More tests not always needed for diagnosis

An EKG technician performs an electrocardiogram on a patient at a hospital in Houston, Texas, July 27, 2009.

Examining patients and taking a medical history are more useful to hospital doctors in diagnosing patients than high-tech scans, according to a study from Israel.

Tests such as CT scans and ultrasounds add to hospital bills, but doctors said that such tests given right after patients showed up in emergency rooms only helped with diagnosis in roughly one of three cases, the study -- published in the Archives of Internal Medicine -- said.

There is also research showing that the radiation from multiple CT scans might increase the risk of cancer over the long term.

To see whether such scans were really helpful, researchers led by Ami Schattner of Kaplan Medical Center in Rehovot, Israel, followed all the patients who showed up at the emergency room of a teaching hospital and were subsequently admitted.

"Basic clinical skills remain a powerful tool, sufficient for achieving an accurate diagnosis in most cases," Schattner and his colleagues wrote.

"Physicians may count more on their clinical faculties when making decisions about patients."

Over about two months, Schattner and his colleagues observed 442 consecutive patients. Each was separately examined by two doctors, a resident and a senior physician, who also asked patients about past health problems.

Both doctors had access to results from all routine tests, including blood and urine analysis, and any extra scans that had been done when the patient first got to the emergency room.

The researchers later looked at how accurate the clinicians were in their decisions, compared to the final diagnoses patients were given during or after their hospitalization. They also asked the doctors what factors they relied on most when diagnosing each patient.

Both clinicians made the correct diagnosis between 80 and 85 percent of the time.

Only about one in six patients had extra testing -- mostly CT scans, usually of the head -- done in the emergency room. The rest just had simple blood, urine or heart tests.

But even for the patients who did have extra scans, the doctors said the results helped to make a diagnosis only about one-third of the time.

Instead, patient history alone or history plus a physical exam were most important to a doctor's correct diagnosis in almost 60 percent of cases. When basic tests were included, they were the basis of more than 90 percent of correct diagnoses along with the history and exam.

"The doctoring process is still a personal communication between the patient and the clinician," said Matthew Sibbald, a cardiologist at the University of Toronto who wasn't involved in the study.

"As much as we want to... rely on the technology, it's not the technology that helps us make a diagnosis," he told Reuters Health.

Sources: http://www.reuters.com/article/2011/08/15/us-tests-idUSTRE77E0DL20110815

More U.S. kids in hospital for mental illness

American kids are increasingly likely to be admitted to the hospital for mental problems, although rates of non-psychiatric hospitalizations have remained flat, a new study shows.
From 1996 to 2007, the rate of psychiatric hospital discharges rose by more than 80 percent for 5-13-year-olds and by 42 percent for older teens.
"This occurs despite numerous efforts to make outpatient services for the more vulnerable kids more widely available," said Joseph C. Blader of Stony Brook State University of New York, whose findings appear in the Archives of General Psychiatry.
He said hospitalization is the last resort, because it's so disruptive for normal life.
"It's a pretty traumatic thing for a family when your child is admitted to a psych unit," he told Reuters Health.
Overall, short-term hospital admissions for mental illness rose from 156 to 283 per 100,000 children per year over the ten-year study period, based on data from the National Hospital Discharge Survey.
For adolescents, the rate increased from 683 to 969 per 100,000, while it went up from 921 to 996 for adults and dropped from 978 to 808 for people 65 and older.
The change for the elderly was expected, Blader said, because of cuts in Medicare reimbursement for inpatient hospitalizations.
For youngsters, bipolar disorder showed the steepest increase, while anxiety diagnoses dropped.
Although there have been concerns about overdiagnosis of bipolar disorder and other mental problems among children, Blader said that was unlikely to be hiking the rates.
That's because hospitalizations are based on whether or not people are considered a danger to themselves or others, not on psychiatric labels.
"Most typically it's volatile and aggressive behavior, or overreaction to minor provocations that lead to assaults on family members or peers," Blader told Reuters Health.
There was also a decline in the proportion of hospital stays paid for by private insurers. But whether that reflects a growing quality gap in mental health care or is a consequence of increased government coverage is unclear.
"There is no way these kinds of data are going give you the answers on a silver platter," Blader said.
He believes the rate hikes are real and alarming and says now is the time to study the underlying reasons.
"Whereas before we had hoped that more outpatient services would lead to a decrease in hospitalizations, the findings suggest a pressing need to learn what might have reversed that trend," Blader said.

Sources : http://www.reuters.com/article/2011/08/03/us-kids-mental-illness-idUSTRE7726UY20110803

Magnetic field exposure linked to asthma risk

Children whose mothers had high exposure to electromagnetic fields while pregnant may have an increased risk of developing asthma, U.S. researchers said on Monday in a study that adds to an ongoing debate.
Many prior studies have failed to consistently show that chronic exposure to electromagnetic fields -- from power lines and appliances such as microwaves ovens, hair dryers and vacuum cleaners -- are harmful to human health.
But many of these studies required people to estimate their exposure levels over several years, says Dr. De-Kun Li, senior research scientist at the Kaiser Permanente in Oakland, California, whose study appears in Archives of Pediatrics & Adolescent Medicine.
To get a more conclusive answer, Li designed a so-called prospective study in which 801 pregnant women wore monitors that measured their exposure to magnetic fields for 24 hours.
These monitors measured their exposure to low-frequency magnetic fields from electronics such as microwaves, hair dryers, fans, coffee grinders and fluorescent light bulbs, power lines, and transformer stations.
It did not monitor exposure to higher frequency electromagnetic fields generated by cellphones or cellphone towers.
The team used medical records to follow the women's children for 13 years. During the follow-up, 130 children, or 20.8 percent of study participants, developed asthma.
Most of these cases were diagnosed before age 5.
They then compared exposure levels during pregnancy to rates of asthma and found that children whose mothers had the highest exposure levels -- within the top 10 percent of women in the study -- were 3.5 times more likely to develop asthma than those who were in the bottom 10 percent.
The risk for children whose exposure was somewhere in the middle -- between 10 percent and 90 percent -- was 75 percent higher than for those in the lowest exposure group.
For the average population, Li said, children of women whose exposure levels were in the range of the bottom 10 percent in the study would have about a 13.6 percent absolute risk of developing asthma. Women whose exposure was in the highest range would have about a 33 percent risk of having children who developed asthma over the 13 year study period.
Some 13 percent of children under age 18 have asthma, which is caused by malfunction of the respiratory organs and the immune system.
Li said it is not clear why exposure to power lines might increase the risk of asthma, but he said there are several possibilities.
He said a prior study by his team found high exposure to electromagnetic fields increased the risk of miscarriages. And some animal studies have suggested that electromagnetic field exposure can affect immune response, which could increase the risk of asthma.
Exposure to power lines has been fodder for significant debate, and while many studies have found an effect of some sort -- ranging from immune disorders and poor semen quality to certain types of cancers -- Li said his study offers a stronger argument that concerns about magnetic fields may affect human health.
"This really needs to be studied," Li said. He said there have been a lot of dismissive attitudes about the health effects of exposure to magnetic fields, and he hopes his study -- which measured exposure levels ahead of time -- will encourage others to look further.
Still, he concedes that his findings need to be replicated by different scientists.
Li said if the findings are confirmed, it may offer new strategies for preventing the chronic disease in children.

Sources : http://www.reuters.com/article/2011/08/01/us-pregnancy-asthma-idUSTRE77066420110801

Acute-care hospitals to see higher Medicare payments

The U.S. government announced an increase in reimbursement rates to acute-care hospitals for 2012, a sharp contrast to the cut it announced for skilled nursing facilities on Friday.
The Centers for Medicare and Medicaid Services (CMS) increased payment rates to acute-care hospitals by 1 percent, compared with a 0.5 percent cut it had proposed earlier.
The CMS expects the rate increase will result in Medicare's operating payments to acute-care hospitals rising by $1.13 billion, or 1.1 percent.
On Friday, the CMS cut 2012 payments for skilled nursing facilities by 11.1 percent, or $3.87 billion, leading to a sharp decline in shares of Skilled Healthcare, Kindred Healthcare and Sun Health Care.
There was a broad sell-off in healthcare stocks on Monday on fears that the debt-ceiling deal to be voted on by the U.S. Congress would cut healthcare spending for federal programs such as Medicare.
Acute-care hospital operators such as HealthSouth Corp, Kindred Healthcare Inc, Tenet Healthcare Corp and Community Health Systems Inc are expected to benefit from the hike in payment rate.

Sources : http://www.reuters.com/article/2011/08/01/us-acutecarehospitals-idUSTRE77062U20110801