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Friday, May 29, 2009
Walk Test Can Predict Course of Heart Failure for Black Patients
interesting read...
The six-minute walk test, a simple, inexpensive diagnostic test, can reliably predict risk of death or re-hospitalization in African-American patients with heart failure, according to a study by a cardiologist now at the University of Illinois at Chicago College of Medicine. "The six-minute walk test is basically just what it sounds like," said Dr. Thomas Stamos, assistant professor of cardiology at UIC and principal investigator of the study.
In the study, which was conducted at was conducted at the John H. Stroger, Jr. Hospital of Cook County, 200 African-American patients, 125 men and 75 women, who were admitted to the hospital with decompensated heart failure (patients whose heart failure has caused their lungs to fill with fluid and who may have fluid in their legs) were asked to walk for six minutes, usually just up and down a hospital corridor. The distance that they are able to walk was then measured. The six-minute walk test has been successful in previous studies in predicting the course of heart failure. But the usual cause of heart failure in African-Americans patients is hypertension rather than the cardiovascular disease seen in the white patient population, says Stamos, and African-Americans often respond differently to medications used to treat heart failure. "There was a possibility that African Americans would have a different response to the six-minute walk test," said Stamos. "It was important to prove that this test could reliably predict outcomes in this patient population."
The researchers found "a clear difference" between patients who could walk at least 200 meters in six minutes and those who couldn't, Stamos said. Patients who walked 200 or more meters -- about twice the length of a football field -- had substantially lower risk of either returning to the hospital or dying during the course of the study. "We hope this study can help us decide which patients we should concentrate our efforts on," said Stamos. "If we know that a patient is at very high risk, we may be more aggressive with their medical therapy, we may have them follow-up in the clinic more frequently and keep a closer eye on them in order to prevent these negative outcomes." The patients were followed for 40 months to see how frequently they were forced to return to the hospital with heart failure as well as what percentage died during the course of the study.
The researchers found that 40 percent of patients who were only able to walk less than 200 meters died in the 40 months following their original hospitalization versus only 19 percent of the patients who were able to walk more than 200 meters. Patients were also re-hospitalized more often if they were unable to walk more than 200 meters. About 70 percent of the patients who were unable to walk more than 200 meters were re-hospitalized during that 40 month time period versus 52 percent of the patients who were able to walk farther. "With this very simple test, we were have a very powerful tool for predicting both who is at highest risk of dying in this period of time, as well as who would be re-hospitalized with heart failure, giving us a chance to plan appropriate treatment," Stamos said. Other contributors on the study are Dr. M. Tarek Alahdab of UIC, Dr. Ibrahim N. Mansour of Stroger Hospital, and Dr. Sirskarn Napan of the Southern Illinois University School of Medicine at Springfield.
The study was published in the March issue of the Journal of Cardiac Failure.
http://tigger.uic.edu/htbin/cgiwrap/bin/newsbureau/cgi-bin/index.cgi?from=Releases&to=PrintRelease&id=2475&fromhome=1
The six-minute walk test, a simple, inexpensive diagnostic test, can reliably predict risk of death or re-hospitalization in African-American patients with heart failure, according to a study by a cardiologist now at the University of Illinois at Chicago College of Medicine. "The six-minute walk test is basically just what it sounds like," said Dr. Thomas Stamos, assistant professor of cardiology at UIC and principal investigator of the study.
In the study, which was conducted at was conducted at the John H. Stroger, Jr. Hospital of Cook County, 200 African-American patients, 125 men and 75 women, who were admitted to the hospital with decompensated heart failure (patients whose heart failure has caused their lungs to fill with fluid and who may have fluid in their legs) were asked to walk for six minutes, usually just up and down a hospital corridor. The distance that they are able to walk was then measured. The six-minute walk test has been successful in previous studies in predicting the course of heart failure. But the usual cause of heart failure in African-Americans patients is hypertension rather than the cardiovascular disease seen in the white patient population, says Stamos, and African-Americans often respond differently to medications used to treat heart failure. "There was a possibility that African Americans would have a different response to the six-minute walk test," said Stamos. "It was important to prove that this test could reliably predict outcomes in this patient population."
The researchers found "a clear difference" between patients who could walk at least 200 meters in six minutes and those who couldn't, Stamos said. Patients who walked 200 or more meters -- about twice the length of a football field -- had substantially lower risk of either returning to the hospital or dying during the course of the study. "We hope this study can help us decide which patients we should concentrate our efforts on," said Stamos. "If we know that a patient is at very high risk, we may be more aggressive with their medical therapy, we may have them follow-up in the clinic more frequently and keep a closer eye on them in order to prevent these negative outcomes." The patients were followed for 40 months to see how frequently they were forced to return to the hospital with heart failure as well as what percentage died during the course of the study.
The researchers found that 40 percent of patients who were only able to walk less than 200 meters died in the 40 months following their original hospitalization versus only 19 percent of the patients who were able to walk more than 200 meters. Patients were also re-hospitalized more often if they were unable to walk more than 200 meters. About 70 percent of the patients who were unable to walk more than 200 meters were re-hospitalized during that 40 month time period versus 52 percent of the patients who were able to walk farther. "With this very simple test, we were have a very powerful tool for predicting both who is at highest risk of dying in this period of time, as well as who would be re-hospitalized with heart failure, giving us a chance to plan appropriate treatment," Stamos said. Other contributors on the study are Dr. M. Tarek Alahdab of UIC, Dr. Ibrahim N. Mansour of Stroger Hospital, and Dr. Sirskarn Napan of the Southern Illinois University School of Medicine at Springfield.
The study was published in the March issue of the Journal of Cardiac Failure.
http://tigger.uic.edu/htbin/cgiwrap/bin/newsbureau/cgi-bin/index.cgi?from=Releases&to=PrintRelease&id=2475&fromhome=1
Wednesday, May 27, 2009
Sounds real 'cute' on paper...
But how will it play out? That's the question...Will we be used as guinea pigs and continue to be pathologized and receive subpar care?
We Can Make the South Side a Model for Health-Care Reform
Eric Whitaker, MD, MPH, vice president for strategic affiliations and associate dean for community-based research, wrote the following op-ed for the April 23, 2009 edition of the Chicago Tribune.
I was born in a legendary Chicago hospital that has nearly disappeared.
Michael Reese Hospital was once a showcase of the South Side, a first-class research center that served as a beacon for people from many walks of life. Scientists there helped develop electrocardiography, found new links between cholesterol and heart disease, and did groundbreaking work on insulin. When my mother studied to be a nurse, Reese and Cook County Hospital were the only teaching hospitals in town that welcomed black trainees.
Once I dreamed of practicing medicine at Reese. Now the hospital is bankrupt and will close soon. The last time I drove past, all the lights were out.
Reese's fate gives a sense of the vast health-care challenges in underserved areas like the South Side. Tight financial resources here can make it difficult to sustain advanced-care centers such as Reese and the University of Chicago Medical Center, where I work.
Yet my home community desperately needs the best care available. We contend with widespread poverty and some of the nation's highest rates of chronic disease -- diabetes, hypertension, asthma.
We don't have to accept a future of declining community health and struggling hospitals. If we take the right steps now, the South Side could become a national model for how to build an innovative and sustainable health network. We'll need to put aside institutional turf and accept that no single medical center can meet all of our patients' needs.
The best strategy would combine the strengths of many South Side centers and treat them as one "virtual hospital," which patients can access in different locations depending on their medical needs.
Such an approach makes economic as well as medical sense. It would sustain the area's network of community hospitals and clinics, and connect low-income patients with the primary care they need to prevent serious complications of chronic conditions. My hospital has worked on this through the Urban Health Initiative, which strives to match patients with local clinics and physicians.
But we will not reach any of our goals without restoring trust within the community. Our patients don't always trust that if we refer them to a different institution, they will still get care of the highest quality. And hospitals often distrust each other, fearful that the patients they refer elsewhere will never come back.
The hospital where I work has not always been a good partner for this kind of collaboration. The U. of C. has been seen as detached from its medical neighbors and at times arrogant and overly competitive.
I think we can change those views and build a true partnership on the South Side. More faculty and residents from my hospital are fanning out to smaller centers where they are sharing knowledge and helping new groups of patients. Many of our patients who voluntarily transfer to those centers report greater satisfaction than they had at our hospital. That's humbling, and a sign that we can learn a lot from our neighbors.
Together we can learn more about our patients' unique health problems. The health disparities that exist between rich and poor are a huge problem for Chicago, yet we still don't know enough about why they persist. For example, why are diabetic adults on the South Side nearly three times more likely to be hospitalized than diabetes patients in the rest of the state? We suspect that diet, genetics and a lack of preventive care all play a role, but we don't know the specifics -- or how to correct the problem.
That's why a coalition of groups from around the city will soon embark on the South Side Health and Vitality Study, an ambitious effort to understand and begin remedying these glaring gaps in health outcomes. We want to create a resource that patients and researchers will draw on for decades, much as the Framingham Heart Study in Massachusetts has shaped ideas about cardiovascular disease.
No single hospital will solve the South Side's health disparities by working within its own four walls. And no center here can thrive without strong affiliations -- that's one lesson of Reese's demise. But if we learn to trust one another and work together, we can help our patients and prevent more hospital lights from flickering out.
We Can Make the South Side a Model for Health-Care Reform
Eric Whitaker, MD, MPH, vice president for strategic affiliations and associate dean for community-based research, wrote the following op-ed for the April 23, 2009 edition of the Chicago Tribune.
I was born in a legendary Chicago hospital that has nearly disappeared.
Michael Reese Hospital was once a showcase of the South Side, a first-class research center that served as a beacon for people from many walks of life. Scientists there helped develop electrocardiography, found new links between cholesterol and heart disease, and did groundbreaking work on insulin. When my mother studied to be a nurse, Reese and Cook County Hospital were the only teaching hospitals in town that welcomed black trainees.
Once I dreamed of practicing medicine at Reese. Now the hospital is bankrupt and will close soon. The last time I drove past, all the lights were out.
Reese's fate gives a sense of the vast health-care challenges in underserved areas like the South Side. Tight financial resources here can make it difficult to sustain advanced-care centers such as Reese and the University of Chicago Medical Center, where I work.
Yet my home community desperately needs the best care available. We contend with widespread poverty and some of the nation's highest rates of chronic disease -- diabetes, hypertension, asthma.
We don't have to accept a future of declining community health and struggling hospitals. If we take the right steps now, the South Side could become a national model for how to build an innovative and sustainable health network. We'll need to put aside institutional turf and accept that no single medical center can meet all of our patients' needs.
The best strategy would combine the strengths of many South Side centers and treat them as one "virtual hospital," which patients can access in different locations depending on their medical needs.
Such an approach makes economic as well as medical sense. It would sustain the area's network of community hospitals and clinics, and connect low-income patients with the primary care they need to prevent serious complications of chronic conditions. My hospital has worked on this through the Urban Health Initiative, which strives to match patients with local clinics and physicians.
But we will not reach any of our goals without restoring trust within the community. Our patients don't always trust that if we refer them to a different institution, they will still get care of the highest quality. And hospitals often distrust each other, fearful that the patients they refer elsewhere will never come back.
The hospital where I work has not always been a good partner for this kind of collaboration. The U. of C. has been seen as detached from its medical neighbors and at times arrogant and overly competitive.
I think we can change those views and build a true partnership on the South Side. More faculty and residents from my hospital are fanning out to smaller centers where they are sharing knowledge and helping new groups of patients. Many of our patients who voluntarily transfer to those centers report greater satisfaction than they had at our hospital. That's humbling, and a sign that we can learn a lot from our neighbors.
Together we can learn more about our patients' unique health problems. The health disparities that exist between rich and poor are a huge problem for Chicago, yet we still don't know enough about why they persist. For example, why are diabetic adults on the South Side nearly three times more likely to be hospitalized than diabetes patients in the rest of the state? We suspect that diet, genetics and a lack of preventive care all play a role, but we don't know the specifics -- or how to correct the problem.
That's why a coalition of groups from around the city will soon embark on the South Side Health and Vitality Study, an ambitious effort to understand and begin remedying these glaring gaps in health outcomes. We want to create a resource that patients and researchers will draw on for decades, much as the Framingham Heart Study in Massachusetts has shaped ideas about cardiovascular disease.
No single hospital will solve the South Side's health disparities by working within its own four walls. And no center here can thrive without strong affiliations -- that's one lesson of Reese's demise. But if we learn to trust one another and work together, we can help our patients and prevent more hospital lights from flickering out.
"University of Chicago shutting Community clinic"
Event: Save University of Chicago Womens Health Center at 47th and Woodlawn
RallyHost: Southside Together Organizing for Power (STOP)
Date/Time: Friday, May 29 at 10:30am
Outraged community to march on U of C to save women's clinic
Patients, community, workers, students launch
Patients, community, workers, students launch
campaign against patient dumping
Following the recent announcement that the University of Chicago intends to close the 47th st. Women's Health Center, outraged patients, community members, workers and U of C students are announcing a campaign to fight the plan starting Friday May 29th with a press conference at the clinc (near Woodlawn and 47th st.) at 10:30am after which they will march to the U of C administration building for a 12pm rally.
"The University of Chicago has treated our community like a guinea pig since its inception. Now that they are at the Forefront of Medicine, they want to treat us like we are toxic waste. We as patients need this clinic and other local clinics cannot handle the dumping the University is planning,” says Deborah Tayler, a patient at the clinic and spokeswoman for Southside Together Organizing for Power (STOP).
The action is being called by an ad hoc coalition of groups that sees the clinic closures as part of the University's broader effort to push poor people - especially people of color - out of the Medical Center and out of the community. The Coalition for Healthcare Access Responsibility and Transparency (CHART) is composed of Southside Together Organizing for Power (STOP), the Illinois Single Payer Coalition, U of C Students for a Democratic Society, Students Organized and United with Labor and the Southside Solidarity Network as well as several members of Teamsters Local 743. CHART is following up the protest with a forum moderated by Cliff Kelly called “Whose Hospital: A Community Forum on the U of C Medical Center” on Wednesday June 3rd at 6:30pm on the U of C campus in the Harper Building at 1116 E. 59th st room 140.
May 29 Actions to Save Clinic
10:30am- Press Conference at clinic 1301 E. 47th St.
11:15am- March from clinic to campus
12noon- Rally at U of C Admin Building – 5801 S. Ellis
"The University of Chicago has treated our community like a guinea pig since its inception. Now that they are at the Forefront of Medicine, they want to treat us like we are toxic waste. We as patients need this clinic and other local clinics cannot handle the dumping the University is planning,” says Deborah Tayler, a patient at the clinic and spokeswoman for Southside Together Organizing for Power (STOP).
The action is being called by an ad hoc coalition of groups that sees the clinic closures as part of the University's broader effort to push poor people - especially people of color - out of the Medical Center and out of the community. The Coalition for Healthcare Access Responsibility and Transparency (CHART) is composed of Southside Together Organizing for Power (STOP), the Illinois Single Payer Coalition, U of C Students for a Democratic Society, Students Organized and United with Labor and the Southside Solidarity Network as well as several members of Teamsters Local 743. CHART is following up the protest with a forum moderated by Cliff Kelly called “Whose Hospital: A Community Forum on the U of C Medical Center” on Wednesday June 3rd at 6:30pm on the U of C campus in the Harper Building at 1116 E. 59th st room 140.
May 29 Actions to Save Clinic
10:30am- Press Conference at clinic 1301 E. 47th St.
11:15am- March from clinic to campus
12noon- Rally at U of C Admin Building – 5801 S. Ellis
Chicago Tribune Article about the closing...
Go meet your Congress(wo)man
House Ways and Means Chairman Charles Rangel, D-Harlem, spoke at a community forum in Manhattan this morning, organized by the National Coalition on Health Care.
RWV co-founder Lois Uttley, a Rangel constituent, was there and filed this report:
Fate of public plan in Senate's hands
The House of Representatives will include a public plan option in its health reform bill, but the fate of a public plan ultimately will be decided in the Senate, Rep. Charles Rangel said today. That plan "would be subsidized based on one's ability to pay," he said. Rangel said his fellow New York Democrat, Senator Charles Schumer, is trying to come up with a public plan proposal that will attract bipartisan support, because Republican votes would be needed to approve a plan with 60 votes. Schumer is proposing a public plan "that does not knock out private plans," Rangel said. "We don't know where that is going." He expressed hope the Senate "will have some sort of public plan that we can build on" when House and Senate conferees get together to negotiate one health reform bill later this year. One questioner told Rangel that "many of us hope that eventually it (a public plan) will beat out private insurers." Rangel, laughing, cautioned: "Don't say that!""Well," the questioner continued, "how do we make sure the public plan doesn't get beaten down?" Rangel replied: "I think you need both of them (private and public insurance plans). If the private sector believes they are being pushed out of business, then they need to look at cutting their profits." Rangel was critical of Republicans for opposing a public plan, calling that stance "unacceptable." The GOP in House, he said, is showing "no leadership." He admonished them: "They can't walk away from health reform."
Why not single payer?
The Director of Physicians for a National Health Program's NY Metro Chapter asked Rangel why single-payer advocates are not being included in the health reform debate in Congress. Rangel replied: "Because we want to get a bill passed. We would be asked, Do we want a government takeover of our health system? I would say yes. A lot or people would say no. Then we would have a debate, but not a bill."
How will benefits be determined?
RWV's Uttley asked Rangel how benefits packages will be determined under national health reform, noting that many groups are concerned about whether breast cancer treatment, care for chronic conditions, comprehensive reproductive health care and other services will be included. We have all been told these decisions will be determined by an independent commission later on, she said. Rangel said simply that "benefits will be determined by medical standards of care."
Get out there and meet your members of Congress!
"I've been in the Congress for close to 40 years, and this is the most revolutionary time I've every read about, let alone participated in," Rangel said. "Finally, we have a President with vision." But, he said, members of the public cannot be silent about health reform. "
You have to know the name of your Congressman and let them know we need health reform."
RWV co-founder Lois Uttley, a Rangel constituent, was there and filed this report:
Fate of public plan in Senate's hands
The House of Representatives will include a public plan option in its health reform bill, but the fate of a public plan ultimately will be decided in the Senate, Rep. Charles Rangel said today. That plan "would be subsidized based on one's ability to pay," he said. Rangel said his fellow New York Democrat, Senator Charles Schumer, is trying to come up with a public plan proposal that will attract bipartisan support, because Republican votes would be needed to approve a plan with 60 votes. Schumer is proposing a public plan "that does not knock out private plans," Rangel said. "We don't know where that is going." He expressed hope the Senate "will have some sort of public plan that we can build on" when House and Senate conferees get together to negotiate one health reform bill later this year. One questioner told Rangel that "many of us hope that eventually it (a public plan) will beat out private insurers." Rangel, laughing, cautioned: "Don't say that!""Well," the questioner continued, "how do we make sure the public plan doesn't get beaten down?" Rangel replied: "I think you need both of them (private and public insurance plans). If the private sector believes they are being pushed out of business, then they need to look at cutting their profits." Rangel was critical of Republicans for opposing a public plan, calling that stance "unacceptable." The GOP in House, he said, is showing "no leadership." He admonished them: "They can't walk away from health reform."
Why not single payer?
The Director of Physicians for a National Health Program's NY Metro Chapter asked Rangel why single-payer advocates are not being included in the health reform debate in Congress. Rangel replied: "Because we want to get a bill passed. We would be asked, Do we want a government takeover of our health system? I would say yes. A lot or people would say no. Then we would have a debate, but not a bill."
How will benefits be determined?
RWV's Uttley asked Rangel how benefits packages will be determined under national health reform, noting that many groups are concerned about whether breast cancer treatment, care for chronic conditions, comprehensive reproductive health care and other services will be included. We have all been told these decisions will be determined by an independent commission later on, she said. Rangel said simply that "benefits will be determined by medical standards of care."
Get out there and meet your members of Congress!
"I've been in the Congress for close to 40 years, and this is the most revolutionary time I've every read about, let alone participated in," Rangel said. "Finally, we have a President with vision." But, he said, members of the public cannot be silent about health reform. "
You have to know the name of your Congressman and let them know we need health reform."
Friday, May 15, 2009
Comprehensive Sex Health Education...
The Reproductive Health and Access Act (HB 2354) would require all Illinois public schools to teach medically-accurate, age-appropriate, comprehensive sexual health education. Parents would be allowed to remove their child from the class if they do not want them to participate.In addition, the bill also prohibits government interference with an individual's decision to use birth control, continue with a pregnancy, or terminate a pregnancy and ensures that government-funded health care programs, such as Medicaid, cover basic reproductive health services, including family planning, pre-natal care, and pap smears.
Currently, Illinois schools are not obliged to teach comprehensive sexual health education, or any sex education at all. If sex education is taught, the Illinois School Code does not require course materials and instruction to include information about contraception.Individuals have the right to education that promotes lifelong responsibility. We know that informed youth make healthy decisions. Students must be taught medically-accurate, age-appropriate, science-based sexual health education that is inclusive of all individuals.
The Reproductive Health and Access Act currently has 37 co-sponsors. On March 11, the bill passed out of the Illinois House Human Services Committee. On April 2, the entire House of Representatives is expected to vote on the bill.We need you to take action! Please contact your state representative by email, letter, phone, or fax and tell her or him to vote in favor of the Reproductive Health and Access Act (HB 2354)!
For more information, visit the Illinois Campaign for Reproductive Health and Access website http://www.illinoisreproductivehealth.org/.
Currently, Illinois schools are not obliged to teach comprehensive sexual health education, or any sex education at all. If sex education is taught, the Illinois School Code does not require course materials and instruction to include information about contraception.Individuals have the right to education that promotes lifelong responsibility. We know that informed youth make healthy decisions. Students must be taught medically-accurate, age-appropriate, science-based sexual health education that is inclusive of all individuals.
The Reproductive Health and Access Act currently has 37 co-sponsors. On March 11, the bill passed out of the Illinois House Human Services Committee. On April 2, the entire House of Representatives is expected to vote on the bill.We need you to take action! Please contact your state representative by email, letter, phone, or fax and tell her or him to vote in favor of the Reproductive Health and Access Act (HB 2354)!
For more information, visit the Illinois Campaign for Reproductive Health and Access website http://www.illinoisreproductivehealth.org/.
Home Birth Safety Act...
HB0226
Synopsis As IntroducedCreates the Home Birth Safety Act. Provides for the licensure of midwives by the Department of Financial and Professional Regulation. Creates the Illinois Midwifery Board. Sets forth provisions concerning qualifications, grounds for disciplinary action, and administrative procedures. Imposes conditions on any rulemaking authority. Amends the Regulatory Sunset Act to set a repeal date for the new Act of January 1, 2020. Amends the Medical Practice Act of 1987 and the Nurse Practice Act to make related changes.House Committee Amendment No. 1Provides that a licensed midwife is prohibited from performing an abortion.
Why license certified professional midwives?
The vast majority of Illinois has no licensed home birth care at all. In the three counties with some licensed home birth providers, there are still not enough. This leaves Illinois women with poor choices for home birth care: hiring an underground network without good access to collaborative care, importing a midwife from another state or giving birth "unassisted" (without any professional help at all).
http://www.ilga.gov/legislation/BillStatus.asp?DocNum=226&GAID=10&DocTypeID=HB&LegId=40333&SessionID=76
Synopsis As IntroducedCreates the Home Birth Safety Act. Provides for the licensure of midwives by the Department of Financial and Professional Regulation. Creates the Illinois Midwifery Board. Sets forth provisions concerning qualifications, grounds for disciplinary action, and administrative procedures. Imposes conditions on any rulemaking authority. Amends the Regulatory Sunset Act to set a repeal date for the new Act of January 1, 2020. Amends the Medical Practice Act of 1987 and the Nurse Practice Act to make related changes.House Committee Amendment No. 1Provides that a licensed midwife is prohibited from performing an abortion.
Why license certified professional midwives?
The vast majority of Illinois has no licensed home birth care at all. In the three counties with some licensed home birth providers, there are still not enough. This leaves Illinois women with poor choices for home birth care: hiring an underground network without good access to collaborative care, importing a midwife from another state or giving birth "unassisted" (without any professional help at all).
http://www.ilga.gov/legislation/BillStatus.asp?DocNum=226&GAID=10&DocTypeID=HB&LegId=40333&SessionID=76
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