Acortar las internaciones no significa peor atención: estudio EEUU

NUEVA YORK (Reuters Health) – Los hospitales de Asuntos del

Veterano (AV) de Estados Unidos pudieron reducir la duración de

las internaciones sin aumentar la cantidad de reingresos.

“A medida que los hospitales se volvieron más eficientes,

creció la preocupación porque estuvieran dándole el alta a

pacientes más enfermos y más rápido”, dijo el autor principal de

un nuevo estudio, doctor Peter Kaboli, del Sistema de Salud de

AV de la ciudad de Iowa. “De hecho, encontramos lo opuesto”,

agregó.

En Annals of Internal Medicine, el equipo de Kaboli escribe

que se está presionando a los hospitales para que disminuyan el

tiempo que los pacientes pasan allí. Pero algunos cuestionan si

el alta temprana eleva el riesgo de reinternación. Estas

segundas hospitalizaciones le cuestan Medicare unos 17.000

millones de dólares por año, según reveló un estudio del 2009.

Es más: el 1 de octubre del 2012, los Centros de Servicios

de Medicare y Medicaid comenzaron a utilizar las tasas de

reinternaciones y los resultados en los pacientes como dos

indicadores para determinar cuánto dinero deberían reembolsarles

a los hospitales.

El equipo de Kaboli estudió si la reducción del tiempo de

internación en los 129 hospitales de AV aumentaba la cantidad de

reinternaciones a los 30 días del alta médica. Para eso, analizó

más de 4 millones de historias clínicas electrónicas de AV de

los pacientes atendidos entre 1997 y el 2010.

En ese período, el tiempo promedio de internación se redujo

de 5,5 a 4 días y la cantidad de pacientes reinternados dentro

de los 30 días posteriores al alta médica cayó alrededor de 3

puntos porcentuales (del 16,5 por ciento en 1997 al 13,8 por

ciento en el 2010).

“Parecería que (la duración de la internación) no haría una

diferencia, pero al demostrar que reduce las reinternaciones

notamos que es una medida positiva”, dijo Kaboli.

Aun así, el equipo halló un punto en el que la internación

más breve estaba asociada con un aumento de los reingresos. Los

hospitales con internaciones de por lo menos un día menos que el

tiempo promedio registraban un aumento de las reinternaciones.

Por otro lado, el equipo observó que la cantidad de

pacientes que morían en el hogar dentro de los 90 días

posteriores al alta médica también fue disminuyendo en esos 14

años.

“Pudimos cuidar mejor a los pacientes, con mejor calidad de

la atención y con una reducción de las tasas de mortalidad al

mismo tiempo”, resumió Kaboli.

El doctor Manesh Patel, profesor asistente de cardiología de

la Duke University, en Durham, opinó que el estudio demuestra

que el sistema de AV mejoró en las áreas más sensibles para los

pacientes.

“La buena noticia es que existiría una conexión (…)

Algunas de las medidas que implementamos serían razonables”,

sostuvo Patel, que no participó del estudio, pero investiga el

tema de las reinternaciones.

FUENTE: Annals of Internal Medicine, online 17 de diciembre

del 2012

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Can Nepal’s Republic Be Saved?

If you were a politician in Nepal during the past two years, there’s some chance you may have been slapped. In January 2011—as well as in May and November of this year—three citizens who were fed up with chronic government inaction physically attacked three senior politicians.

Nepal’s citizens survived 10 years of a bloody Maoist insurrection that killed an estimated 16,000 people but also brought about the end of a centuries-old monarchy in 2008. Since then, however, the country has been hampered by chronic political and economic crises that have created a severe legitimacy crisis for the ruling elites. Can this nascent republic be saved?

It seems to be an impossible challenge in the near term. The current political crisis is so dire that there has been no parliament since May. In November, hints surfaced of a presidential coup to oust the Maoist-led caretaker government of Prime Minister Baburam Bhattarai. President Ram Baran Yadav heard advice from the military chief and the Indian ambassador about the best way out of the crisis, but he ultimately took no action. Weeks later, the political crisis persists.

On Nov. 29, Prime Minister Bhatterai and various political factions failed to meet the president’s deadline to form a national unity government that would lead to parliamentary elections for April or May. On Dec. 6, the factions failed again to meet the extended deadline. A day later, on Dec. 7, President Yadav offered yet another six-day extension. But the ruling alliance of the Unified Communist Party of Nepal (Maoist) and United Democratic Joint Madhesi Front, as well as the opposition Nepali Congress and Communist Party of Nepal, failed to select a prime ministerial candidate, missing the latest deadline. Amid such political deadlock, there has been no progress on a new constitution—a critical component of the peace deal that ended the Maoist civil war in the first place.

This political crisis has amplified the economic weaknesses of the aid-dependent country, a quarter of whose population lives below the poverty line. Youth unemployment is over 40 percent and job creation is a struggle, especially with growth expected to drop to 3.8 percent in 2012-13, from 4.5 percent the previous year, according to the International Monetary Fund. The approval of the government’s budget on Nov. 21 averted a major financial crisis that would have left half a million civil servants, soldiers, and police without pay. This was a rare spot of good news for the dysfunctional country.

Though India and China already have significant stakes in their neighbor, the political crisis puts further foreign investment in jeopardy. One report suggests that Nepal’s diplomats have secured additional investment abroad, but this is contingent on the establishment of a constitution and the return of political stability. Other potential investors, including many businessmen from Saudi Arabia, have admitted losing interest in Nepal because of the political impasse. The country’s dismal ranking of 141 (out of 176 countries) on Transparency International’s Corruption Perceptions Index, the recurring power crisis, and additional structural limitations are not helping matters.

If the political and economic situation continues to stagnate, and no constitution is finalized to unite the people, it is likely that ethnic and religious differences—as well as the frustrations of historically marginalized groups from lower castes—will serve as significant sources of conflict.

It’s clear that the ruling elites are rapidly losing domestic legitimacy. Unfortunately, this has not motivated them to resolve the political crisis with dispatch. Perhaps it’s time for foreign donors to apply overt pressure on Nepal by making future aid conditional on a resolution to the political deadlock.

Even if a political consensus emerges as to how to move forward, it will take time before Nepal’s rulers regain the legitimacy needed to allow the government to ease the economic crisis. If no consensus is reached in 2013, mass street protests—which in the past brought down the monarchy—are likely to resurface. The way things are going, another Nepali politician could get slapped.

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Showrooming little threat to clothiers in ho-hum holidays

Chicago (Reuters) – In retail, showrooming has not hit shirts yet.

Showrooming, the retail term for shoppers who try a product, then buy it cheaper on Amazon.com or other websites, has driven retailers to the point of hiding barcodes, improving their own websites and coming up with methods to get people to complete their purchase in the store.

But brand-name clothing retailers have an advantage over companies that sell items you can buy anywhere, like televisions and home goods.

“Specialty apparel retailers are some of the least affected by showrooming since the more exclusive the product is, the harder it is to showroom,” said Joel Bines, managing director of the retail practice at advisory firm AlixPartners.

That, in turn, has helped retailers like Gap Inc and Lululemon Athletica Inc find favor with investors.

A survey of 2,010 adults conducted by AlixPartners showed consumers who shop for apparel were among the least likely (35 percent) to go to other websites after they liked an item at a store, compared with 42 percent of electronics shoppers and 41 percent of those looking for accessories like watches and jewelry.

“If you look at some of the most successful (clothes) companies in the past few years, they are those that have that moat around them,” said hedge fund manager Shawn Kravetz, who runs Esplanade Capital in Boston.

He cites yogawear maker Lululemon and Gap as good examples of how it can help to have clothes that are not sold elsewhere.

If a shopper wants to buy a Banana Republic or Nordstrom shirt from the latest season, they have to buy it either from their stores or online shop.

Discount retailers like Zappos, Amazon and others stock brand-name products, but the merchandise is often not from the current season or limited in colors and sizes.

“I don’t need to see if a television fits my body shape when I buy a TV,” said Joe Megibow, senior vice president of omni-channel e-commerce at American Eagle Outfitters. The teen clothes retailer has seen better sales than its peers over the past year.

“I can get a sense of the TV and I’m good. Clothing is different. Does it fit me, is it my style, do I like the quality of the material and how it is put together. There’s so much more with apparel that matters,” he said.

That is the part of the reason, analysts say, why online-only clothing companies like Bonobos and Gap’s Piperlime have started opening brick-and-mortar stores or tied up with retailers to sell their products in physical locations.

Choice and easy availability are the two most important aspects of shopping, especially during a holiday season that has lost steam after what looked like strong Thanksgiving sales.

Estelle Tran, an “impulsive” shopper in her twenties, agreed.

“If I want to buy books, tech items, DVDs, I would definitely buy online. For clothes, I would rather (visit stores) as it is also a fun experience to try on clothes,” said the Chicago-based finance auditor.

Tran said she would definitely check prices online if she was spending more than $ 100.

Luxury and high-priced items can be more susceptible to showrooming, because pricing is what drives the behavior, said Marshal Cohen, chief economist at the consultancy NPD Group.

“With electronics and certain consumer goods it is very easy to compare specific brands across multiple websites. But (showrooming is) happening and it will be growing. If a (clothes) retailer isn’t taking it seriously, they are going to fall behind,” said Bolette Andersen, principal in KPMG’s retail industry practice.

ROOM TO GROW

Some investors are betting on apparel stocks because of their relative insulation from the threat of showrooming.

While the S&P Apparel Index has returned a sizzling 27.71 percent year to date, according to Reuters data, far outperforming the S&P 500, which is up 14.80 percent, more gains may be coming.

“We still think there’s plenty of room to grow,” said Brian Peery, co-portfolio manager at Hennessy Funds. Its growth fund, heavily weighted in apparel and consumer discretionary goods shares, is up 30 percent over the year.

“As we look into the sector 12-18 months, we continue to buy the discretionary area. Two of our heaviest investments would be Foot Locker Inc and TJX Companies Inc,” he said.

Discount chains like TJX and Ross Stores, which sell branded clothes at low prices, have benefited from the surge in bargain-seeking shoppers.

Even the stocks of retailers like Gap and American Eagle that have staged or are staging turnarounds have gotten a good boost over the year. Gap has soared 69 percent and American Eagle is up 31 percent.

R. Shawn Neville, president of Avery Dennison retail branding and information solutions, said another reason that apparel and to a broader extent other consumer discretionary stocks do well is because of their sustainability.

“In uncertain times, investors look towards market segments that have strong underlying demand which are more stable, like the apparel industry,” Neville said.

Moreover, in times of economic uncertainty, shoppers can still afford clothes and shoes, as opposed to a new car, home, or expensive vacations, helping apparel stocks do well, he said.

“Though Amazon is clearly stealing some share in various categories, clothes retailers, say Abercrombie & Fitch isn’t going anywhere. They’re not being run out of the shopping mall,” said Esplanade’s Kravetz.

(Editing by Jeffrey Benkoe)

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Investors shed shares of Blackberry maker

NEW YORK (AP) — Shares of Blackberry maker Research in Motion slumped more than 16 percent Friday with future revenue coming into question and a declining number of subscribers.

RIM’s stock jumped initially Thursday when the Canadian company released better-than-expected third-quarter results and a stronger cash position.

Shares reversed course during a conference call later, when executives said that the company won’t generate as much revenue from telecommunications carriers once it releases the new BlackBerry 10.

RIM’s stock had been on a three-month rally in which the stock more than doubled from levels not previously seen since 2003.

“Despite a solid quarter, the stock is trading down due to the introduction of a lower enterprise service tier and fears that RIM will not receive monthly services revenues for consumer BB10 subscribers,” said Jefferies analyst Peter Misek. He thinks RIM has offered carriers a lower-priced option in exchange for a bigger purchase commitment for the new device. He kept his “Hold” rating.

Sterne Agee analyst Shaw Wu kept maintained a “Neutral” rating on the stock, but lowered his earnings estimates, saying he continued to be concerned about RIM’s ability to compete with Apple and Google.

Shares of Research in Motion Ltd. fell $ 2.29 to $ 11.83 in morning trading.

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AffordRx.com Makes Prescription Drugs Affordable

AffordRx.com to donate thousands of discount drug cards to those in need.

Margate, NJ (PRWEB) December 21, 2012

AffordRx, a discount prescription drug card, is currently giving away thousands of free discount cards to those in need.

Countless senior citizens and children living in the United States are not able to afford their prescriptions regularly. Many people are left with no choice but to skip doses or cut pills in half.

AffordRx representative Dylan Marc explained his company’s mission, “We are aware that millions of Americans are losing out on healthcare because prescription prices are too high. That’s why our card offers you a discount of up to 75% on thousands of prescription drugs.”

Too many people are still without prescription insurance coverage. Even those with coverage may not be able to get the medications they need. People stuck in the Medicare “donut hole” in particular can benefit from AffordRx; while the card does not work with covered prescriptions or existing copays, it can be applied to a deductible, or used to cover prescriptions that are not covered by an existing plan. Sometimes the card’s discount for a given prescription may be even cheaper than it would be under insurance.

These cards can be printed at home and used immediately, or they can be mailed directly to customers upon request. The cards do NOT require a medical examination to qualify, and can be presented to any participating pharmacy along with any qualifying prescription.

AffordRx discount prescription cards are accepted at more than 59,000 pharmacies nationwide, including large chains like CVS, Albertsons, Kmart, Walgreens, and Target as well as independent pharmacies. These cards do not expire; and there is no limitation on how many times or how often they may be used.

AffordRx has helped thousands of patients afford their medications and is ready to help thousands more. Visit AffordRx.com to find more information or to download a free prescription discount card.

Dylan Marc
AffordRx.com
(515) 992-0349
Email Information

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US budget negotiations setback drives stocks down

PARIS (AP) — A failed attempt find a compromise in U.S. budget negotiations sent global stock markets plummeting Friday, as investors feared the world’s largest economy could teeter into recession if no deal is found.

Without an agreement, the U.S. economy will fall off the so-called “fiscal cliff” on Jan. 1 when Bush-era tax cuts expire and spending cuts kick in automatically. The measures were designed to have a negative effect on the U.S. economy, in the hopes that the feared outcome would push lawmakers and President Barack Obama to find a deal.

“We’ve seen Europe’s politicians repeatedly flirt lemming-like with cliff-diving in 2012, and now it’s the turn of U.S. ‘leaders,’” said Kit Juckes, an analyst with Societe Generale. “The nagging fear is always there that someone, on one side of the Atlantic or the other, will forget to let rational thought take over at the last second.”

Amid the uncertainty, European shares fell. France’s CAC dropped 0.15 percent to 3,661, while the DAX in Germany dropped 0.6 percent at 7,626. The FTSE index of leading British shares retreated 0.6 percent to 5,929.

The euro also fell sharply, dropping 0.3 percent to $ 1.3182.

In Asia, Japan’s Nikkei 225 index closed 1 percent lower at 9,940.06. Hong Kong’s Hang Seng lost 0.7 percent to 22,506.29. South Korea’s Kospi shed 1 percent at 1,980.42. Australia’s S&P/ASX 200 fell 0.2 percent to 4,623.60. Mainland Chinese stocks were mixed.

U.S. stock futures tumbled after rank-and-file Republican lawmakers failed to support an alternative tax plan by House Speaker John Boehner late Thursday in Washington. That plan would have allowed tax rates to rise on households earning $ 1 million and up. Obama wants the level to be $ 400,000.

In early trading in New York, the Dow Jones industrial average dropped 1 percent to 13,183, while the broader Standard & Poor’s index fell 1.1 percent at 1,427.

“The fiscal cliff is a real threat not just for U.S. growth next year but for the outlook for global growth,” said Jane Foley, currency analyst with Rabobank.

When growth slows, energy demand does, too, and oil prices fell in anticipation.

Benchmark crude for February delivery fell $ 1.92 to $ 88.19 per barrel in electronic trading on the New York Mercantile Exchange.

___

Pamela Sampson in Bangkok and Fu Ting in Shanghai contributed to this report.

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Kenya police: 28 people killed in clashes

NAIROBI, Kenya (AP) — A police official says 28 people have been killed in clashes between farmers and herders in south-eastern Kenya.

Anthony Kamitu, who is leading police operations to prevent the attacks, said Friday that the Pokomo tribe of farmers raided a village of the Orma herding community, called Kipao, at dawn in the Tana River Delta.

The latest deaths in a tit-for-tat cycle of killings may be related to a redrawing of political boundaries and next year’s general elections, according to the U.N.

At least 110 people were killed in clashes between the Pokomo and Orma in September and October.

Animosity between the two communities over land and water resources has existed for decades.

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Facebook predicted to overtake Google in mobile display ad revenue this year

Shares of Facebook (FB) have begun to rebound since the company’s disastrous initial public offering this past May. After opening at $ 38 per share the company’s stock plummeted into the mid-20s over the summer months and eventually fell to a low of $ 17.55 in early September. Since then, however, Facebook shares have begun to bounce back after the company posted better-than-expected results in the third quarter. While Facebook stock is still down more than 25% on the year, it is rising steadily as analysts and investors become increasingly bullish about the company’s future as a leading advertising platform.

[More from BGR: BlackBerry 10 browser smokes iOS 6 and Windows Phone 8 in comparison test [video]]

According to a new report from eMarketer, Facebook is predicted to surpass Google (GOOG) in mobile display advertising in 2012. Google is expected to generate $ 339 million in mobile ad revenue this year, a significant increase from previous estimates of between $ 45 and $ 100 million. The research firm notes that Facebook is expected to capture an 18.4% share of the mobile display ad market in the U.S. this year, compared to Google’s 17% share, which is down from 23% in 2011.

[More from BGR: New iMac early adopters upset that they can’t run Boot Camp]

“Major ad publishers are strengthening their offerings much faster than previously expected,” said Clark Fredricksen, vice president of communications at eMarketer. “I don’t think anybody thought after the second quarter that Google and Facebook would be in position that they are now in the mobile ad marketplace.”

The company’s mobile ad revenue is expected to more than triple by 2014 when it will reach an estimated $ 1.2 billion. The firm predicts that Facebook and Google will continue to battle for the No.1 spot in the mobile ad market over the next few years. Facebook is expected to increase its lead to 25.2% in 2013, compared to Google’s 19.6% share. Google is estimated to bounce back in 2014, however, with a market leading 23.1% share, ahead of Facebook’s 22.7% share.

Despite the impressive numbers, eMarketer notes that mobile still represents a small slice of the total advertising market. In 2012, only 2.4% of total ad spending in the U.S. is expected to go towards mobile ads, but the market is expected to reach an 11% share by 2016 when it surpasses both radio and print spending.

This article was originally published by BGR

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Thousands mourn U.S.-Mexican singer Jenni Rivera

LOS ANGELES (Reuters) – Thousands of mourners on Wednesday packed a Los Angeles theater to pay their final respects to Mexican-American singer Jenni Rivera more than a week after her death in a plane crash.

Rivera, 43, best known for her work in the Mexican folk Nortena and Banda genres, died after the small jet she was traveling in crashed in northern Mexico on December 9.

Rivera’s family, dressed in white, led the memorial service eulogizing the singer. A bank of white roses was displayed in front of Rivera’s bright red coffin and a brass band performed musical interludes.

More than 6,000 people crowded into the theater about 30 miles north of her childhood home in Long Beach, California. Tickets for the service at the Gibson Amphitheatre sold out within minutes, organizers said.

The daughter of Mexican immigrants, Rivera was called the “Diva de la Banda.” She sold about 15 million albums and earned a slew of Latin Grammy nominations during her 17-year career.

“Jenni made it OK for women to be who they are,” her manager Pete Salgado said at the service. “Jenni also made it OK to be from nothing, with the hopes of being something.”

Rivera had five children, the first at age 15, and was married three times. Her third husband was baseball pitcher Esteban Loaiza. Rivera’s private life influenced her songs, which often referenced living through hardship.

“She’s a fighter and she knows it’s in all of us,” Rivera’s son Michael said between video tributes.

In recent years, Rivera branched out into television, appearing on a reality television show and serving as a judge on the Mexican version of the singing competition “The Voice.” Television broadcaster ABC was reported to be developing a comedy pilot for the singer.

Rivera’s plane crashed in mountains south of Monterrey killing all seven on board.

The singer was to perform in the city of Toluca, 40 miles southwest of Mexico City, in central Mexico after a concert in Monterrey. It is not clear what caused the crash.

(Reporting by Eric Kelsey; Editing by Stacey Joyce)

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FCA releases two new reports on important role of family caregivers in reducing negative outcomes for patients

Increased training, support and recognition are needed by families as healthcare increasingly moves into home settings

SAN FRANCISCO, Dec. 20, 2012 /PRNewswire-USNewswire/ – The National Center on Caregiving at Family Caregiver Alliance has released two new reports that shine a light on the important roles of family caregivers in U.S. healthcare—and how those caregivers are often unrecognized and unsupported within medical and long-term service systems.

Family Caregiving and Transitional Care: A Critical Review is an examination of the often ignored — yet absolutely essential — role of caregiving families as patients transition from one healthcare setting to another, for example discharge from hospital to home or hospital to rehab facility.

The report notes that although family caregivers are usually the individuals who will actually implement care plans following release from the hospital, they are rarely actively included in discharge planning; worse, their training, even for complex medical procedures, is often insufficient. The all-too-common result: preventable negative outcomes for patients.

The report looks at ways family caregivers characterize their experiences when a transition occurs and they are expected to take on challenging care tasks such as direct medical treatments (e.g., monitoring ventilators or home dialysis), managing medications, and coordinating essential medical services. Transition decisions made hurriedly at the point of discharge can change patient outcomes, and can be implicated in costly hospital readmissions, serious medication errors and omissions in follow-up treatment.

The authors state, “As the US continues its pressing search for ways to contain healthcare costs and improve quality, the one group whose role has been largely ignored is the nation’s 41 million family caregivers… Family caregivers are a critical missing link in improving transitional care for frail older adults with disabilities.”

The report also examines the relatively few model transitional care programs that do support family caregivers, and concludes with recommendations on improvements needed for practice, research and public policy.

Authors: Mary Jo Gibson, MA, whose career spans 30 years of work on family caregiving, health and long-term services and supports (LTSS) policy; Kathleen Kelly, MPA, Executive Director of Family Caregiver Alliance, the National Center on Caregiving and the Bay Area Caregiver Resource Center; and Alan K. Kaplan, MSc, JD, who has more than 30 years of experience on patients’ rights, medical peer review and Medicare quality assurance issues. The report is available at: http://caregiver.org/caregiver/jsp/content/pdfs/FamCGing_TransCare_CritRvw_FINAL10.31.2012.pdf

A second report, Selected Caregiver Assessment Measures: A Resource Inventory for Practitioners, was developed for researchers and program developers to accurately assess the knowledge and well-being of family caregivers as they perform the tasks necessary to maintain the health of their ill or elderly relatives. It is the second edition and follow-up for the first Resource Inventory, published by Family Caregiver Alliance’s National Center on Caregiving in 2002.

Many family caregivers have multiple, varied and serious unmet financial, physical, emotional and social needs which require attention. As healthcare continues to move into home settings, it is important not only to assess the skills and capacity of caregivers to provide care, but also to address caregiver well-being and health in order to prevent more serious health problems for families in the long-term. Valid, reliable assessment tools are necessary to gauge families’ abilities to continue providing care.

The Resource Inventory provides a compendium of caregiver assessment measures that are practice-oriented, practical and applicable, and which address the multidimensional aspects of the caregiving experience.

“As the population ages and caregiving needs increase throughout the country, the essential role families play in the healthcare system is undeniable,” said FCA’s Kathleen Kelly. “At the same time, healthcare budgets are severely stressed and resources strained. Whether family caregivers provide transportation, food preparation, help with personal care or complex medical care such as dealing with wound care or feeding tubes, they are involved at every level. Unfortunately, caregivers’ needs are often unassessed, unrecognized, or even worse, ignored.”

The Resource Inventory was developed by Family Caregiver Alliance’s National Center on Caregiving in collaboration with the Margaret Blenkner Research Institute of the Benjamin Rose Institute on Aging. It was compiled by Sarah Schwartz, MSSA and Laura Darlak, BA, under supervision of Carol J. Whitlatch, PhD, with oversight by Kathleen Kelly, MPA. David M. Bass, PhD, was the reviewer. The report is available at: http://caregiver.org/caregiver/jsp/content/pdfs/SelCGAssmtMeas_ResInv_FINAL_12.10.12.pdf

Family Caregiver Alliance and its National Center on Caregiving offer local and national programs to support and sustain the important work of families and friends caring for loved ones with chronic, disabling health conditions. A wealth of caregiving advice, resource listings, newsletters, fact sheets, research reports, policy updates, discussion groups, and the Family Care Navigator are available free on the FCA website. Visit http://www.caregiver.org or call (800) 445-8106 for more information.

SOURCE Family Caregiver Alliance

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