High-level trauma care may limit disability

Reuters – 1 hr 27 mins ago NEW YORK (Reuters Health) - People treated for severe injuries at a specialized trauma center may survive with fewer disabilities than those at other hospitals, a study from Australia suggests.

The findings, researchers say, add to evidence that patients fare better when they're treated under an organized trauma system -- where hospitals, emergency services and state governments have coordinated plans for getting the right patients to the appropriate treatment.

So-called Level I trauma centers provide the most comprehensive care for traumatic injuries and have to meet certain requirements -- like having a specific number of surgeons and other specialists on duty 24 hours a day.

Studies have found that for severely injured people, getting care at a Level I trauma center can cut the risk of dying by 25 percent.

But there'd been some question about whether that drop in death rates might mean more people are surviving with severe disabilities, according to Belinda J. Gabbe, the lead researcher on the study from Monash University in Melbourne.

"Our study shows that care at specialized trauma centers improves the chances of a better functional outcome -- that is, less disability, which really strengthens the evidence for organized trauma systems," Gabbe told Reuters Health in an email.

The study, reported in the Annals of Surgery, found that of nearly 5,000 seriously injured patients treated in the state of Victoria's trauma system, those seen at a Level I center tended to be less severely disabled one year later.

The sample included people who'd been in a car or motorcycle accident or had suffered a fall with head, chest or spinal cord injuries.

Overall, 35 percent of patients had a "good" recovery -- either back to their healthy selves or with some disruption to their daily activities and relationships.

The odds of a better recovery were 22 percent higher for patients treated at Level I centers versus similar patients at other hospitals.

Overall, patients' outlook also got better over time -- with generally lower levels of disability among patients treated in 2008-2009 versus 2006-2007.

Gabbe said it's not clear why that is.

But, she added, it might be due to the "maturing" of the state's trauma system.

In the U.S., about 45 million people live more than an hour away from a Level I or Level II trauma center (by ambulance or helicopter), according to the Centers for Disease Control and Prevention.

Like Victoria, where this study was done, some U.S. states have statewide trauma systems that aim to get the right patients to the right hospital as quickly as possible.

But there are also county-level systems.

"There are studies from San Diego, Los Angeles, Maryland and Milwaukee showing similar results" as the current one, said Dr. Raul Coimbra, who heads the division of trauma, surgical critical care and burns at the University of California, San Diego Health System.

So the new findings are "not novel," according to Coimbra, who was not involved in the study.

But, he said in an email, "the findings provide additional support to the concept that organized, regionalized systems of care

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FDA Seeks to Limit Antibiotics in Animal Feed

HealthDay – 57 mins ago WEDNESDAY, April 11 (HealthDay News) -- The U.S. Food and Drug Administration unveiled Wednesday a plan to reduce the use of antibiotics in animal feed.

The practice of mixing antibiotics in animal feed to make livestock, pigs and chickens gain weight and become more resistant to disease has been criticized in many quarters. Health experts contend that this overuse of antibiotics has led to an increase of germs that are growing increasingly resistant to antibiotics, threatening human health.

The FDA said it was issuing three documents to help veterinarians, farmers and animal producers use medically important antibiotics "judiciously" by limiting their use only to combat diseases and other health problems. Under this "voluntary" initiative, certain antibiotics would not be used for so-called "production" purposes, which include enhancing growth or improving the effectiveness of animal feed, the agency said in a news release.

These antibiotics would still be available to prevent, control or treat illnesses in food-producing animals under the supervision of a veterinarian, the agency said.

"It is critical that we take action to protect public health," FDA Commissioner Dr. Margaret Hamburg, said in the news release. "The new strategy will ensure farmers and veterinarians can care for animals while ensuring the medicines people need remain safe and effective. We are also reaching out to animal producers who operate on a smaller scale or in remote locations to help ensure the drugs they need to protect the health of their animals are still available."

The FDA said it was publishing three documents Wednesday in the Federal Register detailing its efforts to limit antibiotic use in animal feed:

A final guidance for industry, The Judicious Use of Medically Important Antimicrobial Drugs in Food-Producing Animals, that recommends phasing out the agricultural production use of medically important drugs and phasing in veterinary oversight of therapeutic uses of these drugs. A draft guidance, open for public comment, which will assist drug companies in voluntarily removing production uses of antibiotics from their FDA-approved product labels; adding, where appropriate, scientifically supported disease prevention, control, and treatment uses; and changing the marketing status to include veterinary oversight.A draft proposed Veterinary Feed Directive regulation, open for public comment, that outlines ways that veterinarians can authorize the use of certain animal drugs in feed, which is important to make the needed veterinary oversight feasible and efficient.

Dr. John Clifford, chief veterinary medical officer for the U.S. Department of Agriculture, said in the news release: "USDA worked with the FDA to ensure that the voices of livestock producers across the country were taken into account, and we will continue to collaborate with the FDA, the American Veterinary Medical Association and livestock groups to ensure that the appropriate services are available to help make this transition."

Public health advocates are skeptical about asking drug makers to voluntarily restrict use of their products, the Associated Press reported.

"This is not an issue where trust should be the measure. This is an issue where the measure is whether or not the FDA has fulfilled its authority of protecting public health," Richard Wood, Chair of the Keep Antibiotics Working coalition, said in a statement, the AP reported.

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