Eczema successfully treated with arthritis drug

http://goo.gl/jHZe5y

Recent years have seen a shift in the debate about the causes of eczema - with more evidence suggesting it may be an autoimmune disease. If that is the case, then Prof. King and colleagues wondered if tofacitinib citrate - a drug approved for the treatment of rheumatoid arthritis - would interrupt the immune response that causes eczema.

Prof. King was involved in two earlier studies of the same drug. One showed that tofacitinib citrate could be used to treat the disfiguring skin condition vitiligo, and the other study showed how the drug helped a man with alopecia areata grow a full head of hair.

Alopecia areata is an autoimmune disorder where the immune system attacks the hair follicles. Vitiligo is also thought to be an autoimmune disorder where the immune system targets skin cells called melanocytes.

Tofacitinib citrate blocks enzymes called Janus kinases (JAKs) that are involved in inflammation in rheumatoid arthritis - a chronic autoimmune disorder that affects the lining of the joints.

If unblocked, JAKs can signal the release inflammatory cytokines that attack the joints and other tissues. The goal of rheumatoid arthritis treatment with tofacitinib is to reduce inflammation and disease activity.

Prof. King says their findings could transform the way that eczema is treated, and concludes:

"Eczema affects millions of children and adults in the United States. I'm hopeful we are entering a whole new era in treatment."

However, he and his colleagues also point out that further research is now needed to confirm that the treatment is safe and to examine its longer-term effectiveness.


Project ECHO: Force Multiplier For Community Health Centers

A model like this would be useful in a lot of circumstances...

http://goo.gl/tcBmPJ

Arora created a free, virtual clinic to mentor community providers in how to treat hepatitis C. In Albuquerque, he assembled a multidisciplinary specialist team—including himself, a psychiatrist, a pharmacist, a nurse, and a social worker—to host weekly teleECHO clinics via videoconference for primary care providers from around the state.

Although the clinics featured brief lectures on hepatitis C management, the most important learning occurred when primary care providers presented their patients’ cases to the specialist team. During these “virtual clinical rounds,” Arora and his specialist colleagues worked with primary care providers to determine patient treatment—training them to manage a condition that previously was outside of their expertise.

After the first Hepatitis C TeleECHO Clinic launched, the wait time for hepatitis C treatment in New Mexico dropped from eight months to two weeks. More than 500,000 miles of patient treatment travel were avoided.

Home and Community-Based Services: Seven Things You Need to Know

Good Overview...

http://goo.gl/XzS30E

Few people have a strong understanding of home and community-based services (HCBS), how they work, how they came about and why they are important. There are a number of reasons why HCBS experts are few and far between. Put simply, administration of HCBS and its relation to Medicaid or Medicaid waiver funding is a convoluted area of the law. This article wades through the muddy waters in an attempt to explain some of the finer points of HCBS. Though just the tip of the iceberg, these are the seven things you need to know about HCBS.

Hipaa’s Use as Code of Silence Often Misinterprets the Law

Those who a law is intended to restrict always game that law against those who the law was intended to protect...

http://goo.gl/NCyrwS

Each scenario, attorneys say, involves a misinterpretation of the privacy rules created under the Health Insurance Portability and Accountability Act. “It’s become an all-purpose excuse for things people don’t want to talk about,” said Carol Levine, director of the United Hospital Fund’s Families and Health Care Project, which has published a Hipaa guide for family caregivers.

Intended to keep personal health information private, the law does not prohibit health care providers from sharing information with family, friends or caregivers unless the patient specifically objects. Even if she is not present or is incapacitated, providers may use “professional judgment” to disclose pertinent information to a relative or friend if it’s “in the best interests of the individual.”

Hipaa applies only to health care providers, health insurers, clearinghouses that manage and store health data, and their business associates. Yet when I last wrote about this topic, a California reader commented that she’d heard a minister explain that the names of ailing parishioners could no longer appear in the church bulletin because of Hipaa.

Agent Orange Act Was Supposed to Help Vietnam Veterans — But Many Still Don’t Qualify

http://goo.gl/6O5jQx

Five decades after the Vietnam War began—and four decades after it ended— veterans exposed to the chemical brew dubbed Agent Orange are still fighting for compensation and benefits for themselves and their children.

And it turns out, not all veterans exposed to Agent Orange are being treated the same.

The fight is playing out in the halls of Congress, in courtrooms and at veterans meetings across the country.



Sen. Elizabeth Warren Seeks Federal Report on Assisted Living Oversight

http://goo.gl/sf6X31

The ongoing debate around how much governmental oversight of assisted living is appropriate and necessary may soon have new fodder. A bipartisan group of four U.S. Senators, including Elizabeth Warren (D-Mass.), is pushing for a review of how state and federal authorities oversee assisted living facilities that care for residents on Medicaid.

Medicaid is jointly funded by states and the federal government, and while the program writ-large is not designed to be a major assisted living payer, some AL residents are covered. This is through waivers—such as Medicaid home- and community-based waivers, and comprehensive demonstration waivers—as well as through state plans, the letter notes.

“Given the growth in federal Medicaid spending for long-term care services and expected program growth caused by the aging and expansion of the population and program, information to understand federal and state spending and oversight of care provided in these settings is needed,” the Senators wrote in their letter, dated July 8.

Specifically, they are requesting that the Government Accountability Office (GAO) gather this information and produce a report on it.


Health Advocate: The ACA and LGBT Health

http://goo.gl/cJ2TMM

In this month’s Health Advocate, NHeLP examines the issue of health care coverage and some of the important gains and unrealized goals for the LGBT community under the Affordable Care Act (ACA). We also examine ACA outreach and implementation challenges and identify advocacy opportunities to help ensure that health reform benefits everyone.


The entire thing was iatrogenic*

http://goo.gl/vMLmY0

For years at the nursing home they kept adding blood pressure medicines to treat her recalcitrant blood pressure. She was falling more than once a day, disoriented and largely wheelchair bound since the staff found using the chair prevented falls. (They would wheel her to meals, etc.) She spent most of her days in bed.

Shortly before she moved to the dementia unit the doctor came to see her and said she was on too much blood pressure medication.  He noted that old people needed higher pressures, something I had been trying to tell her previous doctors for a couple of years.

Bottom line--he stops all but one blood pressure medication. I ask them to put her on an antidepressant, and she is now walking around without even a walker. We even took her to IHOP and the grocery store and she had more stamina than ever before. She is happy. 

The entire thing was iatrogenic!  
--
*Definition:  Induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures.


High-pressure oxygen can effectively treat fibromyalgia

http://goo.gl/j4nkfl

Fibromyalgia is almost impossible to diagnose. The chronic pain syndrome strikes an estimated 1 in 70 Americans, most of them women. The disorder is often triggered by head trauma, a neurological infection, or severe emotional stress, and is characterized by symptoms such as musculoskeletal pain, fatigue, memory loss and mood swings. Fibromyalgia is often mistaken for other culprits and most patients suffer months, even years, of unrelenting pain before being properly diagnosed. And once diagnosed, patients enjoy little respite because few therapies have been found to be effective in assuaging its symptoms.

A new study published in PLoS ONE by Tel Aviv University researchers may turn the tide. The research found that women with fibromyalgia were able to drastically reduce, or even eliminate, their use of pain medication following hyperbaric oxygen treatment. The study was led by the late Prof. Eshel Ben-Jacob of TAU's School of Physics and Astronomy and Rice University's Center for Theoretical Biological Physics, Dr. Shai Efrati of TAU's Sagol School of Neuroscience and Assaf Harofeh Medical Center, and Prof. Dan Buskila from Soroka Medical Center, and was conducted by a team of scientists from TAU, Rice University, Assaf Harofeh Medical Center, Ben-Gurion University, and Tel Aviv Sourasky Medical Center.

The TAU researchers believe they have also identified the primary factor causing fibromyalgia: the disruption of the brain mechanism for processing pain. "As a physician, the most important finding for me is that 70 percent of the patients could recover from their fibromyalgia symptoms," said Dr. Efrati. "The most exciting finding for the world of research, however, is that we were able to map the malfunctioning brain regions responsible for the syndrome."


New Alzheimer's study reveals how spouse-caregivers sustain relationships

http://goo.gl/cCskzs

Thirty conversations were analyzed with qualitative methods. Three overall themes of spousal care were identified: engaging with compassion; patiently reaching out; and trusting in the existence of deep attachment. In addition, 10 communication patterns were identified. Communication patterns included "news of the day," which provided caregivers and spouses normalcy and serenity by talking about the mundane activities of daily life; "sharing memories," whereby caregivers attempted to reminisce with their spouses about memories of people and past events; "storytelling," as caregivers persevered in telling a detailed story although the conversation seemed like a monologue with no verbal participation from the spouses; and "delighting in the unexpected," as caregivers were overjoyed when their spouses contributed more to the conversation than expected. The researchers also observed that caregivers accepted a spouse's version of the story, valuing the relationship more than being right and therefore refrained from interrupting or interjecting.