Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Repost] Tip-of-the-tongue moments may be benign

The 2011 Association for Psychological Science...

The 2011 Association for Psychological Science convention, which featured a Wikipedia booth with information about the APS Wikipedia Initiative and the Wikipedia Ambassador Program (Photo credit: Wikipedia)

 

From the 16 October 2013 EurekAlert

 

Despite the common fear that those annoying tip-of-the-tongue moments are signals of age-related memory decline, the two phenomena appear to be independent, according to findings published in Psychological Science, a journal of the Association for Psychological Science.

Anecdotal evidence has suggested that tip-of-the-tongue experiences occur more frequently as people get older, but the relationship between these cognitive stumbles and actual memory problems remained unclear, according to psychological scientist and lead author Timothy Salthouse of the University of Virginia:

“We wondered whether these self-reports are valid and, if they are, do they truly indicate age-related failures of the type of memory used in the diagnosis of dementia?”

To find out, Salthouse and Arielle Mandell — an undergraduate researcher who was working on her senior thesis — were able to elicit tip-of-the-tongue moments in the laboratory by asking over 700 participants ranging in age from 18 to 99 to give the names of famous places, common nouns, or famous people based on brief descriptions or pictures.

Throughout the study, participants indicated which answers they knew, which they didn’t, and which made them have a tip-of-the-tongue experience.

Several descriptions were particularly likely to induce a tip-of-the-tongue moment, such as: “What is the name of the building where one can view images of celestial bodies on the inner surface of a dome?” and “What is the name of the large waterfall in Zambia that is one of the Seven Wonders of the World?” Of the pictures of the politicians and celebrities, Joe Lieberman and Ben Stiller were most likely to induce a tip-of-the-tongue moment.

Overall, older participants experienced more of these frustrating moments than did their younger counterparts, confirming previous self-report data. But, after the researchers accounted for various factors including participants’ general knowledge, they found no association between frequency of tip-of-the-tongue moments and participants’ performance on the types of memory tests often used in the detection of dementia.

“Even though increased age is associated with lower levels of episodic memory and with more frequent tip-of-the-tongue experiences…the two phenomena seem to be largely independent of one another,” write Salthouse and Mandell, indicating that these frustrating occurrences by themselves should not be considered a sign of impending dementia.

 

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For more information about this study, please contact: Timothy A. Salthouse at salthouse@virginia.edu.

This research was supported by the National Institute on Aging and a Harrison Undergraduate Research Award from the University of Virginia.

The article abstract can be found online: http://pss.sagepub.com/content/early/2013/10/08/0956797613495881.abstract?patientinform-links=yes&legid=sppss;0956797613495881v1

The APS journal Psychological Science is the highest ranked empirical journal in psychology. For a copy of the article “Do Age-Related Increases in Tip-of-the-Tongue Experiences Signify Episodic Memory Impairments?” and access to other Psychological Science research findings, please contact Anna Mikulak at 202-293-9300 or amikulak@psychologicalscience.org.

 

 

 

 

October 16, 2013 Posted by | Medical and Health Research News, Psychiatry | , , , , , | Leave a comment

Beyond Antibiotics: ‘PPMOs’ Offer New Approach to Bacterial Infection, Other Diseases

From the 15 October 2013 ScienceDaily article

Researchers at Oregon State University and other institutions today announced the successful use of a new type of antibacterial agent called a PPMO, which appears to function as well or better than an antibiotic, but may be more precise and also solve problems with antibiotic resistance.

 

Read the entire article here

 

October 16, 2013 Posted by | Medical and Health Research News | , , | Leave a comment

[Repost] Feds Refuse To Shut Down Controversial ‘Two-Midnight’ Rule For Hospitals

English: Bryce Hospital, Admission Unit

English: Bryce Hospital, Admission Unit (Photo credit: Wikipedia)

 

From the 3 October 2013 article at Forbes with Evan Albright, Contributor

 

The federal agency in charge of Medicare announced that for the next three months it will relax enforcement of its controversial “two-midnight rule,” but will not eliminate it per the desires of healthcare providers and now members of Congress.

Earlier this year the Centers for Medicare and Medicaid Services (CMS) announced a new standard for determining whether a patient is admitted to a hospital or there for observation, the two-midnight rule. Medicare patients must spend at least two continuous midnights in a hospital to be classified as inpatient, a status which comes with the highest reimbursement rates. Patients who spend less than two midnights will be automatically considered outpatient or under observation status.

As with any rule there will be exceptions:…

For patients, the advice we offered a few weeks ago still stands: If you are admitted to a hospital, ask and ask often about your status. For more information about how to manage hospital visits, download this pamphlet from the United Hospital Fund, “Hospital Admission: How to Plan and What to Expect During the Stay.” The section pertaining to inpatient versus observation status begins on page 9.***

 

 

 

***From page 9 of Hospital Admission: How to Plan and What to Expect During the Stay

 

Hospital Admission or Observation Status?

Just because your family member is in a hospital bed, on a hospital unit, eating hospital food, and undergoing hospital tests does not automatically mean that he or she has been admitted to a hospital. Sometimes doctors want to watch a patient for a few hours or a day to see whether there is really a need to be admitted to the hospital. This is called “observation.” More patients are now in hospitals being observed rather than admitted. This is largely because of Medicare’s efforts to reduce expensive hospital admissions and possible readmissions.

Does it matter if your family member is admitted to the hospital or is just being observed? Yes, because Medicare pays for hospital admissions and observation differently. As a result, your family member’s part of the bill is likely to be higher if he or she is only being observed than if he or she were actually admitted.

Admission vs. Observation

Hospital admissions are covered under Medicare Part A. Under Medicare Part A, after a one-time deductible fee, all hospital costs are covered when a person is admitted as an inpatient.

page10image6320Observation status and emergency room care (without admission) are considered outpatient care, and are covered only by Medicare Part B. Medicare Part B treats each lab test, X-ray, and other service as individual items, each with a copay. Prescription drugs are not covered and may be a separate charge.

There’s more. To be eligible for Medicare-covered skilled nursing facility services, your family member must have been a hospital inpatient for at least three days. The observation days do not

The result? After 72 hours of observation, your family member will have a higher hospital bill and will not be eligible for Medicare- paid rehabilitation services in a skilled nursing facility. Note that these rules apply to regular (that is, fee-for-service) Medicare; if your family member belongs to a Medicare Advantage (HMO) plan, check with the plan for its requirements.

What can you do?

 In addition to all your other questions, ask repeatedly, “Has my family member been officially admitted to the hospital, or is he or she under observation status?” Your family member’s primary care doctor will probably not be involved in this decision.

 Make a note of each staff person’s response, including the name and date.

 The hospital can retroactively (after the fact) change the patient’s status from inpatient to outpatient. This change is supposed to be made while the patient is still in the hospital, with a written notification to the patient.

 If you do not receive this notification, or if you want to appeal the decision, you can contact your state Quality Improvement Office at http://www.qualitynet.org/dcs/ContentServer?c=Page&page name=QnetPublic%2FPage%2FQnetTier2&cid=11447678747 93

 

 

 

 

 

 

 

Read the entire article here

 

 

October 16, 2013 Posted by | health care | , , , , , | Leave a comment

[Reblog] New database from CMS: Medicare Provider Charge Data

From the 15 October 2013 post at Public Health – Research & Library News

 

The Department of Health & Human Services has created a database that for the first time gives consumers information on what hospitals charge.  The data, on the charges for services that are provided during the 100 most common Medicare inpatient stays and 30 common outpatient services, show significant variation across the country and within communities.

For example, average inpatient charges for services a hospital may provide in connection with a joint replacement range from a low of $5,300 at a hospital in Ada, Okla., to a high of $223,000 at a hospital in Monterey Park, Calif.  Even within the same geographic area, hospital charges for similar services can vary significantly. For example, average inpatient hospital charges for services that may be provided to treat heart failure range from a low of $21,000 to a high of $46,000 in Denver, Colo., and from a low of $9,000 to a high of $51,000 in Jackson, Miss.

Access the database here and on the Health Statistics research guide.

 

Hospital

Hospital (Photo credit: José Goulão)

 

 

October 16, 2013 Posted by | health care | , , , , , , , | Leave a comment

Preventing disease is a problem for the health industry

By  | PHYSICIAN | OCTOBER 3, 2013, at KevinMD.com

……

People come to me for answers, and my profession pitches doctors as the ones with answers.  We fix problems.

This, of course, is not true — a fact that I have come to see as a core problem in the practice of medicine in America, and a reality that (as everything seems to do) comes largely from the way we pay for medicine.  We are paid to fix problems.  How do we fix problems?  With procedures.

The best evidence for this are the things at the heart of health care: codes.   There are three types of codes that dominate the financial and clinical lives of anyone in health care:

  • ICD codes: codes for medical problems
  • CPT codes: codes for medical procedures
  • E/M codes: codes used by doctors who don’t do procedures so they can get paid for office visits

What this encourages from the medical profession is predictable: lots of problems treated by lots of procedures.  This is good for doctors who do procedures, especially ones that are cutting-edge (like robotic surgery) or ones that seem particularly dramatic and/or heroic (open heart surgery, heart stents).  These are the things the headline consuming public is most hungry for.  Just like it grabs more headlines to catch a terrorist plot just before it has its horrible effect than to prevent it early in the process, it’s a lot sexier to do a procedure to treat heart disease than to simply prevent the disease in the first place.  Which is the better outcome?  Preventing heart disease.  Which is paid more?  Not even close.

The problem with problems

A more subtle (and perhaps more significant) effect of this mindset is the way in which everything is labeled as “problems” or “diseases.”  A recent ruling of the AMA that obesity is a “disease” stirred up quite a bit of controversy. The AMA ruling does nothing to change the nature of obesity, and clearly is more a discussion of semantics, politics, and funding, than it is a true medical question.  In reality, I used to not be able to bill the ICD-9 code for obesity and get paid, but now I guess I could (if I did that kind of thing any more).  I suspect this opens the door for more procedures to be paid for by insurers, as the response to any problem is always a procedure in our system.

There is pressure now to respond to each “problem” with a procedure, or at least a thing to eliminate it as a problem.  Examples:

  • Sinus infections are routinely treated with antibiotics despite no evidence that it actually helps.  Having marketed our profession as problem-fixers, we are met with patients expecting a fix to their problem.  They are disappointed (and even angry) when we don’t “do something” for a “problem” that will resolve on its own, even if the intervention probably causes more harm than benefit.  Problem: sinusitis.  Procedure: antibiotic.  Check.
  • Cholesterol treatment is another example of this.  High cholesterol, be it LDL, total, or triglyceride is seen as a “problem,” even in people who are not at risk for heart disease.  I’ve seen many low-risk patients come to my practice on cholesterol medication that does little more than improve their numbers.  The evidence shows that certain high-risk people benefit from being on certain medications which lower the cholesterol.  For folks outside of those high-risk groups, the medications simply make numbers look better (at best) and potentially harm them (at worst).  Problem: High cholesterol.  Procedure: cholesterol drug.  Check.
  • Depression and anxiety are normal emotions.  Life is painful and unsure.  There only are two ways to avoid these emotions: die or get stoned.  My personal experience (some fairly recent) is that the times of life most marked by anxiety and depression are accompanied by significant personal growth.  Before everyone gets mad at me for saying these aren’t diseases, I must add that there are cases of both of these emotions that are terribly destructive and potentially fatal if not treated.  But we physicians have lowered the price of admission to treatment, including people going through hard times as those who have clinical depression.  Responding to TV ads about “that pill that will make me happy,” we are met with patients expecting us to “fix their problem” — a problem that is not really a problem; it’s life.  Problem: anxious and depressed people.  Procedure: medication.  Check.

A better way

I think there’s a better way to look at things.  I’ve said this before, but I am coming to grasp just how radical this approach is and just how much it undermines our health care system.  There is something far more important than problems:

Risk.

When someone comes to my office with chest pain, my thoughts do not go to the question: “what is going on?”  A more important problem comes first: “is this a dangerous situation?”  I want to know if the person is ready to die from a heart attack or other serious problem.  This is true in nearly every decision I make as a doctor when faced with a condition.  Could that cough be latent lung cancer?  Could that headache be a brain tumor?  Could the depressed man kill himself?

Risk reduction also rules how I approach disease.  I treat cholesterol and hypertension, not because they themselves are problems, but because they can lead to heart disease, stroke, and other problems.  High cholesterol is not, in my opinion, a “disease” for most people; it is a risk factor.  I treat diabetes mainly to prevent the complications.  Do I care if a 90-year-old has an A1c of 8?  No way.  It doesn’t increase their risk enough to matter.

This does not mean we approach “prevention” like the system presently does: throwing procedures at it.  The health care system doesn’t reward having healthy patients, it rewards doing procedures reported to prevent problems.  Yet the system is not addressing the true goal of prevention: risk reduction. We are “rewarded” by ordering tests, whether or not they reduce risk.  PSA testing is a perfect example of this, as are many other misguided attempts to treat prevention as another problem to  fix with a procedure.

The problem with this, of course, is that it far more to the financial benefit of doctors (and drug companies) for us to address every problem and show we are giving “good care” by checking off the box next to each problem.  In the bigger picture, risk reduction makes the jobs of future cardiovascular surgeons (and drug companies) much less secure.  It attacks the revenue stream of most doctors and hospitals (and drug companies) right where it counts: you can’t make nearly as much money off of healthy people as you can people with “problems.”

This is why, I believe, any system that profits more from people with “problems” than those without is destined to collapse.  Our system is opposed to the goal of every person I see: to stay healthy and stay on as few drugs, have as few procedures, and avoid as many doctors (and drug companies) as possible.

What would happen if we prevented disease?  What would happen if people didn’t have medical problems?  For society it would be great.  For the health care industry it would be a huge problem.

Rob Lamberts is an internal medicine-pediatrics physician who blogs at More Musings (of a Distractible Kind).

Read the entire article here

 

October 16, 2013 Posted by | health care | , , , , , | Leave a comment

   

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