

Furthermore, although the Times Dispatch has not published much about the controversy over the relationship between VCU and Philip Morris (see post here), it did acknowledge

But collaboration between VCU and Philip Morris also has stirred controversy because of the tobacco company's apparent level of control over research it sponsors through the university.

'The events of the summer are unfortunate,' [Professor of Political Science and Public Administration Blue] Wooldridge said, 'and would be a stain on [Trani's] legacy that didn't need to be there.'

A former president of the faculty senate, Wooldridge said he admires much of what Trani has done -- from building the engineering school to forging 15 alliances with universities in other countries -- especially while maintaining his own scholarship as a historian.

However, too often Trani hasn't considered the full costs to the university of his ambitions or listened to the informed opinions of others, Wooldridge said.

'I don't think the faculty has had their voices heard as much as they should.'

I hope that the impending retirement of President Trani will lead the VCU administration to rethink its apparent infatuation with cultivating tobacco as a source of funding for the medical school. The medical school's mission of promoting the health of individual patients, and the health of the public through teaching and research is ill served by financial arrangements with companies whose products only promote ill health.

Source : http://hcrenewal.blogspot.com/

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COMMERCIAL BIAS at STANFORD and CORCEPT

COMMERCIAL BIAS at STANFORD and CORCEPT

Stanford University has replaced Dr. Alan Schatzberg as Principal Investigator on his NIH grant that studies psychotic depression. This step followed persistent questions from Senator Grassley about conflicts of interest and financial disclosure. Dr. Schatzberg’s drug mifepristone has been in NIH-supported clinical trials at Stanford and in FDA-monitored trials sponsored by Corcept, the company Dr. Schatzberg founded.

The University emphasized “We want to put to rest confusion about the integrity of the research involving mifepristone.” Questions did arise following NIH-supported publications from Stanford in 2001 and 2002. Neither one found significant evidence of efficacy, yet both were repeatedly touted by Dr. Schatzberg and his associates as positive. The 2001 report had no significant findings even after attempts to cherry-pick the data. In the 2002 report the data were so weak that Dr. Schatzberg elected to present no statistical analyses of outcome at all. We now know from Corcept’s three negative FDA-monitored Phase III trials that the early challenges to mifepristone’s efficacy had merit (see Abstract #63). As Dr. Schatzberg should know, wishful thinking and hand waving are no substitute for quality data that are rigorously analyzed. Dr. Schatzberg is accountable for the unwarranted positive tone of those early publications. His later promotional claims reveal a commercial bias that has no place in academic medicine.

Scientists are required to present both the positive and the negative aspects of their research “fully and honestly.” Here is one example of this code (see item 2). Here is another (see item 15). The standard does not change when commerce is involved. The standard applies in review articles as much as in original reports. Did the Stanford-Corcept group meet this standard? That is the issue Stanford now confronts.

In a 2003 textbook that he coauthored (Manual of Clinical Psychopharmacology), Dr. Schatzberg made a clearly biased claim. He stated “Two recent studies of … (mifepristone) … by our group have demonstrated efficacy in the treatment of psychotic depression.” He was referring to the 2001 and 2002 Stanford-NIH publications. Dr. Schatzberg went on to state that “The effects were more pronounced on the psychosis than on the depression, but both were significantly improved within 7 days.”

The claim of “demonstrated efficacy” is categorically false. It may be fraudulent. Neither study achieved any accepted evidence of efficacy. The second claim also is categorically false. No quantitative data on significant improvement of psychotic symptoms or depression severity exist in the two studies for drug over placebo. Lack of efficacy is what the investigative journalist Paul Jacobs exposed so well, with the consultation of independent statisticians, in the San Jose Mercury News July 10, 2006.

These false claims in a well-known textbook promoted a positive climate of opinion for Dr. Schatzberg’s drug in the period leading up to Corcept’s planned IPO. Through the textbook, Dr. Schatzberg also promoted positive professional expectations in advance of the marketing of his drug. Moreover, in this American Psychiatric Press publication Dr. Schatzberg did not disclose his large financial interest.

The pattern of exaggerating positive trends in the data while suppressing mention of negative analyses has become a trademark of Stanford-Corcept publications. Dr. Schatzberg made similar unwarranted claims in a 2003 journal article. In 2006 Dr. Schatzberg did likewise in another APA Press publication (The American Psychiatric Publishing Textbook of Mood Disorders). Once again, Dr. Schatzberg used an APA Press textbook to talk up his drug’s prospects. Once again, Dr. Schatzberg did not disclose his own financial interest.

In 2006, Corcept’s CEO (Dr. Joseph Belanoff) and the former Chief Medical Officer (Dr. Charles DeBattista) published a review article on use of mifepristone in neuropsychiatric disorders. In violation of the journal publisher’s policy, the article was sourced only to Stanford University. These current and past Corcept officers did not disclose their financial interest or their relationship to the corporation. They highlighted the use of mifepristone in psychotic depression. Referring to the 2001 Stanford-NIH trial, they claimed “all five patients showed a substantial improvement in depression.” This claim is categorically false. The question of fraud arises again.

These examples illustrate what I have termed commercial promotion and branding through academic outlets. In all, 13 scientific journals, 4 textbooks, and other media have been tainted by these and similar misrepresentations. These biased claims in reference to the Stanford-NIH trials were also featured in press releases and press interviews while Corcept was raising private and public capital.

This pattern of bias raises questions of ethics, and of possible fraud. One could make the case that the misrepresentations described here do not fall under the safe harbor provisions of US securities law. It is one thing for entrepreneurs to speculate giddily about the potential of their product if the available scientific data are presented accurately (“fully and honestly”). In that circumstance, caveat investor applies. But it is an altogether different matter when entrepreneurs misrepresent the available scientific data by emphasizing positive trends while suppressing the inconvenient, negative aspects of the data. That is what Corcept did in discussing the 2002 Stanford-NIH trial in its SEC filing March 19, 2004 leading up to the IPO. That is also what Dr. Schatzberg and his associates did in the examples given above.

Dr. Schatzberg is slated to become president of the American Psychiatric Association in 2009. The APA would do well to reconsider his fitness for that office. We would have expected Dr. Schatzberg, who is also President of the American Psychiatric Press, the publishing arm of the APA, to understand that he and his corporate associates should discuss their scientific data “fully and honestly,” while being transparent about their competing financial interests. As for Stanford University, these academic biases and systemic conflicts of interest signal the need for a fresh look at the academic-corporate boundary.

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