Health and Disability

The number of measles cases from the outbreak linked to Disneyland has now risen to at least 98. But measles remains extremely rare in the United States.

The rest of the world hasn't been so fortunate. Last year roughly 250,000 people came down with measles; more than half of them died.

Currently the Philippines is experiencing a major measles outbreak that sickened 57,000 people in 2014. China had twice that many cases, although they were more geographically spread out. Major outbreaks were also recorded in Angola, Brazil, Ethiopia, Indonesia and Vietnam.

"The measles virus is probably the most contagious infectious disease known to mankind," says Stephen Cochi, a senior adviser with the Centers for Disease Control and Prevention's global immunization division.

Medical errors kill more people than car crashes or new disease outbreaks. They kill more people annually than breast cancer, AIDS, plane crashes, or drug overdoses. Depending which estimate you use, medical errors are either the 3rd or 9th leading cause of death in the United States. Those left dead as a result of their medical care could fill an average-sized Major League Baseball stadium — sometimes twice over.

Medical errors tend to fall into two buckets. There are the mistakes that happen when doctors set a wrong plan: when they prescribe the wrong medication, for example, thinking it was the right treatment. Then there are the errors that occur when doctors set the right plan but don't follow it — when messy handwriting means a patient gets the wrong drug dosage, for example, or when a surgeon operates on the wrong body part (yes, this actually happens).

"Something like 2 to 3 percent of people who go into the hospital are going to have some pretty severe harm as a result," says Don Berwick, the Obama administration's former Medicare administrator. "Australian studies show that the rate might be as high as 12 percent. The harder you look, and the more you study the issue, the more errors you find."

Wow. 533,000 people. So, what's going on here? Well, possibilities include:

• The earlier estimates may have simply been underestimating by 10% or so.
• The earlier estimates may have been accurate at the time, but it's possible that another 40K or so Michiganders who didn't qualify last spring have fallen on hard times since then and do qualify now.
• There may be a small amount of genuine fraud going on here; hey, it does happen.

There's one other possibility: 36,307 of the 533K total are people who were previously covered through Medicaid's adult benefits waiver program. I've been assuming all along that the 477K - 500K eligible estimate included those 36K as well, but it's possible that it didn't. If that's the case, then the actual number eligible should be closer to 540K, which would dovetail nicely with today's update.

Australian researchers have found a possible key to a cure for people with potentially fatal peanut allergies.

A Melbourne-based study has already transformed the lives of many of the children who took part in the clinical trial.

Researchers from the Murdoch Childrens Research Institute gave about 30 allergic children a daily dose of peanut protein together with a probiotic in an increasing amount over an 18-month period.

The probiotic used in the study was Lactobacillus rhamnosus and the dose was equivalent to eating about 20kg of yoghurt each day. At the end of the trial 80% of the children could eat peanuts without any reaction.

“Many of the children and families believe it has changed their lives, they’re very happy, they feel relieved,” said the lead researcher, Mimi Tang. “These findings provide the first vital step towards developing a cure for peanut allergy and possibly other food allergies.”

But one day last summer, after he disputed nursing home bills that had suddenly doubled Mrs. Palermo’s copays, and complained about inexperienced employees who dropped his wife on the floor, Mr. Palermo was shocked to find a six-page legal document waiting on her bed.

It was a guardianship petition filed by the nursing home, Mary Manning Walsh, asking the court to give a stranger full legal power over Mrs. Palermo, now 90, and complete control of her money.

Few people are aware that a nursing home can take such a step. Guardianship cases are difficult to gain access to and poorly tracked by New York State courts; cases are often closed from public view for confidentiality. But the Palermo case is no aberration. Interviews with veterans of the system and a review of guardianship court data conducted by researchers at Hunter College at the request of The New York Times show the practice has become routine, underscoring the growing power nursing homes wield over residents and families amid changes in the financing of long-term care.

From analyzing 1,106 studies from the PubMed, Web of Science and Scopus databases, the team identified 25 studies that included 253 sudden unexpected death cases among patients with epilepsy, in which sleeping positions at time of death were documented.

The researchers found that in 73.3% of cases, patients died while sleeping on their stomach - known as the "prone" position - while the remaining 26.7% of patients died in other sleeping positions.

The team notes that 11 cases of sudden unexpected death identified in this study were monitored via video and electroencephalography (EEG). In all of these cases, patients died while sleeping in on their stomach.

By assessing a subgroup of 88 patients, the team found that patients under the age of 40 were four times more likely to be found in the prone position at time of sudden unexpected death than patients over the age of 40.

Just before the new year, the Treasury Department and IRS issued long-awaited final rules that directly address hospital financial assistance, billing and collections. The regulations finalize the details for a broader ACA mandatethat governs how tax-exempt hospitals provide community benefit. Historically, hospital community benefit programs—including financial assistance or free care—have been a mixed bag in terms of content, governance, and level of investment; and states have taken an uneven approach to regulating hospital behavior. While the new regulations leave most of the details to hospitals to decide, they set a new federal floor that greatly increases transparency on financial assistance and collections, provides some protection against medical debt and overcharging, and offers communities greater insight and potential influence on the way hospitals understand and address broader health issues.

http://goo.gl/v951q4

The article continues with how they made the change and a summary of what they learned, even including sample scripts for how staff actually says to family members. (Talk about “thank you for sharing”…)  And this, in the conclusion:

The research team analyzed data from previous studies that evaluated health outcomes and hospitalization rates of Medicare and Medicaid patients by state. In states where APRNs were fully independent in their practice, the researchers found significant improvement in quality of care and health outcomes.

"The movement for unrestricted APRN practice nationwide is happening right now," Rantz said, "More and more states are changing their laws because they've seen the improvements. They're looking ahead to the future and providing access to care."

Professor Martin McKee of the London School of Hygiene & Tropical Medicine and co-author of the research paper, added: "This raises serious concerns about the quality of care provided in some care homes. When a care home has more than a few residents admitted to hospital with high sodium levels this may well be indicative of a systematic problem at the care home and the issue should be raised formally".

Co-author Professor David Stuckler, from the University of Oxford, said: "Clearly this level of dehydration is a problem. Further research is needed to understand why it is occurring. Are care home residents choosing to drink less than they should? Or, as has been speculated, are care home staff not offering enough water to reduce incontinence and the amount of assistance their residents require?"