WASHINGTON – The AARP has posted the results of a national survey in which physicians gave their top choices for “out-of-town” hospitals based on specialty.

The list was compiled by the nonprofit Consumers’ Checkbook and coincides with the release of the May/June issue of AARP The Magazine, which features information for consumers deciding whether to travel away from home for medical care.

Consumers’ Checkbook surveyed physicians from across the United States and collected 140,000 ratings of hospitals in their own communities. The nonprofit also asked doctors whether, and where, they would recommend patients seeking care in other communities for extremely difficult cases of heart conditions, cancer aor other ailments.

AARP intends the list as a guide to “appropriate hospitals” if patients decide they need to travel outside their hometown for care. AARP The Magazine has also debuted an online interactive map listing the top-ranked hospitals in the United States by geographic area.

The survey was part of the research for a new book from Consumers’ Checkbook called Consumers’ Guide to Hospitals, which uses volumes of government safety statistics and data on death and complication rates, along with survey results, to compare and rank hospitals in the country’s 53 largest metro areas.

When asked where they were most likely to send patients with extremely difficult cases, physicians surveyed by Consumers’ Checkbook named the following hospitals:

Heart, General

• Cleveland Clinic, Cleveland, Ohio
• Mayo Clinic, Rochester, Minn.
• Children’s Hospital Boston, Boston, Mass.
• New York-Presbyterian/Columbia, New York, N.Y.
• Massachusetts General Hospital, Boston, Mass.
• Brigham and Women’s Hospital, Boston, Mass.
• The Johns Hopkins Hospital, Baltimore, Md.
• Stanford University Medical Center, Palo Alto, Calif.
• Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Tex.

Cancer, General

• The University of Texas M.D. Anderson Cancer Center, Houston, Tex.
• Memorial Sloan-Kettering Cancer Center, New York, N.Y.
• Dana-Farber Cancer Institute, Boston, Mass.
• Mayo Clinic, Rochester, Minn.
• City of Hope, Duarte, Calif.
• The Johns Hopkins Hospital, Baltimore, Md.
• Duke University Hospital, Durham, N.C.
• Roswell Park Cancer Institute, Buffalo, N.Y.

Mystery Diagnoses

• Mayo Clinic, Rochester, Minn.
• Cleveland Clinic, Cleveland, Ohio
• The Johns Hopkins Hospital, Baltimore, Md.
• Massachusetts General Hospital, Boston, Mass.
• Ronald Reagan UCLA Medical Center, Los Angeles, Calif.

Neurosurgery

• Duke University Hospital, Durham, N.C.
• Mayo Clinic, Rochester, Minn.
• University of California San Francisco Medical Center, San Francisco, Calif.
• Cleveland Clinic, Cleveland, Ohio
• Massachusetts General Hospital, Boston, Mass.
• The Johns Hopkins Hospital, Baltimore, Md.
• Ronald Reagan UCLA Medical Center, Los Angeles, Calif.

Eyes

• Bascom Palmer Eye Institute, University of Miami, Miami, Fla.
• Wills Eye Institute, Philadelphia, Pa.
• Ronald Reagan UCLA Medical Center, Los Angeles, Calif.
• Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Md.

There are certainly some surprises here for me- and I’m sure there will be for you as well.

           

More than 150,000 Medicare patient deaths and 13,000 in hospital complications could be avoided each year if all hospitals performed as well as those ranked in the top 5 percent nationally, according to a new HealthGrades study.

The top-tier hospitals ranked by HealthGrades, an independent healthcare ratings organization, had a 29 percent lower risk-adjusted mortality rate than other hospitals throughout the nation. They also had risk-adjusted complication rates that were 9 percent lower than other hospitals, and show that they can improve clinical quality faster than other facilities.

“What’s extraordinary is that these hospitals are not standing still,” said Dr. Rick May, a HealthGrades vice president and one of the study’s authors. “In fact, the data show that they are continuing to improve their patient outcomes at a faster rate, reflecting a commitment to quality that stands as a model for all other hospitals.”

Thirty-six states have one or more hospitals in the top 5 percent. Delaware has the highest percentage of such hospitals, followed by Maryland, Minnesota, Florida and Connecticut. Thirteen states–including Nevada, Arkansas and Massachusetts–had no hospitals ranked in the top 5 percent.

In reaching its conclusions, HealthGrades studied 40 million CMS patient records at 5,000 non-federal hospitals nationwide from 2006 through 2008. The risk-adjusted mortality and complication rates were evaluated across 26 procedures and diagnoses.

       

I know for a fact- that if I have to go to hospital- I will be using the following list in making my determination of where to go:

HealthGrades Distinguished Hospital for Clinical Excellence Award™ Hospital Recipients

Alabama

D.C.H. Regional Medical Center
Tuscaloosa, AL

Alaska

There are no recipients of this award in this state.

Arizona

Banner Boswell Medical Center
Sun City, AZ

Banner Del E. Webb Medical Center
Sun City West, AZ

Mayo Clinic Hospital
Phoenix, AZ

Scottsdale Healthcare - Osborn
Scottsdale, AZ

Scottsdale Healthcare - Shea
Scottsdale, AZ

Arkansas

There are no recipients of this award in this state.

California

Beverly Hospital
Montebello, CA

Centinela Freeman Regional Medical Center - Centinela
Inglewood, CA

including Centinela Freeman Regional Medical Center - Memorial
Inglewood, CA

El Camino Hospital
Mountain View, CA

Fountain Valley Regional Hospital and Medical Center
Fountain Valley, CA

Garfield Medical Center
Monterey Park, CA

Glendale Memorial Hospital & Health Center
Glendale, CA

Good Samaritan Hospital
Los Angeles, CA

Hoag Memorial Hospital Presbyterian
Newport Beach, CA

Huntington Memorial Hospital
Pasadena, CA

John Muir Medical Center - Concord
Concord, CA

John Muir Medical Center - Walnut Creek
Walnut Creek, CA

Mills-Peninsula Health Services
Burlingame, CA

including Mills Health Center
San Mateo, CA

Saddleback Memorial Medical Center - Laguna Hills
Laguna Hills, CA

including Saddleback Memorial Medical Center San Clemente
San Clemente, CA

Saint Johns Hospital Health Center
Santa Monica, CA

Saint Jude Medical Center
Fullerton, CA

Saint Vincent Medical Center
Los Angeles, CA

Santa Monica - UCLA Medical Center
Santa Monica, CA

Scripps Memorial Hospital Encinitas
Encinitas, CA

Scripps Memorial Hospital La Jolla
La Jolla, CA

Scripps Mercy Hospital
San Diego, CA

including Scripps Mercy Hospital - Chula Vista
Chula Vista, CA

Sequoia Hospital
Redwood City, CA

Colorado

Centura Health - Penrose Saint Francis Health Services
Colorado Springs, CO

North Colorado Medical Center
Greeley, CO

Poudre Valley Hospital
Fort Collins, CO

Presbyterian/Saint Luke’s Medical Center
Denver, CO

The Medical Center of Aurora
Aurora, CO

Connecticut

Danbury Hospital
Danbury, CT

Griffin Hospital
Derby, CT

Hartford Hospital
Hartford, CT

Hospital of Saint Raphael
New Haven, CT

Manchester Memorial Hospital
Manchester, CT

Middlesex Hospital
Middletown, CT

Norwalk Hospital Association
Norwalk, CT

Yale - New Haven Hospital
New Haven, CT

Delaware

Beebe Medical Center
Lewes, DE

Christiana Care Health System - Christiana Hospital
Newark, DE

including Wilmington Hospital
Wilmington, DE

District of Columbia

There are no recipients of this award in this state.

Florida

Baptist Hospital of Miami
Miami, FL

Baptist Medical Center
Jacksonville, FL

Bay Medical Center
Panama City, FL

Boca Raton Community Hospital
Boca Raton, FL

Brandon Regional Hospital
Brandon, FL

Broward General Medical Center
Fort Lauderdale, FL

Central Florida Regional Hospital
Sanford, FL

Charlotte Regional Medical Center
Punta Gorda, FL

Cleveland Clinic Hospital
Weston, FL

Community Hospital
New Port Richey, FL

Delray Medical Center
Delray Beach, FL

Doctors Hospital of Sarasota
Sarasota, FL

Fawcett Memorial Hospital
Port Charlotte, FL

Flagler Hospital
Saint Augustine, FL

Florida Hospital Fish Memorial
Orange City, FL

Florida Hospital Memorial Medical Center
Daytona Beach, FL

including Florida Hospital Oceanside
Ormond Beach, FL

Florida Hospital Orlando
Orlando, FL

Gulf Coast Medical Center
Panama City, FL

Halifax Medical Center
Daytona Beach, FL

including Atlantic Medical Center
Daytona Beach, FL

Holy Cross Hospital
Fort Lauderdale, FL

JFK Medical Center
Atlantis, FL

Jupiter Medical Center
Jupiter, FL

Kendall Regional Medical Center
Miami, FL

Lawnwood Regional Medical Center and Heart Institute
Fort Pierce, FL

Lee Memorial Hospital
Fort Myers, FL

Martin Memorial Medical Center
Stuart, FL

Mayo Clinic
Jacksonville, FL

Memorial Hospital
Jacksonville, FL

Memorial Hospital Pembroke
Pembroke Pines, FL

Mercy Hospital
Miami, FL

Munroe Regional Medical Center
Ocala, FL

NCH Healthcare System
Naples, FL

Oak Hill Hospital
Brooksville, FL

Ocala Regional Medical Center/West Marion Hospital
Ocala, FL

Palm Beach Gardens Medical Center
Palm Beach Gardens, FL

Parrish Medical Center
Titusville, FL

Physicians Regional Medical Center
Naples, FL

Sarasota Memorial Hospital
Sarasota, FL

Sebastian River Medical Center
Sebastian, FL

University Hospital & Medical Center
Tamarac, FL

Wuesthoff Medical Center Rockledge
Rockledge, FL

Georgia

Dekalb Medical
Decatur, GA

Gwinnett Medical Center
Lawrenceville, GA

including Gwinnett Medical Center - Duluth
Duluth, GA

Houston Medical Center
Warner Robins, GA

Memorial University Medical Center
Savannah, GA

Northeast Georgia Medical Center
Gainesville, GA

including Northeast Georgia Medical Center – Lanier Park
Gainesville, GA

Piedmont Fayette Hospital
Fayetteville, GA

Piedmont Hospital
Atlanta, GA

Saint Joseph’s Hospital of Atlanta
Atlanta, GA

Hawaii

There are no recipients of this award in this state.

Idaho

There are no recipients of this award in this state.

Illinois

Advocate Good Samaritan Hospital
Downers Grove, IL

Advocate Lutheran General Hospital
Park Ridge, IL

Alexian Brothers Medical Center
Elk Grove Village, IL

Centegra Memorial Medical Center
Woodstock, IL

Central Dupage Hospital
Winfield, IL

Evanston Hospital
Evanston, IL

including Highland Park Hospital
Highland Park, IL

Ingalls Memorial Hospital
Harvey, IL

Little Company of Mary Hospital
Evergreen Park, IL

Loyola University Hospital
Maywood, IL

Mercy Hospital & Medical Center
Chicago, IL

Northwest Community Hospital
Arlington Heights, IL

Northwestern Memorial Hospital
Chicago, IL

Our Lady of the Resurrection Medical Center
Chicago, IL

Palos Community Hospital
Palos Heights, IL

Provena Saint Joseph Medical Center
Joliet, IL

Rush University Medical Center
Chicago, IL

Saint Alexius Medical Center
Hoffman Estates, IL

Saint Joseph Hospital
Chicago, IL

Saint Mary and Elizabeth Medical Center - Division
Chicago, IL

Sherman Hospital
Elgin, IL

Skokie Hospital
Skokie, IL

Swedish Covenant Hospital
Chicago, IL

Indiana

Clarian Health Partners Incorporated
Indianapolis, IN

including Indiana University Medical Center
Indianapolis, IN

Clark Memorial Hospital
Jeffersonville, IN

Floyd Memorial Hospital and Health Services
New Albany, IN

Saint Vincent Indianapolis Hospital
Indianapolis, IN

The Community Hospital
Munster, IN

Iowa

Mercy Medical Center - Cedar Rapids
Cedar Rapids, IA

Mercy Medical Center - Des Moines
Des Moines, IA

Saint Lukes Hospital
Cedar Rapids, IA

Kansas

Saint Francis Health Center
Topeka, KS

University of Kansas Hospital
Kansas City, KS

Via Christi Regional Medical Center
Wichita, KS

Kentucky

Baptist Hospital East
Louisville, KY

Owensboro Medical Health System
Owensboro, KY

Saint Elizabeth Medical Center
Edgewood, KY

Louisiana

Ochsner Clinic Foundation
New Orleans, LA

Maine

There are no recipients of this award in this state.

Maryland

Baltimore Washington Medical Center
Glen Burnie, MD

Doctor’s Community Hospital
Lanham, MD

Franklin Square Hospital Center
Baltimore, MD

Frederick Memorial Hospital
Frederick, MD

Good Samaritan Hospital
Baltimore, MD

Greater Baltimore Medical Center
Baltimore, MD

Harbor Hospital
Baltimore, MD

Holy Cross Hospital
Silver Spring, MD

Howard County General Hospital
Columbia, MD

Peninsula Regional Medical Center
Salisbury, MD

Saint Joseph Medical Center
Towson, MD

Sinai Hospital of Baltimore
Baltimore, MD

Suburban Hospital
Bethesda, MD

Upper Chesapeake Medical Center
Bel Air, MD

Washington Adventist Hospital
Takoma Park, MD

Massachusetts

There are no recipients of this award in this state.

Michigan

Allegiance Health
Jackson, MI

Beaumont Hospital - Grosse Pointe
Grosse Pointe, MI

Beaumont Hospital - Royal Oak
Royal Oak, MI

Bronson Methodist Hospital
Kalamazoo, MI

Genesys Regional Medical Center
Grand Blanc, MI

Hackley Hospital
Muskegon, MI

Henry Ford Hospital
Detroit, MI

Holland Hospital
Holland, MI

Huron Valley Sinai Hospital
Commerce Township, MI

McLaren Regional Medical Center
Flint, MI

Munson Medical Center
Traverse City, MI

Providence Hospital
Southfield, MI

Saint John Macomb Hospital
Warren, MI

including Saint John Oakland Hospital
Madison Heights, MI

Saint Mary Mercy Hospital
Livonia, MI

Sinai - Grace Hospital
Detroit, MI

Spectrum Health Butterworth Hospital
Grand Rapids, MI

including Spectrum Health Blodgett Hospital
Grand Rapids, MI

William Beaumont Hospital - Troy
Troy, MI

Minnesota

Fairview Ridges Hospital
Burnsville, MN

Fairview Southdale Hospital
Edina, MN

North Memorial
Robbinsdale, MN

Park Nicollet Methodist Hospital
Minneapolis, MN

Saint Cloud Hospital
Saint Cloud, MN

Saint Lukes Hospital
Duluth, MN

Unity Hospital
Fridley, MN

Mississippi

There are no recipients of this award in this state.

Missouri

Boone Hospital Center
Columbia, MO

Missouri Baptist Medical Center
Saint Louis, MO

Skaggs Regional Medical Center
Branson, MO

Ssm Saint Joseph Health Center
Saint Charles, MO

including Ssm Saint Joseph Health Center - Wentzville
Wentzville, MO

Ssm Saint Marys Health Center
Richmond Heights, MO

St. Luke’s Hospital
Chesterfield, MO

Montana

Benefis Health System
Great Falls, MT

Kalispell Regional Medical Center
Kalispell, MT

Nebraska

BryanLGH Medical Center East
Lincoln, NE

including BryanLGH Medical Center West
Lincoln, NE

Nevada

There are no recipients of this award in this state.

New Hampshire

There are no recipients of this award in this state.

New Jersey

Clara Maass Medical Center
Belleville, NJ

Community Medical Center
Toms River, NJ

Hackensack University Medical Center
Hackensack, NJ

Jersey Shore University Medical Center
Neptune, NJ

Ocean Medical Center
Brick, NJ

New Mexico

There are no recipients of this award in this state.

New York

Albany Medical Center Hospital
Albany, NY

Maimonides Medical Center
Brooklyn, NY

New York - Presbyterian/Weill Cornell
New York, NY

including New York Presbyterian - Columbia
New York, NY

Stony Brook University Medical Center
Stony Brook, NY

Winthrop - University Hospital
Mineola, NY

North Carolina

Gaston Memorial Hospital
Gastonia, NC

Rex Hospital
Raleigh, NC

North Dakota

Altru Hospital
Grand Forks, ND

Saint Alexius Medical Center
Bismarck, ND

Ohio

Akron General Medical Center
Akron, OH

Aultman Hospital
Canton, OH

Bethesda North Hospital
Cincinnati, OH

Christ Hospital
Cincinnati, OH

Community Health Partners of Oh - West
Lorain, OH

EMH Regional Medical Center
Elyria, OH

Good Samaritan Hospital
Dayton, OH

including Dayton Heart and Vascular Hospital
Dayton, OH

Good Samaritan Hospital
Cincinnati, OH

Grandview Medical Center
Dayton, OH

Hillcrest Hospital
Mayfield Heights, OH

Kettering Medical Center
Kettering, OH

Marymount Hospital
Garfield Heights, OH

Mercy Franciscan Hospital - Mount Airy
Cincinnati, OH

Miami Valley Hospital
Dayton, OH

Mount Carmel Health
Columbus, OH

Northside Medical Center
Youngstown, OH

Ohio State University Hospitals
Columbus, OH

including The Ohio State University Hospital East
Columbus, OH

Parma Community General Hospital
Parma, OH

Saint Elizabeth Health Center
Youngstown, OH

Saint John West Shore Hospital
Westlake, OH

Saint Vincent Charity Hospital
Cleveland, OH

South Pointe Hospital
Warrensville Heights, OH

Southwest General Health Center
Middleburg Heights, OH

Summa Health Systems Hospitals
Akron, OH

The Toledo Hospital
Toledo, OH

Oklahoma

There are no recipients of this award in this state.

Oregon

Mercy Medical Center
Roseburg, OR

Saint Charles Medical Center - Bend
Bend, OR

Pennsylvania

Alle Kiski Medical Center
Natrona Heights, PA

Allegheny General Hospital
Pittsburgh, PA

including Allegheny General Hospital - Suburban
Pittsburgh, PA

Easton Hospital
Easton, PA

Hamot Medical Center
Erie, PA

Lancaster General Hospital
Lancaster, PA

Lehigh Valley Hospital
Allentown, PA

Main Line Hospitals - Lankenau
Wynnewood, PA

Mercy Hospital Scranton
Scranton, PA

Pocono Medical Center
East Stroudsburg, PA

Saint Luke’s Hospital
Bethlehem, PA

including Saint Luke’s Hospital - Allentown
Allentown, PA

The Reading Hospital and Medical Center
Reading, PA

The Western Pennsylvania Hospital - Forbes Regional
Monroeville, PA

University of Pittsburgh Mc - Saint Margaret
Pittsburgh, PA

Rhode Island

There are no recipients of this award in this state.

South Carolina

Anmed Health
Anderson, SC

South Dakota

Sanford USD Medical Center
Sioux Falls, SD

Tennessee

Baptist Memorial Hospital
Memphis, TN

Memorial Healthcare System
Chattanooga, TN

Methodist Medical Center of Oak Ridge
Oak Ridge, TN

Saint Thomas Hospital
Nashville, TN

Texas

CHRISTUS Santa Rosa Healthcare - San Antonio
San Antonio, TX

Doctors Hospital at Renaissance
Edinburg, TX

Harlingen Medical Center
Harlingen, TX

Memorial Hermann Healthcare System
Houston, TX

Memorial Hermann Memorial City Hospital
Houston, TX

Methodist Hospital
San Antonio, TX

including Methodist Specialty and Transplant Hospital
San Antonio, TX

including Metropolitan Methodist Hospital
San Antonio, TX

including Northeast Methodist Hospital
San Antonio, TX

Methodist Willowbrook Hospital
Houston, TX

Mother Frances Hospital - Tyler
Tyler, TX

Providence Healthcare Network
Waco, TX

Rio Grande Regional Hospital
Mcallen, TX

Saint Lukes Episcopal Hospital
Houston, TX

San Jacinto Methodist Hospital
Baytown, TX

South Texas Health - Edinburg Regional Medical Center
Edinburg, TX

including South Texas Health - McAllen Medical Center/ Heart Hospital
Mcallen, TX

Texas Health Harris Methodist Hospital Fort Worth
Fort Worth, TX

The Methodist Hospital
Houston, TX

including Diagnostic Center Hospital
Houston, TX

Tomball Regional Hospital
Tomball, TX

Valley Regional Medical Center
Brownsville, TX

Woodland Heights Medical Center
Lufkin, TX

Utah

Intermountain Medical Center
Murray, UT

Vermont

There are no recipients of this award in this state.

Virginia

Augusta Health
Fishersville, VA

Bon Secours Memorial Regional Medical Center
Mechanicsville, VA

Henrico Doctors’ Hospital - Forest
Richmond, VA

including Henrico Doctors’ Hospital - Parham
Richmond, VA

Inova Alexandria Hospital
Alexandria, VA

Inova Fair Oaks Hospital
Fairfax, VA

Inova Fairfax Hospital
Falls Church, VA

Inova Loudoun Hospital
Leesburg, VA

Washington

Evergreen Hospital Medical Center
Kirkland, WA

Providence Regional Medical Center Everett
Everett, WA

West Virginia

Princeton Community Hospital
Princeton, WV

Wisconsin

Aurora Saint Lukes Medical Center
Milwaukee, WI

including Saint Lukes Medical Center
Cudahy, WI

Gundersen Luth Medical Center
La Crosse, WI

West Allis Memorial Hospital
West Allis, WI

Wheaton Franciscan Healthcare - Elmbrook Memorial
Brookfield, WI

Wyoming

There are no recipients of this award in this state.

The secret to better health - exercise

Whether you’re 9 or 90, abundant evidence shows exercise can enhance your health and well-being. But for many people, sedentary pastimes, such as watching TV, surfing the Internet, or playing computer and video games, have replaced more active pursuits.

What exercise can do for you

Millions of Americans simply aren’t moving enough to meet the minimum threshold for good health - that is, burning at least 700 to 1,000 calories a week through physical pursuits. The benefits of exercise may sound too good to be true, but decades of solid science confirm that exercise improves health and can extend your life. Adding as little as half an hour of moderately intense physical activity to your day can help you avoid a host of serious ailments, including heart disease, diabetes, depression, and several types of cancer, particularly breast and colon cancers. Regular exercise can also help you sleep better, reduce stress, control your weight, brighten your mood, sharpen your mental functioning, and improve your sex life.

A well-rounded exercise program has four components: aerobic activity, strength training, flexibility training, and balance exercises. Each benefits your body in a different way.

    

Fighting disease with aerobic activity

Aerobic exercise is the centerpiece of any fitness program. Nearly all of the research regarding the disease-fighting benefits of exercise revolves around cardiovascular activity, which includes walking, jogging, swimming, and cycling. Experts recommend working out at moderate intensity when you perform aerobic exercise-brisk walking that quickens your breathing is one example. This level of activity is safe for almost everyone and provides the desired health benefits. Additional health benefits may flow from increased intensity.

    

Protecting bone with strength training

Strength or resistance training, such as elastic-band workouts and the use of weight machines or free weights, are important for building muscle and protecting bone.

Bones lose calcium and weaken with age, but strength training can help slow or sometimes even reverse this trend. Not only can strength training make you look and feel better, but it can also result in better performance of everyday activities, such as climbing stairs and carrying bundles. Stronger muscles also mean better mobility and balance, and thus a lower risk of falling and injuring yourself. In addition, more lean body mass aids in weight control because each pound of muscle burns more calories than its equivalent in fat.

    

Ease back pain with flexibility exercises

Stretching or flexibility training is the third prong of a balanced exercise program. Muscles tend to shorten and weaken with age. Shorter, stiffer muscle fibers make you vulnerable to injuries, back pain, and stress. But regularly performing exercises that isolate and stretch the elastic fibers surrounding your muscles and tendons can counteract this process. And stretching improves your posture and balance.

    

Preventing falls with balance exercises

Balance tends to erode over time, and regularly performing balance exercises is one of the best ways to protect against falls that lead to temporary or permanent disability. Balance exercises take only a few minutes and often fit easily into the warm-up portion of a workout. Many strength-training exercises also serve as balance exercises. Or balance-enhancing movements may simply be woven into other forms of exercise, such as tai chi, yoga, and Pilates.

Exercise at a glance

In a nutshell, exercise can:

• reduce your chances of getting heart disease. For those who already have heart disease, exercise reduces the chances of dying from it.
• lower your risk of developing hypertension and diabetes.
• reduce your risk for colon cancer and some other forms of cancer.
• improve your mood and mental functioning.
• keep your bones strong and joints healthy.
• help you maintain a healthy weight.
• help you maintain your independence well into your later years.

Solution to killer superbug found in Norway

MARGIE MASON and MARTHA MENDOZA
Published: Dec 30, 2009

OSLO, Norway (AP) - Aker University Hospital is a dingy place to heal. The floors are streaked and scratched. A light layer of dust coats the blood pressure monitors. A faint stench of urine and bleach wafts from a pile of soiled bedsheets dropped in a corner.

Look closer, however, at a microscopic level, and this place is pristine. There is no sign of a dangerous and contagious staph infection that killed tens of thousands of patients in the most sophisticated hospitals of Europe, North America and Asia this year, soaring virtually unchecked.

The reason: Norwegians stopped taking so many drugs.

Twenty-five years ago, Norwegians were also losing their lives to this bacteria. But Norway’s public health system fought back with an aggressive program that made it the most infection-free country in the world. A key part of that program was cutting back severely on the use of antibiotics.

Now a spate of new studies from around the world prove that Norway’s model can be replicated with extraordinary success, and public health experts are saying these deaths - 19,000 in the U.S. each year alone, more than from AIDS - are unnecessary.

“It’s a very sad situation that in some places so many are dying from this, because we have shown here in Norway that Methicillin-resistant Staphylococcus aureus (MRSA) can be controlled, and with not too much effort,” said Jan Hendrik-Binder, Oslo’s MRSA medical adviser. “But you have to take it seriously, you have to give it attention, and you must not give up.”

The World Health Organization says antibiotic resistance is one of the leading public health threats on the planet. A six-month investigation by The Associated Press found overuse and misuse of medicines has led to mutations in once curable diseases like tuberculosis and malaria, making them harder and in some cases impossible to treat.

Now, in Norway’s simple solution, there’s a glimmer of hope.

—

Dr. John Birger Haug shuffles down Aker’s scuffed corridors, patting the pocket of his baggy white scrubs. “My bible,” the infectious disease specialist says, pulling out a little red Antibiotic Guide that details this country’s impressive MRSA solution.

It’s what’s missing from this book - an array of antibiotics - that makes it so remarkable.

“There are times I must show these golden rules to our doctors and tell them they cannot prescribe something, but our patients do not suffer more and our nation, as a result, is mostly infection free,” he says.

Norway’s model is surprisingly straightforward.

- Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.

- Patients with MRSA are isolated and medical staff who test positive stay at home.

- Doctors track each case of MRSA by its individual strain, interviewing patients about where they’ve been and who they’ve been with, testing anyone who has been in contact with them.

Haug unlocks the dispensary, a small room lined with boxes of pills, bottles of syrups and tubes of ointment. What’s here? Medicines considered obsolete in many developed countries. What’s not? Some of the newest, most expensive antibiotics, which aren’t even registered for use in Norway, “because if we have them here, doctors will use them,” he says.

He points to an antibiotic. “If I treated someone with an infection in Spain with this penicillin I would probably be thrown in jail,” he says, “and rightly so because it’s useless there.”

Norwegians are sanguine about their coughs and colds, toughing it out through low-grade infections.

“We don’t throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better,” says Haug.

Convenience stores in downtown Oslo are stocked with an amazing and colorful array - 42 different brands at one downtown 7-Eleven - of soothing, but non-medicated, lozenges, sprays and tablets. All workers are paid on days they, or their children, stay home sick. And drug makers aren’t allowed to advertise, reducing patient demands for prescription drugs.

In fact, most marketing here sends the opposite message: “Penicillin is not a cough medicine,” says the tissue packet on the desk of Norway’s MRSA control director, Dr. Petter Elstrom.

He recognizes his country is “unique in the world and best in the world” when it comes to MRSA. Less than 1 percent of health care providers are positive carriers of MRSA staph.

But Elstrom worries about the bacteria slipping in through other countries. Last year almost every diagnosed case in Norway came from someone who had been abroad.

“So far we’ve managed to contain it, but if we lose this, it will be a huge problem,” he said. “To be very depressing about it, we might in some years be in a situation where MRSA is so endemic that we have to stop doing advanced surgeries, things like organ transplants, if we can’t prevent infections. In the worst case scenario we are back to 1913, before we had antibiotics.”

—

Forty years ago, a new spectrum of antibiotics enchanted public health officials, quickly quelling one infection after another. In wealthier countries that could afford them, patients and providers came to depend on antibiotics. Trouble was, the more antibiotics are consumed, the more resistant bacteria develop.

Norway responded swiftly to initial MRSA outbreaks in the 1980s by cutting antibiotic use. Thus while they got ahead of the infection, the rest of the world fell behind.

In Norway, MRSA has accounted for less than 1 percent of staph infections for years. That compares to 80 percent in Japan, the world leader in MRSA; 44 percent in Israel; and 38 percent in Greece.

In the U.S., cases have soared and MRSA cost $6 billion last year. Rates have gone up from 2 percent in 1974 to 63 percent in 2004. And in the United Kingdom, they rose from about 2 percent in the early 1990s to about 45 percent, although an aggressive control program is now starting to work.

About 1 percent of people in developed countries carry MRSA on their skin. Usually harmless, the bacteria can be deadly when they enter a body, often through a scratch. MRSA spreads rapidly in hospitals where sick people are more vulnerable, but there have been outbreaks in prisons, gyms, even on beaches. When dormant, the bacteria are easily detected by a quick nasal swab and destroyed by antibiotics.

Dr. John Jernigan at the U.S. Centers for Disease Control and Prevention said they incorporate some of Norway’s solutions in varying degrees, and his agency “requires hospitals to move the needle, to show improvement, and if they don’t show improvement they need to do more.”

And if they don’t?

“Nobody is accountable to our recommendations,” he said, “but I assume hospitals and institutions are interested in doing the right thing.”

Dr. Barry Farr, a retired epidemiologist who watched a successful MRSA control program launched 30 years ago at the University of Virginia’s hospitals, blamed the CDC for clinging to past beliefs that hand washing is the best way to stop the spread of infections like MRSA. He says it’s time to add screening and isolation methods to their controls.

The CDC needs to “eat a little crow and say, ‘Yeah, it does work,’” he said. “There’s example after example. We don’t need another study. We need somebody to just do the right thing.”

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But can Norway’s program really work elsewhere?

The answer lies in the busy laboratory of an aging little public hospital about 100 miles outside of London. It’s here that microbiologist Dr. Lynne Liebowitz got tired of seeing the stunningly low Nordic MRSA rates while facing her own burgeoning cases.

So she turned Queen Elizabeth Hospital in Kings Lynn into a petri dish, asking doctors to almost completely stop using two antibiotics known for provoking MRSA infections.

One month later, the results were in: MRSA rates were tumbling. And they’ve continued to plummet. Five years ago, the hospital had 47 MRSA bloodstream infections. This year they’ve had one.

“I was shocked, shocked,” says Liebowitz, bouncing onto her toes and grinning as colleagues nearby drip blood onto slides and peer through microscopes in the hospital laboratory.

When word spread of her success, Liebowitz’s phone began to ring. So far she has replicated her experiment at four other hospitals, all with the same dramatic results.

“It’s really very upsetting that some patients are dying from infections which could be prevented,” she says. “It’s wrong.”

Around the world, various medical providers have also successfully adapted Norway’s program with encouraging results. A medical center in Billings, Mont., cut MRSA infections by 89 percent by increasing screening, isolating patients and making all staff - not just doctors - responsible for increasing hygiene.

In Japan, with its cutting-edge technology and modern hospitals, about 17,000 people die from MRSA every year.

Dr. Satoshi Hori, chief infection control doctor at Juntendo University Hospital in Tokyo, says doctors overprescribe antibiotics because they are given financial incentives to push drugs on patients.

Hori now limits antibiotics only to patients who really need them and screens and isolates high-risk patients. So far his hospital has cut the number of MRSA cases by two-thirds.

In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh about conducting a small test program. It started in one unit, and within four years, the entire hospital was screening everyone who came through the door for MRSA. The result: an 80 percent decrease in MRSA infections. The program has now been expanded to all 153 VA hospitals, resulting in a 50 percent drop in MRSA bloodstream infections, said Dr. Robert Muder, chief of infectious diseases at the VA Pittsburgh Healthcare System.

“It’s kind of a no-brainer,” he said. “You save people pain, you save people the work of taking care of them, you save money, you save lives and you can export what you learn to other hospital-acquired infections.”

Pittsburgh’s program has prompted all other major hospital-acquired infections to plummet as well, saving roughly $1 million a year.

“So, how do you pay for it?” Muder asked. “Well, we just don’t pay for MRSA infections, that’s all.”

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Beth Reimer of Batavia, Ill., became an advocate for MRSA precautions after her 5-week-old daughter Madeline caught a cold that took a fatal turn. One day her beautiful baby had the sniffles. The next?

“She wasn’t breathing. She was limp,” the mother recalled. “Something was terribly wrong.”

MRSA had invaded her little lungs. The antibiotics were useless. Maddie struggled to breathe, swallow, survive, for two weeks.

“For me to sit and watch Madeline pass away from such an aggressive form of something, to watch her fight for her little life - it was too much,” Reimer said.

Since Madeline’s death, Reimer has become outspoken about the need for better precautions, pushing for methods successfully used in Norway. She’s stunned, she said, that anyone disputes the need for change.

“Why are they fighting for this not to take place?” she said.

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Martha Mendoza is an AP national writer who reported from Norway and England. Margie Mason is an AP medical writer based in Vietnam, who reported while on a fellowship from The Nieman Foundation at Harvard University.