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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_422"
                     title="Nurses Often Silent About Workplace Violence (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/HospitalBasedMedicine/WorkForce/tb/18335?impressionId=1265758764757"
                     
      The physical and verbal abuse nurses face on the job often goes unreported, according to an Australian survey.&lt;br&gt;
&lt;br&gt;Over the prior year, 52% of nurses in one community hospital said they had been physically assaulted and 69% reported being threatened with violence, according to Rose Chapman, PhD, of the University of Western Australia in Perth, and colleagues.&lt;br&gt;
&lt;br&gt;Verbal abuse was almost universal, being reported by 92% of respondents, the researchers wrote in the February issue of the &lt;em&gt;Journal of Clinical Nursing&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;However, only half mentioned the incidents to senior staff or co-workers, and just 16% filed an official report.&lt;br&gt;
&lt;br&gt;&quot;The reasons for not reporting are many and may include lack of time and management support and the belief that being attacked is &apos;just part of the job,&apos;&quot; they wrote.&lt;br&gt;
&lt;br&gt;The same is true in the U.S., where assaults and under-reporting appear just as common as suggested in the Australian survey, commented Kathleen M. McPhaul, PhD, RN, MPH, of the University of Maryland School of Nursing in Baltimore, who has been involved in such research in the U.S.&lt;br&gt;
&lt;br&gt;A culture change would likely be needed to make a real difference for nurses, Chapman&apos;s group suggested.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Hospitals would have to ensure that nurses have necessary support, education, encouragement, and time to complete official reports. Nurses who report abuse should get positive feedback from all levels of nursing, they said.&lt;/p&gt;
&lt;p&gt;&quot;If administrators and governments are serious in their intention to reduce workplace violence and provide staff with safe work environments, they should be seen to act on all reported [incidents],&quot; which is rare today, Chapman&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;However, currently there&apos;s no strong lever or incentive to address this kind of workplace abuse since hospitals focus mainly on patient safety as part of accreditation, and national and state workplace safety organizations have little mechanism for monitoring such incidents, McPhaul noted.&lt;/p&gt;
&lt;p&gt;The researchers&apos; survey was intended to reach all 332 nurses working at one nontertiary hospital across all departments  --  emergency, medical, surgical, maternity, pediatric, and mental health.&lt;/p&gt;
&lt;p&gt;The 113 nurses who responded were mainly women in their early 40s who worked part time.&lt;/p&gt;
&lt;p&gt;Among them, about three-quarters reported at least one incident of workplace violence over the preceding 12 months  --  25% said it occurred weekly, 27% said monthly, and for 25% it was rarer, at once every six months. &lt;ul&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;Fully 30% of the nurses said they had been involved in an episode involving a weapon  --  often hospital equipment and more rarely a knife or gun.&lt;/p&gt;
&lt;p&gt;The number of total incidents was lowest among nurse midwives, with a mean of 1.67 per year.&lt;/p&gt;
&lt;p&gt;Not surprisingly, the rate was highest among emergency department and mental health staff, who reported an average of 46.43 and 40.39 episodes over 12 months.&lt;/p&gt;
&lt;p&gt;One reason behind the high risk in these two departments may be the &quot;shift to a community-based approach to mental health care and a reduction in mental health beds&quot; such that the same psychiatric patients that assault mental health department nurses are mainstreamed to the emergency department as their point of entry to the hospital, the researchers said.&lt;/p&gt;
&lt;p&gt;However, more years of experience or higher educational qualification didn&apos;t appear to protect nurses. Senior nurse unit managers and clinical nurse specialists actually reported more physical assaults than less senior nurses.&lt;/p&gt;
&lt;p&gt;Age and gender didn&apos;t predict occurrence or type of incident either.&lt;/p&gt;
&lt;p&gt;When nurses did report workplace violence or verbal abuse, it was most often to their immediate manager (29%), other senior nursing staff (14.5%), or to their friends and colleagues (6%).&lt;/p&gt;
&lt;p&gt;Overall, 30% of nurses who responded to the survey gave as their reason for not reporting that workplace violence happens all the time and is simply part of the job.&lt;/p&gt;
&lt;p&gt;Even among those who did make a report of some sort, half said they thought hospital management failed to act on it.&lt;/p&gt;
&lt;p&gt;In fact, when the researchers audited hospital records, they found that 42 official incident reports had been filed by nurses over the prior one year period, nearly always involving injuries.&lt;/p&gt;
&lt;p&gt;In 95% of the cases, the only action taken by the hospital was making staff in the area aware of the incident. No other actions had been documented.&lt;/p&gt;
&lt;p&gt;The researchers cautioned that the voluntary nature and limited scope of the study may have limited generalizability, although the occurrence of violence against nurses is likely similar across developed countries.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers provided no information on conflicts of interest.&lt;/p&gt;&lt;p&gt;McPhaul reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_228"
                     title="Nurses Should Have a Bigger Leadership Role in Healthcare"
                     score="-0"
                     href="http://www.medpagetoday.com/PracticeManagement/StaffingScheduling/tb/18080?impressionId=1265758764757"
                     
      &lt;p&gt;Opinion leaders across a wide variety of groups think nurses should have more influence in health policy, planning, and management, according to a new Gallup survey.&lt;/p&gt;
&lt;p&gt;Although nurses are viewed as being the most valued source of health information behind physicians, survey respondents rank them as the least likely of healthcare stakeholders  --  including patients  --  to have a great deal of influence in healthcare reform over the next 10 years.&lt;/p&gt;
&lt;p&gt;This despite the fact that among the 1,504 thought leaders in academia, insurance, health services, government, industry, and the corporate world polled, 51% said nurses are very important in reducing medical errors and improving patient safety, and 50% said they are very influential in improving the quality of patient care.&lt;/p&gt;
&lt;p&gt;The major barriers to increased nurse influence, nearly 70% of respondents said, are perceptions that they are lower on the totem pole than physicians when it comes to decision-making and revenue generation.&lt;/p&gt;
&lt;p&gt;When asked what could be done to ensure that nurses take on more leadership responsibility, the first priority, respondents said, was that they make their voices heard  --  56% had said that nursing lacks a single voice in speaking on national issues. More than half of respondents also noted that there was a lack of opportunities for nurses to advance into leadership positions.&lt;/p&gt;
&lt;p&gt;The survey, conducted by Gallup for the Robert Wood Johnson Foundation, examined professional views of nursing, nursing leadership, the future of the industry, and potential barriers to leadership roles for nurses among various healthcare-related groups. It included responses from opinion leaders in academia (276), health services (253), government (253), industry (253), insurance (237), and the corporate world (232).&lt;/p&gt;
&lt;p&gt;Nine out of 10 said nurses should have more influence in increasing the quality of care and reducing medical errors.&lt;/p&gt;
&lt;p&gt;About 85% said they wanted nurses to have more influence in promoting wellness and preventive care, improving efficiency and cost, coordinating care through the healthcare system, and adjusting care to meet an aging population.&lt;/p&gt;
&lt;p&gt;Additionally, 72% thought increased nurse influence would help the healthcare system adapt to the growing change in ethnic, racial, and cultural diversity in patient populations.&lt;/p&gt;
&lt;p&gt;The opinion leaders were also asked whether they feel there is a nursing shortage in the U.S. Just over 80% said Yes and of those, only 2% said it was not a serious problem.&lt;/p&gt;
&lt;p&gt;To blame for the shortage? Respondents cited a stressful/poor work environment (44% see that as a very important reason), not enough openings in nursing schools (40%), and too many nurses leaving the profession (37%). Only 22% cited low pay as very instrumental in causing the shortage.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_157"
                     title="COLUMN: Re-engineering Made Easy"
                     score="-0.005"
                     href="http://www.medpagetoday.com/Columns/17986?impressionId=1265758764757"
                     
      &lt;p&gt;Re-engineering was a catch-phrase in the business world not long ago, and it has crept into the medical &quot;business&quot; too. But what does it really mean to &quot;re-engineer your practice&quot;?&lt;/p&gt;
&lt;p&gt;According to Michael Hammer and James Champy, authors of the seminal book about re-engineering, it is &quot;the fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical contemporary measures of performance, such as cost, quality, service, and speed.&quot;&lt;/p&gt;
&lt;p&gt;The principles of re-engineering are:&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Combine tasks&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Empower employees&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Perform process steps in a natural order&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Design processes to be flexible&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Minimize checks and controls&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Implement hybrid centralized/decentralized operations&lt;/p&gt;
&lt;p&gt;&amp;#8226;	Manage customers (read patients) through a single point of contact&lt;/p&gt;
&lt;p&gt;How do you apply those principles to your practice? Here&apos;s where we make it easy with an example that happens over and over in different specialties across the country.&lt;/p&gt;
&lt;p&gt;Example:&lt;/p&gt;
&lt;p&gt;&lt;em&gt;Tim, a patient in an internal medicine practice, has a prescription that is due to expire about two weeks before his scheduled annual exam. On a Monday, a couple days before it expires, he calls the medical office to get his prescription reissued. About two hours later, he gets a call from the pharmacist explaining that the pharmacy doesn&apos;t have his medication in stock, but it will be arriving the next day and it will cost about $60. &lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;Tim is puzzled by this because in the past he paid only his $10 prescription copay for the medication. The pharmacist explains that the prescription that the doctor&apos;s office transmitted is not for a generic. Tim is even more puzzled because all his previous prescriptions were written for generics. &lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;So, Tim calls the practice for a second time (by now, it is midafternoon) to get the prescription written as the generic he was trying to refill.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt;On Tuesday morning Tim goes to the pharmacy but they claim they have received nothing from the medical practice. So Tim calls the practice while he&apos;s at the pharmacy. He explains the situation as an extension of the previous afternoon&apos;s call.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;&lt;em&gt; But the secretary who answered the call is not the person Tim spoke with yesterday. She is confused about which medication is generic but promises to have the prescription rewritten to fill with the generic and transmit that to the pharmacy. Doing so will probably take a couple of hours she tells Tim, who leaves the pharmacy knowing he&apos;ll have to make yet another trip and vows to call before going.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;So, one &quot;simple&quot; medication reissue request generated three unique phone calls from the patient to the practice, a call from the pharmacist to the patient, and two trips to the pharmacy by the patient.&lt;/p&gt;
&lt;p&gt;It is painfully obvious that we created the problem in the practice when we mishandled the initial request. Less obvious is how to re-engineer to avoid such a situation  --  how to rethink our process so that we achieve a dramatic improvement in the cost of our operation and the service to our patient.&lt;/p&gt;
&lt;p&gt;We need to stop and ask why we are getting that initial call to reissue the medication in the first place. A radical redesign of our process would be coordinating prescription expirations with follow-up appointments!&lt;/p&gt;
&lt;p&gt;In other words, Tim must be given an appointment for his annual exam that occurs before the date his prescription will expire! That&apos;s the natural order to perform medication reissues, that&apos;s re-engineering and it&apos;s that easy!&lt;/p&gt;
&lt;p&gt;So, how do you get started in your practice?&lt;/p&gt;
&lt;p&gt;Look at the re-work and duplicative activities and the waste that occurs each day. Do you get prescription re-issue requests like Tim&apos;s? Start with all appointments from this day forward and be sure that you order a follow-up appointment that falls at least two weeks before the expiration of the prescription order you&apos;re writing. If you write a 90-day prescription, order a follow-up appointment for 10 weeks from today instead of 12 weeks or three months.&lt;/p&gt;
&lt;p&gt;Look at other incoming telephone calls and examine why patients are calling  --  30% to 40% of incoming calls are from patients seen in the office in the preceding two weeks.&lt;/p&gt;
&lt;p&gt;Do patients have questions that should have been addressed during their appointment? Would a referral to a Web site with patient education material provided at the appointment reduce those calls?&lt;/p&gt;
&lt;p&gt;Are patients calling to learn about test results? Look to re-engineer the process for notifying patients about their tests and eliminate those calls.&lt;/p&gt;
&lt;p&gt;Manage all the calls through a single point of contact  --  a centralized call center. The size of your call center will vary depending on the size of your practice. A one- or two-physician practice may get by with only one person, while a practice with 20 providers may need three to five FTEs to staff the call center.&lt;/p&gt;
&lt;p&gt;Rethinking the way you handle prescriptions and refill calls can cut down on the number of times patients phone the practice, and that can save significant dollars  --  each incoming call costs the practice just under $10, on average.&lt;/p&gt;
&lt;p&gt;In the case of our hypothetical patient Tim, better timing on prescription refills or his office visit would have saved $30 and a lot of aggravation.&lt;/p&gt;
&lt;p&gt;Re-engineering is as easy as looking at the processes that you do every day over and over and rethinking how to improve them. Take time out to rethink and you&apos;ll have made re-engineering easy!&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20090101_19_4133"
                     title="The Top 10 Medical Advances of the Decade"
                     score="-0.005"
                     href="http://www.medpagetoday.com/InfectiousDisease/PublicHealth/tb/17594?impressionId=1265758764757"
                     
      &lt;p&gt;The first decade of the 21st Century brought a number of discoveries, mistakes, and medical advances that have influenced medicine from the patient&apos;s bedside to the medicine cabinet.&lt;/p&gt;
&lt;p&gt;In some cases these advances changed deep-seated beliefs in medicine; in others, they opened up possibilities beyond what doctors thought was possible years ago.&lt;/p&gt;
&lt;p&gt;ABC News, in collaboration with &lt;em&gt;MedPage Today&lt;/em&gt; reached out to more than 800 specialists as well as a distinguished panel of medical historians to put together a top 10 list of medical advances one decade into this century.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;1. Human Genome Discoveries Reach the Bedside&lt;/strong&gt;&lt;/p&gt;

&lt;p&gt;In 2000, scientists in with the International Human Genome Project released  a rough draft of the human genome to the public. For the first time the world could read the complete set of human genetic information and begin to &lt;a href=&quot;http://abcnews.go.com/Health/story?id=5490354&quot; mce_href=&quot;http://abcnews.go.com/Health/story?id=5490354&quot; target=&quot;_blank&quot;&gt;discover what our roughly 23,000 genes do&lt;/a&gt;.&lt;/p&gt;
&lt;p&gt;Mapping the human genome had become a race of time and money in the 1990s, with two competitors at the forefront: the government-funded Human Genome Project, which completed its task in 15 years with more than $3 billion in taxpayer money, and a private company, Celera Genomics, which was financed with $100 million and took less than a decade.&lt;/p&gt;
&lt;p&gt;Both groups announced a rough draft at joint press conference on June 26, 2000.&lt;/p&gt;
&lt;p&gt;In 2003 a &quot;final&quot; draft was released by researchers, and in 2007 more updates to the genome were published by Craig Venter, PhD, chief scientist behind Celera Genomics.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s the precursor for lots of medical advances,&quot; said Venter, now chairman and president of the nonprofit J. Craig Venter Institute.&lt;/p&gt;
&lt;p&gt;&quot;That was absolutely the hope for it, that it will begin to change things,&quot; said Venter, who was awarded the National Medal of Science by President Obama last month for his work on the human genome.&lt;/p&gt;
&lt;p&gt;At the moment Venter sees more medical potential than medical achievements in genomic research. But when those advances do come, Venter predicts it will help preventative medicine and cut our rapidly accelerating medical costs from increasingly expensive treatments.&lt;/p&gt;
&lt;p&gt;&quot;I think the biggest area of the future will be preventive medicine,&quot; said Venter. &quot;By understanding the genetic causes and links to disease we can spend more and more attention on preventing disease.&quot;&lt;/p&gt;
&lt;p&gt;For example, Venter said doctors have &lt;a href=&quot;http://abcnews.go.com/Health/AmazingAnimals/story?id=8421218&quot; mce_href=&quot;http://abcnews.go.com/Health/AmazingAnimals/story?id=8421218&quot; target=&quot;_blank&quot;&gt;developed a genetic test&lt;/a&gt; for a gene associated with prostate cancer, &quot;and there&apos;s a drug available that greatly lowers the risk for prostate cancer in the future.&quot;&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;2. Doctors and Patients Harness Information Technology &lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Patients may not even think of it as they sign in with a pad and pen, then sit in the waiting room while the nurse pulls their file. But doctors say the Internet and information technology has actually changed the way they practice medicine for the better. Even doctors need to look things up from time to time.&lt;/p&gt;
&lt;p&gt;&quot;Early in practice, if I had a clinical question to research, I had to go to the library, pull out multiple years of the Index Medicus, look up the topic, write down the references, go to the stacks and pull the volumes of journals, find the article, read the article, go to the copy machine and make a copy&amp;amp; if I were lucky, I would have my answer in about four hours,&quot; said John Messmer, MD, associate professor at the Penn State College of Medicine in Hershey.&lt;/p&gt;&lt;img src=&quot;/upload/2009/12/17/17582_1.jpg&quot;&gt;
&lt;p&gt;&quot;Now I can be on rounds and in five minutes have more information on the topic than I need&amp;amp; on my iPod Touch, I can look up a medication, check the formulary to see if it&apos;s covered, check for interactions with a patient&apos;s other meds and double-check details of the pharmacology of the med plus quickly review the problem I am treating, and I don&apos;t even have to go online,&quot; said Messmer.&lt;/p&gt;
&lt;p&gt;Information technology has also, to some degree, made life safer for the patient. Once admitted to a hospital, they get a bar code which matches their blood samples and their IVs.&lt;/p&gt;
&lt;p&gt;&quot;The ways in which computer systems are improving hospital care&amp;amp; are pervasive and radical,&quot; explained  Margaret Humphreys, MD, PhD, editor of the &lt;em&gt;Journal of the History of Medicine&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;But many physicians have been reluctant to go digital because there is a significant upfront investment, which is why several of the healthcare reform measures now before Congress include provisions to underwrite some of this cost.&lt;/p&gt;
&lt;p&gt;And with or without reform, the Obama administration has an ambitious program aimed at &lt;a href=&quot;http://abcnews.go.com/Health/HealthCare/story?id=7907291&amp;amp;page=1&quot; mce_href=&quot;http://abcnews.go.com/Health/HealthCare/story?id=7907291&amp;amp;page=1&quot; target=&quot;_blank&quot;&gt;converting paper records to electronic health records. &lt;/a&gt;It has earmarked $20 billion to pay for the switch-over and named medical IT wonk David Blumenthal, MD, to serve as National Coordinator for Health Information Technology.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;3. Anti-Smoking laws and Campaigns Reduce Public Smoking&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;There is no national smoking ban in the U.S., but 27 states and the District of Columbia have enacted smoking bans, including seven states that ban smoking in bars and casinos in recent years.&lt;/p&gt;
&lt;p&gt;In a report issued last October, the Institute of Medicine said those public smoking bans have cut exposure to secondhand smoke, which, in turn, has contributed to a reduction in heart attacks and death from heart disease.&lt;/p&gt;
&lt;p&gt;Lynn Goldman, MD, of Johns Hopkins Bloomberg School of Public Health, who chaired the committee that wrote the Institute&apos;s report, said the debate was over  --  &quot;&lt;a href=&quot;http://www.medpagetoday.com/PrimaryCare/Smoking/16451&quot; mce_href=&quot;http://www.medpagetoday.com/PrimaryCare/Smoking/16451&quot; target=&quot;_blank&quot;&gt;Smoking bans work&lt;/a&gt;.&quot;&lt;/p&gt;&lt;img src=&quot;/upload/2009/12/17/17582_2.jpg&quot;&gt;
&lt;p&gt;Experts in the history of medicine agreed.&lt;/p&gt;
&lt;p&gt;&quot;Anti-smoking campaigns (at least in the U.S.), including banning of smoking in workplaces and public places, [have] enormous impact across socioeconomic classes on many diseases,&quot; said Humphreys, who added that smoking increases the risk for strokes and many cancers.&lt;/p&gt;
&lt;p&gt;In terms of the greatest good for the greatest number, there can be no doubt that the decline in smoking (through various means) has had the greatest impact,&quot; said Humphreys. &quot;Virginia and North Carolina are just getting around to banning cigarettes in all restaurants now, so the public bans do track over the last 10 years.&quot;&lt;/p&gt;
&lt;p&gt;While public smoking bans protect people from &lt;a href=&quot;http://www.medpagetoday.com/PrimaryCare/Smoking/17283&quot; mce_href=&quot;http://www.medpagetoday.com/PrimaryCare/Smoking/17283&quot; target=&quot;_blank&quot;&gt;secondhand smoke,&lt;/a&gt; doctors say they also motivate people to quit.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s probably the most important &apos;doable&apos; public health measure for decreasing morbidity and mortality,&quot; said Richard Kahn, MD, of Tenants Harbor, Maine. &quot;There is good data that as it becomes more difficult for people to smoke, more will quit.&quot;&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;4. Heart Disease Deaths Drop by 40 Percent&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Those looking for dramatic improvements in public health need look no further than the world of heart disease.&lt;/p&gt;
&lt;p&gt;A mere 25 years ago, when a patient came to a hospital with a heart attack, the best that could be done was to put the patient in a darkened room, give him or her morphine for pain and lidocaine, which doctors believed would prevent dangerous irregular heartbeats, and hope for the best.&lt;/p&gt;
&lt;p&gt;Heart attacks, called infarcts, were &quot;big&quot; and the damage to the heart muscle was often catastrophic, leading eventually to heart failure and death.&lt;/p&gt;
&lt;p&gt;By contrast, today treating a heart attack is all about speed: speed the patient to the hospital so that a clot that blocks the life-saving flow of blood can be &quot;busted&quot; with drugs like the genetically engineered tissue plasminogen activator or tPA.&lt;/p&gt;&lt;img src=&quot;/upload/2009/12/17/17582_3.jpg&quot;&gt;
&lt;p&gt;Or, if the problem is a vessel narrowed by buildup of plaque, a tiny flexible tube called a stent can be guided from an artery in the groin or the forearm up into the heart, where it is used to prop open the vessel to allow blood to flow normally.&lt;/p&gt;
&lt;p&gt;Still other patients are sent to surgery, where surgeons have learned sophisticated techniques to sew new vessels into the heart to bypass diseased arteries.&lt;/p&gt;
&lt;p&gt;Moreover, drugs that didn&apos;t exist 25 years ago  --  chiefly statins like simvastatin, Lipitor, mevacor, and Crestor  --  are now routinely used to slow the &lt;a href=&quot;http://www.medpagetoday.com/Cardiology/Atherosclerosis/17569&quot; mce_href=&quot;http://www.medpagetoday.com/Cardiology/Atherosclerosis/17569&quot; target=&quot;_blank&quot;&gt;progression of atherosclerosis,&lt;/a&gt; the medical term that describes the build-up of the hard, waxy substance called plaque that narrows arteries.&lt;/p&gt;
&lt;p&gt;Cardiologists say these efforts really began to bear fruit after 2000.&lt;/p&gt;
&lt;p&gt;&quot;In 1998/2000 the American Heart Association set a decade-long goal to reduce coronary heart disease and stroke and risk by 25% by 2010. We actually realized this goal by 2008 and have seen continued improvements in the reduction of deaths due to coronary heart disease and stroke,&quot; said Clyde Yancy, MD, of Baylor University Medical Center in Dallas, Texas. &quot;As of today, we have seen a near 40 percent reduction in death due to coronary artery disease since 1998/2000.&lt;/p&gt;
&lt;p&gt;Yancy said research shows about half of the gains in heart disease came from new treatment interventions, the other half (up to 60 percent) are due to prevention.&lt;/p&gt;
&lt;p&gt;&quot;Importantly, what this means is that the community &apos;gets it.&apos; Better control of blood pressure, preemptive lowering of blood cholesterol levels, better diets, and reduced smoking are resulting in fewer (cardiac) events,&quot; he said.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;5. Stem Cell Research: Laboratory Breakthroughs and Some Clinical Advances&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Probably no area of research has so fired the public imagination and so ignited the fires of public controversy as that of stem cell research. In reality, this area has generated more political action than reproducible clinical advances -- &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/StemCellResearch/17273&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/StemCellResearch/17273&quot; target=&quot;_blank&quot;&gt;the much-publicized ban on Federal funding of embryonic stem cell research was rescinded this year&lt;/a&gt;.&lt;/p&gt;
    &lt;img src=&quot;/upload/2009/12/17/17582_4.jpg&quot;&gt;
&lt;p&gt;But the clinical advances with embryonic or adult stem cells -- even when they have come from pilot studies -- have been tantalizing.&lt;/p&gt;
&lt;p&gt;For example, European researchers genetically manipulated bone marrow cells taken from two 7-year-old boys and then transplanted the altered cells back into the boys and apparently arrested the progress of a fatal brain disease called adrenoleukodystropy or ALD, which was the disease that affected the child in the movie &lt;a href=&quot;http://www.medpagetoday.com/Genetics/GeneralGenetics/16850&quot; mce_href=&quot;http://www.medpagetoday.com/Genetics/GeneralGenetics/16850&quot; target=&quot;_blank&quot;&gt;&quot;Lorenzo&apos;s Oil.&quot;&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;Cases like those fuel the promise of stem cell research, be it embryonic or adult stem cells. As the population ages, the opportunity for &apos;replacement parts&apos; becomes more and more inviting, and I&apos;m counting on stem cell research to give me, at least, new cartilage for my knees,&quot; joked Humphreys. &quot;This seems likely to be the future of regenerative medicine.&quot;&lt;/p&gt;
&lt;p&gt;Stem cell researcher George Daley, MD, PhD, of Children&apos;s Hospital in Boston, called progress in both adult and embryonic stem cell research this decade &quot;breathtaking.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Now we can make embryonic-like stem cells directly from skin cells, which makes it possible to model a multitude of human diseases in the petri dish. New drugs based on stem cells are being developed, and the first human clinical trial based on products of human embryonic stem cells is expected in 2010,&quot; said Daley. &quot;The science of the past decade has been spectacular, and we&apos;re hopeful that in the next decade, we&apos;ll start to realize the promise of new stem cell therapies.&quot;&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;6.Targeted Therapies for Cancer Expand With New Drugs&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Two blockbuster-targeted therapies burst on the cancer scene in late 1990s, and arguably changed forever the concept of cancer treatment, converting what was often a fatal disease into a chronic illness. The first, Herceptin, is a drug that targets a type of breast cancer that is characterized by a specific cancer gene  --  an oncogene  --  called HER-2.&lt;/p&gt;
&lt;p&gt;Women whose&lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/SABCS/17565&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/SABCS/17565&quot; target=&quot;_blank&quot;&gt; cancers express&lt;/a&gt; HER-2, which is estimated to be about 25 percent of women with breast cancer, will respond to Herceptin even when other powerful chemotherapy drugs have failed.&lt;/p&gt;&lt;img src=&quot;/upload/2009/12/17/17582_5.jpg&quot;&gt;
&lt;p&gt;Kimberly Blackwell, MD, of Duke University Medical Center, said doctors received a standing ovation when they presented the results of Herceptin drug trials.&lt;/p&gt;
&lt;p&gt;&quot;The introduction/approval of trastuzumab (Herceptin) and lapatinib (TyKerb) in breast cancer will prevent many women&apos;s breast cancers from recurring and have &lt;a href=&quot;http://abcnews.go.com/Health/WellnessNews/death-decline-cdc-finds/story?id=9351370&quot; mce_href=&quot;http://abcnews.go.com/Health/WellnessNews/death-decline-cdc-finds/story?id=9351370&quot; target=&quot;_blank&quot;&gt;significantly improved survival&lt;/a&gt; for many women faced with breast cancer. More important, these drugs represent highly effective agents that target the cancer, not the patient,&quot; said Blackwell.&lt;/p&gt;
&lt;p&gt;&quot;Probably one of the only standing ovations I will witness in my career was when [it was] presented by Edward Romond at the Annual Meeting of the American Society of Clinical Oncology.&quot;&lt;/p&gt;
&lt;p&gt;The other drug, a cancer pill called Gleevec, targets genetic mutation called bcr-abl (b.c.r. able) that causes cancer cells to grow and multiply in patients with a variety of cancers, including chronic myeloid leukemia or with &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ASCO/5821&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ASCO/5821&quot; target=&quot;_blank&quot;&gt;a stomach cancer called GIST.&lt;/a&gt;&lt;/p&gt;
&lt;p&gt;These two breakthrough agents opened the door to a number of cancer drugs that target specific molecules that control not only cell growth, but also the blood supply that feeds tumors.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;7. Combination Drug Therapy Extends HIV Survival&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Since the introduction of highly active antiretroviral therapy, or HAART, as this combination therapy approach is called, &lt;a href=&quot;http://abcnews.go.com/Health/AIDS/german-hitler-ad-shocks-aids-charities-us-uk/story?id=8516276&quot; mce_href=&quot;http://abcnews.go.com/Health/AIDS/german-hitler-ad-shocks-aids-charities-us-uk/story?id=8516276&quot; target=&quot;_blank&quot;&gt;HIV/AIDS has evolved into a serious, but chronic disease&lt;/a&gt; with survival stretching into decades.&lt;/p&gt;
&lt;p&gt;Moreover, this &quot;cocktail&quot; approach to treatment where drugs are combined in different ways or different sequences has become a model for treating other diseases ranging from lung cancer to heart disease.&lt;/p&gt;
&lt;img src=&quot;/upload/2009/12/17/17582_6.jpg&quot;&gt;
&lt;p&gt;&quot;In 1996 a 20-year-old person in the U.S. with AIDS expected to live about three to five years and now expects to live to be 69 years. That is amazing,&quot; said John Bartlett, MD, past president of the Infectious Diseases Society of America. &quot;Think of it -- in 1996 everyone in our HIV clinic was prepared to die. Now they all live. And most of them look great. They just need to take the meds.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Next challenge is the cure,&quot; said Bartlett.&lt;/p&gt;
&lt;p&gt;In more than a decade since the &lt;a href=&quot;http://www.medpagetoday.com/HIVAIDS/HIVAIDS/17238&quot; mce_href=&quot;http://www.medpagetoday.com/HIVAIDS/HIVAIDS/17238&quot; target=&quot;_blank&quot;&gt;emergence of HAART&lt;/a&gt;, researchers have constantly refined the regimens to improve results, with evidence now emerging that some combinations may be more effecting patients with more extensive disease.&lt;/p&gt;
&lt;p&gt;Thomas Coates, MD, of the University of California Los Angeles, pointed out that the HIV death rates are still dropping due to continual HIV research.&lt;/p&gt;
&lt;p&gt;&quot;The drop in death rates from HIV in the developed world (is) due to improved medications,&quot; Coates said. &quot;There was the 10 percent drop in deaths due to HIV in the US between 2006 and 2007.&quot;&lt;/p&gt;
&lt;p&gt;In Africa, where the HIV/AIDS crisis hits hardest today, Coates said doctors are slowly making progress-and in some cases real gains, which is the case with the use of antiretroviral drugs to block mother-to-infant HIV transmission.&lt;/p&gt;
&lt;p&gt;&quot;It has made a big difference in the developed world where vertical transmission rates have plummeted from over 1,000 at the peak to fewer than 100 per year (in the US),&quot; said Coates. &quot;Advances are being made in the developing world, with Botswana leading the way not with a 3% vertical transmission rate. It was the first and still is the most effective prevention strategy we have.&quot;&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;8. Minimally Invasive and Robotic Techniques Revolutionize Surgery&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Ten years ago a patient would typically be left with a 10-inch scar when a doctor removed a kidney, but in late 2007 the surgeons at the Cleveland Clinic began removing kidneys through a single incision in the patient&apos;s navel.&lt;/p&gt;
&lt;p&gt;And earlier this year, a Cleveland Clinic surgeon removed a diseased kidney from a woman using a technique called natural orifice translumenal endoscopic surgery or NOTES. In the case of the woman the kidney was removed through her vagina-an approach originally developed for hysterectomy. &lt;/p&gt;
&lt;p&gt;Tiny metal hands carefully manipulating sutures deep inside the heart seems like a scenario pulled from &quot;Star Trek,&quot; but the reality is that robotic surgery is occurring daily in a growing number of centers across the country.&lt;/p&gt;
    &lt;img src=&quot;/upload/2009/12/17/17582_7.jpg&quot;&gt;
&lt;p&gt;The greatest benefit of tiny openings into the body rather than large incisions made by traditional surgery, may -- believers say -- be shorter and less painful recovery time.&lt;/p&gt;
&lt;p&gt;Medical historian Sandra Moss, MD, believes this, especially after watching a sibling undergo a minimally-invasive surgery.&lt;/p&gt;
&lt;p&gt;&quot;My younger sister and I had the same operation 20 years apart. I was hors de combat (out of commission) for one month and loopy from pain meds for two weeks -- she was back at work in a few days on no pain medications,&quot; said Moss.&lt;/p&gt;
&lt;p&gt;Doctors have also used robotic surgery to improve the accuracy of procedures, especially in cancer cases.&lt;/p&gt;
&lt;p&gt;&quot;Robotic surgery increased the ability of cancer surgeons to get clean margins as well due to the magnification of the structures,&quot; said Douglas Bacon, MD, of the Mayo Clinic in Rochester, Minn.&lt;/p&gt;
&lt;p&gt;Richard Caselli, MD, of the Mayo Clinic in Scottsdale, Ariz., pointed out that robotic surgery &quot;offers the potential for surgeons to operate on patients remotely.&quot;&lt;/p&gt;
&lt;p&gt;But critics, and there are many, say the cost of the robotic hardware may outweigh the benefit. Moreover, critics say that the &lt;a href=&quot;http://www.medpagetoday.com/Urology/ProstateCancer/16406&quot; mce_href=&quot;http://www.medpagetoday.com/Urology/ProstateCancer/16406&quot; target=&quot;_blank&quot;&gt;robot revolution&lt;/a&gt; is racing ahead of the evidence.&lt;/p&gt;

&lt;p&gt;&lt;strong&gt;9. Study Finds Heart, Cancer Risk with Hormone Replacement Therapy&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Until July 2002 most doctors treating middle-age women believed that giving their patients hormones  --  either estrogen alone or estrogen combined with progestin  --  would protect their hearts from the ravages of age that seemed to attack women after menopause.&lt;/p&gt;
&lt;p&gt;Hormone replace therapy, or HRT, was also thought to be good for the bones, the brain, the skin, the figure, and the libido, and was considered the best treatment to control the annoying and sometimes disabling symptoms of menopause such as hot flashes, depression, and sleep disturbances.&lt;/p&gt;&lt;img src=&quot;/upload/2009/12/17/17582_8.jpg&quot;&gt;
&lt;p&gt;And then the world changed, the National Heart Lung and Blood Institute, which was sponsoring a placebo-controlled trial of hormone replacement therapy in more than 161,000 healthy women, announced that it was shutting down the study because HRT increased the risk of heart attack, stroke, blood clots, and breast cancer.&lt;/p&gt;
&lt;p&gt;It was the &quot;oops&quot; heard round the world.&lt;/p&gt;
&lt;p&gt;Larry Norton, MD, of the Memorial Sloan-Kettering Cancer Center in New York City, believes the two biggest advances in breast cancer this decade was the targeted-breast cancer treatment with Herceptin and &quot;the finding that postmenopausal hormone replacement is associated with a huge increase in the risk of breast cancer.&quot;&lt;/p&gt;
&lt;p&gt;But the news from the Women&apos;s Health Initiative, as the study was known, wasn&apos;t all bad. &lt;a href=&quot;http://www.medpagetoday.com/Endocrinology/Menopause/3046&quot; mce_href=&quot;http://www.medpagetoday.com/Endocrinology/Menopause/3046&quot; target=&quot;_blank&quot;&gt;HRT&lt;/a&gt; did reduce the risk of colorectal cancer and fractures and was proven to be an effective treatment for hot flashes and some other menopause symptoms.&lt;/p&gt;
&lt;p&gt;&lt;strong&gt;10. Scientists Peer Into Mind With Functional MRI&lt;/strong&gt;&lt;/p&gt;
&lt;p&gt;Mind-reading has moved from carnival attraction to the halls of medicine with what is known as a functional MRI.&lt;/p&gt;
&lt;p&gt;The medical mind-readers are not trying to identify a card randomly selected from a deck  --  they are using sophisticated imaging techniques to map the way the mind works.&lt;/p&gt;
&lt;p&gt;The process, often called fMRI, traces the working of neurons  --  brain cells  --  by tracking changes in the oxygen levels and blood flow to the brain. The more brain activity in one area, the more oxygen will be used and the more blood will flow to that area. The patient lies awake inside an MRI scanner. He or she is asked to perform a simple task, like identifying a color or solving a math problem.&lt;/p&gt;&lt;img src=&quot;/upload/2009/12/17/17582_9.jpg&quot;&gt;
&lt;p&gt;As the patient answers the question, the fMRI tracks the areas of the brain that are activated by tracing the speed at which the cells metabolize the sugar, or glucose.&lt;/p&gt;
&lt;p&gt;First developed in the early 1990s, fMRI began to shape research at the beginning of the decade.&lt;/p&gt;
&lt;p&gt;&quot;It has certainly taken off in the past 10 years as a means for studying the living human brain in action,&quot; said Caselli. &quot;It has given us innumerable insights into cognition, social interactions, reward systems, decision-making, and so on.&quot;&lt;/p&gt;
&lt;p&gt;Using this technique, researchers are learning valuable information about disease such&lt;a href=&quot;http://www.medpagetoday.com/Psychiatry/Depression/2976&quot; mce_href=&quot;http://www.medpagetoday.com/Psychiatry/Depression/2976&quot; target=&quot;_blank&quot;&gt; as depression&lt;/a&gt;, brain cancer, autism, memory disorders, and even conditions such as the skin disorder psoriasis.&lt;/p&gt;
&lt;p&gt;&lt;em&gt;This article was developed in collaboration with ABC News. &lt;/em&gt;&lt;img src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; mce_src=&quot;http://www.medpagetoday.com/upload/2009/10/1/14357_1.jpg&quot; alt=&quot;&quot;&gt;&lt;/p&gt;
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