ScienceDaily (Aug. 3, 2011) — A signaling system in the brain previously shown to regulate sleep is also responsible for inducing lethargy during illness, according to research conducted at Oregon Health & Science University Doernbecher Children’s Hospital.
This research is particularly meaningful because it implies that a new class of drugs developed to treat sleep disorders can reverse the inactivity and exhaustion brought on by acute illness. Although the sleep drugs were initially designed to treat narcolepsy, they have the potential to restore energy and motivation in patients with acute and chronic disease, the researchers report. Their findings are published in the The Journal of Neuroscience.
“We all know what it means to feel ‘bad’ when we’re acutely ill. In particular, patients with chronic diseases experience a compromise in motivated behaviors. They don’t feel like getting up and doing anything. Yet the brain mechanisms behind this common experience have remained obscure,” said Daniel L. Marks, M.D., Ph.D., principal investigator and associate professor of pediatrics in the Papé Family Pediatric Research Institute at OHSU Doernbecher Children’s Hospital….
- For Men and Women, Response to Stress Is Very Different (fitsugar.com)
- Too Sick to Work? (webmd.com)
The emerging literature on chronic disease management suggests that successful programs rely on patient self management skills. Having been in the primary care role for 20 years, that initially seemed self evident and a bit “so what?” to me, thinking it meant that we just need to teach our patients a bit more in the primary care office.
However self-management skills refer to specific curricula of skills that can be taught to patients in formal programs, without doctors. Coordinating these activities with what goes on a primary care office, and the community, and other care-giving settings is critical. These specific skills involve patients setting their own goals, and then creating plans to reach those goals with the assistance of their primary care team and others, but not at the direction of their primary care team. This is a real mind shift for the primary care doctor also.
- The benefits of successful patient self-management programs (kevinmd.com)
- Summary Box: Trying a new approach to primary care (seattletimes.nwsource.com)
- New Brief Outlines Strategies to Put Patients at the Center of Primary Care (jflahiff.wordpress.com)
Chronic non-communicable diseases (NCD), such as cardiovascular disease,diabetes, arthritis, chronic respiratory disorders and cancer represent the major global health problem of the 21st century and affect all age groups. The cost of treating these diseases is substantial, and for many countries is an under-appreciated cause of poverty.
In BioMed Central’s open access journal Genome Medicine an international group of scientists and medical doctors have proposed an integrated method, using systems medicine, research, and personalized patient centered treatment, to look at chronic disease as a whole. ..
…Prof Jean Bousquet, from Arnaud de Villeneuve Hospital, CHU Montpellier, said, “Integration between results from primary care, research, and public health studies would fine tune computational and mathematical modeling. Increased access to patient data by health professionals (as long as patient confidentiality could be assured) would feed into this data pool in order to provide a better understanding of disease progression and treatment.
“Many people who suffer from chronic NCD are affected by more than one disease and would benefit from a personalized holistic treatment at the level of primary care. A better understanding of chronic disease through systems medicine would allow a more efficient use of health resources and focus attention on prevention as well as control, so reducing the cost and burden of care to society.” ..
- Questions to Ask Your Doctor About Chronic Kidney Disease (everydayhealth.com)
- Coping with diseases can go beyond medication (search.japantimes.co.jp)
- Patients with chronic conditions get one-stop care (theglobeandmail.com)
(Garrison, NY) In a feature article in The New Republic,(subscription only, check your local public library for availability) Daniel Callahan and Sherwin Nuland propose a radical reinvention of the American medical system requiring new ways of thinking about living, aging, and dying. They argue that a sustainable—and more humane— medical system in the U.S. will have to reprioritize to emphasize public health and prevention for the young, and care not cure for the elderly.
An interesting twist on their argument, which would aim to bring everyone’s life expectancy up to an average age of 80 years but give highest priority for medical treatment to those under 80, is that Callahan and Nuland are themselves 80 years old. Daniel Callahan, Ph.D., is cofounder and president emeritus of The Hastings Center and author most recently of Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System. Sherwin Nuland, M.D., is a retired Clinical Professor of Surgery at the Yale School of Medicine and author of How We Die and the Art of Aging. He is also a Hastings Center Fellow and Board member.
“The real problem is that we have medicine excessively driven by progress, which aims to rid us of death and disease and treats them as the targets of unlimited medical warfare,” said Callahan and Nuland. “That warfare, however, has come to look like the trench warfare of World War I: great human and economic cost for little progress. Neither infectious disease nor the chronic diseases of an aging society will soon be cured. Cancer, heart disease, stroke, and Alzheimer’s disease are our fate for the foreseeable future. Medicine and the public must adapt it to that reality, one that has mainly brought us lives that end poorly and expensively in old age.”
The article notes that the Affordable Care Act might ease the financial burden of this system, but not eliminate it. It reports, for example, that the cost of Alzheimer’s disease is projected to rise from $91 billion in 2005 to $189 billion in 2015, and to $1 trillion in 2025 – twice the cost of Medicare expenditures for all diseases now.
“We need to change our priorities for the elderly. Death is not the only bad thing that can happen to an elderly person,” the authors write. “An old age marked by disability, economic insecurity, and social isolation are also great evils.” They endorse a culture of care, not cure, for the elderly, with a stronger Social Security program and a Medicare program weighted toward primary care that supports preventative measures and independent living.
Callahan and Nuland point the way to a more sustainable path that reprioritizes the entire system. Among their recommendations:
- improve medicine at the level of public health and primary care, while reducing its use for expensive high-tech end-of-life care;
- shift resources for the elderly to greater economic and social security and away from more medical care;
- subsidize the education of physicians, particularly those who go into primary care, and decrease medical subspecialization;
- train physicians better to tell the truth to patients about the way excessively aggressive medicine can increase the likelihood of a poor death;
- shift the emphasis in chronic disease to care rather than cure;
- conduct a top-down, bottom-up, long-range study of the entire American system of health care, including the training of physicians, with a view toward reconstituting it along systematic lines that take science, humanistic concerns, economics, and social issues into account.
- Andrew Reinbach: Health Care Could Kill Us: We Don’t Have to Let It (huffingtonpost.com)
- New at Reason: Ronald Bailey on Health Care Reform (reason.com)
ScienceDaily (Mar. 29, 2011) — Members of California’s aging lesbian, gay and bisexual population are more likely to suffer from certain chronic conditions, even as they wrestle with the challenges of living alone in far higher numbers than the heterosexual population, according to new policy brief from the UCLA Center for Health Policy Research.
Half of all gay and bisexual adult men in California between the ages of 50 and 70 are living alone, compared with 13.4 percent of heterosexual men in the same age group. And although older California lesbians and bisexual women are more likely to live with a partner or a family member than their male counterparts, more than one in four live alone, compared with one in five heterosexual women.
A lack of immediate family support may impact aging LGB adults’ ability to confront statistically higher rates of diabetes, hypertension, poor mental health, physical disability and self-assessed fair or poor health, compared with demographically similar aging heterosexual adults.
The study, which draws upon three cycles of data from the biennial California Health Interview Survey (CHIS), underscores the importance of considering these unique needs and chronic health conditions in providing health care and social services to the estimated 170,000 self-identified aging LGB adults in California — a population that will double in size over the next 20 years.
“Many aging LGB Californians do not have biological children or strong family support,” said Steven P. Wallace, the lead researcher on the project. “Organizations that serve these communities need to take this into account and consider outreach and support mechanisms that enable these individuals to maintain their independence and ability to age safely and in good health.”
The policy brief, “The Health of Aging Lesbian, Gay and Bisexual Adults in California,” includes the first data published on aging LGB adults based on a large statewide population. And among a population whose health needs are too often associated only with HIV and AIDS, the study offers the first insights about broader health conditions and trends….
- Groundbreaking report released: ‘Bisexual Invisibility: Impacts and Recommendations’ (pinkbananaworld.com)
- Lesbians, gays, bisexuals at higher risk for severe mental health problems (news.bioscholar.com)
- San Francisco Human Rights Commission Approves Groundbreaking Report: Bisexual Invisibility: Impacts and Recommendations (pinkbananaworld.com)
- Day 27- Sexuality in the US (feministactivism.wordpress.com)
- Bullying, Harassment of Gay/Lesbian Teens: Expert Q&A (webmd.com)
- Strong link found between victimization, substance abuse (eurekalert.org)
- Physiological Impacts Of Homophobia (mccswu.wordpress.com)
- Americans Have Higher Rates of Most Chronic Diseases Than Same-Age Counterparts in England (jflahiff.wordpress.com)
- Doctors lack data on LGBT community: report
ScienceDaily (Mar. 14, 2011) — Those working for healthier humans around the globe are making headway in fighting communicable diseases such as AIDS, malaria and diarrheal illness, according to research from the Frederick S. Pardee Center for International Futures in the University of Denver‘s (DU) Josef Korbel School of International Studies.
The center recently released the third in a series of five volumes [full online text of all 3 volumes] that focus on human progress in which researchers explore topics such as education, poverty, infrastructure and governance. The latest book is Improving Global Health: Forecasting the Next 50 Years [full online text] (Paradigm Publishers and Oxford University Press India, 2011).
The latest volume sheds light on a transition the authors see occurring in global health — a transition of disease burdens from communicable diseases to chronic ones such as cancer, diabetes and heart disease….
- Non Communicable Diseases Hit The World’s Poorest People (medicalnewstoday.com)
- In Africa, cancer is a burden that can no longer be ignored | Emilie Filou (guardian.co.uk)
- Non Communicable Diseases: The World’s Number One Killer For Women (medicalnewstoday.com)
ScienceDaily (Mar. 14, 2011) — A new report shows that older people who receive Guided Care, a new form of primary care, use fewer expensive health services compared to older people who receive regular primary care.
Research published in the March 2011 edition of Archives of Internal Medicine ***found that after 20 months of a randomized controlled trial, Guided Care patients experienced, on average, 30 percent fewer home health care episodes, 21 percent fewer hospital readmissions, 16 percent fewer skilled nursing facility days, and 8 percent fewer skilled nursing facility admissions. Only the reduction in home health care episodes was statistically significant.
According to the study, Guided Care produced even larger reductions in a subset of patients who received their primary care from one well managed health system. Guided Care patients in Kaiser Permanente of the Mid Atlantic States experienced, on average, 52 percent fewer skilled nursing facility days, 47 percent fewer skilled nursing facility admissions, 49 percent fewer hospital readmissions, and 17 percent fewer emergency department visits; the differences for skilled nursing facility days and admissions were statistically significant….
More information about Guided Care is available at twww.GuidedCare.org.
From the Web site…”Guided Care® is a new solution to the growing challenge of caring for older adults with chronic conditions and complex health needs. A Guided Care nurse, based in a primary care office, works with 2-5 physicians and other members of the care team to provide coordinated, patient-centered, cost-effective health care to 50-60 of their chronically ill patients. The Guided Care nurse conducts in-home assessments, facilitates care planning, promotes patient self-management, monitors conditions monthly, coordinates the efforts of all health care professionals, smoothes transitions between sites of care, educates and supports family caregivers, and facilitates access to community resources. “
- Guided Care improves physician satisfaction with patient/family communications (scienceblog.com)
- Chronic disease care poorer in nursing and residential homes under GP target scheme (eurekalert.org)
- Post Trauma Care: Better Chance Staying At Home (medicalnewstoday.com)
ScienceDaily (Mar. 9, 2011) — Researchers have announced in the American Journal of Epidemiology ***that despite the high level of spending on healthcare in the United States compared to England, Americans experience higher rates of chronic disease and markers of disease than their English counterparts at all ages. Why health status differs so dramatically in these two countries, which share much in terms of history and culture, is a mystery….
This February 28 2011 report is published by the Pew Research Center, a “nonpartisan “fact tank” that provides information on the issues, attitudes and trends shaping America and the world. It does so by conducting public opinion polling and social science research; by analyzing news coverage; and by holding forums and briefings. It does not take positions on policy issues.” [From the Pew Research Center About Page]
Some excerpts from the report
- Many Americans turn to friends and family for support and advice when they have a health problem. This report shows how people’s
networks are expanding to include online peers, particularly in the crucible of rare disease. Health professionals remain the central
source of information for mostAmericans, but “peer‐to‐peer healthcare” is a significant supplement.
- One in five internet users have gone online to find others like them.Eighteen percent of internet users say they have gone online
to find others who might have health concerns similar to theirs.
- In the moment of need, most people turn to a health professional for information, care, or support. When asked about the last time they had a health issue, 70% of adults in the U.S. say they receivedinformation, care, or support
from a health professional.
ICU communication study reveals complexities of family decision-making
While a much hailed communication intervention works for families making decisions for chronically-ill loved ones in medical intensive care units, Case Western Reserve University researchers found the intervention was less effective for surgical and neurological ICU patients.
Barbara Daly and Sara Douglas, the study’s lead researchers from the Frances Payne Bolton School of Nursing at Case Western Reserve, attribute the varied results to different types of patients served by the three types of ICUs and differences among ICU cultures.
“We found the same approach is not going to have the same results for everyone,” Daly said
With the number of ICU patients predicted at more than 600,000 patients annually by 2020, researchers search for ways to help families make critical decisions for their loved ones. This study contributes to those ICU practices involving complex communication issues.
The researchers repeated a study from a Boston hospital that resulted in shorter stays and less unneeded tests and treatments when families were routinely informed through a systemized communications intervention about their family member’s progress in a medical ICU. They compared the effect of the new communication system in 346 patients to usual practice in 135 patients.
The intervention involved a 30-minute communication meeting between the clinical staff and family, beginning five days after a patient requiring a ventilator was admitted to the ICU. The staff and family covered five components: medical update, preferences and goals for the patient, treatment plans, prognosis, and milestones (the markers that can tell whether a person is improving).
The meetings continued weekly until the patient was transferred to a regular hospital ward, to a long-term facility, went home or died.
According to Daly, the discussions are important because up to 40% of these ICU patients do not survive beyond two months if they have spent more than five days on a mechanical ventilator.
For survivors, the most likely outcome is for long-term care, which raises issues about the quality of life that the patient might want to have, she said.
Overall, the researchers found no significant differences between the control and intervention groups in length of stay in the ICU or in limitations of aggressive interventions.
“The Boston study had been the ideal situation where the director of the ICU was conducting the study and the ICU staff accepted the intervention as part of its routine practices, said Daly, professor of nursing and clinical ethics director at University Hospitals Case Medical Center. “We took the study into real-life situations.”
Daly attributes the varying effectiveness of the new communication system to different ages and needs of patients in the medical, compared to surgical units and to differences in clinical staff attitudes towards decisions to limit aggressive interventions, such as feeding tubes and tracheostomy.
In the medical units, the patients generally are older and chronically ill—many suffering several chronic illnesses. The other ICUs generally serve younger patients who are more likely to have suffered a sudden acute health crisis, such as an emergency surgery or trauma from a motor vehicle accident.
Daly said many treatments in the medical ICU will not sustain life, and families face complicated end-of-life decisions to stop or continue ineffective treatments.
The research group also tracked conversational interchanges between family members and doctors.
All families received medical updates. About 86% of the meetings covered treatment plans; 94%, prognosis; 78 percent, preferences and goals; and only 68%, milestones.
Daly said analyses of the types of conversations found that 98% of the time was spent relaying facts about the patient, and only 2% was spent on personal, emotional, or relationship conversation.
The researchers also found that on average, doctors asked families one question, which was: “Do you have any questions?”
The families asked an average of six.
“Better communications is needed. Overall the process is not working as well as we would like and there are missed opportunities to better support families in their decisions,” Daly concluded.
The full results of the National Institute for Nursing Research-funded study were published in the article, “Effectiveness Trial of an Intensive Communication Structure for Families of Long-Stay ICU Patients,” in the journal Chest.