Friday, February 25, 2011

Hepatitis C Medicines; Packaged With Triad Group Alcohol Prep Pads

Hepatitis C Medicines

Triad Pads Packaged with Pegasys In The U.S.

Genentech, Inc., a member of the Roche Group distributed the Triad pads packaged with Pegasys; "The Triad Group alcohol prep pads are co-packaged and distributed with Genentech medicines, Boniva Injection, Fuzeon, Nutropin A.Q. Pen, Pegasys, and TNKase to customers in the United States."

Merck

PEGINTRON single dose RediPen® and PEGINTRON® vials for markets in Europe, Asia Pacific (excluding Japan), Latin America and Canada, and INTRON® A Multidose RediPen® and INTRON®= "Merck medicines distributed in the "United States" are not impacted by the Triad Group recall".

U.S. Merck issued a warning on Jan. 23, 2011 - Merck (known as MSD outside the United States and Canada) has become aware of the market recall of alcohol prep pads, alcohol swabs, and alcohol swabsticks manufactured by the Triad Group in the United States. The Triad Group recall impacts the alcohol prep pads that are co-packaged and distributed with the Merck medicines PEGINTRON® (peginterferon alfa-2b) single dose RediPen® and PEGINTRON® vials for markets in Europe, Asia Pacific (excluding Japan), Latin America and Canada, and INTRON® A (interferon alfa-2b) Multidose RediPen® and INTRON® A Solution vials for markets in Europe, Asia Pacific (excluding Japan) and Latin America. Merck medicines distributed in the United States are not impacted by the Triad Group recall.

Upon discussion and agreement with local Ministries of Health, Merck will begin packaging orders without alcohol prep pads until a suitable alternative has been identified.

It is important to note that the Merck medicines are not contaminated, and should continue to be used in accordance with the package insert, and as directed by a healthcare provider, except the alcohol prep pad should be discarded.

Reported allegedly after using a Triad pad packaged with (Pegasys) peginterferon alfa-2a

Medpage;@ MSNBC also reported that a 55-year-old Tennessee man who contracted endomyocarditis, allegedly after using a Triad pad packaged with Genentech's peginterferon alfa-2a drug for hepatitis C. The man survived but required cardiac valve replacement surgery in December. He too has filed suit against Triad, with Genentech also named as a defendant".

FDA Recall
Alcohol prep pads, alcohol swabs, and alcohol swabsticks are used to disinfect prior to an injection. They were distributed nationwide to retail pharmacies and are packaged in individual packets and sold in retail pharmacies in a box of 100 packets. The affected Alcohol Prep Pads, Alcohol Swabs and Alcohol Swabsticks can be identified by either "Triad Group," listed as the manufacturer, or the products are manufactured for a third party and use the names listed below in their packaging: Cardinal Health, PSS Select, VersaPro, Boca/ Ultilet, Moore Medical, Walgreens, CVS, Conzellin.

.. See; Triad: Drug Recall Notice
Group's customer service hotline at (262) 538-2900.

Reported @ MSNBC
MSNBC has reported the sad story of the Kotharis family who believe alcohol swabs made by TRIAD Group, Inc., were to blame for the death of their two year old son. The child Harrison Kothari, died from a rare infection blamed on the wipes; which were allegedly contaminated with a bacteria called bacillus cereus.

The hospital Children’s Memorial released this statement "Children’s Memorial Hermann Hospital is deeply saddened by the death of any child in our care," it read. "Memorial Hermann was notified of the product recall in January, one month after this child died. At that time, the product was removed from our shelves. We are dedicated to providing the highest standard of quality care and patient safety at Children’s Memorial Hermann Hospital."

Triad Alcohol Pad Recall Announced on Good Morning America

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Reported By MSNBC

Problems with sterilization, contamination

Documents show that FDA officials expressed concerns following visits to the Triad plant from July 15 to July 17, 2009, and again from April 19 to May 18, 2010. Inspectors reported that the company could not validate the processes used to ensure quality or sterility not only of alcohol prep pads and wipes, but also other products used for intimate care.


Those include hemorrhoid creams, infant and adult glycerin suppositories and sterile lubricating jelly widely used in homes, as well as in clinics and hospitals for medical exams.
The inspection documents, known as FDA Form 483s, were obtained by msnbc.com from a confidential source and confirmed by FDAzilla.com, an independent Web site that monitors the FDA. Copies of the documents were sent to the FDA for review; the agency did not deny their authenticity.

In the documents, inspectors cited Triad’s sterilization process for alcohol prep products, questioning dosages of the gamma radiation process that ensures sterility.
“Specifically, there is no validation of the gamma radiation sterilization process for the Alcohol Swabsticks labeled as sterile,” the report said.

In addition, shipments of Triad Plus BZK prep pads that failed to meet specifications were released for distribution, inspectors said.

The documents did not mention specific contamination of the swabs or pads with Bacillus Cereus.
However, inspectors said Triad’s processes “may not be adequate to sterilize” the lubricating jelly and charged that Triad had failed to address “high microbial bioburden levels” previously detected in the purportedly sterile jelly. Information about the specific type of contamination was redacted in the documents. Inspectors reported worn and broken manufacturing equipment, misidentified batches of hemorrhoid cream, and instances where if a single batch of hemorrhoid ointment or glycerin suppositories failed quality standards, others weren’t tested for the same problem and were released for distribution.

In one case, inspectors noted that a batch of lubricating jelly failed viscosity tests on Jan. 28, 2010, but was released anyway with the specific consent of Triad’s president, David Haertle. A week later, the decision to release the jelly per Haertle’s authority was revised and cases of the jelly were scrapped, but some already had been distributed, according to the report.
“No action was taken on the distributed cases,” inspectors wrote.
Overall, officials concluded the company had no procedures in place for reporting or acting on manufacturing problems….

Before the recall, FDA had received no reports of adverse events related to Triad alcohol prep products, Kelly said.

From Jan. 5 to Jan. 31, the company received about 100 reports of problems with alcohol prep products, which Kelly said was typical of the number of reports received after most recalls are posted. They included about 50 reports of infection and one death, which could not be tied to contaminated wipes.

Source; MSNBC

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Hepatitis C News; Antiviral Therapy for HCV "Attitudes Regarding Future Use" Also "BMS-790052, BMS-650032"


Coverage From NATAP
Reported by Jules Levin
The 21st Conference of the Asian Pacific Association for the Study of the LiverAPASL
Feb 17-20, 2011
Bangkok, Thailand


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"In summary, the responses to this Internet-based survey of more than 1,000 current HCV treaters indicated that although the majority of respondents appear ready to utilize DAA agents in the future, referrals to "hepatitis C experts" will increase when these agents become available. In addition, future referrals to ID specialists appear to be limited. Finally, as more than half of respondents to the survey with "minimal knowledge" of DAA therapies also appear to be willing to utilize these compounds in the future, significant provider education will be required to minimize inappropriate use of these agents."


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Just In;

Scripps Pioneers Individualized Medicine by Offering Genetic Testing to Hepatitis C Patients
Individualized Therapies Now Available for Drug Treatment of Hepatitis C
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SAN DIEGO, Feb. 25, 2011 (GLOBE NEWSWIRE) -- Scripps Health is one of the first health systems in the United States to offer genetic testing as part of its care for hepatitis C patients planning to undergo drug treatment.
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The tests offer hope to the more than 4 million patients diagnosed annually in the U.S. with hepatitis C and could spare them from taking interferon, which is commonly prescribed. Interferon causes flu-like symptoms as a side effect and costs more than $50,000 annually. Instead, the genetic test determines whether patients have a common gene variant that predicts a favorable cure rate if they are treated with the drug combination therapy of pegylated interferon and ribavirin.
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A manuscript describing this approach to treatment, authored by Paul J. Pockros, MD, clinical director of research at the Scripps Translational Science Institute, head of the Division of Gastroenterology and Hepatology and director of the Liver Disease Center at Scripps Clinic, will be published in the journal Drugs in March.
"This is a huge step forward in the movement toward individualized medicine," said Dr. Pockros, "As a physician, knowing what drug therapies will have benefit and which ones won't based on a patient's IL28B genotype is significant because we are able to be more targeted in our approach to treatment."
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This is the first of numerous genetic tests that will accurately give doctors vastly improved data, leading to better prescription of drug treatments. Later this year, a second test will be available that will accurately predict anemia in hepatitis C patients taking the pegylated interferon and ribavirin drug combination. Anemia is one of the most common side effects of the regimen. This will allow doctors to modify the therapy before starting the regimen to prevent patients from developing this problematic side effect.
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Genetic testing for hepatitis C patients carries significant implications for patient care, as there are more than 4 million infected people in the United States, most of them undiagnosed and untreated.
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Scripps Clinic now routinely orders IL28B genotyping on all patients with Hepatitis C who are potential candidates for anti-viral therapy. If the patients have a favorable IL28B genotype and advanced fibrosis on liver biopsy, doctors can initiate therapy with the current standard of care. If patients have a less favorable genotype or they have mild fibrosis, doctors can recommend waiting for FDA approval of direct acting antiviral drugs to improve their chances of response.
Currently, LabCorps Diagnostics is performing the IL28B testing for Scripps patients, a procedure covered by most insurance plans. The results are transmitted to the treating physician in about one week and the treatment choice is tailored based on the patient's likelihood to have a favorable response.
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The hepatitis C genetic testing is the latest example of Scripps' leadership in individualized medicine. Scripps doctors were the first to use genetic testing for cardiovascular patients planning to undergo elective stent procedures to determine if they have one or more of the common gene variants linked to an inability to metabolize the anti-clotting drug Plavix (clopidrogel). Plavix is the second-most commonly prescribed drug in the United States and is given to most patients after they receive coronary stents.
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ABOUT SCRIPPS HEALTH
Founded in 1924 by philanthropist Ellen Browning Scripps, Scripps Health is a $2.3 billion nonprofit community health system based in San Diego, Calif. Scripps treats a half-million patients annually through the dedication of 2,500 affiliated physicians and 13,000 employees among its five acute-care hospital campuses, home health care services, and an ambulatory care network of physician offices and 22 outpatient centers and clinics. Scripps has been recognized by Thomson Reuters as one of the Top 10 health systems in the nation for quality care. Scripps is also at the forefront of clinical research, genomic medicine, wireless health and graduate medical education. With three highly respected graduate medical education programs, Scripps is a longstanding member of the Association of American Medical Colleges. More information can be found at www.scripps.org.
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This information was brought to you by Cision http://www.cisionwire.com
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Prediction of response to Hep C therapy using genetic polymorphisms
The decision model was generated by data mining analysis.
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The model predicted sustained virological response with 78% specificity Journal of Hepatology

March's issue of the Journal of Hepatology investigates the pre-treatment prediction of response to pegylated-interferon plus ribavirin for chronic hepatitis C using genetic polymorphism in IL28B and viral factors.

Pegylated interferon and ribavirin therapy for chronic hepatitis C virus genotype 1 infection is effective in 50% of patients.

Recent studies revealed an association between the IL28B genotype and treatment response.
Dr Masayuki Kurosaki and colleagues from Japan developed a model for the pre-treatment prediction of response using host and viral factors.

Data were collected from 496 patients with hepatitis C genotype 1 treated with Pegylated interferon/ribavirin at 5 hospitals and universities in Japan.

IL28B genotype and mutations in the core and intereron sensitivity determining region (ISDR) of hepatitis C were analyzed to predict response to therapy.

The IL28B polymorphism correlated with early virological response and predicted null virological response and sustained virological response independent of other covariates.
The research team found that mutations in the ISDR predicted relapse and sustained virological response independent of IL28B.

The decision model revealed that patients with the minor IL28B allele and low platelet counts had the highest null virological response and lowest sustained virological response.
The researchers found that those with the major IL28B allele and mutations in the ISDR or high platelet counts had the lowest null virological response and highest sustained virologicial response.

The team found that the model had high reproducibility and predicted sustained virological response with 78% specificity and 70% sensitivity.
Dr Kurosaki's team concludes, "The IL28B polymorphism and mutations in the ISDR of hepatitis C were significant pre-treatment predictors of response to pegylated-interferon/ribavirin."
"The decision model, including these host and viral factors may support selection of optimum treatment strategy for individual patients."

In The News

Twelve Pregnant Women Die In Indian Hospital, Contaminated IV Fluids Suspected
Updated: Friday, 25 Feb 2011, 8:29 AM EST Published :

By: AFP
Twelve pregnant women died in 10 days in an Indian government hospital, with contaminated fluids administered during childbirth suspected to be the cause, reports said Friday.
Another five women were in serious condition, according to doctors at Umaid Hospital in the city of Jodhpur, in a case that highlights the often-poor standards of care in state-run health facilities in India.

The first death occurred Feb. 13, and a meeting of leading doctors that was held three days later failed to identify the cause, The Indian Express newspaper reported, citing doctors and officials at the hospital.

"All the women died after severe hemorrhaging, and for now, we believe the cause might be an infection after they were administered tainted IV fluids," Umaid Hospital superintendent N.G. Chaggani told the newspaper.

Police lodged a case against the local company that supplied the fluids and the Indian manufacturer.

"We have begun our investigation and are checking the suspected stock," Jodhpur police commissioner Bhupendra Kumar Dak told the Times of India newspaper.
India has a two-speed medical system in which shabby and often insanitary state facilities coexist with state-of-the-art private hospitals that cater for wealthy overseas medical tourists who visit India for low-cost surgery.
In July, Indian news channel NDTV reported that at least eight children were infected with HIV by blood transfusions given at Umaid Hospital in the previous six months, while 43 contracted Hepatitis C.

In addition to poor standards of care, most Indians are required to pay for their health care out of their own pockets, with the state and insurance companies picking up just a fraction of overall spending.

A major study published in January in British medical journal The Lancet said payments by individuals accounted for 71.1 percent of spending on health, with 39 million Indians pushed back below the poverty line each year because of the cost of care.
Copyright 2011 AFP. All rights reserved.
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Cancer


Monitoring circulating tumor cells using gold nanoparticles
Once these tumor cells are tagged with the gold nanoparticles, laser illumination reveals which cells are tumors in the bloodstream. This technique was tested on 19 patients with head and neck cancer, and showed excellent correlation with previous techniques. If this method can be validated in larger studies, it shows promise as a faster, more economical method to detect circulating tumor cells.
“The key technological advance here is our finding that polymer-coated gold nanoparticles that are conjugated with low molecular weight peptides such as EGF are much less sticky than particles conjugated to whole antibodies,” says Shuming Nie, PhD, a professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University. “This effect has led to a major improvement in discriminating tumor cells from non-tumor cells in the blood.”.. read more...

Hershey, PA Posted on February 24th, 2011

Nanotechnology may open a new door on the treatment of liver cancer, according to a team of Penn State College of Medicine researchers. ...

Researchers evaluated the use of molecular-sized bubbles filled with C6-ceramide, called cerasomes, as an anti-cancer agent. Ceramide is a lipid molecule naturally present in the cell's plasma membrane and controls cell functions, including cell aging, or senescence.Hepatocellular carcinoma is the fifth most common cancer in the world and is highly aggressive. The chance of surviving five years is less than five percent, and treatment is typically chemotherapy and surgical management including transplantation."The beauty of ceramide is that it is non-toxic to normal cells, putting them to sleep, while selectively killing cancer cells," said Mark Kester, Ph.D., G. Thomas Passananti Professor of Pharmacology.Cerasomes, developed at Penn State College of Medicine, can target cancer cells very specifically and accurately, rather than affecting a larger area that includes healthy cells. The problem with ceramide is that as a lipid, it cannot be delivered effectively as a drug. To solve this limitation, the researchers use nanotechnology, creating the tiny cerasome, to turn the insoluble lipid into a soluble treatment.
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Healthy You
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This year will see an unprecedented surge in the number of Americans becoming eligible for Medicare, as the leading edge of the Baby Boom generation begins to turn 65. This will spark a fundamental shift in the US...

High HDL Levels Tied to Longevity in Men
Friday, February 25, 2011 7:17 AM
Men who reach their 85th birthdays tended to have high levels of good cholesterol while in their 60s, a new study says.

Researchers found that men with the highest good (HDL) cholesterol were 28 percent less likely to die before they reached 85, compared to men in the lowest HDL group.
This paper, published in the American Journal of Cardiology, adds to the evidence that HDL is important for a long life, said Dr. Nir Barzilai, who heads the Institute for Aging Research at Albert Einstein College of Medicine in New York and was not part of the study.
However, "we always have to remember that it's an association," and it does not mean that having high HDL increases life span, he told Reuters Health.

About 12 million men suffered from heart disease and stroke in 2006, but high levels of HDL cholesterol may reduce the risks, according to the American Heart Association.
Low levels of HDL, less than 40 milligrams per deciliter (mg/dL) of blood for men, are known to increase the risk of heart disease, according to the heart association.

The researchers, from the Massachusetts Veterans Epidemiology and Research Information Center in Boston, looked at the medical records of about 650 veterans when they were around 65 years old, then grouped them based on HDL levels.

Starting with low levels of 40 mg/dL, they found that for each 10 mg/dL increase of HDL, the men were 14 percent less likely to have died by 85. Overall, 375 survived to that age.
Also, fewer of the men with higher HDL were overweight, and they tended not to have more than two drinks a day. And fewer of them had heart disease or smoked, compared to the lowest HDL group.

These other factors might have had an effect on survival, Barzilai said. However, the researchers did account for this, and still showed a link between reaching 85 and high HDL levels, he told Reuters Health.

"It's difficult to change HDL levels," Barzilai said. Exercise might raise it a few points, but it isn't a very efficient way to improve, he said. "We need to get a drug eventually."
Merck and Roche are both working on an HDL-raising drug, he told Reuters Health. Pfizer stopped its research into another such drug, torcetrapib, in 2006 because people taking it along with Lipitor in a study had a higher rate of death.

The B-vitamin niacin may raise HDL levels 15 to 35 percent. However, side effects can include liver damage and increased blood sugar, according to the Mayo Clinic.
A three-month supply costs about $9. Niacin is also found in dairy products, lean meats, nuts, eggs, and fish.
However, it's unclear how much raising HDL will prevent heart disease, Barzilai said, so whether drugs might improve people's health remains to be seen.
The study authors could not be reached by deadline.
© 2011 Reuters. All rights reserved. Republication or redistribution of Reuters content, including by caching, framing or similar means, is expressly prohibited without the prior written consent of Reuters.



A 48-year-old man was sentenced yesterday to six months' imprisonment suspended for two years and 200 hours of unpaid work for selling and supplying herbal medicines to the public without a marketing authorisation...

Dan Frosch(The New York Times, February 21, 2011)"
Just 15 states and the District of Columbia license naturopaths, according to the American Association of Naturopathic Physicians. That process requires completion of a four-year accredited, specialized school, passing an exam and a certain amount of clinical training. This year, at least 11 states are trying to pass licensing legislation…Naturopaths who favor licensing say they are not interested in becoming medical doctors...Moreover, they contend that it is dangerously easy to get a certificate that shows expertise in naturopathy and people need some way of discerning between a knowledgeable naturopath and a quack."
As thousands of breast cancer survivors battle persistent fatigue, a Michigan State University nursing researcher is studying whether acupressure - a technique where physical pressure is applied to acupuncture points by the...

Off The Cuff
Shan Juan and Cang Wei (China Daily, February 21, 2011)"

About 70 percent of Chinese families improperly use medicine, according to a survey conducted by China Nonprescription Medicines Association. The survey, which polled 10,000 people…concluded that a majority of the populace tends to go to drugstores to buy medications for minor sicknesses instead of seeing a doctor…The reasons for concern are particularly pressing on the mainland, where, because of loose supervision, the public can often buy prescription drugs at drugstores without doctors' prescriptions."

Bruce Japsen(Chicago Tribune, February 19, 2011)
Hospitals across the country are running out of key drugs used in surgeries and to treat some diseases…causing doctors to turn to older treatments...Part of the shortage is being caused by manufacturing issues and quality-control problems at a number of companies…Drugmakers say they are obliging tougher safety rules put in place by the U.S. Food and Drug Administration, which has intensified scrutiny to avoid allowing unsafe medicines on the market."

Scott Hiaasen and David Ovalle (The Miami Herald, February 23, 2011)
Narcotics agents across South Florida descended on more than a dozen pain clinics...in the most dramatic effort yet to curb the region’s booming business of illegal prescription narcotics…These clinics have exploded all over South Florida in recent years…making the region the prime supplier of illegal pills in the eastern United States. The clinics attract drug couriers posing as patients who travel from Kentucky, Ohio and West Virginia, where an oxycodone pill can sell for 10 times the price charged by a South Florida doctor.

An undiagnosed genetic disease appears to have been the critical factor in the 2009 death of a University of Chicago researcher from plague, investigators have concluded.
The 60-year-old man, Malcolm Casadaban, PhD, had been working with an attenuated strain of Yersinia pestis, the plague bacterium, as part of his research. The strain was subsequently cultured from his blood after death.

Although a forensic team from state and local health departments and the CDC were unable to determine how exactly Casadaban came into contact with the organism, autopsy results also indicated he had hereditary hemochromatosis, according to a report in the Feb. 25 issue of the CDC's Morbidity and Mortality Weekly Report.

Big Pharma

Drug R&D Costs Are Less Than Estimated -- So Why the High Prices?
André Picard(The Globe and Mail, Toronto, February 23, 2011)
"It costs, on average, $1.3-billion (U.S.) in research and development to bring a new drug to market. That level of investment in R&D by Big Pharma justifies the high cost of prescription drugs. Those statements are repeated so often that they have come to be accepted as fact. But are they fact or fiction? An article in the current edition of the journal BioSocieties...argues that the real cost of R&D is...a fraction of the commonly cited estimate…If R&D costs are only a fraction of what is asserted, then what is the justification for high prescription drug prices?"

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Thursday, February 24, 2011

Green Tea and the Risk of Gastric Cancer in Japan

Original Article

Green Tea and the Risk of Gastric Cancer in Japan

Yoshitaka Tsubono, M.D., Yoshikazu Nishino, M.D., Shoko Komatsu, M.D., Chung-Cheng Hsieh, Sc.D., Seiki Kanemura, M.D., Ichiro Tsuji, M.D., Haruo Nakatsuka, Ph.D., Akira Fukao, M.D., Hiroshi Satoh, M.D., and Shigeru Hisamichi, M.D.
N Engl J Med 2001; 344:632-636
March 1, 2001

Background
Although laboratory experiments and case–control studies have suggested that the consumption of green tea provides protection against gastric cancer, few prospective studies have been performed.

Methods
In January 1984, a total of 26,311 residents in three municipalities of Miyagi Prefecture, in northern Japan (11,902 men and 14,409 women 40 years of age or older), completed a self-administered questionnaire that included questions about the frequency of consumption of green tea. During 199,748 person-years of follow-up, through December 1992, we identified 419 cases of gastric cancer (in 296 men and 123 women). We used Cox regression to estimate the relative risk of gastric cancer according to the consumption of green tea.

Results
Green-tea consumption was not associated with the risk of gastric cancer. After adjustment for sex, age, presence or absence of a history of peptic ulcer, smoking status, alcohol consumption, other dietary elements, and type of health insurance, the relative risks associated with drinking one or two, three or four, and five or more cups of green tea per day, as compared with less than one cup per day, were 1.1 (95 percent confidence interval, 0.8 to 1.6), 1.0 (95 percent confidence interval, 0.7 to 1.4), and 1.2 (95 percent confidence interval, 0.9 to 1.6), respectively (P for trend=0.13). The results were similar after the 117 cases of gastric cancer that were diagnosed in the first three years of follow-up had been excluded, with respective relative risks of 1.2 (95 percent confidence interval, 0.8 to 1.8), 1.0 (95 percent confidence interval, 0.7 to 1.5), and 1.4 (95 percent confidence interval, 1.0 to 1.9) (P for trend=0.07).

Full Text of Background...

Discussion

Our study had several methodologic advantages over prior studies of green tea and the risk of gastric cancer. We recruited subjects from the general population, and there was a large variation in green-tea consumption among our subjects. In addition, we assessed the consumption of green tea and other variables before cases of gastric cancer and other diseases were diagnosed, thus avoiding recall bias. The questionnaire used to measure green-tea consumption had a reasonably high level of validity and reproducibility. A large number of cases of gastric cancer were identified, because the incidence rate in the study region was high and the period of follow-up was reasonably long.

Our study had some limitations. Our food-frequency questionnaire included only a limited number of items and could not be used to calculate the consumption of total energy and other nutrients. Although we adjusted for the consumption of dietary items other than green tea as much as possible, we could not exclude the possibility of residual confounding by other dietary characteristics.

We did not obtain information on the presence or absence of a history of infection with Helicobacter pylori, a strong risk factor for gastric cancer.16 The prevalence of H. pylori seropositivity (determined by the presence of IgG antibodies) among subjects 55 to 64 years of age in the study area was 88 percent in men and 87 percent in women.17 The subjects with chronic gastritis caused by H. pylori infection might have limited their consumption of foods and beverages, including green tea. Some studies have suggested an antibacterial effect of green tea,18,19 which may apply to H. pylori. In either case, the prevalence of infection would have been lower in the subjects with higher intakes of green tea. Thus, we believe it is unlikely that the failure to account for H. pylori infection masked an inverse association between the risk of gastric cancer and the consumption of green tea.

Another concern is that 16 percent of the participants were lost to follow-up. Nevertheless, the proportion did not differ according to the category of green-tea consumption. Therefore, we believe that loss to follow-up did not have a substantial effect on the observed associations between the consumption of green tea and the risk of gastric cancer.
Our findings are in general agreement with those of a prospective study of Japanese persons in Hawaii, which found no inverse association between green-tea consumption and gastric cancer.12 Although in that study there was a nonsignificant increase in the risk of gastric cancer among subjects with higher levels of green-tea consumption, the number of cases of gastric cancer was relatively small (108).

Our results contradict those of most case–control studies, which show an inverse association between the risk of gastric cancer and the consumption of green tea.5-10 In these retrospective investigations, some patients with gastric cancer might have decreased their consumption of green tea before the diagnosis because of their abdominal symptoms. This change in practice might have biased their recall of past intake in such a way that they underestimated their true consumption, resulting in spurious inverse associations. Epidemiologic studies have found that patients with gastric cancer decrease their consumption of tea two years before the diagnosis20 and that the accuracy of the recall of an earlier diet is strongly influenced by the recent diet.21 This bias would partly explain the difference in the findings between prospective and case–control studies.

We also found that there was no association between the risk of gastric cancer and the consumption of black tea or coffee. These results are consistent with the findings of a review conducted by the World Cancer Research Fund, which concluded that probably neither beverage is associated with a decreased or increased risk of gastric cancer.22
In conclusion, in a prospective cohort study, we found no association — inverse or otherwise — between the consumption of green tea and the risk of gastric cancer in Japan.
Supported in part by grants from the Japanese Ministry of Health and Welfare and the Japanese Ministry of Education, Science, and Culture.

Source Information
From the Divisions of Epidemiology (Y.T., Y.N., S. Kanemura, I.T., S.H.) and Environmental Health Sciences (H.S.), Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; the Department of Nutrition, Harvard School of Public Health, Boston (Y.T.); the Faculty of Physical Education, Sendai College, Miyagi, Japan (S. Komatsu); the Division of Biostatistics and Epidemiology, Cancer Center, University of Massachusetts Medical Center, Worcester (C.-C.H.); Miyagi University School of Nursing, Sendai, Japan (H.N.); and the Department of Public Health, Yamagata University School of Medicine, Yamagata, Japan (A.F.).

Address reprint requests to Dr. Tsubono at the Division of Epidemiology, Department of Public Health and Forensic Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan, or at .

Full Text of Background...
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Foodborne Disease in 2011 — The Rest of the Story


Perspective

Foodborne Disease in 2011 — The Rest of the Story


NEJM February 23, 2011 Topics: Drugs, Devices, and the FDA, Public Health
Michael T. Osterholm, Ph.D., M.P.H.


Recent media headlines might have you believe that our food supply is substantially more safe than it was a decade ago and about to get even safer. First, on December 15, 2010, the Centers for Disease Control and Prevention (CDC) announced a long-awaited reanalysis of the burden of foodborne illness in the United States and reported a substantial decrease in the estimated incidence of foodborne disease between 1999 and 2011. Then, on January 4, 2011, President Barack Obama signed into law the Food Safety Modernization Act, the first major legislation related to the food-safety authority of the Food and Drug Administration (FDA) since 1938. But as the late radio commentator Paul Harvey would say, “You know what the news is; in a minute, you’re going to hear . . . the rest of the story.”


As the first set of headlines indicated, the CDC reported a substantial decrease in the estimated incidence of foodborne disease between 1999 and 2011. In 1999, Mead and colleagues published the first comprehensive estimates of foodborne disease in the United States.1 Scallan and colleagues, in two recent articles, detail new estimates of the burden of foodborne disease for 31 known2 and unspecified3 infectious agents. In 1999, it was estimated that annually, foodborne pathogens caused 76 million episodes of illness, 325,000 hospitalizations, and 5000 deaths. On the basis of these estimates, 27% of Americans could expect to have a foodborne illness each year, 115 per 100,000 population would be hospitalized, and almost 2 per 100,000 would die.
The CDC now estimates that there are approximately 48 million foodborne illnesses, 128,000 hospitalizations, and 3000 deaths per year.


That means that 15% of Americans can expect to have a foodborne illness annually and that 41 in 100,000 will be hospitalized and 1 in 100,000 will die. However, the authors have strongly cautioned that the 1999 estimates cannot be compared with the current ones for purposes of trend analysis, because different methods and underlying assumptions were used.


Therefore, we cannot draw inferences from these CDC data about the relative safety of our food supply today, as compared with 12 years ago.

More reliable trend data for disease incidence are available from the Foodborne Disease Active Surveillance Network (FoodNet) of the CDC’s Emerging Infections Program. FoodNet supports active, population-based surveillance in 10 states for all laboratory-confirmed infections with selected pathogens that are commonly transmitted through food.4 The system has been in place since 1996. It provides a relatively constant measuring stick of the incidence of foodborne disease across geographic areas and over time. Additional data that are collected by local and state health departments participating in FoodNet also help to define routes of exposure to various foodborne pathogens, in part by identifying the roles played by food not typically associated with outbreaks of foodborne disease and food preparation in the risk of disease. These data show that even with improvements made during the past decade, the burden of foodborne disease persists.


According to a 2010 FoodNet report, which included preliminary data from 2009, rates of infection with shigella, yersinia, Shiga-toxin–producing Escherichia coli (STEC) O157, campylobacter, and listeria were at least 25% lower than they were a decade ago; the rate of infection with salmonella, a bellwether pathogen for foodborne-disease surveillance, was only 10% lower.
Rates of vibrio infection were substantially higher in 2009 than in the period from 1996 through 1998.4 All these findings, however, must be interpreted with caution, since most of the decreases occurred between 1996 and 2000, and there has been little additional change since then. When the 2009 incidence of infections with the eight primary bacterial and parasitic pathogens is compared with their incidence in the period from 2006 through 2008, no significant change can be seen for six pathogens; only the infection rates with shigella and STEC O157 show significant decreases (see graph).
In addition, recent studies have demonstrated a significant increase in the incidence of foodborne disease caused by emerging non-O157 STEC, suggesting that surveillance for O157 is no longer sufficient to determine the effect of foodborne STEC infections.




Percent Change in the Incidence of Laboratory-Confirmed Bacterial and Parasitic Infections from 2006–2007 to 2009, According to Pathogen.

On the basis of FoodNet data for the past 14 years, we must conclude that the improvements made in the late 1990s in the safety of our food supply are still having a positive effect. But we’ve made little additional progress in the past decade. Although the media and some food producers, processors, wholesalers, and retailers may conclude that the recent CDC estimates offer evidence of major improvements in food safety since 1999, data from active population-based surveillance offer a more nuanced and neutral picture. Moreover, in this issue of the Journal, Barton Behravesh et al. remind us that previously unrecognized vehicles for foodborne disease, such as jalapeño peppers, can cause large nationwide outbreaks. And outbreaks associated with raw produce are among the most difficult ones for public health officials to identify and control, since produce from a single farm may be distributed widely and consumed rapidly because it is perishable.

So will the Food Safety Modernization Act result in immediate improvements in food safety? The legislation brings long overdue modernization to the FDA’s food-safety activities. It gives the FDA broader authority to regulate food facilities, including authorization to inspect records related to food. It “requires each owner, operator, or agent in charge of a [nonexempt] food facility to identify and implement preventive controls to significantly minimize or prevent hazards that could affect food manufactured, processed, packed, or held by [that] facility.” It also requires the FDA “to issue guidance documents to reduce the risk from the most significant foodborne contaminants” and to “establish minimum standards for the safe production and harvesting of fruits and vegetables based on known safety risks.” It further requires the FDA “to allocate resources to inspect facilities and imported food according to the known safety risks of the facilities or food; and [to] establish a product tracing system to track and trace food that is in the United States or offered for import into the United States.” It gives the FDA authority to order a recall of a food when it is contaminated or implicated in an outbreak.
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Finally, it “requires U.S. importers to perform risk-based foreign supplier verification activities to verify that imported food is produced in compliance with applicable requirements related to hazard analysis and standards for produce safety and is not adulterated or misbranded.”
Although all these new forms of authority will substantially enhance the FDA’s ability to prevent foodborne disease and respond more effectively when an outbreak occurs, the new law has a major shortcoming: dollars. There was no appropriation approved by the Congress for the act or authorization in the bill for the FDA to assess fees on the companies that it inspects. The Congressional Budget Office estimated that implementing this legislation would require $1.4 billion between 2011 and 2015.5 Though the bill authorizes the FDA to collect fees when a facility requires reinspection and a recall fee for mandatory recalls, these fees are expected to provide minimal resources.
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In short, the actual effect of this important law will at best be extremely limited if Congress and the administration don’t appropriate and sign additional legislation providing the necessary funds to carry out its mandates. Recent reports in the media calling this act “historic legislation” must be tempered by the reality that without the necessary resources, requiring the FDA to carry out the law’s required activities will be like trying to get blood out of a rock. And in the end, food safety in the United States cannot be expected to improve in more than an incremental manner.

As Paul Harvey would have said, “That’s the rest of the story.”
This article (10.1056/NEJMp1010907) was published on February 23, 2011, at NEJM.org.
Disclosure forms provided by the author are available with the full text of this article at NEJM.org .

Source Information
From the Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis.
References
Mead PS, Slutsker L, Dietz V, et al. Food-related illness and death in the United States. Emerg Infect Dis 1999;5:607-625CrossRef Web of Science Medline

Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States — major pathogens. Emerg Infect Dis 2011;17:7-15Medline

Scallan E, Griffin PM, Angulo FJ, Tauxe RV, Hoekstra RM. Foodborne illness acquired in the United States — unspecified agents. Emerg Infect Dis 2011;17:16-22Medline

Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food — 10 states, 2009. MMWR Morb Mortal Wkly Rep 2010;59:418-422Medline

Congressional Budget Office. Senate File 510: Food Safety Modernization Act — as reported by the Senate Committee on Health, Education, Labor, and Pensions. August 12, 2010.
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50 Best Hospitals in America

50 Best Hospitals in America
By Leigh Page February 24, 2011

Becker's Hospital Review has named the 50 best hospitals in America, which cover a wide spectrum from well-known academic medical centers to less widely recognized community hospitals that have reached greatness. Each of these organizations has put patients' needs first, driven a variety of innovations and helped to set the bar for high-quality care. Each hospital has an impressive list of achievements and a story to tell. Here are the hospitals, in alphabetical order.

Editor's note: This list focuses on acute-care, multi-specialty academic medical centers and large community hospitals. This list does not focus on specialty hospitals or smaller community hospitals. To view lists recognizing these hospitals, please look in upcoming issues for our lists of 100 Great Places to Work in Healthcare (appearing in the May/June issue), 50 of the Best Specialty Hospitals, 30 of the Best Community Hospitals, 20 Hospitals With Great Orthopedic Programs, 20 Hospitals With Great Heart Programs and more.This list is sponsored by Cjeka Search and MED3000 .

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Advocate Illinois Masonic Medical Center (Chicago)
Illinois Masonic derives its name from members of the Eastern Star freemasons, a fraternal order that bought a hospital in 1921 and raised millions for an ambitious expansion campaign. The 408-licensed bed teaching hospital is now part of Oakbrook, Ill.-based Advocate Health Care. The hospital has more than 880 active physicians representing more than 40 specialties and is one of four Level I Trauma Centers in Chicago. Advocate Health Care has an Aa2 bond rating from Moody's Investor Services and recently entered talks with M.D. Anderson Cancer Center in Houston about a partnership.

Akron (Ohio) General Hospital
Vincent McCorkle, the new president and CEO of the hospital's parent, Akron General Health System, is fond of saying, "culture eats strategy." Rather than mandating changes, he prefers a participatory process, where everyone has a role. In a hotly contested market, not that far from heavy hitters like the Cleveland Clinic, 511-bed Akron General has had to stay nimble. The health system, which includes a community hospital and Partners Physician Group, posted a 1.4 percent positive margin on operating revenue of $553.4 million in 2009, after losing money in 2008. Arriving in July 2010, Mr. McCorkle hired back Alan Papa, a former Akron General executive, as president of the medical center and continued physician recruitment by acquiring a five-cardiologist group.

Barnes-Jewish Hospital (St. Louis)
This huge institution, the largest private employer in the St. Louis area, was formed by the 1996 merger of Barnes Hospital, founded in 1914, and the Jewish Hospital of St. Louis, founded in 1902. With 1,258 beds, it is the largest in Missouri. It is the teaching hospital for Washington University School of Medicine. Barnes-Jewish is part of BJC Health System, which has an Aa2 bond rating with Moody's Investor Services. The old Barnes Hospital was one of the first to treat diabetic patients with insulin and the first to install an electronic data processing system in a hospital.

Beaumont Hospital (Royal Oak, Mich.)
In Oct. 2010, the hospital opened a new cardiovascular center, which is offering "7 tests for $70," screenings for people at risk of heart disease. This 1,061-bed hospital, the flagship of three-hospital Beaumont Hospitals, operates highly regarded interventional cardiology and community clinical oncology programs. It is a leading center for treating liver disease, hepatitis, ulcers and related disorders and for conducting research in incontinence and interstitial cystitis. The inaugural class of the new Oakland University William Beaumont School of Medicine will begin instruction in Aug. 2011.

Brigham and Women's Hospital (Boston)
The Brigham, as it is affectionately called, is a teaching affiliate of Harvard Medical School and cofounder, with Massachusetts General Hospital, of Partners HealthCare, which has an Aa2 bond rating from Moody's Investor Services. Its Boston Hospital for Women, with 750 beds, is a leader in women's health services. It is a top recipient of research grants from the National Institutes of Health with an annual research budget of more than $537 million. In addition to other awards, it won the NQF National Quality Healthcare Award in 2009.

Cedars-Sinai Medical Center (Los Angeles)
Cedars-Sinai Medical Group and Cedars-Sinai Health Associates was one of the top 10 physician groups in Southern California listed by Integrated Health Care Associates. The hospital has 10,000 employees and more than 2,000 physicians in almost every specialty. More than 350 residents and fellows participate in more than 60 programs. Last year, Cedars-Sinai opened a 30-bed inpatient unit to provide advanced heart failure patients using an intensive, multi-disciplinary approach.

Central DuPage Hospital (Winfield, Ill.)
The hospital, located in the growing western suburbs of Chicago, boasts the second busiest surgical center in the state. Opening in 1964 with 113 beds, it now has 361 beds. It operates a physicians group with more than 50 physicians at 17 locations at last count. In Dec. 2010, the hospital signed a definitive agreement to merge with 159-bed Delnor Health System in nearby Geneva, Ill., pending regulatory review. Previously, Central DuPage signed an affiliation agreement with Cleveland Clinic's cardiac surgery program to improve heart care and refer complex cases to Cleveland Clinic.

The Christ Hospital (Cincinnati, Ohio)
With a staff of more than 1,000 physicians, this 555-bed hospital boasts major services lines in cardiovascular care, spine treatment, women’s health, major surgery, cancer, behavioral medicine, orthopedics, emergency care and kidney transplants. The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital has participated in more than 1,000 clinical research trials, including 130 active trials. Among other distinctions, the hospital was the 2010 Top Workplace in Greater Cincinnati and Northern Kentucky by Cincinnati.com.

Christiana Care Health System (Wilmington, Del.)
Christiana Care is a teaching hospital with two campuses, more than 1,100 beds and more than 240 residents and fellows. The system has launched two health IT initiatives on meaningful use standards, utilizing its computerized provider order entry system and the nation's first statewide health information network. It has an Aa3 bond rating with Moody's Investor Services. In addition to other recognitions, Christiana Care received a three-star rating from the Society of Thoracic Surgeons in 2009 and the Ernest A. Codman Award from the Joint Commission in 2007.

Cleveland Clinic (Cleveland)
The Cleveland Clinic is always on the move. In recent months, it signed an affiliation agreement with Central DuPage Hospital, announced it would help a group of physicians in the Washington, D.C., area turn their ideas into marketable inventions, began planning a Medical Mart in Cleveland and completed a $163 million expansion of its Hillcrest Hospital in Mayfield Heights, Ohio, ahead of schedule and under budget. This year, the clinic plans to launch the Center for Personalized Healthcare, which will create tools to help physicians develop care plans based on the individual characteristics of each patient.

Duke University Medical Center (Durham, N.C.)
With 924 licensed beds, this academic medical center has more than 10,000 full-time employees, of which about 15 percent have a medical or doctoral degree, or both. It is part of three-hospital Duke University Health System, which has an Aa2 bond rating from Moody's Investor Services. In Dec. 2010, the hospital began an $800 million expansion project, including a cancer center and a new hospital tower adding 20 percent more beds. Recently Duke initiated a community care model to reduce unnecessary ED visits in partnership with a local federally qualified health center.

Evanston (Ill.) Hospital
Evanston Hospital is the flagship of four-hospital NorthShore University HealthSystem, which has an Aa2 bond rating from Moody's Investor Services and annual revenue of more than $1.5 billion. With 775 beds and a staff of nearly 9,000, the hospital boasts a cancer center, cardiovascular care center and medical genetics program. "We stress the fact that we are a system of care, not just one place of care," said NorthShore President & CEO Mark R. Neaman. NorthShore was an early adopter of electronic medical records in 2003. Formerly known as Evanston Northwestern Healthcare, the system changed its name when it switched affiliation from Northwestern University to the University of Chicago Pritzker School of Medicine. One of NorthShore Medical Group's most recent acquisitions is 12-physician North Shore Cardiologists.

Hackensack (N.J.) University Medical Center
The medical center campus boasts one of the largest ambulatory facilities in the country, housed in a nine-story, 276,000-square-foot tower. This 775-bed teaching and research hospital is affiliated with the University of Medicine and Dentistry of New Jersey-New Jersey Medical School. It is the largest healthcare provider in the state, both in inpatient and outpatient services. In Jan. 2011, it opened a $130 million cancer center and a $25 million cardiac and vascular "hospital within a hospital." It also formed an affiliation with 111-bed Hackettstown (N.J.) Regional Medical Center to provide expertise there and send Hackettstown's more complex medical cases to Hackensack.

Hamot Medical Center (Erie, Pa.)
In Jan. 2011, the board of Hamot Health Foundation, the hospital's parent, voted to integrate into the University of Pittsburgh Medical Center. As part of the deal, UPMC has agreed to give Hamot $300 million to support expansion and improvements of medical services. The hospital has 417 physicians on staff, 3,159 employees and 375 beds. In addition to other awards, the American Heart Association and American Stroke Association honored Hamot with their "Get With The Guidelines" Stroke Gold Plus Performance Achievement Award and Highmark Blue Cross Blue Shield named it a Blue Distinction Center for cardiac care, bariatric surgery and knee and hip replacement.

Henrico Doctors' Hospital (Richmond, Va.)
This 340-bed hospital, part of the HCA Virginia Health System, derives its name from Henricus, an early settlement massacred by Powhatan Indians in 1622, then rebuilt nearby as Virginia's new capital. The hospital was called Henrico Doctors' Hospital-Forest until Feb. 2009, when the name was simplified. The opening of a cardiac medical intensive care unit and a new ED in Jan. 2011 is the latest phase of its five-year, $100 million renovation. An intra-operative MRI suite opened in April 2010 and the hospital will open a new lobby, a pre-admission testing area, a laboratory and a satellite pharmacy in fall 2011. The hospital was the first in central Virginia to receive patient data via WiFi. Among many distinctions, the hospital received the outstanding achievement award from the American College of Surgeons Commission on Cancer, an award given to less than 20 percent of all cancer centers.

Hospital of the University of Pennsylvania (Philadelphia)
The hospital recently announced plans to begin a hand transplant program limited to people who have lost both hands. It is the flagship of Penn Medicine, which includes University of Pennsylvania School of Medicine, two other large hospitals, primary care and specialty groups, and affiliations with 11 community hospitals. Penn Medicine has nearly 2,100 physicians on staff (including more than 1,800 full-time faculty), more than 1,000 residents and fellows and 18,000 employees. In addition to other recognitions, the hospital won the 2010 Delaware Valley Patient Safety Award.

Inova Fairfax Hospital (Falls Church, Va.)
With 904 beds, Inova Fairfax Hospital is the largest hospital in Northern Virginia and the biggest hospital in greater Washington D.C., based on revenue. It is part of Inova Health System, which has had an Aa2 bond rating from Moody's Investor Services. Inova is partnering with Virginia Commonwealth University to create VCU School of Medicine Inova Campus. In Dec. 2010, the system announced plans to add up to 250 primary care physicians to its medical group, more than doubling its size. In addition to other distinctions, it received a three-star cardiac ranking by the Society for Thoracic Surgeons.

Jersey Shore University Medical Center (Neptune, N.J.)
This institution started in 1904 as a 50-bed convalescent home for women and children. It is now a 502-bed academic medical center affiliated with Robert Wood Johnson Medical School. Jersey Shore is part of Meridian Health, a five-hospital system that completed a merger with Bayshore Community Hospital and Health Services in Holmdel, N.J., in Sept. 2010. A $300 million expansion project at the medical center, completed in 2009, added 136 beds, a new ED and trauma center, surgical suites and an expanded outpatient pavilion. The medical center has been a winner of the John M. Eisenberg Award for Patient Safety from the National Quality Forum.

Johns Hopkins Hospital (Baltimore)
The 1,025-bed hospital is in the middle of a $1 billion redevelopment, scheduled to open in 2012, that will feature 560 private rooms, 33 new ORs and a large ED. It is part of Johns Hopkins Health System, which grew from two to six hospitals in just three years. "We did not go out searching for hospitals," said Edward D. Miller, CEO of Johns Hopkins Medicine, who oversees the system. These hospitals sought out Johns Hopkins. The system's flagship has a venerable history, having practically invented the concept of the teaching hospital and coining such terms as "residents," "rounds" and "house staff."

Lehigh Valley Hospital (Allentown, Pa.)
Part of two-hospital Lehigh Valley Health Network, this 514-bed hospital is a clinical campus of Penn State University College of Medicine and has 1,100 physicians on staff, including 400 employed by the health network. In addition to other recognitions, the hospital won the 2010 Quality Leadership Award from the University HealthSystem Consortium. It operates the third largest heart surgery program and the fourth largest cancer program in the state.

Massachusetts General Hospital (Boston)
The third-oldest hospital in the nation, Mass General is celebrating its bicentennial this year. This summer it will open a $579 million, 10-story addition that will increase its bed count by almost 20 percent while adding 19 ORs and a new ED. It is a founding partner of Partners Healthcare System, which has an Aa2 bond rating with Moody's Investor Services. The major teaching hospital of Harvard University, Mass General has one of the largest hospital-based research budgets in the world. It is the largest non-governmental employer in Boston, with more than 10,000 employees.

Mayo Clinic (Rochester, Minn.)
Mayo Clinic is often thought of as a large multispecialty practice but it runs a substantial inpatient operation, using 1,265-bed Saint Marys Hospital and 794-bed Rochester Methodist Hospital. Mayo Foundation has an Aa2 bond rating from Moody's Investor Services. In addition to other awards, it won the Quality Leadership Award from the University HealthSystem Consortium in 2010 and the American College of Surgeons recognized Mayo for exemplary outcomes in 2009. Recently, Mayo formed a research alliance with the University of Illinois at Urbana-Champaign and indicated an interest in partnering with providers in the Chicago area.

Munson Medical Center (Traverse City, Mich.)
Positioned near the gateway to the isolated Upper Peninsula of Michigan, Munson's service area stretches into 32 Michigan counties and it has nearly 400 physicians on staff. The medical center delivered a shocker in Sept. 2010, when it pulled out of a planned merger with Spectrum Health in Grand Rapids, Mich. New suitors, such as University of Michigan Health Systems, emerged immediately. The 391-bed hospital is a real prize, having won the American Hospital Association-McKesson Quest for Quality Prize in 2008 and having been the only hospital in the state to win the Everest Award from Thomson Reuters in 2009.

New York-Presbyterian University Hospital of Columbia and Cornell (New York City)
This huge hospital is made up of two institutions: NewYork-Presbyterian Hospital/Columbia University Medical Center and NewYork-Presbyterian Hospital/Weill Cornell Medical Center. It is affiliated with Columbia University College of Physicians and Surgeons and Weill Cornell Medical College. Two of its physician-scientists, Mehmet Oz, MD, and Nicholas Schiff, MD, ranked in Time Magazine's annual list of the top 100 most influential people in the world.

Northeast Regional Medical Center (Kirksville, Mo.)
Northeast Regional, part of Franklin, Tenn.-based Community Health Systems, is closely affiliated with Kirksville College of Osteopathic Medicine, the birthplace of osteopathy, where osteopathic-founder Andrew Taylor Still's original office is on display. With 115 beds, it has with more than 130 physicians on staff in 26 specialties and subspecialties, and 123 full-time registered nurses. It logs 4,243 admissions, 1,390 inpatient surgeries and 77,764 outpatient visits a year. Among its distinctions, Northeast Regional is the only Missouri hospital to be named an Everest winner by Thomson Reuters and won the Quality Respiratory Care Recognition award in 2010.

Northwestern Memorial Hospital (Chicago)
A new 897-bed facility for Northwestern Memorial opened in 1999, located in two towers in Chicago's posh Streeterville neighborhood. Northwestern Memorial has a medical staff of more than 1,500 physicians who are faculty at Feinberg School of Medicine at Northwestern University. The hospital has an Aa2 bond rating from Moody's Investor Services. Northwestern's parent, Northwestern Memorial HealthCare, opened the $500 million Prentice Women's Hospital near Northwestern Memorial in 2007. In 2010 NMH acquired 215-bed Lake Forest (Ill.) Hospital and outpatient center in Grayslake, Ill.

Ochsner Medical Center (New Orleans)
With 473 beds, the medical center is the offspring of the fabled Ochsner Clinic, founded by surgeon Alton Ochsner in the 1942. It is the flagship of Ochsner Health System, which owns eight hospitals after purchasing 165-bed NorthShore Regional Medical Center in Slidell, La., in April 2010. To reduce crowding, the medical center's ED created a protocol called QTrack separating out the sickest patients and speeding up care for the others. Ochsner is one of the largest non-university based physician training centers in the nation, with more than 200 medical residents and more than 300 medical residents from affiliated programs. Among many distinctions, it won the Emergency Medicine Excellence Award and Kidney Transplant Excellence Award from HealthGrades in 2010.

Ohio State University Medical Center (Columbus, Ohio)
This 900-bed academic medical center is on a growth track. It won a $100 million federal construction grant in Dec. 2010 to add advanced radiation therapy for its new cancer center, boosting the budget for its planned expansion to $1.1 billion. A $649 million, 420-bed critical care and cancer hospital is expected to open in 2014. OSU Medical Center will spend $102 million on an electronic health record system over the next five years and its physicians and hospitals expect to win back $25 million in federal payments for meeting meaningful use standards for EHRs. The medical center's signature programs are in cancer, critical care, heart, imaging, neurosciences and transplantation. The medical center also operates Ohio State University Hospital East, which it purchased in 1999.

Poudre Valley Hospital (Fort Collins, Colo.)
This 241-bed hospital, the only one in Fort Collins, specializes in orthopedic surgery, neuroscience, cancer, bariatric weight-loss surgery, and women and family services. In 2008 its parent, two-hospital Poudre Valley Health System, which, among other distinctions, won the Baldrige Award, recognizing a handful of organizations across industries for performance excellence each year. In June 2010, the system announced it is partnering with Longmont (Colo.) United Hospital on a medical facility in Frederick, Colo. The hospital has received an American Nurses Association teaching hospital award for outstanding nursing quality three times in a row.

Presbyterian Hospital (Charlotte, N.C.)
This 531-bed hospital heads the Presbyterian Healthcare group, which operates two nearby community hospitals and is planning a third one. In turn, Presbyterian Healthcare is part of Novant Health, which operates a dozen hospitals with more than 3,000 beds. The Novant Medical Group consists of almost 1,100 physicians in 359 clinic locations seeing 3.9 million patients a year. Novant also operates outpatient surgery centers and 100 outpatient diagnostic imaging centers through its MedQuest subsidiary. Among other distinctions, Novant twice won the Ernest A. Codman Award from the Joint Commission for improving system-wide quality and safety.

Providence Hospital and Medical Center (Southfield, Mich.)
This 365-bed hospital is part of St. John Providence Health System and is home to 20,000 employees, 3,200 physicians, 175 medical offices and 10 hospitals in six counties. The system is part of Ascension Health, a Catholic organization that is the largest non-profit health system in the nation. Providence Hospital has more than 3,400 staff members, 1,500 physicians and about 150 residents in 19 residency programs. After more than 100 years in Detroit, the hospital moved to the suburbs in 1965. A few years ago, it opened a sister hospital, 200-bed, patient-friendly Providence Park Hospital in a 200-acre wooded campus in Novi, Mich.

Providence Regional Medical Center (Everett, Wash.)
Providence Regional is the third-largest hospital in Washington, with two campuses. It is currently building a $500 million, 368-bed tower, which will double capacity. In 2008, the medical center decided to grow Providence Physician Group to about 100 members over the next three years. To reach this goal, it has increased physicians' involvement in decision-making, such as giving them half the membership in a committee establishing priorities for its capital plan. The 268-bed hospital runs the largest musculoskeletal program in northwest Washington. It is part of Providence Health & Services, one of the nation's largest Catholic healthcare organizations, which has been adding hospitals and physician practices and becoming more integrated. Providence Health System has an Aa2 bond rating from Moody's Investor Services.

Rex Hospital (Raleigh, N.C.)
Part of UNC Healthcare, Rex has 4,600 employees, more than 1,100 physicians on staff, and 665 beds and treats nearly 34,000 inpatients each year. Rex Physicians, its group of employed physicians, works closely with UNC Physicians & Associates and UNC Healthcare on managed care contracts. In July 2010, state regulators approved Rex's certificate of need application to build a $60 million cancer hospital that will open in 2014. In addition to other distinctions, it received the Five Star Performer Award from Professional Research Consultants for Best Overall Quality of Care in 2010, for the third consecutive year.

Ronald Reagan UCLA Medical Center (Los Angeles)
This 520-bed medical center was totally rebuilt to conform to the latest California seismic safety requirements and reopened in 2008. In Sept. 2010, the Integrated Healthcare Association rated the affiliated UCLA Medical Group, with more than 1,000 physicians and 72 ambulatory practice sites, as one of California's top medical groups, meaning it had one of the highest overall performance in 2009 based on statewide pay-for-performance program measures. In addition to other distinctions, the medical center won the AHA Award for Heart Failure Care in Dec. 2010.

Rush University Medical Center (Chicago)
Rush, with 676 beds, operates its own medical school and is currently building a $617 million, 14-story acute and critical care tower, which will bring its total bed count to 720 when it opens in 2012. In 2009, the hospital and its affiliated orthopedic surgery group opened a five-story, $75 million orthopedic building. Under a federal grant for medical tourism, Rush is working with University HealthSystem Consortium to identify strategies to attract more foreign residents to seek care in the United States. Among Rush's many awards, the hospital's comprehensive stroke program won the Gold Performance Achievement Award.

Saint Alexius Medical Center (Bismarck, N.D.)
Founded in a hotel in downtown Bismarck by an order of Roman Catholic nuns in 1885, Saint Alexius treated both President Teddy Roosevelt and the son of the Sioux chief Sitting Bull. Since then, the medical center has grown to serve a vast region including central and western North Dakota, northern South Dakota and eastern Montana. It has 2,379 employees, including 100 physicians and mid-level providers. In addition to its 306-bed medical center, St. Alexius owns and operates two hospitals and several primary care clinics in North Dakota and manages a hospital in South Dakota. The medical center is sponsored by the Sisters of St. Benedict of the Annunciation Monastery.

St. Cloud (Minn.) Hospital
Founded in 1886 by the Sisters of the Order of St. Benedict, St. Cloud Hospital serves a 12-county area with a population of 671,308. The hospital is in the middle of a $225-million construction project, including a nine-floor wing featuring private rooms and new surgery suites, to be completed in 2011. Operating under the auspices of the Roman Catholic Church, the hospital has 489 licensed beds, more than 4,300 employees and a medical staff of 412 physicians. It is part of three-hospital CentraCare Health System, which also operates almost a dozen clinics. The average length of service of nurses at the hospital is 11 years.

St. Luke’s Episcopal Hospital (Houston)
St. Luke's operates within the famed Texas Medical Center and is affiliated with prestigious Texas Heart Institute. It is the 948-bed flagship of five-hospital St. Luke's Episcopal Health System, operated by the Episcopal Diocese of Texas. Almost two-thirds of more than 600 physicians on the hospital's active medical staff have teaching appointments at Baylor College of Medicine or the University of Texas Medical School at Houston. In 2002, the system acquired the Kelsey-Seybold physician group. In Nov. 2010, it acquired 51 percent of 61-bed Patients Medical Center, a physician-owned hospital in South Pasadena, Texas. In addition to other recognitions, Modern Maturity Magazine named St. Luke's Episcopal one of the 50 Top Hospitals in the U.S.

Saint Thomas Hospital (Nashville, Tenn.)
The hospital, with 541 beds, is part of four-hospital Saint Thomas Health Services, a member of Ascension Health, a Roman Catholic organization that is the largest not-for-profit health system in the nation. In 2010, Saint Thomas Health Services announced plans to double the number of outpatient rehabilitation clinics it operates in the next 18 months. In 2009, it announced an expansion of its neurosciences division. The hospital has 1,800 employees and 750 physicians on staff. Among many distinctions, the hospital won the American Stroke Association’s "Get With The Guidelines" Stroke Gold Performance Achievement Award in 2009.

St.Vincent Indianapolis Hospital (Indianapolis)
This 747-bed quaternary-care hospital is part of St.Vincent Health, one of the largest employers in the state, with more than 11,500 employees and 2,500 physicians. In 2010, the Care Group, the largest cardiology practice in the nation, with 135 physicians, joined St. Vincent Health. The system also owns three tertiary-care hospitals, seven critical access hospitals, seven specialty hospitals, several joint-venture partners and clinical affiliates. In Nov. 2009, it acquired minority ownership in Indiana Orthopedic Hospital from OrthoIndy, a physician-owned company. St.Vincent Health has been working with orthopedic surgeons to create a management company providing orthopedic services to hospitals across Indiana.

Sanford USD Medical Center (Sioux Falls, S.D.)
With 545 licensed beds, the hospital is the flagship of Sanford Health, the largest employer in the Dakotas, with 30 hospitals and a network of clinics serving five states. It changed its name from Sioux Valley Hospitals & Health System in 2007 upon receiving $400 million gift from businessman T. Denny Sanford. In 2010, Sanford recruited 75 physicians, announced plans to acquire an 80-bed hospital in Minnesota, build a new clinic in North Dakota and open two new hospitals in Minnesota and North Dakota. Among other distinctions, the medical center received national recognition for hip and knee replacement excellence from the Blue Cross and Blue Shield Association in 2010.

Spectrum Health Butterworth Hospital (Grand Rapids, Mich.)
The hospital dates back to 1846, when the Female Union Charitable Association was formed to ease the human suffering in the small frontier village of Grand Rapids. The primary care offices of Spectrum Health Medical Group have been designated patient-centered medical homes by Blue Cross Blue Shield of Michigan. Spectrum Health, the hospital's parent, is the largest not-for-profit health care system in West Michigan, with nine hospitals, more than 170 service sites and 1,881 licensed beds. Spectrum is the 9th most integrated health system, according to U.S. News & World Report. It is one of only 38 health systems in the nation with an Aa3 rating by Moody's Investors Service.

UCSF Medical Center (San Francisco)
The medical center, the first in the University of California system, was founded a year after the devastating 1906 earthquake and fire in San Francisco, which exposed the lack of healthcare services for the city. Affiliated with the University of California at San Francisco, the medical center has 600 beds, 7,000 employees and outreach clinics throughout Northern California. It includes UCSF Medical Center at Parnassus, UCSF Medical Center at Mount Zion and a planned 289-bed, $1.5 billion medical center in the Mission Bay district near downtown San Francisco, scheduled to open in 2014.

The University of Chicago Medical Center (Chicago)
Michelle Obama, who headed the medical center's community and external affairs department for seven years, helped found an ongoing collaborative to create medical homes for people on Chicago's South Side. The medical center has 532 beds, more than 9,500 employees, more than 700 attending physicians, nearly 900 residents and fellows and more than 1,500 nurses. University of Chicago Medical Center has an Aa3 bond rating with Moody's Investor Services. Affiliated with the University of Chicago Pritzker School of Medicine, it is staffed by more than 700 physicians from the University of Chicago Physicians Group.

University of Iowa Hospitals and Clinics (Iowa City)
This institution traces its roots back to 1873, when the University of Iowa's medical department signed an agreement with the Sisters of Mercy to operate a small hospital in the community. Today, it is a 762-bed institution that also includes University of Iowa Physicians, the state's largest multi-specialty medical group, with more than 650 physicians in 19 clinical departments. The hospital also employs 720 resident and fellow physicians and dentists, 1,671 nurses and nearly 5,000 other professional and support staff. The organization announced last year it was hiring 142 more nurses, citing an increase of in its daily inpatient count from about 50-70. It has an Aa2 bond rating from Moody's Investor Services.

University Medical Center (Tucson, Ariz.)
Besides saving the life of critically injured U.S. Rep. Gabrielle Giffords (D-Ariz.) following a senseless shooting on Jan. 8, University Medical Center has been very busy in the past year. In 2010, the hospital opened 116-bed Diamond Children's Medical Center, a partnership with the University of Arizona Steele Children's Research Center, merged with the physician practice of the University of Arizona College of Medicine and replaced Greg Pivirotto, who had been CEO for 21 years, with Kevin Burns, the former CFO. This year, the 487-bed hospital, on the campus of the Arizona Health Sciences Center, plans to complete its merger with University Physicians Hospital and the University of Arizona College of Medicine to form UA Healthcare.

University of Michigan Hospitals and Health Centers (Ann Arbor, Mich.)
Physicians in UMHS saved $15 million in the first four years of the Medicare Physician Group Practice Demonstration Project, the precursor to ACOs, mainly by focusing on transitions of patients coming in and out of hospital. With 930 beds, 179 ICU beds, and 66 ORs, UMHS generates 44,683 total surgical cases a year. Moody's Investor Services gave University of Michigan Hospitals an Aa2 bond rating. Among many distinctions, the HHS Hospital Compare Report gave UMHS high marks in for care in heart attack, heart failure, pneumonia and surgical infection prevention.

University of Pittsburgh (Pa.) Medical Center Presbyterian
Presbyterian Hospital, founded in 1893, took over a small medical school in 1908 and renamed it the University of Pittsburgh. Today, this 1,602-bed hospital is a leading center for organ transplantation, cardiology and cardiothoracic surgery, critical care medicine, trauma services, neurosurgery and cancer. The hospital is the flagship of UPMC, with 20 hospitals, 400 outpatient sites and physicians' offices and an insurance plan. UPMC had a $77 million increase in operating revenues in summer 2010. Overseas, the system operates in Italy, Ireland and Qatar, and plans to enter China. UPMC recently announced plans to integrate 375-bed Hamot Medical Center in Erie, Pa.

UW Medical Center (Seattle)
The medical center is the flagship of UW Medicine, which owns or operates three hospitals and is affiliated with the University of Washington School of Medicine. Its parent, UW Medicine, also operates Harborview Medical Center. The medical center acquired Northwest Hospital & Medical Center in Seattle in 2009 and is now discussing an affiliation with Valley Medical Center in Renton, Wash. The medical center has 450 licensed beds, 4,311 employees and 1,823 physicians on staff. In 2009, it broke ground on a project to provide additional space for premature babies, oncology programs and diagnostic imaging.

Vanderbilt University Medical Center (Nashville, Tenn.)
The medical center owes its name to Cornelius Vanderbilt, a New Yorker and once the wealthiest man in America, who bequeathed $1 million for Vanderbilt University at his death in 1877. Today the 832-bed medical center includes Vanderbilt University Hospital, with 600 beds, a children's hospital, cancer center, psychiatric hospital, rehabilitation hospital and more than 50 satellite clinics. The medical center pioneered electronic medical records 10 years ago and its homegrown system is now commercialized as CareAlign. In Oct. 2010, the medical center announced plans to build a new $200 million medical campus in Franklin, Tenn., to attract fully insured patients in the suburbs.

Yale-New Haven (Conn.) Hospital
This institution, the birthplace of President George W. Bush, is the 944-bed flagship of three-hospital Yale-New Haven Health System, which commands a 20.5 percent market share for the whole state. It has a medical staff of 2,200 physicians and more than 500 residents and fellows training in more than 100 specialties and subspecialties and provides services to more than 503,000 outpatients a year. Among other distinctions, Yale-New Haven received the Connecticut Hospital Association's 2010 award for excellence in the delivery of healthcare through the use of data.

Related;

Best Hospitals For Liver Transplantation
On (November 17, 2010) – HealthGrades made available to organ transplant patients a list of those hospitals with the best track record for survival and chances of receiving a donor organ. This information is available, free to the public, at HealthGrades.com and is intended to help patients in need of kidney, lung, heart or liver transplants.

HealthGrades Liver Transplant Excellence Award recognized 4 recipients out of 95 hospitals evaluated:
California Pacific Medical Center – Pacific
UCSF Medical Center
Cleveland Clinic
Saint Lukes Episcopal Hospital

The ratings of individual hospitals, as well as the full methodology of the analysis, can be found at http://www.healthgrades.com/.
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