The New Old Age Blog: Doctor's Orders? Another Test

It is no longer news that Americans, and older Americans in particular, get more routine screening tests than they need, more than are useful. Prostate tests for men over 75, annual Pap smears for women over 65 and colonoscopies for anyone over 75 — all are overused, large-scale studies have shown.

Now it appears that many older patients are also subjected to too-frequent use of the other kind of testing, diagnostic tests.

The difference, in brief: Screening tests are performed on people who are asymptomatic, who aren’t complaining of a health problem, as a way to detect incipient disease. We have heard for years that it is best to “catch it early” — “it” frequently being cancer — and though that turns out to be only sometimes true, we and our doctors often ignore medical guidelines and ongoing campaigns to limit and target screening tests.

Diagnostic tests, on the other hand, are meant to help doctors evaluate some symptom or problem. “You’re trying to figure out what’s wrong,” explained Gilbert Welch, a veteran researcher at the Dartmouth Institute for Health Policy and Clinical Practice.

For these tests, medical groups and task forces offer many fewer guidelines on who should get them and how often — there is not much evidence to go on — but there is general agreement that they are not intended for routine surveillance.

But a study using a random 5 percent sample of Medicare beneficiaries — nearly 750,000 of them — suggests that often, that is what’s happening.

“It begins to look like some of these tests are being routinely repeated, and it’s worrisome,” said Dr. Welch, lead author of the study just published in The Archives of Internal Medicine. “Some physicians are just doing them every year.”

He is talking about tests like echocardiography, or a sonogram of the heart. More than a quarter of the sample (28.5 percent) underwent this test between 2004 and 2006, and more than half of those patients (55 percent) had a repeat echocardiogram within three years, most commonly within a year of the first.

Other common tests were frequently repeated as well. Of patients who underwent an imaging stress test, using a treadmill or stationery bike (or receiving a drug) to make the heart work harder, nearly 44 percent had a repeat test within three years. So did about half of those undergoing pulmonary function tests and chest tomography, a CAT scan of the chest.

Cytoscopy (a procedure in which a viewing tube is inserted into the bladder) was repeated for about 41 percent of the patients, and endoscopy (a swallowed tube enters the esophagus and stomach) for more than a third.

Is this too much testing? Without evidence of how much it harms or helps patients, it is hard to say — but the researchers were startled by the extent of repetition. “It’s inconceivable that it’s all important,” Dr. Welch said. “Unfortunately, it looks like it’s important for doctors.”

The evidence for that? The study revealed big geographic differences in diagnostic testing. Looking at the country’s 50 largest metropolitan areas, it found that nearly half the sample’s patients in Miami had an echocardiogram between 2004 and 2006, and two thirds of them had another echocardiogram within three years — the highest rate in the nation.

In fact, for the six tests the study included, five were performed and repeated most often in Florida cities: Miami, Jacksonville and Orlando. “They’re heavily populated by physicians and they have a long history of being at the top of the list” of areas that do a lot of medical procedures and hospitalizations, Dr. Welch said.

But in Portland, Ore., where “the physician culture is very different,” only 17.5 percent of patients had an echocardiogram. The places most prone to testing were also the places with high rates of repeat testing. Portland, San Francisco and Sacramento had the lowest rates.

We often don’t think of tests as having a downside, but they do. “This is the way whole cascades can start that are hard to stop,” Dr. Welch said. “The more we subject ourselves, the more likely some abnormality shows up that may require more testing, some of which has unwanted consequences.”

Properly used, of course, diagnostic tests can provide crucial information for sick people. “But used without a good indication, they can stir up a hornet’s nest,” he said. And of course they cost Medicare a bundle.

An accompanying commentary, sounding distinctly exasperated, pointed out that efforts to restrain overtesting and overtreatment have continued for decades. The commentary called it “discouraging to contemplate fresh evidence by Welch et al of our failure to curb waste of health care resources.”

It is hard for laypeople to know when tests make sense, but clearly we need to keep track of those we and our family members have. That way, if the cardiologist suggests another echocardiogram, we can at least ask a few pointed questions:

“My father just had one six months ago. Is it necessary to have another so soon? What information do you hope to gain that you didn’t have last time? Will the results change the way we manage his condition?”

Questions are always a good idea. Especially in Florida.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Grim recovery forecast for U.S., global economies

WASHINGTON — In a grim new forecast, a leading international economic group sharply cut its outlook for U.S. and global growth next year and warned that the debt crisis in Europe and fiscal policy risks in America could plunge the world back into recession.

As it stands now, the industrialized world is looking at a muted and uneven recovery over the next two years, according to the Organization for Economic Cooperation and Development.

The Paris-based OECD projected gross domestic product across its 34 member nations — which include the U.S., Japan and the 17-nation Eurozone — to grow a sluggish 1.4% next year. That is down from 2.2% that the group had forecasted six months earlier.

Growth prospects in the U.S. also were slashed for next year. Experts at the OECD now see inflation-adjusted GDP, the broadest measure of economic activity, rising 2% next year in the U.S., roughly equivalent to this year and down from its earlier forecast of an increase of 2.6%.

The new projections are all the more sobering in that they are based on assumptions that Europe's debt crisis won't get much worse and that the U.S. won't go over the so-called fiscal cliff — a combination of more than $500 billion in automatic tax hikes and federal spending cuts slated to begin at the start of next year.

Quiz: How much do you know about the 'fiscal cliff'?

"If key adverse risks cannot be averted, and especially if the Eurozone crisis were to intensify significantly, the likely outcome would be considerably weaker, potentially plunging the global economy into deep recession and deflation, with large additional rises in unemployment," the OECD said.

The report, released Tuesday, is on the pessimistic side.

Although economists widely agree on the recession risks in the event that the U.S. isn't able to solve the fiscal impasse, a number of experts now say that the U.S. and global economies could see considerably stronger growth next year if Washington can reach agreement on tax and spending policies that avoid a big fiscal contraction in 2013.

"The economy in the U.S. is really poised to grow," said Bernard Baumohl, chief global economist at the Economic Outlook Group, noting that GDP growth in the U.S. could surge to a solid 3.5% or higher next year if the budget issues are resolved.

The latest forecast from the Federal Reserve, compiled in mid-September, sees U.S. GDP increasing 2.5% to 3% next year.

Baumohl's reasons for greater optimism include a recovering housing market, improving job growth and healthier personal finances, all of which should help drive stronger consumer spending.

Total consumer debt, which has fallen for four years, dropped by $74 billion to $11.31 trillion in the third quarter from the previous quarter, and it is now down $1.37 trillion from the peak in September 2008, according to a report Tuesday from the New York Fed.

Reflecting these trends, the Conference Board said Tuesday that its latest survey showed consumer confidence at its highest level since early 2008, results similar to a survey by the University of Michigan.

American business sentiments, however, have been more cautious of late, and many companies have held back on making investments in recent months. But banks are generally in good shape, and big companies are sitting on mountains of cash and are expected to ramp up investments once the fiscal and tax pictures become clearer.

The OECD report nodded to these factors, but noted that the global recovery slowed markedly over the last year amid faltering confidence and weakening world trade, in part because of problems in the Eurozone, which contributed to an unexpectedly strong slowdown in developing countries such as China.

The 17-nation Eurozone will probably remain in recession well into next year, the OECD said.

Meanwhile, Japan, the world's third-largest economy, has fallen back into a downturn after a growth spurt last year aided by massive reconstruction spending following the earthquake and tsunami in March 2011. The Japanese economy is expected to move at a lumbering pace over the next two years.

The outlook for China, Brazil and India — three of the biggest developing economies, none of which is a member of the OECD — looks comparatively brighter:  Growth will probably accelerate next year and in 2014, with China, the world's second-largest economy, again leading the pack.

The OECD forecast sees China's GDP expanding 8.5% next year and nearly 9% in 2014 after slowing this year to about 7.5%.

Although far from immune from the troubles in the U.S. and Europe, which still account for much of the global demand for goods, China and other major emerging economies have more wherewithal to boost growth than their more-indebted developed counterparts by ramping up government spending and lowering interest rates.

The report notes that spending cuts throughout OECD member countries have taken a toll on economic growth, particularly in the Eurozone, where GDP growth for next year was slashed to -0.1% from a positive rate of 0.9%.

Many developed countries are now struggling with financial and economic challenges related to an aging population, large public debts and high unemployment.

Assuming Europe's debt crisis stabilizes, the Eurozone is forecast to recover in 2014. For OECD countries overall, GDP growth is projected to pick up in 2014 to 2.3%.

The U.S. economy is expected to outperform most other OECD nations in 2014, with its GDP stepping up to a more sturdy growth of 2.8%. That compares with the Fed's forecast of 3% to 3.8% growth in 2014.

Either way, U.S. economic growth isn't likely to come close to keeping up with the rapid advance of developing countries, notably China.

Last year, the U.S. accounted for 23% of the global economy, with the Eurozone and China tied for second, each with a 17% share each.

But by 2030, the OECD estimates, China's share of the global economy will rise to 28%, while the U.S. will slip to No. 2 with 18% of world GDP, and the Eurozone's share will fall to 12%.

don.lee@latimes.com

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Gunfire at gang funeral: 'It s broad daylight,' says stunned neighbor

Rev. Corey Brooks talks about shooting after a funeral in Chicago on Monday, November 26, 2012. (Scott Strazzante, Chicago Tribune)

Shots rang out, causing panic and chaos as hundreds of mourners were leaving a Catholic church on the South Side following funeral services Monday for a slain reputed gang member.

As people scattered for exits, a woman knocked Deborah Echols-Moore, 59, to the floor and fell atop her. Her shoes were thrown off her feet. When she stood back up, she fled barefoot out a door.

“When I came outside, you still can hear shooting. Boom! Boom! Boom! I still ran…people was running behind me,” the longtime CTA employee said not long after the 12:30 p.m. shooting. “You didn’t know which way to go or what to do. All I knew to do was run for my life.”

Chicago police said one man was killed, another critically injured in the bloodshed at St. Columbanus Church. Police identified both as Gangster Disciples members and convicted felons, illustrating once again the high risks of gang membership in a year in which rising homicides have brought Chicago unwanted national attention.

GDs alone make up more than a quarter of the city’s approximately 470 homicide victims. About 60 percent of this year’s homicide victims were gang members, according to department statistics.

Police were still investigating who was responsible for the shooting, but investigators said the neighborhood has long been rife with conflict between GDs and rival Black Disciples.

Illustrating the sudden, often unpredictable nature of the violence, police Superintendent Garry McCarthy just a couple of hours earlier was touting the department’s crime-fighting strategies in tamping down the city’s rate of violence since earlier in the year when homicides soared. Through Sunday, homicides have risen more than 19 percent over the same period a year earlier, department records show.

There were five fewer homicides during the first 25 days of November compared to the same period in 2011, according to department statistics. But shootings during the first 25 days of this month have risen sharply by 45 percent.

From November 1 through Sunday there were 161 shootings compared to 111 during the same period in 2011, department statistics show.

Rev. Corey Brooks, a well-known South Side pastor who officiated at Monday’s services for James Holman, 32, said a church would have been off-limits for gangbangers at one time.

“Now we are living at a day and time where these younger criminals have no regard for life or for street rules,” he said.

Holman, identified by police as a gang member, was gunned down last week at an apartment building in the Washington Park neighborhood.

The shooting took place just outside St. Columbanus, the same church where gangster Al Capone’s wife and mother attended mass daily more than half a century ago.

A Cook County Medical Examiner's spokesman identified one of the two victims as Sherman Miller, 21, and said he was pronounced dead at Stroger Hospital. A 26-year-old man was shot in the back and listed as in “extremely critical condition,” a hospital spokesman said.

Miller, who is also identified in court records as William Miller, was on parole for being in possession of a stolen vehicle and escaping from police custody, according to the Illinois Department of Corrections Web site.

The surviving victim has a 2004 felony weapons conviction in his criminal background, court records show.

Police said two guns were recovered, one down the block from the church at East 71st Street and South Prairie Avenue and another on one of the victims.

About a dozen bullet casings littered the steps outside the church where yellow evidence markers were placed. Beat cops blocked off traffic with their squad cars and sealed off the church’s entrance with yellow and red tape. As evidence technicians took photos of the crime scene, detectives went door-to-door to nearby homes scouring for witnesses.

April Smith, 30, said she looked out a second-floor window of her home when she heard her car alarm sound off and noticed a man wearing a black hooded sweatshirt and blue jeans walking toward the church entrance on 71st Street. She then heard about a dozen gunshots and saw two passersby crouch for protection.

Moments later, the same man in the sweatshirt ran back onto Prairie and fled south, said Smith. Mourners then frantically exited the church.

“To know that something like that happened right across the street...it’s terrible,” Smith, who has lived at her home for seven years, said in disbelief. “It’s broad daylight.”

Brooks, who is pastor of New Beginnings Church of Chicago in the Woodlawn neighborhood and is considering a run for former U.S. Rep. Jesse Jackson Jr.’s vacant congressional seat, said about 500 people attended the funeral, including about 50 children. The church was so crowded that people were standing in the back.

Brooks had finished the eulogy and Holman’s family and close friends had gone out the front door of the church when shots rang out.

“That's when all the gunfire broke out and it was just crazy,” Brooks said. “People were hollering and screaming and kids running everywhere.”

Charles Childs, a co-owner of the A.A. Rayner and Sons Funeral Home across the street from the church, held an uneventful visitation for Holman on Sunday. On Monday he said he saw the gunman firing his weapon as he came down the front steps outside the church.

“No place is safe,” he said. “It’s just despicable.”

Tribune reporter Naomi Nix contributed to this story.

jgorner@tribune.com
lford@tribune.com
csadovi@tribune.com

Twitter: @ChicagoBreaking

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India: 2 policemen suspended, magistrate transferred for arrest of 2 women over Facebook post

NEW DELHI – An Indian official says two senior policemen have been suspended for arresting two women over a Facebook post criticizing the shutdown of Mumbai for the funeral of a powerful politician.

Maharashtra state Home Minister R.R. Patil said Tuesday the policemen were suspended indefinitely and the magistrate who registered the case against the women has been transferred to another district.

Police also arrested nine men who vandalized a medical clinic run by the uncle of one of the women, Patil said.

One of the women had posted a Facebook comment complaining that Mumbai had come to a standstill after the death of rightwing leader Bal Thackeray. Her friend “liked” the post.

Their arrest last week was seen as a misuse of Internet laws and an attempt to curb freedom of expression.

Social Media News Headlines – Yahoo! News

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New Zealand becomes Middle Earth as Hobbit mania takes hold

WELLINGTON (Reuters) – New Zealand‘s capital city was rushing to complete its transformation into a haven for hairy feet and pointed ears on Tuesday as stars jetted in for the long-awaited world premiere of the first movie of the Hobbit trilogy.

Wellington, where director Peter Jackson and much of the post production is based, has renamed itself “the Middle of Middle Earth“, as fans held costume parties and city workers prepared to lay 500 m (550 yards) of red carpet.

A specially Hobbit-decorated Air New Zealand jet brought in cast, crew and studio officials for the premiere.

Jackson, a one-time printer at a local newspaper and a hometown hero, said he was still editing the final version of the “Hobbit, an Unexpected Journey” ahead of Wednesday’s premiere screening.

The Hobbit movies are based on J.R.R. Tolkien’s book and tell the story that leads up to his epic fantasy “The Lord of the Rings“, which Jackson made into three Oscar-winning films about 10 years ago.

It is set 60 years before “The Lord of The Rings” and was originally planned as only two movies before it was decided that there was enough material to justify a third.

New Zealand fans were getting ready to claim the best spots to see the film’s stars, including British actor Martin Freeman, who plays the Hobbit Bilbo Baggins, Hugo Weaving, Cate Blanchett, and Elijah Wood.

“It’s been a 10-year wait for these movies, New Zealand is Tolkien’s spiritual home, so there’s no way we’re going to miss out,” said office worker Alan Craig, a self-confessed Lord of the Rings “nut”.

The production has been at the centre of several controversies, including a dispute with unions in 2010 over labor contracts that resulted in the government stepping in to change employment laws, and giving Warner Brothers increased incentives to keep the production in New Zealand.

“The Hobbit did come very close to not being filmed here,” Jackson told Radio New Zealand.

He said Warners had sent scouts to Britain to look at possible locations and also matched parts of the script to shots of the Scottish Highlands and English forests.

“That was to convince us we could easily go over there and shoot the film … and I would have had to gone over there to do it but I was desperately fighting to have it stay here,” Jackson said.

Last week, an animal rights group said more than 20 animals, including horses, pigs and chickens, had been killed during the making of the film. Jackson has said some animals used in the film died on the farm where they were being housed, but that none had been hurt during filming.

The films are also notable for being the first filmed at 48 frames per second (fps), compared with the 24 fps that has been the industry standard since the 1920s.

The second film “The Hobbit: The Desolation of Smaug” will be released in December next year, with the third “The Hobbit: There and Back Again” due in mid-July 2014.

(Editing by Paul Tait)

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The New Old Age Blog: New Efforts to Close Hospitals' Revolving Doors

In the past, the only thing a patient was sure to get after a hospital stay was a bill. But as Medicare cracks down on high readmission rates, hospitals are dispatching nurses, transportation, culturally specific diet tips, free medications and even bathroom scales to patients deemed at risk of relapsing.

Robert Wood Johnson University Hospital in New Brunswick, N.J., has nurses visit high-risk patients at their home within two days of leaving the hosital. Teresa De Peralta, a nurse practitioner who runs the program, said they frequently find that patients don’t realize a drug they were prescribed in the hospital does the same thing as one they have already been taking.

“When medications are changed, they don’t want to throw things out, they think it’s a waste,” Ms. De Peralta said. “We actually go through the cupboards and painstakingly write out in big letters what they should be taking during the day.”

Many hospital officials say their efforts to keep patients healthy after discharge have been spurred by new financial penalties Medicare started imposing in October on places with too many readmissions. Increasingly, hospitals are no longer leaving to patients the responsibility for setting up follow-up appointments or filling new prescriptions.

And hospitals are not assuming that personnel in nursing homes and other facilities know how to properly care for their patients and follow the hospital discharge instructions.

Patients taking the wrong dose or mixing medicines that react badly often end up back in the hospital. A survey of 377 elderly patients at Yale-New Haven Hospital, published this year in The Journal of General Internal Medicine, discovered that 81 percent of the patients either didn’t understand what all their prescriptions were for; were prescribed the wrong drug or the wrong dose; were taken off a drug they needed, or never picked up a new prescription.

Dr. Leora Horwitz, the study’s leader, said patients who were called a week after their discharge and were asked what changes to their medication they were supposed to make “overwhelmingly” couldn’t tell them.

A big part of reducing readmissions is making sure that patients understand early warning signs that their health is deteriorating. Sun Health Care Transitions, a foundation-supported program in Sun City, Ariz., gives scales to some patients with congestive heart failure because small weight gains indicate they are retaining water, a sign that their heart isn’t pumping adequately.

“We have them keep a log,” said Jennifer Drago, a Sun Health vice president. “We want them to be looking for a two-pound daily weight gain, or five pounds over the week.”

Patients whose weight creeps up are quickly sent back to their doctor. Debra Richards, director of case management at Banner Del E. Webb Medical Center, one of the hospitals Sun Health is assisting, said, “That program has helped us quite a bit.”

Shady Grove Adventist Hospital in Rockville, Md., has started taking patients’ cultural backgrounds into consideration when doling out advice about maintaining their health. For example, the hospital encourages Salvadoran patients to substitute olive oils for the palm oils their cuisine traditionally calls for, to roast or bake meat instead of frying it and to use sugar substitutes when making horchata, a popular Central American drink.

When Hackensack University Medical Center sent staff members to teach caregivers how to take care of their patients, one place “didn’t even know what a low-salt diet was,” even though that’s a critical part of keeping heart failure patients from retaining fluids, said Dr. Charles Riccobono, chief quality and safety officer at the New Jersey hospital.

Aurora Health Care, a Milwaukee-based health system, now places its own nurse practitioners in several nursing homes to watch over Aurora’s discharged patients. Aurora says readmission rates of those patients have decreased, in some months by as much as half.

Dr. Eric Coleman, a Denver geriatrician whose ideas on reducing readmissions have been adopted by a number of hospitals and Medicare, said that while some hospital changes are “exciting and new,” others are “relabeling old wine in new bottles.”

“Yesterday we had ‘discharge planning’ and today we have a ‘rapid response transition team,’ and content-wise they’re doing the same thing,” Dr. Coleman said. “But it’s a nice thing to report out to the board of trustees.”

Jordan Rau is a reporter for Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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Holiday sales continue to soar on Cyber Monday

Web shopping soared on Cyber Monday, continuing a strong start to the holiday season.

Online sales were up 26.6 percent from last year by Monday evening, according to IBM Digital Analytics Benchmark, which tracks data from 500 retail sites. ComScore meanwhile, expected online sales to hit a record of about $1.5 billion by day's end.

Cyber Monday has become the biggest online shopping day in recent years as employees head back to the office but continue to cybershop for holiday gifts. The growth of smartphones and tablets has only increased that ability, an opportunity Web retailers have been eager to exploit.

This year, retailers aggressively pushed "Pre-Black Friday" promotions and flooded consumers with emails touting good deals in the days before Thanksgiving. As a result, the big shopping days of Thanksgiving, Black Friday and Cyber Monday have blurred into a sale-laden week.

Some retail analysts had worried that strong online sales growth on Thanksgiving Day and Black Friday would entice shoppers to buy earlier, threatening revenue later in the season.

"So far, that is not the case," said Jay Henderson, the strategy director for IBM Smarter Commerce. "Extending the shopping season has really just fueled additional online spending rather than cannibalizing days later in the season."

Sales across Amazon.com, the largest online retailer, had risen 52 percent from the previous year by midmorning Monday, according to ChannelAdvisor, which offers services to third-party sellers on e-commerce sites. Meanwhile, eBay sales volume increased 57 percent, the firm said.

The average online order size on Cyber Monday was $130.30. That was down from almost $200 during the whole of Cyber Monday last year, according to IBM.

But Monday's discounts on the websites of bricks -and-mortar retailers weren't necessarily as broad or as deep as consumers could find if they shopped in the days before, according to Michael Brim, founder of deal site BFAds.net. "We're not seeing across the board the lowest prices like we do on Black Friday or Thanksgiving," he said. "It's better than the average weekly sales, but it's not on the level of Black Friday … yet," he said.

Most retailers — about 97 percent — were expected to offer Cyber Monday deals this year, up from 90 percent last year, according to the National Retail Federation. That means good deals were there for the finding on sites that might not normally have sales, Brim said.

Laptops and apparel at specialty sites were popular items Monday, Brim said.

Amazon offered $30 off its 7-inch Kindle Fire tablet, which usually sells for $159. The deal was available only on Cyber Monday.

Hoffman Estates-based retailer Sears said it found that a number of its shoppers opted to buy online and pick up merchandise in the store, according to spokesman Tom Aiello, who declined to say whether online traffic increased Monday. Shoppers want "to save on shipping, or they want to touch it — and get it the same day and make sure they've got that gift in their hands," he said.

Tribune news services contributed.

crshropshire@tribune.com

Twitter @corilyns

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Pfleger points police to suspect in fatal stabbing

During an argument with his wife Wednesday, Demetrius Jackson allegedly stabbed to death a 55-year-old man who intervened, then called St. Sabina Catholic Church to pray with the Rev. Michael Pfleger.

Shortly after a Cook County judge ordered Jackson, 32, held without bond on Sunday on a charge of first-degree murder, Pfleger, reached by phone, recounted the conversation he had with Jackson on Friday, a day before he turned himself in.

"He told me the guy who he allegedly stabbed is his best friend," Pfleger said. "He said (the victim) punched him in the face. He told me he just reacted. He asked me to pray with him, and I prayed with him."

Jackson, who lives in Chicago's Roseland neighborhood, hung his head in Cook County Bond Court as a judge said he faced a murder charge in the death of William Terry of the 10300 block of South Forest Avenue.

Jackson and his wife were arguing in their home, also in the 10300 block of South Forest, Wednesday night when he allegedly grabbed a knife and threatened to kill her, prosecutors said. The wife fled to Terry's home and called 911, prosecutors said.

Before police arrived, Jackson's wife and Terry decided to walk back to Jackson's home. Still holding a knife, Jackson confronted the two outside and continued to berate his wife, authorities said. Terry stepped between them, "trying to calm" the defendant, Assistant State's Attorney Brad Dickey said. Terry fell to the ground, and Jackson leapt on top of him, stabbing him multiple times in front of several witnesses, authorities said.

"Terry was able to stagger to his home," Dickey said. Gasping for breath, he collapsed on his front porch. He was taken to Advocate Christ Medical Center in Oak Lawn shortly after 8 p.m. and pronounced dead, according to police. Other county officials said Terry lived in Riverdale.

Jackson, who appears to have no criminal record, worked with St. Sabina on the Safe Passage project, public defender Stephen Herczeg said. A Chicago Public Schools program, Safe Passage employs community members to help improve safety by standing guard along the routes children travel to schools.

When the two spoke, Pfleger encouraged Jackson to turn himself in to police.

"I told him, 'I'm not a court or a lawyer or a judge,'" Pfleger said. "I told him I wouldn't judge him. I just encouraged him to turn himself in and not run. A lot of times, people are afraid to go to the police directly. I said I would try to set it up."

When Jackson agreed, Pfleger said he called police at the Gresham District, telling them of Jackson's intentions.

As promised, Jackson showed up at a police station Friday morning and gave a video-taped confession, according to court documents.

"Thank God it worked," said Pfleger. "It's very sad. I feel bad about the man who got killed, too. It's a loss of two lives."

efmeyer@tribune.com

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Dog bite sidelines ‘Dirty Dozen’ trumpeter Towns

NEW ORLEANS (AP) — Dirty Dozen Brass Band trumpeter Efrem Towns is recovering at home in New Orleans from a vicious attack by a Rottweiler at an Atlanta motel.

He missed performances in Colorado and New Orleans after the attack on Nov. 18, and doesn’t know if he’ll make the band’s next scheduled gig on Dec. 28, The Times-Picayune (http://bit.ly/XOJoNr) reported.

He and baritone sax player Roger Lewis said the dog surged from an open motel room door after Towns knocked on the door of Lewis’ room.

“I didn’t know if it was a dog, wolverine, bear, mongoose or what. I just knew something had me,” Towns said.

He said the dog‘s owner came out of the next room, and they were able to subdue it.

At Atlanta’s Grady Hospital, he received 30 stitches in his groin. Towns, who has health insurance through his wife, Tracie, said he will be seeing a urologist this week.

The Dirty Dozen Brass Band formed in 1977, and is credited with creating the contemporary, funk-infused brass band sound. It’s been featured on albums with David Bowie, Elvis Costello and the Black Crowes.

Towns said he probably could practice while convalescing. “But I’m very uncomfortable right now,” he said Friday evening. “I’m basically immobilized — it’s hard getting around. I’m kind of miserable.”

The experience hasn’t soured Towns on dogs. He and his wife own three miniature schnauzers, a standard schnauzer and a mixed breed. On Friday, his daughter’s dachshund was visiting.

“I’m a dog person,” he said. “And even though I got bit, I hope they don’t put that dog to sleep.”

___

Information from: The Times-Picayune, http://www.nola.com

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Agency Investigates Deaths and Injuries Associated With Bed Rails

Thomas Patterson for The New York Times

Gloria Black’s mother died in her bed at a care facility.

In November 2006, when Clara Marshall began suffering from the effects of dementia, her family moved her into the Waterford at Fairway Village, an assisted living home in Vancouver, Wash. The facility offered round-the-clock care for Ms. Marshall, who had wandered away from home several times. Her husband Dan, 80 years old at the time, felt he could no longer care for her alone.

Thomas Patterson for The New York Times

Gloria Black, visiting her mother’s grave in Portland, Ore. She has documented hundreds of deaths associated with bed rails and said families should be informed of their possible risks.

But just five months into her stay, Ms. Marshall, 81, was found dead in her room apparently strangled after getting her neck caught in side rails used to prevent her from rolling out of bed.

After Ms. Marshall’s death, her daughter Gloria Black, who lives in Portland, Ore., began writing to the Consumer Product Safety Commission and the Food and Drug Administration. What she discovered was that both agencies had known for more than a decade about deaths from bed rails but had done little to crack down on the companies that make them. Ms. Black conducted her own research and exchanged letters with local and state officials. Finally, a letter she wrote in 2010 to the federal consumer safety commission helped prompt a review of bed rail deaths.

Ms. Black applauds the decision to study the issue. “But I wish it was done years ago,” she said. “Maybe my mother would still be alive.” Now the government is studying a problem it has known about for years.

Data compiled by the consumer agency from death certificates and hospital emergency room visits from 2003 through May 2012 shows that 150 mostly older adults died after they became trapped in bed rails. Over nearly the same time period, 36,000 mostly older adults — about 4,000 a year — were treated in emergency rooms with bed rail injuries. Officials at the F.D.A. and the commission said the data probably understated the problem since bed rails are not always listed as a cause of death by nursing homes and coroners, or as a cause of injury by emergency room doctors.

Experts who have studied the deaths say they are avoidable. While the F.D.A. issued safety warnings about the devices in 1995, it shied away from requiring manufacturers to put safety labels on them because of industry resistance and because the mood in Congress then was for less regulation. Instead only “voluntary guidelines” were adopted in 2006.

More warnings are needed, experts say, but there is a technical question over which regulator is responsible for some bed rails. Are they medical devices under the purview of the F.D.A., or are they consumer products regulated by the commission?

“This is an entirely preventable problem,” said Dr. Steven Miles, a professor at the Center for Bioethics at the University of Minnesota, who first alerted federal regulators to deaths involving bed rails in 1995. The government at the time declined to recall any bed rails and opted instead for a safety alert to nursing homes and home health care agencies.

Forcing the industry to improve designs and replace older models could have potentially cost bed rail makers and health care facilities hundreds of million of dollars, said Larry Kessler, a former F.D.A. official who headed its medical device office. “Quite frankly, none of the bed rails in use at that time would have passed the suggested design standards in the guidelines if we had made them mandatory,” he said. No analysis has been done to determine how much it would cost the manufacturers to reduce the hazards.

Bed rails are metal bars used on hospital beds and in home care to assist patients in pulling themselves up or helping them out of bed. They can also prevent people from rolling out of bed. But sometimes patients — particularly those suffering from Alzheimer’s — can get confused and trapped between a bed rail and a mattress, which can lead to serious injury or even death.

While the use of the devices by hospitals and nursing homes has declined as professional caregivers have grown aware of the dangers, experts say dozens of older adults continue to die each year as more rails are used in home care and many health care facilities continue to use older rail models.

Since those first warnings in 1995, about 550 bed rail-related deaths have occurred, a review by The New York Times of F.D.A. data, lawsuits, state nursing home inspection reports and interviews, found. Last year alone, the F.D.A. data shows, 27 people died.

As deaths continued after the F.D.A. warning, a working group put together in 1999 and made up of medical device makers, researchers, patient advocates and F.D.A. officials considered requiring bed rail makers to add warning labels.

But the F.D.A. decided against it after manufacturers resisted, citing legal issues. The agency said added cost to small manufacturers and difficulties of getting regulations through layers of government approval, were factors against tougher standards, according to a meeting log of the group in 2000 and interviews.

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