The U.S. News & World Report recently released its 2010-2011 rankings of the best hospitals in the United States. Although its core business is the delivery of mainstream news, the U.S. News & World Report is best known for its annual rankings of best colleges, graduate schools, and hospitals. Given the success of these rankings, they have extended them to include anything-and-everything under the sun, such as best insurance plans, nursing homes, mutual funds, high schools, vacations, and places to retire.

There were 152 hospitals included in the 2010-2011 rankings of best hospitals, but the Honor Roll of elite institutions is slimmer this year at 14 hospitals, compared to the 21 listed last year. Topping the list for the twentieth consecutive year is the Johns Hopkins Hospital (Baltimore, Maryland). The hospital has 5 adult specialties ranked as the top in the nation, including Otorhinolaryngology (Ear, Nose, and Throat) , Gynecology, Neurology & Neurosurgery, Rheumatology, and Urology. Ten other specialties were listed among the top five in the nation. According to a national survey of hospitals, 82% of patients discharged from the Johns Hopkins Hospital would definitely recommend the hospital to family and friends. Comparatively, the state and national averages are 64% and 68%, respectively.

Another outstanding contender for the past 21 years that the Honor Roll has existed has been the Mayo Clinic (Rochester, Minnesota). The Mayo Clinic has excelled with Endocrinology, Gastroenterology, and Nephrology as top-ranked specialties. As for the remaining hospitals on the Honor Roll, there have been some shifts since last year. The Massachusetts General Hospital (Boston, Massachusetts) swapped with the Ronald Reagan UCLA Medical Center (Los Angeles, California) to take the #3 spot in exchange for the #5 spot. The Barnes-Jewish Hospital (St. Louis, Missouri) exchanged places with the Hospital of the University of Pennsylvania (Philadelphia, Pennsylvania). Similarly, Duke University Medical Center (Durham, North Carolina) edged Brigham and Women’s Hospital (Boston, Massachusetts).

Drum roll for the top fourteen …

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I was delighted to have discovered that our article about the choice of wiper fluid and Legionnaire’s disease was picked as one of four Editor’s Selections yesterday on the ResearchBlogging site.

ResearchBlogging.org is a repository of academic blog posts about peer-reviewed research. The topics range from anthropology and astronomy to psychology and social science. Relevant to On The Wards, there are categories for health and clinical research. The site emphasizes “serious posts” and is not intended for “news, politics, family, bagpipes, and so on”. An informal peer-review process occurs through member bloggers who report posts that do not adhere to publication guidelines. So far our past submissions have not been dinged, and I hope that continues to be the case.

The standard screening “HIV test” used in clinics or Emergency Departments works to detect human antibodies to HIV. While the test can provide quick-and-easy results, a significant drawback has been the inability to detect early HIV infections. In the acute or early phase of HIV infection, the body does not yet produce antibodies to the virus; consequently, the HIV-infected individual may still appear “HIV-negative”. There are PCR-based methods to detect HIV nucleic acids, but these have a longer turnaround time and are not cost-effective for routine screening.

To circumvent the problem of false negative results early in an infection, the Architect HIV Ag/Ab Combo Assay (Abbott Laboratories) was designed to detect both HIV antigen (p24) and antibody. It is the first of its kind and is also intended for diagnosis of both HIV-1 and HIV-2 infections. The assay was just approved for clinical use by the U.S. Food and Drug Administration. It is not intended for routine screening of blood donors, except in urgent situations.

The “New & Interesting” series is a biweekly compilation of select research findings, news articles, and random tidbits in bullet-point format. The entries are highly abbreviated, but provide links to the original articles or abstracts if you desire to read further.

General Articles

• Telaprevir leads to 75% cure rate in hepatitis C virus (HCV) infected individuals, as shown in late-stage Phase III drug trial. This is a significant improvement over the 40-50% cure rate of the current HCV therapies: interferon and ribavirin. The side effect profile of telaprevir is also much more tolerable than with interferon and ribavirin. If approved by the FDA, telaprevir may also lead to a multi-billion dollar boon for its developer, Vertex Pharmaceuticals. (Reuters)

• Researchers at Ulm University in Germany discovered that children who ate three or more hamburgers a week had a 40% greater risk of developing asthma than those who ate less hamburgers. The group hypothesizes that saturated fats promote asthma by causing inflammation in the airways. This does not apply to all fats, such as omega-3, which may instead have a protective effect. (WebMD)

Technical Articles

• Bilateral necrosis of earlobes and cheeks may be another complication of cocaine. There has been an increasing percentage of cocaine cut with the antihelmintic agent levimasole. Levimasole is an immunomodulating agent that has neutropenia and vasculitis as adverse effects. Physicians from the University of Rochester report two cases of cocaine abusers who developed these yet unknown consequences of cocaine use. (Ann Intern Med)

• Inactive hepatitis B still carries risk for hepatocellular carcinoma and liver-related death. The REVEAL-HBV (Risk Evaluation of Viral Load Elevation and Associated Liver Disease/Cancer in HBV) Study Group found that the annual incidence rates of hepatocellular carcinoma and liver-related death was higher in inactive HBV carriers when compared to uninfected controls. (Gastroenterology)

In our currently fragile economy, lifestyle changes are often necessary to maintain a reasonable budget. We may carpool more often, eat out less frequently, or reduce the number of foreign excursions. While making changes to shave costs are generally helpful, there are some corners that should not be cut.

In a recent study published in the European Journal of Epidemiology, the cost-cutting practice of replacing water for windshield wiper fluid has been linked with an increased risk of developing Legionnaire’s disease.

It appears that stagnant water in wiper fluid reservoirs promote bacterial growth, including the Legionella bacteria that are typically spread through water systems (e.g., air conditioners, showers, and fountains). When sprayed on the windshield, the bacteria are aerosolized and disseminated through air vents or open windows.
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