tag:ltcreform.posthaven.com,2013:/posts Health and Disability 2017-08-21T10:38:59Z Norm DeLisle tag:ltcreform.posthaven.com,2013:Post/1185347 2017-08-21T10:38:59Z 2017-08-21T10:38:59Z Prolonged sitting and frailty a deadly combination https://goo.gl/9GiC4k

The Physical Activity Guidelines for Americans state that adults aged 18 to 64 and those aged 65 and older should aim to get at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity every week.

For adults who are unable to meet these guidelines, it is recommended that "they should be as physically active as their abilities and conditions allow."

According to statistics from the 2016 National Health Interview Survey, just 44.9 percent of older adults aged 65 to 74 met the physical activity guidelines last year.

What is more, previous research has shown that older adults spend more than 9 hours of their day sitting down.

The harms of sedentary behavior have been well documented. A study reported by Medical News Today last year, for example, suggested that sitting for more than 3 hours daily is responsible for more than 430,000 deaths across 54 countries every year.

The study included the data of 3,141 adults aged 50 and older who participated in the 2003-2004 and 2005-2006 United States National Health and Nutrition Examination Survey.

As part of the survey, subjects were required to wear activity trackers during waking hours, and the researchers used these data to calculate how much time each adult spent sedentary.

The team also used a 46-item index to assess the frailty of each subject. Frailty is generally defined as an aging-related process characterized by weakness, unintended weight loss, slowness, and fatigue.

Participants were followed up until 2011, or until their date of death.

Among adults who scored highly on the frailty index and did not meet the physical activity guidelines, the researchers found that prolonged sitting was associated with an increased risk of death. This was not the case for adults with low frailty who met exercise guidelines.

"Thus, among people who are inactive and vulnerable or frail, sitting time increases mortality risk, but among those who are non-frail or active, sitting time does not affect the risk of mortality," say the researchers.


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Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1185346 2017-08-21T10:35:39Z 2017-08-21T10:35:39Z The Walgreens Center for Health & Well being Research
Interesting to me because the focus is on community retailers as a source of improved healthcare.
https://goo.gl/vuVgcG

Welcome to the Walgreens Center for Health & Wellbeing Research.

Walgreens strives to impact the Triple Aim by improving the experience of care, improving the health of populations and reducing total healthcare costs. Our dedicated team works to demonstrate the impact and effectiveness of various pharmacy-led programs and services and how they can benefit patients, providers, and payers.

Here you will find summaries, links and original documents related to our research in peer-reviewed publications and presentations at scientific conferences.

We look forward to your feedback and our efforts to improve health and wellness in America! If you have questions or suggestions, please contact us at research@walgreens.com.

Research Initiatives:

Access to Care & Patient Experience
Adherence & Clinical Outcomes
Common Chronic Conditions
Digital Health & Member Engagement
Healthcare Costs
HIV & Specialty Pharmacy
Vaccinations
Value of the Pharmacist


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Norm DeLisle
tag:ltcreform.posthaven.com,2013:Post/1185345 2017-08-21T10:31:26Z 2017-08-21T10:31:27Z Asthma, on rise in older adults, tends to be ignored https://goo.gl/vX2hTf

In early June, Donna Bilgore Robins stood on a patio in Beaver Creek, Colo., under a crystal-clear blue sky and tried to catch her breath.

She couldn't.
With mountain vistas around her, Robins felt as if she was drowning. She gasped for air hungrily again and again.
    Robins knew all too well what was happening. Something -- some kind of plant? something in the mountain air? -- had triggered her asthma, a lifelong condition.
    She also knew she was in danger, even with a rescue inhaler at hand. "I don't slowly get sick -- I just drop," said Robins, who with help from her husband was soon on the road to seek medical attention over 100 miles away at National Jewish Health in Denver, a leading hospital for people with respiratory conditions.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1184922 2017-08-19T10:45:19Z 2017-08-19T10:45:19Z Researchers discover fundamental pathology behind ALS https://goo.gl/nVbaUt

    A team led by scientists at St. Jude Children's Research Hospital and Mayo Clinic has identified a basic biological mechanism that kills neurons in amyotrophic lateral sclerosis (ALS) and in a related genetic disorder, frontotemporal dementia (FTD), found in some ALS patients. ALS is popularly known as Lou Gehrig's disease.

    In further studies, the researchers found that TIA1 mutations occurred frequently in ALS patients. The scientists also found that people carrying the mutation had the disease. When the investigators analyzed brain tissue from deceased ALS patients with the mutations, the scientists detected a buildup of TIA1-containing organelles called stress granules in the neurons. Such granules form when the cell experiences such stresses as heat, chemical exposure and aging. To survive, the cell sequesters in the granules' genetic material that codes for cell proteins not necessary for survival-critical processes.

    The granules also contained a protein called TDP-43, another building block of stress granules, whose abnormality has been implicated in causing ALS. In test tube studies and experiments with cells, the researchers found that the TIA1 mutation causes the protein to become more "sticky," delaying the normal disassembly of stress granules, trapping TDP-43.

    "This paper provides the first 'smoking gun,' showing that the disease-causing mutation changes the phase transition behavior of proteins," Taylor said. "And the change in the phase transition behavior changes the biology of the cell."

    "We know that these material properties are under tight regulation, so perhaps we don't have to target the disease-causing mutation itself," Taylor said. "Perhaps we can restore balance by targeting any of a large number of regulatory molecules in the cell. There are already therapeutic approaches in laboratory testing that seek to do just that."


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1184633 2017-08-18T09:30:21Z 2017-08-18T09:30:21Z CMS Releases Hospice Compare Website to Improve Consumer Experiences, Empower Patients https://goo.gl/JrNFgL

    Today, as part of our continuing commitment to greater data transparency, Centers for Medicare & Medicaid Services (CMS) unveiled the Hospice Compare website. The site displays information in a ready-to­­-use format and provides a snapshot of the quality of care each hospice facility offers to its patients. CMS is working diligently to make healthcare quality information more transparent and understandable for consumers to empower them to take ownership of their health. By ensuring patients have the information they need to understand their options, CMS is helping individuals make informed healthcare decisions for themselves and their families based on objective measures of quality.

    “The Hospice Compare website is an important tool for the American people and will help empower them in a time of vulnerability as they look for information necessary to make important decisions about hospice care for loved ones,” said CMS Administrator Seema Verma. “The CMS Hospice Compare website is a reliable resource for family members and care givers who are looking for facilities that will provide quality care.”

    Hospice facilities offer specialized care and support to individuals with a terminal illness and a prognosis of six months or less if the illness runs its normal course. Once a patient elects hospice care, the focus shifts from curative treatment to palliative care for relief of pain and symptom management, and care is generally provided where the patient lives. Additionally, caregivers can get support through the hospice benefit, such as grief and loss counseling. Hospice Compare helps patients and caregivers find hospice providers in their area and compare them on quality of care metrics.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1184110 2017-08-16T10:40:26Z 2017-08-16T10:40:26Z Tip Sheets For Navigators https://goo.gl/LbxdJM

    These six tip sheets were created to assist navigation staff in supporting clients in their management of specific conditions and serious mental illness (SMI). The tip sheets augment navigators’ understanding of the standards of care for those conditions, and are available in both English and Spanish.

    Resource Type: 
    Target Population: 
    Stakeholders: 
    Behavioral Health Providers


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1183817 2017-08-15T11:00:28Z 2017-08-15T11:00:28Z Studies: Biologic Proves Worth as Monotherapy in RA https://goo.gl/ajHyf1

    Rheumatoid arthritis (RA) patients who received tocilizumab (Actemra) with methotrexate achieved low disease activity and could discontinue methotrexate while maintaining disease control, researchers said here.

    In a study designed to evaluate whether tocilizumab monotherapy was non-inferior to the combination, patients who achieved a DAS28-ESR (Disease Activity Score) of 3.2 or lower at week 24 were eligible for the trial to determine if they could safely discontinue methotrexate, according to Joel Kremer, MD, of Albany Medical College and The Center for Rheumatology in Albany, N.Y., and colleagues in a presentation at the Rheumatology Nurses Society annual meeting.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1183453 2017-08-14T11:00:11Z 2017-08-14T11:00:11Z Out-of-pocket costs exceed what many insured cancer patients expect to pay https://goo.gl/cuHtky

    Some patients spend a third of household income on cancer care, despite insurance.

    A third of insured people with cancer end up paying more out-of-pocket than they expected, despite having health coverage, researchers at the Duke Cancer Institute have found.

    The data showed that costs such as copays and deductibles could lead to financial distress among insured patients of all income levels and with all stages of cancer. Findings will be published in the journal JAMA Oncology.

    Many cancer patients can be burdened by 'financial toxicity' that can erode their mental and physical state, especially if they stop pursuing treatment because they feel they can't afford it, said senior author Yousuf Zafar, M.D., a medical oncologist at Duke.

    "This study adds to the growing evidence that we need to intervene," Zafar said. "We know there are a lot of barriers that prevent patients from talking about cost with their providers. We need to create tools for patients at risk of financial toxicity and connect them with resources in a timely fashion so they can afford their care."


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1182942 2017-08-12T10:58:50Z 2017-08-12T10:58:50Z Does Widespread Pain Spread From the Brain? https://goo.gl/Tw423s

    Pain is the most common reason people seek medical care, according to the National Institutes of Health.

    “Sometimes we can easily pinpoint what is causing a person pain,” says Richard Harris, Ph.D., associate professor of anesthesiology and rheumatology at Michigan Medicine. “But, there are still 1 in 5 Americans who suffer from persistent pain that is not easily identifiable.”

    Whenever someone experiences pain, they often think about how intense the pain is — but rarely do they also consider how widespread the pain is.

    “Surprisingly, many of the individuals, in addition to having pain located in the pelvic region, had pain also widely distributed throughout their body,” Harris says. “Interestingly, when we put these individuals into the brain imaging scanner, we found that those who had widespread pain had increased gray matter and brain connectivity within sensory and motor cortical areas, when compared to pain-free controls.”

    Urological chronic pelvic pain syndrome patients with widespread pain showed increased brain gray matter volume and functional connectivity involving the sensorimotor and insular cortices.

    “What was surprising was these individuals with widespread pain, although they had the diagnosis of urological chronic pelvic pain, were actually identical to another chronic pain disorder: fibromyalgia,” Harris says.

    The team notes the changes in brain gray matter volume and functional connectivity were identical to outcomes present in fibromyalgia patients, but were not seen in the pain-free control group.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1182667 2017-08-11T10:19:12Z 2017-08-11T10:19:12Z Antidepressant use increases risk of head injuries among persons with Alzheimer's disease https://goo.gl/5XgvQ5

    Antidepressant use is associated with an increased risk of head injuries and traumatic brain injuries among persons with Alzheimer's disease, according to a new study from the University of Eastern Finland. Antidepressant use has previously been linked with an increased risk of falls and hip fractures, but the risk of head injuries has not been studied before. The results were published in Alzheimer's Research & Therapy.

    Antidepressant use was associated with a higher risk of head injuries especially at the beginning of use - during the first 30 days, but the risk persisted even longer, up to two years. The association was also confirmed in a study design comparing time periods within the same person, thus eliminating selective factors. The association with traumatic brain injuries was not as clear as for head injuries, which may be due to a smaller number of these events in the study population. The use of other psychotropic drugs did not explain the observed associations.

    Head injuries are more common among older people than younger ones, and they are usually caused by falling. As antidepressant use has previously been associated with an increased risk of falling, the researchers were not surprised that the use of antidepressants also increased the risk of head injuries.

    "However, our findings give cause for concern because persons with Alzheimer's disease frequently use antidepressants, which have been considered a safer alternative to, for example, benzodiazepines," says Senior Researcher Heidi Taipale from the University of Eastern Finland.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1182666 2017-08-11T10:17:46Z 2017-08-11T10:17:47Z Immunotherapy found safe for type 1 diabetes in landmark trial https://goo.gl/GVQsNz

    For type 1 diabetes, immunotherapies consist of molecules that imitate a proinsulin peptide. In this context, researchers based in the United Kingdom set out to examine the benefits of immunotherapy in a landmark trial that included a placebo control group.

    Dr. Ali and team examined the effect of the peptide in 27 people who had been diagnosed with type 1 diabetes within the previous 100 days.

    For 6 months, the participants received either shots of the immunotherapy or the placebo at 2- or 4-week intervals. Their C-peptide levels - which are markers of insulin - were tested at 3, 6, 9, and 12 months, and they were compared with baseline levels.

    The trial found no evidence of toxicity or negative side effects, and beta cells were not impaired or reduced as a consequence of the therapy. The authors write, "Treatment was well tolerated with no systemic or local hypersensitivity," which led the researchers to conclude that "proinsulin peptide immunotherapy is safe."

    Additionally, "Placebo subjects showed a significant decline in stimulated C-peptide (measuring insulin reserve) at 3, 6, 9, and 12 months versus baseline, whereas no significant change was seen in the 4-weekly peptide group at these time points," say the researchers.

    Importantly, over a period of 12 months, the daily insulin intake in the placebo group increased by 50 percent, whereas the treatment group kept stable levels of insulin use.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1182041 2017-08-09T11:47:31Z 2017-08-09T11:47:32Z Prisoner of My Preconceptions https://goo.gl/9ugRSJ

    I soon overheard our charge nurse mention that a prisoner from a regional correctional facility was in the emergency department (ED) with “really bad sepsis.”

    “Ugh,” I muttered in quiet annoyance. In my experience, these patients never fared well. Moreover, my cynical side suspected that more wasteful use of limited health care resources was on the horizon. Perhaps I would have felt differently if the patient were not a prisoner; I have no doubt a large part of my reaction was that part of me assumed that anyone who winds up in prison probably is a “bad person.”

    Four heavy-set grizzly men in tan security guard uniforms accompanied the cachectic prisoner into the MICU. I immediately noticed that he was shackled to the hospital bed by numerous cuffs and full-body restraints, all of which seemed unnecessary since he was heavily sedated, intubated, and mechanically ventilated. It seemed as though the excessive correctional paraphernalia were there simply to indicate the misguided and reckless life choices that he presumably chose. They may as well have written on his forehead, “I am deplorable.”

    I overheard the signing-off ED nurse say in a monotone voice, “the patient is a 53-year-old male inmate with diffuse large B-cell lymphoma being admitted for presumed septic shock from a necrotic right thigh mass.”

    “53? He looks more like 83,” I thought in sheer disbelief. I considered what a grueling life this man must have led to look as feeble as he did.

    Once the transfer was complete and the patient was settled in his room, it was obvious that his sepsis was due to a decaying, malodorous mass protruding from his lower extremity, along with a large left pneumonia and empyema. Standard sepsis bundles and protocols were initiated and the patient continued receiving a broad-spectrum of antibiotics, intravenous fluids, and two vasopressors. For source control, general surgery was consulted for debridement of his grossly infected, necrotic thigh mass, and he would require a chest tube to drain the empyema. I immediately cringed at the assuredly onerous process of obtaining informed consent for the invasive procedures. Consent could not be obtained directly from the patient for obvious reasons, and I was dubious that any family members would be reachable. Even if kin could be reached, I knew of the cumbersome hoops that I would need to surmount to obtain the obligatory consent. I had no time for this right now; the patient was now hemodynamically unstable and his respiratory status was deteriorating. I talked with an intern and asked him to tackle the dreaded consent quandary.

    Ten minutes later, the intern said to me proudly, “Consents for the procedures are in the chart.” I was flabbergasted and perplexed by the rapidity of the process. Little did I know that the patient was a married man with three children. Also unanticipated was that, despite being incarcerated, the patient was in fairly regular contact with family, which made for an effortless phone conversation between the family and intern, who easily and appropriately obtained consent.

    As I sterilized and draped the patient in anticipation of his chest tube procedure, I was instantly jolted by compassion as I gazed into his lifeless eyes.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1181667 2017-08-08T11:49:14Z 2017-08-08T11:49:15Z How Not to Talk to Patients https://goo.gl/hFYzpQ

    Being a doctor is about as much of a social job as one can get. Even though computers and healthcare information technology mean that physicians are now spending a disproportionately large amount of their time staring at their computer screens, there's no getting around the importance of good old face-to-face interactions. That's also what's valued by your patients. In this time of great upheaval in healthcare, everything has changed apart from human nature.

    Here are five things that doctors should never do:

    1. Keep turning around and looking at your computer screen when your patient is trying to talk to you. This is consistently one of the things that annoys patients the most. Of course, it's very difficult for doctors as well, who have a high amount of bureaucratic "tick boxes" to satisfy, but try setting aside a dedicated amount of time just to sit face-to-face and talk the good old-fashioned way.

    2. Make it obvious you are in a hurry. Humans are perceptive animals, and we can all sense when someone is trying desperately to get away from us! Be aware of the subtle body language clues that will give this away, including starting to walk away (in a hospital), cutting people off, or worst of all -- telling the patient how busy you are


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1181666 2017-08-08T11:47:50Z 2017-08-08T11:47:50Z JAMA Forum: Reforming Medicaid https://goo.gl/3FexL3

    We are 2 former Administrators of the Medicare and Medicaid programs, under Presidents Barack Obama and George H. W. Bush. Although we represent different political parties, we take pride in the accomplishments of these 2 programs, which collectively help millions of US residents get the health care they need.

    Medicaid has become a major focus in the debate over repealing the Affordable Care Act (ACA), because the proposed replacement bills go beyond the ACA into the underlying Medicaid program that was originally passed by Congress in 1965. As we have overseen the Medicaid program at various stages, we are familiar with its successes, its areas for improvement, its effect on state budgets, and its importance to millions of ordinary people who count on the program and will need it in the future.

    That is why we are calling for Congress to separate reforms to the Medicaid program from the most pressing task at hand—stabilizing and improving the nongroup market. Given the divergent views on appropriate Medicaid changes, we recommend initiating a 12-month bipartisan review process that focuses on long-term reforms to improve care and reduce costs. Such a process would benefit from broad stakeholder involvement and expert feedback, gathered outside of the heat of the current political environment. Changes to the individual market alone have a greater chance of receiving bipartisan support while substantive work on Medicaid is under way.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1181665 2017-08-08T11:46:01Z 2017-08-08T11:46:01Z The Myth of Drug Expiration Dates https://goo.gl/gX4JAS

    The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates — possibly toxic, probably worthless.

    But to Lee Cantrell, who helps run the California Poison Control System, the cache was an opportunity to answer an enduring question about the actual shelf life of drugs: Could these drugs from the bell-bottom era still be potent?

    ProPublica has been researching why the U.S. health care system is the most expensive in the world. One answer, broadly, is waste — some of it buried in practices that the medical establishment and the rest of us take for granted.  We’ve documented how hospitals often discard pricey new supplies, how nursing homes trash valuable medications after patients pass away or move out, and how drug companies create expensive combinations of cheap drugs. Experts estimate such squandering eats up about $765 billion a year — as much as a quarter of all the country’s health care spending.

    The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations.

    “Lo and behold,” Cantrell says, “The active ingredients are pretty darn stable.”

    It turns out that the FDA, the agency that helps set the dates, has long known the shelf life of some drugs can be extended, sometimes by years.

     In fact, the federal government has saved a fortune by doing this.

    For decades, the federal government has stockpiled massive stashes of medication, antidotes and vaccines in secure locations throughout the country. The drugs are worth tens of billions of dollars and would provide a first line of defense in case of a large-scale emergency.

    2006 study of 122 drugs tested by the program showed that two-thirds of the expired medications were stable every time a lot was tested. Each of them had their expiration dates extended, on average, by more than four years, according to research published in the Journal of Pharmaceutical Sciences.

    Some that failed to hold their potency include the common asthma inhalant albuterol, the topical rash spray diphenhydramine, and a local anesthetic made from lidocaine and epinephrine, the study said. But neither Cantrell nor Dr. Cathleen Clancy, associate medical director of National Capital Poison Center, a nonprofit organization affiliated with the George Washington University Medical Center, had heard of anyone being harmed by any expired drugs. Cantrell says there has been no recorded instance of such harm in medical literature.



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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1181267 2017-08-07T10:08:47Z 2017-08-07T10:08:47Z Whole Person Care Takes Another Step Forward

    Thanks and a hat tip to Dohn H.......

    https://goo.gl/RqTuzF

    If you are looking for trends in the health and human services industry, California is often the place to look (see California As A Bellwether). Another great recent example of California at the forefront of industry trends is whole person care coordination – the practice of treating consumers with co-occurring health conditions and social services needs, specific to each consumer’s needs.

    In July, the California Department of Health Care Services (DHCS) launched seven new Medi-Cal Whole Person Care (WPC) pilots and expanded another eight – bringing the total number of pilot programs to 25 (see California Medicaid Launches 7 New Whole Person Care Pilots, Expands 8 Others). These five-year WPC pilots are locally-based initiatives that coordinate physical health, behavioral health, and social services, including non-Medicaid services, housing, and supportive services for Medicaid beneficiaries. Also key to the initiative – the pilots rely on data sharing to identify the targeted populations, link them to services, and track the intervention impact on outcomes.

    First and foremost, how will these pilots change the work done by provider organizations in the California market and how does this represent an opportunity? There are two elements to keep in mind:

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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1181014 2017-08-06T13:42:23Z 2017-08-06T13:42:23Z Clinical Trial Suggests Parkinson’s Can Be Halted https://goo.gl/8n5367

    It may be possible to stop the progression of Parkinson’s disease with exenatide, a drug typically used to treat Type 2 diabetes, a new U.K. clinical trial suggests. Parkinson’s gradually damages the brain as cells that produce dopamine start dying. Currently, drugs can help manage the symptoms, but they do not prevent the progression of the disease. “This is the first clinical trial in actual patients with Parkinson’s where there has been anything like this size of effect,” said Tom Foltynie, a professor who worked on the trial. “It gives us confidence exenatide is not just masking symptoms; it’s doing something to the underlying disease. We have to be excited and encouraged, but also cautious as we need to replicate these findings.”



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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1180399 2017-08-04T09:49:27Z 2017-08-04T09:49:27Z Meta-Analysis: Tai Chi Keeps Seniors from Falling https://goo.gl/2WioHL

    Tai chi may reduce the rate of falls and injury-related falls during the first year by about half in older and at-risk adults, according to a new meta-analysis.

    Pooled data from 10 randomized controlled trials showed a significant 43% reduction in the risk of falls compared with other interventions at 12 months or less, and a reduction in the risk of injurious falls by 50% over the short term, Rafael Lomas-Vega, PhD, from the University of Jaén in Spain, and colleagues reported online in the Journal of the American Geriatrics Society.



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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1180398 2017-08-04T09:46:39Z 2017-08-04T09:46:39Z Welcome to Iridis

    Thanks and a hat tip to Kathryn W.....

    https://goo.gl/TtTfVH

    Thank you for signing up to hear about the latest news on Iridis. We are delighted that you want to be part of this cutting-edge revolution in the sharing of dementia design principles. 

    The University of Stirling’s Dementia Services Development Centre (DSDC)has an international reputation for promoting best practice in design for people with dementia. We know that good design can help people with dementia stay independent for longer and improve their well-being and overall quality of life. 

    Dementia Design Audit Tool
    You may already be aware of DSDC’s Dementia Design Audit Tool, which has been used around the world to assist with the designing of dementia inclusive environments. Iridis will allow us to take the research based design principles, which underpin the audit tool, and translate them into a digital tool which can be accessed by those who want to improve environments for people with dementia. 

    Iridis 

    The Iridis app has been made possible through collaborating with Space Group, international design and technology specialists for property and construction.  By combining our range of knowledge and expertise we will be able to provide you with a ground-breaking app which will help to improve the lives for people with dementia and their carers. 

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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1179656 2017-08-02T11:40:26Z 2017-08-02T11:40:26Z Centrist lawmakers plot bipartisan health care stabilization bill https://goo.gl/xJXzhP

    A coalition of roughly 40 House Republicans and Democrats plan to unveil a slate of Obamacare fixes Monday they hope will gain traction after the Senate’s effort to repeal the law imploded.

    The Problem Solvers caucus, led by Tom Reed (R-N.Y.) and Josh Gottheimer (D-N.J.), is fronting the effort to stabilize the ACA markets, according to multiple sources. But other centrist members, including Rep. Kurt Schrader (D-Ore.), and several other lawmakers from the New Democrat Coalition and the GOP’s moderate Tuesday Group are also involved.

    Their plan focuses on immediately stabilizing the insurance market and then pushing for Obamacare changes that have received bipartisan backing in the past.

    The most significant proposal is funding for Obamacare’s cost-sharing subsidies. Insurers rely on these payments – estimated to be $7 billion this year — to reduce out-of-pocket costs for their poorest Obamacare customers.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1178545 2017-07-30T10:53:06Z 2017-07-30T10:53:06Z IL-6 Blocker Wins in Vasculitis https://goo.gl/8WBTZb

    Among a cohort of 251 patients with biopsy or imaging-confirmed giant-cell arteritis who underwent a 26-week prednisone taper, 56% of those who received subcutaneous tocilizumab once weekly were in sustained remission at week 52, as were 53% of those who were given the interleukin-6 receptor alpha inhibitor every other week, according to John H. Stone, MD, of Massachusetts General Hospital in Boston, and colleagues.

    In contrast, only 14% of patients given placebo with a 26-week prednisone taper had sustained remission after 1 year, as did 18% of those given placebo with a 52-week prednisone taper (P<0.001 for both tocilizumab groups versus placebo), the researchers reported in the New England Journal of Medicine.

    However, longer-term follow-up is needed to more fully assess the safety of tocilizumab.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1176494 2017-07-24T10:28:21Z 2017-07-24T10:28:21Z Lower Readmissions Not Linked to Post-Discharge Mortality Risk https://goo.gl/oNMh8R

    A review of more than six million hospitalizations shows no linkage between reduced 30-day readmissions and increased post-discharge mortality, according to a new study in JAMA.

    Yale New Haven Health researchers, led by Kumar Dharmarajan, MD, wanted to see if the Affordable Care Act's Hospital Readmissions Reduction Program had the unintended consequence of increasing mortality rates. Researchers and advocacy groups have raised concerns that hospitals might not readmit patients out of fear of financial penalties associated with HRRP, thus increasing post-discharge mortality.

    Those concerns, apparently, are unfounded, the study showed.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1176253 2017-07-23T12:14:21Z 2017-07-23T12:14:21Z Nursing Facilities, Staffing, July 2017 Residents and Facility Deficiencies, 2009 Through 2015 https://goo.gl/xkFLGx

    Nursing facilities are one part of the long-term care delivery system that also includes home and community based services, but their relatively high cost has led them to be the focus of much attention from policymakers. Medicaid plays a major role in financing nursing facility care in the United States, and recent policy proposals to limit federal financing for Medicaid may lead to cuts in eligibility or scope of coverage for long-term care services. In addition, new regulations, effective November 2016, aim to address longstanding challenges in quality and safety in nursing facilities. 

    As the demand for long term care continues to increase and new policy proposals and regulations unfold, the characteristics, capacity, and care quality of facilities remain subjects of concern among consumers and policy makers. This report provides information on recent trends in nursing facilities in the United States, drawing on data from the federal On-line Survey, Certification, and Reporting system (OSCAR) and Certification and Survey Provider Enhanced Reports (CASPER), to provide information on nursing facility characteristics, resident characteristics, facility staffing, and deficiencies by state from 2009 through 2015. 

    Additional detail on the survey and methods underlying the data in this report are provided in the Appendix at the end of the report. This information enables policymakers and the public to monitor and understand recent changes in nursing facility care in the United States and helps highlight areas of ongoing concern for ongoing policymaking


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1175989 2017-07-22T11:17:40Z 2017-07-22T11:17:40Z 'Just What We Dreamed.' New Vertex Drugs Show Dramatic Benefit Against Cystic Fibrosis https://goo.gl/8RmHVF

    Three different three-drug regimens all provided dramatic results against cystic fibrosis, a fatal disease of the lungs and digestive system that afflicts 75,000 people worldwide. The results are a step forward both for the drugs’ maker, Vertex Pharmaceuticals of Boston, Mass., and a long-awaited victory in the quest to use genes to develop new drugs.

    “This is just what we dreamed would someday happen,” says Francis Collins, the director of the National Institutes of Health, who led the discovery of the cystic fibrosis gene two decades ago. “This is a remarkably happy moment to see how far this has come and how incredibly encouraging this news is.”


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1175397 2017-07-20T11:03:33Z 2017-07-20T11:03:33Z A toddler's brain damage has been reversed over a year after near drowning https://goo.gl/wc9q6y

    Physicians used a series of oxygen treatments, like hyperbaric oxygen therapy, to significantly reverse the 2-year-old's brain damage after she was in the water for 15 minutes.

    To "wake up" her brain, doctors gave Carlson oxygen at a pressure higher than the general atmospheric pressure — increasing the amount of oxygen in her blood and repairing her damaged tissue in a sealed, pressurized hyperbaric chamber.

    "The startling regrowth of tissue in this case occurred because we were able to intervene early in a growing child, before long-term tissue degeneration," hyperbaric specialist Paul Harch from LSU Health New Orleans said in the case report published by Medical Gas Research.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1174663 2017-07-18T11:18:25Z 2017-07-18T11:18:26Z Don’t EVER Use Turmeric If You’re On Any of The Following Medications https://goo.gl/FKtSV2

    It’s a well-known fact that turmeric is one of the most effective health-boosting substances available today. Its active ingredient, curcumin, is a natural compound with anti-inflammatory, antioxidant, as well as heart disease-and-cancer-fighting properties (123).

    Other studies have indicated that taking medicinal doses of turmeric may even protect your brain. This is because turmeric boosts Brain-Derived Neurotrophic Factor (BDNF), a growth hormone that prevents depression, Alzheimer’s disease, and dementia (45).

    Compared to other pharmaceutical treatments, turmeric has a generally low risk of adverse effects (6). It almost sounds too good to be true. So is it?  Can you take turmeric with medications?


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1174660 2017-07-18T11:15:12Z 2017-07-18T11:15:12Z Large Study Confirms Elevated Risk of Diabetes When Prescribed Antipsychotics https://goo.gl/g9q6JW

    A large longitudinal cohort study out of Denmark, recently published in the American Journal of Psychiatry, corroborates previous evidence that antipsychotics increase the risk of developing diabetes in people diagnosed with schizophrenia.

    Numerous medications have been associated with elevated risk of diabetes. Antidepressants, for example, are understood to reduce pancreatic insulin secretion, which is believed to increase the risk of developing diabetes. This elevated risk has also been demonstrated in children and youth exposed to antipsychotics.

    The authors of the present study point out that the prevalence of diabetes mellitus is 4-5 times higher in people diagnosed with schizophrenia. Similar to the theory surrounding antidepressants, it is believed that impaired glucose tolerance and increased insulin resistance can explain some of the elevated rates of diabetes within individuals diagnosed with schizophrenia who are prescribed antipsychotics. Moreover, abnormal glucose tolerance has been shown to be more prevalent among individuals diagnosed with schizophrenia than those without.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1174292 2017-07-17T10:16:00Z 2017-07-17T10:16:00Z Implementing MTM for COPD https://goo.gl/W5HDDH

    Chronic obstructive pulmonary disease (COPD) is a preventable disease in which persistent respiratory symptoms and airflow limitations worsen with time. COPD is the fourth leading cause of death in the world. The treatment of COPD includes various inhaled therapies as well as preventive measures, such as smoking cessation and immunizations. Patient education is crucial to the management of COPD. Medication therapy management (MTM) can play a role in helping patients learn how to manage COPD and decrease complications. Successful MTM interventions can improve patient care and provide a positive impact on the star measures of both pharmacies and healthcare plans.

    Medication therapy management (MTM) services have demonstrated impact in a number of areas, including cardiovascular diseases, mental health, and transitions of care.1 MTM services are defined as a service or group of services that optimize therapeutic outcomes for individual patient and include activities such as immunizations, disease state coaching, and medication therapy reviews.2 The purpose of this article is to provide the pharmacist with a brief overview of chronic obstructive pulmonary disease (COPD) and identify areas within an MTM encounter the community pharmacist can capitalize on to improve management of this disease state.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1174290 2017-07-17T10:13:42Z 2017-07-17T10:13:42Z How Telehealth Platforms Will Reshape U.S. Healthcare Delivery https://goo.gl/vFW0F2

    Telehealth in the United States is entering a new phase of accelerating growth. Indicators of this next phase include: FDA approval of remote diagnostic tools; the rapid evolution of telehealth platforms focused on managing chronic conditions as well as achieving specific patient outcomes; the expansion of telehealth services offered by private and government operated healthcare systems (such as the Veterans Administration); and a new direct-to-consumer initiative by Samsung and American Well.

    However, the telehealth industry is still young. In many ways, today’s telehealth industry is comparable to the Internet services industry, when the reigning speed of Internet access was 56.6 kbps. As far higher broadband speeds became the norm, entire industries were upended. Similarly, as the telehealth industry matures, healthcare delivery across our nation will experience disruptive shifts.

    This article explores how telehealth will change the delivery of healthcare in the United States, and its impact on the organization of many activities now provided by local hospitals and health systems throughout the nation.


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    Norm DeLisle
    tag:ltcreform.posthaven.com,2013:Post/1173986 2017-07-16T11:23:14Z 2017-07-16T11:23:14Z Elderly Dehydration: Prevention & Treatment https://goo.gl/Bk10nQ

    Watching for signs of illness in a loved one can be challenging. Some illnesses show up quite clearly, while others have a more subtle effect on daily living. Dehydration, depending on the severity, sometimes creates only small telltale signs while having a big effect on the body, especially in the elderly.

    Dehydration occurs when a person loses more water than they take in. Adequate fluid allows the body to regulate temperature through sweating, maintain blood pressure and eliminate bodily waste. If severe enough, dehydration can lead to confusion, weakness, urinary tract infectionspneumoniabedsores in bed-ridden patients or even death. Generally speaking, humans can't survive more than four days without water.

    CAUSES OF SENIOR DEHYDRATION

    Elderly dehydration is especially common for a number of reasons:

    • Medications
      It's not uncommon for seniors to be on several medications at any given time. Some of these may be diuretic, while others may cause patients to sweat more.
    • Decreased Thirst
      A person's sense of thirst becomes less acute as they age. In addition, frail seniors may have a harder time getting up to get a drink when they're thirsty, or they may rely on caregivers who can't sense that they need fluids.
    • Decreased Kidney Function
      As we age our bodies lose kidney function and are less able to conserve fluid (this is progressive from around the age of 50, but becomes more acute and noticeable over the age of 70). 
    • Illness
      Vomiting and/or diarrhea can quickly cause elderly dehydration.


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    Norm DeLisle