Patients with advanced co-existing illnesses and their carers face uphill struggle

http://goo.gl/D7WOmW

Patients in their last year of life with co-existing illnesses struggle to cope with a bewildering array of services and treatments, which are often poorly coordinated and lack any continuity of care, indicates an analysis of patient and carer feedback, published online in BMJ Supportive & Palliative Care.

Patients and carers frequently found accessing the support they needed "impersonal" and "challenging," the comments showed.

It's important to get this right, say the researchers, because 'multimorbidity,' in which patients are coping with several illnesses at the same time, is increasingly common in the last year of life, and associated with frequent hospital admissions.


First-of-its-kind study to examine smoking prevalence in people with mobility impairments

http://goo.gl/XF0CK5

Researchers from The Miriam Hospital have found that people with mobility impairments under age 65 have significantly higher rates of smoking than those without mobility impairments. Additionally, smokers with mobility impairments were less likely to attempt quitting than those without mobility impairments, and evidence-based, quit-smoking treatments may not be sufficient for this population. The study and its findings are published online in advance of print in the American Journal of Public Health.

Borrelli focused on smokers with mobility impairment because in addition to being at risk for the same smoking-related health problems as the general population, this population is at risk for worsening their existing disability and underlying medical condition. Continued smoking exacerbates physical disabilities and causes or contributes to many secondary conditions including respiratory and circulatory difficulties, muscle weakness, delayed wound healing, worsening arthritis and osteoporosis. Smokers with a relapsing-remittingmultiple sclerosis (MS) are three times more likely to develop a secondary-progressive disease course.


'High proportion' of kidney donors face insurance difficulties

http://goo.gl/LMMXvz

The authors of the new study cite recent high-profile news stories providing examples of donors being classified as "high-risk" by insurance companies due to only having one kidney, even though the donors have no evidence of kidney injury or disease.

Surveys of insurance companies show that only a small proportion of companies claim that they would charge higher insurance premiums to donors after donation. Despite this, in a survey of transplant centers in the US, 39% of centers reported that potential donors decline donation due to apprehension over future insurance problems.

Among the 186 donors in the study who changed or initiated life insurance after their donation, 46 (25%) had similar difficulties. Twenty-three of these people were denied life insurance altogether, 27 were charged a higher premium, and 17 were told their donor status meant they had a pre-existing condition.

In addition, the researchers found that men and donors above the age of 40 were more likely to report having difficulty changing or initiating life insurance.

Other insurance-related difficulties facing donors that were observed by the researchers included delays and added paperwork.


Survey of Health Insurance Marketplace Assister Programs

http://goo.gl/bdVrQ4

More than 4,400 Assister Programs, employing more than 28,000 full-time-equivalent staff and volunteers, helped an estimated 10.6 million people during the first Open Enrollment period.

Assistance resources were not evenly distributed across states.  In states with State-based Marketplaces (SBM) and Consumer Assistance Partnership Marketplaces (FPM), there were about twice as many Assisters available per 10,000 uninsured, compared to states with a Federally-facilitated Marketplace (FFM).  The number of people helped per 1,000 uninsured was also greater in State and Partnership Marketplaces; SBMs helped about twice as many people relative to the uninsured population compared to FFMs, while FPMs helped about 1.5 times as many relative to the uninsured population. Some people who were helped enrolled in new QHPs, and some in Medicaid and CHIP.  Others who sought help didn’t enroll in coverage, for example, if they were ineligible for both Medicaid and premium tax credits.


Consumer Voice Launches New Website That Will Provide Enhanced Access to Long-Term Care Resources & Information

http://www.pr.com/press-release/563925

The National Consumer Voice for Quality-Long Term Care (Consumer Voice), the leading national voice representing consumers in issues related to long-term care, announced today the release of its new and improved website – http://www.theconsumervoice.org - that will provide consumers, advocates and family members with enhanced access to resources and information on how to achieve quality long-term care.


Home blood pressure-monitoring kits save insurance companies money

http://goo.gl/nTLTRD

Insurance companies can save money by paying for home blood pressure-monitoring kits, which can improve healthcare quality and reduce healthcare costs. Home monitoring kits can be very effective in diagnosing high blood pressure and should become a mainstay of diagnosis and treatment in the United States.

Home blood pressure-monitoring kits can save insurance companies money by improving healthcare quality and reducing healthcare costs, according to new research in the American Heart Association's journal Hypertension.


New research: teaching the brain to reduce pain

http://goo.gl/7LKF9a

To explore this "pain inhibits pain" phenomenon, painful electric pulses were first administered to a subject's foot (first pain) and the resulting pain intensity was then measured. Then the subject was asked to put their hand in a bucket of ice water (novel stimulus causing pain reduction), and as they did so, a telephone ringtone sounded in headphones. After this procedure had been repeated several times, it was observed that the pain felt from the electrical stimulation was reduced simply when the ring tone sounded.

The brain had been conditioned to the ringtone being a signal to trigger the body's physical pain blocking mechanism. The people being tested not only felt significantly less pain, but there were also fewer objective signs of pain, such as activity in the muscles used in the facial expression of pain (frowning). In total, 32 people were tested.


Stop trying so hard!

http://goo.gl/Bu1m4a

After several years of chemotherapy, my late friend Monique Doyle Spencer's veins had deteriorated to the point that it was very hard for nurses to insert IV lines.  The most painful moments for her would occur when someone would try multiple times to insert a line.  She noticed that, if they didn't succeed the first or second time, the process would just get worse and worse as they tried harder and harder.  The psychology of the moment was that the person would "anchor" into a certain approach, and the nurse's well intentioned efforts would fall to failure as frustration and anxiety grew--for both parties.

I mentioned this story to my colleague Bijan Teja, a second year surgical resident, who has seen the same phenomenon occur with regard to central line insertions by doctors.  He sent the following note:

Please see attached two papers that have shown that the complication rates increase dramatically with more than two failed attempts at central venous line placement. The recommendation is to stop after two or three tries, and usually try a different site, a different operator, or both.


Four evidence-based indicators of concussion

http://goo.gl/H7rUuL

Based on 11 independent patient samples, the panel identified four indicators of concussion in awake individuals:
  • Observed and documented disorientation or confusion immediately after a blow to the head
  • Impaired balance within one day after injury
  • Slowed reaction times within two days after injury
  • Impaired verbal learning and memory within two days after injury