Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Article] Hospitals find ways to navigate homeless into shelters

From the 6 November 2013 Los Angeles Daily News article

WOODLAND HILLS >> Almost once a week, Guadalupe Tolentino’s liver and bloodstream drown in liquor and sorrow, and that gets him a free ambulance ride to Kaiser Permanente’s Emergency Department.

There, doctors and nurses flush the alcohol out of the 55-year-old man’s veins with IV fluids, calm his tremors with vitamins and medications and, if he stays long enough, provide him a meal and clean clothes.

Despite an existence in crisis, liquor is never far from Tolentino’s mind, and neither is Kaiser’s emergency department in Woodland Hills, which he visits up to 40 times a year.

For Tolentino and other chronic homeless men and women like him, the emergency department is a place of stability and peace, where the sound of rushing crash carts and the beeps of telemetry monitors can be a lullaby compared to the sounds of sleeping on the streets.

But for the hospital’s “homeless navigator” Jonathan Lopez, those such as Tolentino, known as frequent flyers, also are never far from his mind. Most pose no harm, but those repeated returns show that their chronic drug or alcohol dependence as well as their homelessness go untreated. And it means the hospital pays an average of $1,500 a night for their stay, money that is never recuperated.

“When a frequent flyer returns to our ED my adrenalin gets going,” said Lopez, “I instantly start to process where I might be able to coordinate a placement,” Lopez said. “I get to relate to these individuals in an extraordinary way.”

Hospitals around the country have been increasingly using homeless navigators to help place indigent men and women into treatments centers or housing after discharge. In the Kaiser system, which has 14 medical centers in Southern California, Lopez’s position is part of a first-of-its-kind, two-year-old pilot program launched at the Woodland Hills campus. He said he crafted the program after watching a similar approach formed by the San Gabriel Valley Consortium on Homelessness.

Read the entire article here

 

November 6, 2013 Posted by | health care | , , , , , , | Leave a comment

[FDA Consumer Update] Pain Medicines for Pets: Know the Risks

From the 5 November 2013 FDA Consumer Update

Pain Medicines for Pets: Know the Risks

 
Walking dog on beach (350x397)

Your 9-year-old German Shepherd is limping, and you think that arthritis may be setting in. A trip to the veterinarian proves that you’re right—it’s osteoarthritis, a degeneration of the cartilage and bone that affects joints. The veterinarian prescribes a non-steroidal anti-inflammatory drug (NSAID).

NSAIDs are a class of drugs extensively used in both human and veterinary medicine for their anti-fever, anti-inflammatory and pain-relieving properties, and they are the most commonly prescribed pain relievers for animals. Inflammation—the body’s response to irritation or injury—is characterized by redness, warmth, swelling, and pain. NSAIDs work by blocking the production of chemicals produced by the body that play a role in inflammation.

“Scientists consider NSAIDs the cornerstone of osteoarthritis therapy in dogs,” says Melanie McLean, D.V.M., a veterinarian at the Food and Drug Administration (FDA). Some NSAIDS are also used to manage pain after surgery in both dogs and cats. No NSAID has been approved for long-term use in cats.

NSAIDs carry risks as well as benefits, however, and all dogs and cats should undergo a thorough physical examination by a veterinarian—including a discussion of the pet’s medical history— before beginning NSAID therapy. McLean notes that it’s also important that you talk to your veterinarian about possible side effects, including those that could signal danger.

Risks and Side Effects

NSAIDS are associated with gastrointestinal ulcers/perforations, kidney, and liver toxicity (damage done by exposure to medications or chemicals) and must be used cautiously in animals with pre-existing kidney or liver problems.

Because most liver-associated toxicities occur during the first three weeks, it’s especially important to closely monitor the results of blood tests during the early stages of long-term NSAID treatment in dogs. Also, before starting long-term treatment with NSAIDs in dogs, blood tests should be conducted to establish baseline data and then repeated on a regular basis. McLean recommends that you talk with your veterinarian about how often this blood work should be done.

Some of the most common side effects of NSAIDS in animals reported to FDA are:

  • vomiting
  • decreased to no appetite
  • decreased activity level
  • diarrhea

While your animal is taking NSAIDs, continuously monitor the pet for these side effects as well as looking for blood in the feces, tar-like stools, yellowing of the whites of the eyes, or yellowing of the gums. If you see these, call your veterinarian immediately, McLean says. Other reported side effects include stomach and intestinal ulcers, intestinal perforation (a hole in the wall of the intestine), kidney failure, liver failure and death.

Giving two NSAIDs at the same time, or giving an NSAID with a steroid, such as prednisone, can significantly increase the risk and severity of side effects, especially gastrointestinal toxicity.

Risks associated with NSAIDs are detailed on the package inserts and the client information sheets that accompany all FDA-approved veterinary oral NSAIDs.

Are OTC Meds for People Safe for Pets?

McLean says that it’s not unusual for pet owners to want to give their animals NSAIDs or acetaminophen (Tylenol and other brands, which are not NSAIDs) straight from their own medicine cabinets. “Many people don’t realize that a medicine that’s safe for people may not be safe for dogs or cats, or that a dose that is safe for people may not be safe for their pets,” she notes.

In fact, some over-the-counter (OTC) human pain relievers can be toxic, or even deadly, in pets. McLean suggests that you check with your veterinarian first if you want to give your animal OTC human drugs.

“You should always check with your veterinarian first before giving your animal any kind of medication, prescription or over-the-counter,” she notes. Similarly, pet owners should not assume that a medicine that is safe for one animal is necessarily safe for another.

Communication with your veterinarian is essential. Before giving your animal an NSAID:

  • Make sure you know what the medication is being prescribed for, how much to give and how long to give it.
  • Discuss possible side effects and symptoms, especially those that require an immediate call to the vet.
  • Tell your veterinarian if the pet has a history of gastrointestinal problems, such as stomach ulcers, or surgery on the stomach or intestines.
  • Tell your veterinarian if your pet is on any other medications or supplements.

This article appears on FDA’s Consumer Updates page, which features the latest on all FDA-regulated products.

Nov. 5, 2013

 

November 6, 2013 Posted by | Pet Health | , , , , , , , | Leave a comment

[Reblog] Hyperdiagnosis: The Wellness Industry Doubles Down on Overdiagnosis

Thinking that ideally everyone would  have a health care provider that knows one’s  medical history well.
S/he can then best work with you on deciding which screenings are best for you.

 

From the 5 November 2013 item at The Health Care Blog By AL LEWIS AND VIK KHANNA

By now we are all familiar with the concept ofoverdiagnosis, where “we” is defined as “the readers of THCB and a few other people whose healthcare literacy is high enough to know when not to seek testing and/or when not to automatically believe the test results.”

The rest of the country hasn’t gotten the memo that, quite counter-intuitively, many suspected clinical problems should simply be left alone.  Many insignificant conditions get overdiagnosed and subsequentlyovertreated, at considerable cost to the health plans and risk to the patient.

For more information on that we  refer you to the bookOverdiagnosed.   The thesis of that book is that insured Americans are far more likely to be harmed by too much care than too little.

Rather than use its resources and influence with human resources departments to mitigate overdiagnosis, most workplace wellness companies have opted for the reverse, taking overdiagnosis to a level which, were they physicians billing the government for this work, could cost them their licenses and possibly their freedom.   Instead, they winawards for it.

We call this new plateau of clinical unreality “hyperdiagnosis,” and it is the wellness industry’s bread-and-butter.  It differs from overdiagnosis four ways:  It is pre-emptive.  It is either negligently inaccurate or purposefully deceptive.  It is powered by pay-or-play forfeitures.  The final hallmark of hyperdiagnosis is braggadocio – wellness companies love to announce how many sick people they find in their screens.

1. Pre-Emptive

Most cases of overdiagnosis start at the doctor’s office, when a patient arrives to join the physician in a generally good faith search for a solution to a manifest problem.  The patient comes in need of testing.   By contrast, in hyperdiagnosis, there is neither a qualified medical professional providing adult supervision nor good faith.  The testing comes in need of patients, via annual workplace screening of up to seventy different lab values.  Testing for large numbers of abnormalities on large numbers of people guarantees large numbers of “findings,” clinically significant or not.  It is a shell game that the wellness vendor cannot lose.

2.Inaccurate or Deceptive

Most of these findings turn out to be clinically insignificant, no surprise given that the US Preventive Services Task Force recommends annual screening only for blood pressure, because otherwise the potential harms of screening outweigh the benefits.  The wellness industry knows this, and they also know that the book Seeking Sickness:  Medical Screening and the Misguided Hunt for Diseasedemolishes their highly profitable screening business model.   (We are not cherry-picking titles here—there is no book Hey, I Have a Good Idea:  Let’s Hunt for Disease.)  And yet most wellness programs require annual screens to avoid a financial forfeiture.   This includes the four programs covered on THCB this year — CVSNebraskaBritish Petroleum, and Penn State.

Those four programs and most others also obsess with annual preventive doctor visits.  Like screening, though, annual “preventive” visits on balance cause more harm than good, according to academic and lay reports.  The wellness industry knows this as well.  We have posted it on their LinkedIn groups, and presumably they have also access to Google.  They addressed the data by banning us from their groups.

3. Pay-or-play forfeitures

Because of the lack of value, the inconvenience, and privacy concerns, most employees would not submit to a workplace screen if left to their own devices.  The wellness industry and their corporate customers “solve” that problem by tying large sums of money annually — $600 for hourly workers at CVS, $1200 at Penn State and $521 on average – to participation in these schemes.  Yet participation rates are still low.  At Penn State, for example, less than half of all employees got screened despite the large penalty.

4. Braggadocio

Few doctors would publicly brag about how many cases of hidden disease they found, especially if they couldn’t convince the patient to do anything about their condition.  But boasting is essential to hyperdiagnosis.  We’ve already blogged on how Nebraska’s program sponsors bragged (and lied, as they later admitted) about the number of cancer cases they found.  They also bragged about the rate of cardiometabolic disease they found — 40% in the screened population — even though they admitted almost no one did anything about those findings.  Hence, it’s the worst of both worlds:  telling people they are sick without helping them get better.

We’d like to think that all our exposés have made a dent in the wellness industry’s business model, but the forces arrayed in the other direction have so far overwhelmed us.   The price of screening has plummeted almost to the $1-per-lab-value level for comprehensive screens, and as with anything, the lower the price, the greater the amount sold.

More ominously, starting in January employers are allowed to tie 30% of premiums to health-contingent employee wellness programs.   And they will, thanks to the canard — also debunked on THCB — that the CDC says 75% of health spending is somehow preventable through wellness.   This statistic is gospel among benefits consultants, vendors and even pharmaceutical companies like Astra-Zeneca and Johnson and Johnson, which should know better.  So as far as the wellness industry is concerned, a 30%-of-premium penalty only scratches the surface, meaning that their hyperdiagnostic jihad against the American workforce has barely begun.

Al Lewis is the author of Why Nobody Believes the Numbers, co-author of Cracking Health CostsHow to Cut Your Company’s Health Costs and Provide Employees Better Care, and president of the Disease Management Purchasing Consortium.

Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness.  An iconoclast to the core, he is the author of the Khanna On Health Blog.  He is also the Wellness Editor-At-Large for THCB.

November 6, 2013 Posted by | health care | , , | Leave a comment

[Press release] Ethical research with minorities

Johns Hopkins press release as posted in the 5 November 2013 EurekAlert

PUBLIC RELEASE DATE:
5-Nov-2013

Contact: Leah Ramsay
lramsay@jhu.edu
202-642-9640
Johns Hopkins Medicine

Ethical research with minorities

Johns Hopkins bioethicist Nancy Kass is a guest editor of the AJPH special issue taking a comprehensive look at the current ethical landscape of human subjects research with minority populations

Remarkable improvements in the quality of life, prevention and treatment of disease have been made possible through advancements in biomedical research, including clinical trials involving human subjects. Future progress will depend in large measure on the inclusion of women and racial and ethnic minority populations into the research enterprise. Unfortunately, research abuses in the past have contributed to fear and mistrust among these populations resulting in regulatory measures designed to protect them due to their real or perceived “vulnerability.”

Increasingly groups seen as vulnerable are demanding access to the benefits of research and investigators are making progress in successful inclusion of women and minorities. This question of vulnerability is just one of many ethically relevant concepts raised in the current theme issue of the American Journal of Public Health, titled “The Ethics of Human Subjects Research on Minorities”.

“While there is growing attention to the participation of minority populations in research, there has been far less attention on the ethical issues raised through research recruitment, enrollment and engagement; our goal was to shine a spotlight on those issues in particular,” says Nancy E. Kass, ScD, one of three guest editors of the issue and the Deputy Director for Public Health at the Johns Hopkins Berman Institute of Bioethics.

The theme issue opens with an editorial by Kass and her co-guest editors Sandra C. Quinn, PhD, and Stephen B. Thomas, PhD, of the Maryland Center for Health Equity (M-CHE) at the University of Maryland School of Public Health. In their editorial, “Building Trust for Engagement of Minorities in Human Subjects Research: Is the Glass Half Full, Half Empty or the Wrong Size?” The editors contextualize the history of human subjects protections for “vulnerable persons,” recognizing that the protections themselves, while critically important and very successful, may also have limited the benefits of research among the populations that were “protected”. They discuss the progress we’ve made, the challenges still to be tackled, and propose a shift in the way researchers approach minority communities.

Other topics explored in the issue include recruitment of minority populations, community engagement, and training of researchers and health professionals in ethics and working with minority populations. Articles in the volume focus on specific populations including Native American and Alaskan Native populations, persons with disabilities, populations at risk of contracting HIV, and racial and ethnic minority populations.

The theme issue is one of the scholarly products made possible by the National Bioethics Research Infrastructure Initiative grant from the NIH-NIMHD, “Building Trust Between Minorities and Researchers ” awarded to the University of Maryland Center for Health Equity. The issue assembles a collection of peer-reviewed papers that explore the complexities involved in the ethical inclusion of minority populations in research and the challenges facing the nation in having a research enterprise that is both protective and inclusive of vulnerable groups. Additionally, contemporary research operates in the long shadow cast by the abuse of human subjects in research, Kass says.

Drs. Quinn, Kass, and Thomas are uniquely suited to guest editing this theme issue. Kass holds a joint appointment in Johns Hopkins’ Berman Institute of Bioethics and Bloomberg School of Public Health as the Phoebe R. Berman Professor of Bioethics and Public Health; she is a globally recognized public health expert and has served on international and national ethics committees, in addition to leading the Johns Hopkins-Fogarty African Bioethics Training Program for the last 13 years.

Quinn has extensive experience investigating the impact of disasters on preparedness of minority communities and the willingness of these groups to accept seasonal flu and other vaccines. Thomas is Professor and Founding Director of the Maryland Center for Health Equity at the University of Maryland School of Public Health and a recognized national expert on community engaged research. His work with Quinn on the legacy of the US Public Health Service Syphilis Study done at Tuskegee contributed to the 1997 Presidential Apology to survivors. Together Thomas and Quinn are principal investigators of the Building Trust project at M-CHE.

According to Dr. Thomas, “It is impressive how several of the articles call for the re-imagination of human subjects protections for vulnerable populations and a reengineering of the research enterprise to elevate the ‘community’ to be as important as the ‘individual’ when it comes to improving the informed consent process” he said.

 

###

The full theme issue is available online now at http://ajph.aphapublications.org/

The print version will be available December 2013.

Funding for the theme issue was provided the by Award Number 7RC2MD004766 (Quinn & Thomas, Principal Investigators) from the National Institute on Minority Health and Health Disparities (NIMHD) and the Office of the Director, National Institutes of Health (NIH).

 

 

November 6, 2013 Posted by | Medical and Health Research News | , , , , , , , , | Leave a comment

[Press Release] Torture permanently damages normal perception of pain

From the Tel Aviv University press release as reported at the 5 November 2013

PUBLIC RELEASE DATE:
5-Nov-2013

 
Contact: George Hunka
ghunka@aftau.org
212-742-9070
American Friends of Tel Aviv University 

Torture permanently damages normal perception of pain

Tel Aviv University researchers study the long-term effects of torture on the human pain system

Israeli soldiers captured during the 1973 Yom Kippur War were subjected to brutal torture in Egypt and Syria. Held alone in tiny, filthy spaces for weeks or months, sometimes handcuffed and blindfolded, they suffered severe beatings, burns, electric shocks, starvation, and worse. And rather than receiving treatment, additional torture was inflicted on existing wounds.

Forty years later, research by Prof. Ruth Defrin of the Department of Physical Therapy in the Sackler Faculty of Medicine at Tel Aviv University shows that the ex-prisoners of war (POWs), continue to suffer from dysfunctional pain perception and regulation, likely as a result of their torture. The study — conducted in collaboration with Prof. Zahava Solomon and Prof. Karni Ginzburg of TAU’s Bob Shapell School of Social Work and Prof. Mario Mikulincer of the School of Psychology at the Interdisciplinary Center, Herzliya — was published in the European Journal of Pain.

“The human body’s pain system can either inhibit or excite pain. It’s two sides of the same coin,” says Prof. Defrin. “Usually, when it does more of one, it does less of the other. But in Israeli ex-POWs, torture appears to have caused dysfunction in both directions. Our findings emphasize that tissue damage can have long-term systemic effects and needs to be treated immediately.”

A painful legacy

The study focused on 104 combat veterans of the Yom Kippur War. Sixty of the men were taken prisoner during the war, and 44 of them were not. In the study, all were put through a battery of psychophysical pain tests — applying a heating device to one arm, submerging the other arm in a hot water bath, and pressing a nylon fiber into a middle finger. They also filled out psychological questionnaires.

The ex-POWs exhibited diminished pain inhibition (the degree to which the body eases one pain in response to another) and heightened pain excitation (the degree to which repeated exposure to the same sensation heightens the resulting pain). Based on these novel findings, the researchers conclude that the torture survivors’ bodies now regulate pain in a dysfunctional way.

It is not entirely clear whether the dysfunction is the result of years of chronic pain or of the original torture itself. But the ex-POWs exhibited worse pain regulation than the non-POW chronic pain sufferers in the study. And a statistical analysis of the test data also suggested that being tortured had a direct effect on their ability to regulate pain.

Head games

The researchers say non-physical torture may have also contributed to the ex-POWs’ chronic pain. Among other forms of oppression and humiliation, the ex-POWs were not allowed to use the toilet, cursed at and threatened, told demoralizing misinformation about their loved ones, and exposed to mock executions. In the later stages of captivity, most of the POWs were transferred to a group cell, where social isolation was replaced by intense friction, crowding, and loss of privacy.

“We think psychological torture also affects the physiological pain system,” says Prof. Defrin. “We still have to fully analyze the data, but preliminary analysis suggests there is a connection.”

 

###

American Friends of Tel Aviv University supports Israel’s leading, most comprehensive and most sought-after center of higher learning, Tel Aviv University (TAU). Rooted in a pan-disciplinary approach to education, TAU is internationally recognized for the scope and groundbreaking nature of its research and scholarship — attracting world-class faculty and consistently producing cutting-edge work with profound implications for the future. TAU is independently ranked 116th among the world’s top universities and #1 in Israel. It joins a handful of elite international universities that rank among the best producers of successful startups.

 

 

November 6, 2013 Posted by | Medical and Health Research News, Psychiatry | , , , , | Leave a comment

Handbook on strategies to reduce overcrowding in prisons

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Here in Toledo, Ohio my (Catholic) parish boundary includes a nearby state prison.
The bishop’s office redrew parish boundaries a few years back and decided our parish, three miles from the prison, includes the Catholics at Toledo Correctional Institution. Quite a challenge for us, we have about 100 “churchgoers” on the average Sunday, about 2/3 are over age 60. About 20 baptized Catholics (of an inmate population of 1,220)  are registered within our parish.

We were encouraged to write the inmates. So I did. After about 3 letter exchanges, one asked me to visit him. So, after 3 weeks of pondering, I did.  It really isn’t any big deal.  Robb is very articulate and we do have some lively discussions in areas of politics, Catholic Church “hot topics”, and philosophy.

In the past year, four inmates have been murdered. at Toledo Correctional.  Allegedly by other inmates.  In Michigan, only one inmate was murdered in the whole state in the last year.  The rise in violence is in tandem with increasing overcrowding, especially double bunking in cells designed for single occupancy.

I am including this item because overcrowding is a safety and (mental) health issue.  The murders here at Toledo Correctional were in the higher security levels, Robb is in the lowest security level. Still, I cannot imagine how this is impacting Robb’s mental health.

Excerpts from the handbook
(I realize American prisons are probably better than the worst of the worst internationally, still, there is room for improvement)

In very diverse environments and over many years, the ICRC has witnessed first- hand the consequences of overcrowding on detainees and on the authorities. Indeed, overcrowding is an increasingly widespread problem in a number of countries and places of detention. In itself, it is a very serious humanitarian concern, as it auto- matically generates substandard and often inhumane conditions of detention. Tens of thousands of people are forced to live for extended periods in congested accom- modation, with insufficient space to move, sit or sleep. This seriously compromises the ability of the administration to fulfil detainees’ basic needs in terms of living conditions, medical care, legal aid and family visits. Being squeezed into cramped living quarters, often in appalling hygiene conditions and with no privacy, makes the experience of being deprived of freedom—already stressful in normal circumstances— exponentially worse. It erodes human dignity and undermines detainees’ physical and mental health, as well as their reintegration prospects. In addition to putting excessive strain on infrastructures, it heightens the potential for tensions and conflicts among detainees and with staff. It quickly leads to difficulties in maintaining good order within the prison, resulting in potentially severe consequences in terms of safety for the detainees, as well as in terms of supervision and security.

While the consequences are particularly grave for the men, women and children deprived of their liberty, they also affect the frontline staff whose job it is to protect and meet the needs of the detainees. Overwhelmed by excessive numbers and directly exposed to the frustration of the detainees without the resources needed to guarantee security or access to the most basic services, detention staff work in difficult condi- tions and are exposed to constant pressure and risk.

ICRC knows from experience that situations of overcrowding, once established, trig- ger a downward spiral which has a negative impact on the entire criminal justice system as a result of increasing congestion, staff demotivation and the development of parallel coping mechanisms or corruption.

3. Broader consequences of excessive imprisonment

The impact of overcrowding does not remain within the prison walls. It can have a detrimental impact on public health. The cost of the excessive use of imprisonment, which is a fundamental reason for prison overcrowding in countries worldwide (see chapter B), can be significant, increasing the poverty levels and socio-economic mar- ginalization of certain groups of people and reducing funds available for other spheres of government expenditure.

….

3.1 The cost of imprisonment

Numerous studies have shown that imprisonment disproportionately affects people living in poverty. When an income generating member of the family is imprisoned, the sudden loss of income can have a severe impact on the economic status of the rest of the family—especially so in low resource countries where the state does not usually provide financial assistance to the poor and where it is not unusual for one person to financially support an extended family network. When released, often with no prospects for employment due to their criminal record, former prisoners are generally subjected to socio-economic exclusion and are vulnerable to an endless cycle of poverty, marginalization, criminality and imprisonment. Thus, imprisonment contributes directly to the impoverishment of the prisoner and his or her family. Studies have also shown that children of parents who have been imprisoned are more likely to come into conflict with the law and that once detained, they are likely to be further criminalized. Thus the cycle is expanded, creating future victims and reducing future potential economic performance

…….

  • State report rips Toledo prison (toledoblade.com, 09/13/2013)
    “A state committee on Thursday issued a harsh, lengthy inspection report of the Toledo Correctional Institution, citing significant increases in assaults, high employee-turnover rates, rampant drug trading, and three homicides reported there in the past year.The 164-page report from the Correctional Institution Inspection Committee shows that inmate-on-inmate assaults increased by nearly 113 percent and inmate-on-staff assaults increased nearly 74 percent from 2010 to 2012. The legislatively established committee monitors prison facilities, conducts unannounced inspections of prisons, and writes reports of their activities.”
    “The prison has the highest staff turnover rate — 16.5 percent — of all prisons in the state, according to the report. Most staff resignations come while employees are being investigated, according to the report.

    Toledo Correctional “has historically had challenges recruiting quality staff, particularly in health care,” the report states.
    Read more at http://www.toledoblade.com/State/2013/09/13/State-report-rips-Toledo-prison.html#RzJGpLqojeJcCKFA.99

  • Prison’s acts failed to halt homicides (toledoblade.com)

November 6, 2013 Posted by | Consumer Health, Consumer Safety, Workplace Health | , , , , , | Leave a comment

[Reblog] Healthcare Solutions

Health care systems and single payer

Health care systems and single payer (Photo credit: Wikipedia)

 

I have a nagging question…is it right that health care is basically a for-profit industry?
Realize I need to clarify and expand on this in order for it to make sense.
However, in the past 20 or so years, I’ve seen the rise of medical complexes,  “battles” among hospitals for market shares,  huge increases in medical/health care advertising, and yet what seems to be a decline in the overall average health of Americans.
So, I have to ask…is this for-profit model working? And if not, what is the answer?

 

 

 

From the 5 November 2013 item at ThePeaceResource

 

The math is not complex. Instead of doling out corporate welfare to insurance firms, we pay that money to deliver actual health care. As health improves, costs go down. “Single-payer allows citizens and businesses to win twice: — less money out of our individual budgets for health insurance, and — no government bureaucracy that gives our tax money to the less efficient health insurance companies through a variety of federal and state programs”http://www.medicareforall.org/pages/Terms_and_Facts health_care_reformOr we stick with corporate cons running the show and 31 million continue to suffer without health care.* This will raise costs of care and lead to more suffering. *{a report from the Congressional Budget Office (CBO) predicts that in the post-Obamacare world of 2023, 31 million, non-elderly Americans will remain uninsured.http://www.cbo.gov/publication/44190}

healthcare1

 

 

More resources on health care options:
ThePortlandAlliance.org/healthcare
health-careresource.blogspot.com/
writingresource.info/healthcare/
internationalpeaceresources.org/healthcare/
unionresource.blogspot.com/

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November 6, 2013 Posted by | health care | , , , , | Leave a comment

[Hospital Newsletter Article] The New Nursing Home

Screen Shot 2013-11-06 at 5.46.49 AM

 

Believe I’ve reblogged on this concept within the past two years…
Yes, this model is a bit pricy, but can we afford not to move in this direction?

Excerpts from the Fall 2003 article at Proto – Dispatches from the Frontiers of Medicine (Massachusetts General Hospital)

At the vanguard of innovation in the nursing home industry, the three-year-old Leonard Florence Center for Living exemplifies a new model of long-term care known as the Green House, and nothing about it seems institutional. Each of the five upper floors constitutes two separate “households” with private rooms for 10 residents. The normally dominant nurse’s station has been eliminated and instead there are common areas in each household—a living room furnished with comfortable sofas and chairs around a fireplace, an open kitchen and a communal dining table where residents often eat together. Cooking, housekeeping and even laundry are handled by two certified nursing aides known as shahbazim—derived from Persian, it means “nurturing of elders”—who also care for residents. Traditional nursing homes, in contrast, have clear demarcations separating housekeepers, kitchen workers, nurses and aides, who follow rigid schedules for serving meals or dispensing medications.

At Leonard Florence, Mehlhop can sleep, bathe, eat and roam around whenever she wants. The environment is calm and cheery, with none of the physical restraints found in most nursing homes or the alarms that sound if residents get up from a wheelchair, for example. (Instead, patients wear ankle bracelets that help the staff keep tabs on them and will disable the elevator if a patient tries to leave.)

Leonard Florence is far from the only nursing facility striving to create a homelike atmosphere and improve residents’ quality of life. Building a new Green House or undertaking a major physical renovation can be part of the strategy, but other nursing homes are primarily working to transform how they’re run, embracing a movement known simply as “culture change” that entails shifting away from the emphasis on efficiency and economies of scale that characterizes most nursing homes. Culture change typically requires an operational reorganization to give staff members more autonomy and to let residents have a say in even the smallest details of their lives. “It’s about not looking at residents as a task, but rather as who they are as individuals,”

Yet building a new, small nursing home that can handle only a relative handful of residents is an expensive proposition. “If it weren’t for the price tag, everyone would be doing it,” says Barry Berman, chief executive officer of the Chelsea Jewish Foundation, which owns the Leonard Florence Center. The home cost $36 million to build, with some two-thirds of the money coming from private donations and government programs. Most traditional nursing homes cost less than half that much, but the Leonard Florence Center is over twice the size of a traditional nursing home and was the first Green House to be built in an urban area. Its multistory construction is also a departure from the usual single-level, ranch-style homes that are typical of Green House centers. The payoff, however, has been the residents’ lower hospitalization and readmission rates. The center has also received high scores for resident and family satisfaction, which Berman describes as “off the charts.” The foundation is now undertaking a $13 million renovation of a 30-year-old, 120-bed skilled nursing facility across town from Leonard Florence. “We’re bringing in as many elements of the Green House as we can and doing our best to retrofit a traditional nursing home,” says Adam Berman, chief operating officer of the nonprofit.

The Green House model is receiving increased academic scrutiny, and early studies have shown positive trends in quality of life for residents, greater family satisfaction, and a lower incidence of rehospitalization, bedsores, depression and other health problems. According to the Green House Project, 83% of Green Houses received a rating of four out of five stars or better on the Centers for Medicare & Medicaid Services’ five-star quality rating system, compared to 42% of nursing homes nationally. But the data are early. “The jury’s still out on whether Green Houses or other small homes achieve equal or better clinical outcomes than traditional models, and whether they’re financially sustainable—factors that may ultimately matter a lot more than the humanistic components in terms of their future growth…

Studies of the model’s effectiveness have found a higher quality of care, reduced staff turnover and lower rates of infections for residents….

As  encouraging as such stories may be, however, there are questions about how far relatively small-scale efforts can go to reform a giant industry. In a 2010 study by Susan Miller, a professor of health services, practice and policy at Brown University School of Public Health, leadership issues, higher costs and regulatory problems were cited by long-term-care leaders as the most common barriers to implementing culture change. Yet many experts believe those obstacles can be overcome. For example, a campaign called Advancing Excellence in America’s Nursing Homes provides an array of do-it-yourself resources and networks of advisors to help improve clinical outcomes. More than 9,000 nursing homes have participated since the campaign’s launch in 2006. Meanwhile, federal regulators have adjusted some rules to encourage and reward culture change—for example, rather than checking that a nursing home has regular meal schedules, making sure that residents are well fed. And proponents point to studies showing that nursing homes committed to culture change may benefit financially. A study by Pioneer Network, for example, found that from 2004 to 2008, facilities undergoing culture change achieved higher occupancy rates and increased revenue.

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November 6, 2013 Posted by | Consumer Health, Consumer Safety, health care | , , , , | Leave a comment

   

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