Health and Disability

A simplified frailty index created by surgeons at Wayne State University School of Medicine in Detroit, Mich., is a reliable tool for assessing risk of mortality and serious complications in older patients considering total hip and knee replacement procedures, according to new study findings presented at the 2014 Clinical Congress of the American College of Surgeons.

The simplified frailty index takes into account 11 data points collected by the ACS NSQIP database. Since most of these variables are considered co-morbidities, such as history of heart attack, stent and hypertension, health care providers can easily calculate a patient's frailty score by taking a simple medical history. No laboratory values are included.

Nearly one in five U.S. adults are in pain most every day for spells of three months or longer, according to an analysis by Jae Kennedy, professor of health policy and administration at Washington State University Spokane. The estimated 39 million adults in persistent pain outnumber the residents of California.

Previous studies have said so much pain costs hundreds of billions of dollars a year in lost productivity and health care. And that doesn't take into account pain's psychic toll.

"A sizeable portion of American adults are dealing with persistent pain and that's affecting their lives profoundly," said Kennedy. "Access to good pain management for this population is limited, and there's a real risk that taking short-term pain medications for a long period of time will lead to dependency or addiction."

Cost of informal caregiving for US elderly is $522 billion annually, according to a new RAND Corporation study.

Replacing that care with unskilled paid care at minimum wage would cost $221 billion, while replacing it with skilled nursing care would cost $642 billion annually.

Three out of five caregivers also are in the labor force. Working-age people under the age of 65 provide 22 billion of those 30 billion caregiving hours, and they often lose income due to reduced work hours. Because their hourly wages are higher than those over 65, they account for the largest portion of the informal costs of caregiving, or $412 billion a year - about midway between the replacement cost of paid unskilled caregiving ($221 billion) and paid skilled caregiving ($642 billion).

An accessible tiny house can be a good choice for people who are older, have health problems or disabilities, as living in a traditional house can be troublesome. Since most standard homes are relatively large (over 2,000 sq. ft. on average), they are generally harder to navigate when you’ve lost that spring in your step. More and more homeowners are discovering that tiny homes are great solutions for accessible living space.

Since an accessible tiny house is generally kept somewhere between 100 and 300 square feet, the living quarters are kept compact. No long hallways that wind and weave past numerous rooms; just multi-purpose space that makes taking care of daily tasks a whole lot faster and easier.

If you have mobility problems, you will particularly enjoy the fact that the bathroom is no more than a few steps away from anywhere in the home. And, when it comes to serving dinner, there’s no carting dishes back and forth from the dining room to the kitchen.

"If this finding holds, it will be exciting because yes, we’ve found something that has never been found before. But there’s this additional layer of looking at a disease that was completely ostracized. So there’s also this component of validation."

The researchers found three types of brain abnormalities in the people who were diagnosed with chronic fatigue syndrome. Firstly, the white matter areas were significantly smaller in those with the syndrome than in the healthy subjects. White matter helps carry nerve impulses between neurons.

Secondly, the arcuate fasciculus, a tract of the brain that connects the temporal and frontal lobes, had abnormalities. Normally, the arcuate fasciculus is in charge of language and comprehension in the left hemisphere of the brain, but after scanning, the scientists found that the people with chronic fatigue syndrome had the abnormalities of the arcuate fasciculus in the right hemisphere. Doctors don’t know yet what the fasciculus does on the right side of the brain and are hoping that some more studies of chronic fatigue patients will reveal more about that.

Thridly, they found that the grey matter around the abnormal arcuate fasciculus is thicker in the patients with the syndrome than in the healthy ones.

Families of children who experience seizures that have not been controlled by medications or surgery may be offered information about Vagus Nerve Stimulation therapy that has been shown to reduce the frequency and intensity of seizures in most patients since the mid-1990s. 

Those who have a vagal nerve stimulator implanted do continue taking medications although the dosage may be reduced after a few months of VNS therapy. Seizure frequency is often reduced by about half the number experienced before implantation.

Vagal or Vagus Nerve Stimulation is accomplished via a pulse generator implanted at the collarbone or armpit that is connected via thin plastic coated wires under the skin to the left vagus nerve in the neck during what is usually a one or two hour outpatient surgery. The battery may be replaced every five or ten years.

The device is usually set to give a half-minute of stimulation per five minutes and "fine-tuned" by the doctor in the weeks following implantation. Another part of the device is a small magnet that is used to start a round of stimulation as a seizure comes on, or to turn off the preset stimulation. Those who have a VNS device may experience hoarseness, changed voice quality, trouble swallowing or a tingling sensation in their neck during the pulse, and so may disengage it while singing or public speaking. 

Historically, Medicare has covered 80 percent of the cost for basic speech-generation devices, the machines many ALS patients use. Those patients could pay out of pocket for upgrades that allow the devices to connect to the Internet and perform services such as opening doors. But in February, the Centers for Medicare and Medicaid Services (CMS) posted a “coverage reminder” noting that the program does not cover the cost of upgradable devices. In other words, Medicare only will cover the cost of the basic speech-generation device — not those that can be upgraded to perform tasks beyond speech generation or perform functions not considered medical.

The researchers - from London Health Sciences Centre and Western University in Ontario, Canada - compared the outcomes of 66 children whose pain was treated using morphine with the outcomes of 68 children who were administered ibuprofen for fracture pain. All participants were aged 5-17 years.

The results demonstrate that, although both of the medications were effective for relieving pain, there were more adverse events - such as drowsiness, nausea and vomiting - associated with morphine.

"Given that morphine was associated with significantly more adverse effects, we conclude that ibuprofen remains a safe and effective therapy for outpatient management of children's fracture pain," write the authors.

"We hope that our results will provide clinicians with a foundation for rational analgesic choices for children with fractures who are discharged from the emergency department," they add.

Preliminary results of an open-label trial carried in the journal of Headache and Pain reported that a single treatment with electroCore's hand held non-invasive vagus nerve stimulation (nVNS) device gammaCore, completely resolved 44.8% of migraines within 30 minutes, with an additional 11.4% experiencing moderate benefits (incomplete resolution of their headaches) by 2 hours. This result follows two presentations at the International headache meeting in Copenhagen (EHMTIC) in September showing that patients using gammaCore plus standard of care achieved a 43.4% reduction in the number of weekly cluster headacheattacks compared with 12.5% (p=0.002) in patients treated with the best available standard of care. It also found that patients experienced a greater reduction in number of attacks the longer they stayed on treatment.