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Human Stem Cells Hold Promise of Unlimited Blood Supply
New technology produces all blood types in vitro, but clinical uses are still far off

Worcester, Mass. – Researchers say they’re closer to developing a generation of transfusable red blood cells derived from human embryonic stem cells that could eventually provide an inexhaustible supply of blood for medical use.

Investigators at the Mayo Clinic in Rochester, Minn., and the University of Illinois in Chicago, in collaboration with biotechnology company Advanced Cell Technology, say they have found a way to cultivate and differentiate mature embryonic stem cells into functional, oxygen-carrying red blood cells (RBCs) that respond favorably to biochemical changes in the human body.

Researchers were able to generate 10 to 100 billion red blood cells from a single six-well plate of stem cells. Using multiple cell lines in vitro, the developers formed functional RBCs for blood types A, B, O and both RhD+ and RhD-.

 Not only can the cells be duplicated and expanded indefinitely, providing a potentially unlimited source of RBCs for human therapy, the “O-” blood-type stem cell line could produce a compatible “universal donor” blood type.

Efficient and controlled differentiation of human embryonic stem cells into homogeneous RBC populations has not been previously achieved. But ACT’s CEO and Chairman William Caldwell said, “more work is required before this can move into the clinical setting.”

George Daley, MD, Ph.D., of the Harvard (University) Stem Cell Institute in Boston praised the scientific discovery but warned the technology is a long way off from changing the way people receive blood transfusions in the near future. 
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With consumer-driven health care, communication is king 
Patients rank bedside manner higher than board certification, survey says

East Lansing, Mich. – When choosing a doctor, health care consumers value a physician’s interpersonal skills more than board certification, according to a recent survey.

The August study by the Evanston, Ill.-based American Board of Medical Specialties found that most Americans–more than nine out of 10–rank bedside manner and communication skills at the top of the list of important physician attributes.

Board certification ranks a close second at 91 percent, compared with 95 percent for bedside manner, the survey reported. Other factors affecting consumer choice include: a physician’s hospital affiliation, place of training, and practice location. While 25 percent of the survey’s roughly 1000 respondents said certification is the “most important” quality they look for—compared with 34 percent who said bedside manner is most important—the majority also said they didn’t understand the meaning of certification.

The survey findings are significant because more hospitals are insisting EPs have board certification in emergency medicine. According to the study, only 45 percent of consumers said they asked if their doctor was certified. Sixty percent incorrectly believed board certification is required for a physician to practice medicine.

“It isn’t surprising [respondents] ranked bedside manner so high since most Americans don’t seem to know what board certification is,” said Harold Thomas, MD, president of the American Board of Emergency Medicine.

One reason may be access to useful, clear information: more than half, or 57 percent, of survey respondents said they lacked such information about their physician.

 Thomas said the ABEM has long recognized the importance of physician-patient communication. Bedside manner is an integral part of its evaluation process when granting certification.
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Some EPs find new patients at the local doctor’s office 
Concierge medicine offers potential for higher pay and more personalized care

Charlotte, N.C. – What could become a popular new health care delivery trend for emergency physicians may not even require a rotation in the hospital ED. 

 Concierge medicine, which began about a decade ago, has held limited appeal for most physicians. But more EPs are pursuing the care model, motivated by opportunities for higher earnings and developing personally satisfying, long-term relationships with patients.

 In exchange for an annual membership fee, concierge physicians provide enhanced health care services and amenities. According to a government survey of 112 concierge physicians, the most popular services include: same- or next-day appointments for non-urgent care; 24-hour telephone access; and periodic preventive-care physical exams.

Additionally, three-fourths of survey respondents reported billing patient health insurance for covered services and, among those physicians, almost all reported billing Medicare.

 Because of the retainer fee, concierge physicians see a smaller number of patients compared with traditional, insurance-based primary care practices. Most concierge doctors also have hospital admitting privileges or admit patients through an affiliated ED.

 In Martha’s Vineyard, Mass., EPs Jeffrey Zack and Sean Kelly opened a practice two years ago while balancing their busy EM jobs at Martha’s Vineyard Hospital. The two charge $750 a week for a family of three to five people, and have positioned the practice specifically to capitalize on the heavy seasonal business in the upscale resort community.
“We’re kind of like an extension of [the hospital ED] rather than being another cook in the kitchen,” Kelly recently told The Martha’s Vineyard Times.

 In some respects, EPs are the ideal provider type to pursue concierge medicine, said Bryan Woodward, MD. They must be available at all hours yet also provide the level of primary care that any office-based family practitioner can deliver. “It’s potentially the best of both worlds,” he said.

Woodward and two colleagues opened a Charlotte, N.C.-based concierge medicine practice about five years ago, and currently serve about 900 patients.

Arlington, Va.-based SwiftMD bills itself as the first telemedicine company staffed exclusively by board-certified EM physicians who are available 24/7 to diagnose and treat non-critical health care problems. SwiftMD members can consult with a doctor via phone or Internet to obtain a diagnosis, prescription or referrals to other types of care.

 An August 2005 Government Accountability Office study found that most concierge practices are located in large cities on the East and West coasts, and vary widely in the fees they charge, services offered, and insurance billing practices. Individual annual fees can range between $60 and $15,000, with about half of respondents reporting fees of $1,500 to $1,599, the study said. Medicare is also increasingly scrutinizing concierge physicians for possible double billing of Medicare patients and skirting compliance laws.  

For physicians interested in the lucrative model, one roadblock is the lingering stigma associated with caring for patients on a private-pay basis. Patients who cannot or choose not to pay do not have access to more convenient, personalized concierge care. But proponents view concierge medicine as a rational response to patient demand for more personalized care, and a solution for busy physicians to regain control of their medical practices and lives. 
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ED diversion program targets the chronically ill
County uses long-term care management to reduce frequent follow-ups

Jacksonville, Fla. – Duval County health officials are working on an ambitious plan they say will sharply cut unnecessary ED visits by up to 40 percent by diverting chronically ill patients to vital long-term, primary care services.

 The Duval County Medical Homes program is still under development, but supporters say they’re confident it will reduce long waits and overcrowding currently plaguing the area’s largest local hospitals.

 A $650,000 annual grant from the state will help fund the first three years of the program, which targets indigent and uninsured patients and provides long-term disease management services for chronic conditions including diabetes, asthma, and cardiovascular disease. 

 “The program seeks to identify special needs patients and address what happens to them after the initial ER visit,” said Wally Plosky, the program’s resource and development coordinator. “We had to create a system that provides services to support the care they need outside the ER.”

 Modeled loosely after a similar federal initiative in development for Medicare patients, the Duval County Medical Homes program will offer diverse services, including pharmacy, self-management training, and regular outpatient clinic care. It is expected to serve about 6,000 Medicaid patients and save area hospitals and patients $14 million over the next ten years.

Local EPs contacted for interviews did not return calls. But most weren’t likely to know much about the program because it’s so new, health officials said. One physician who asked not to be identified said the program shows the county’s willingness to grapple with the overcrowding crisis. “I just hope it makes a big enough dent,” he said.
 
 
 

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