Health and Disability

There are many other examples of ritual treatment producing relief even when the person knows it is a ritual......

http://goo.gl/KaO63W

Harvard researcher Dr. Ted Kaptchuk made this counterintuitive conclusion in a study published last week in Science Translational Medicine. Kaptchuk and colleagues found that the placebo effect greatly enhanced pain relief in migraine sufferers who had the expectation they were getting an effective drug, compared to when they took the active drug with the incorrect label “placebo.” More surprising, however, is that the patients reported significant pain relief, compared to an untreated migraine attack, even when they knew they had swallowed nothing more than a sugar pill.

http://goo.gl/UpWsUk

Under the final rule, Medicaid programs will support home and community-based settings that serve as an alternative to institutional care and that take into account the quality of individuals’ experiences.  The final rule includes a transitional period for states to ensure that their programs meet the home and community-based services settings requirements.  Technical assistance will also be available for states.

In addition to defining home and community-based settings, the final rule implements the Section 1915(i) home and community-based services State Plan option. This includes new flexibility provided by the Affordable Care Act that gives states additional options for expanding home and community-based services and to target services to specific populations.  It also amends the 1915(c) home and community-based services waiver program to add new person-centered planning requirements, allow states to combine multiple target populations in one waiver, and streamlines waiver administration.

http://goo.gl/MH6hyg

Current anti-migraine medications are only moderately effective and often not well tolerated. In addition, overuse of anti-migraine medications is an essential factor in the worsening of the disease and its development into chronic migraine. Cefaly (R) is therefore a means of choice to treat a majority of migraine patients.

Cefaly(R) is an innovative medical device protected by a number of patents. It is the first device to offer external cranial neurostimulation. Cranial neurostimulation is a technique that has been used for a number of years in neurology, but this has been carried out using implantable neurostimulators (similar to pacemakers). The technological advances made by Cefaly means that there is now a simple, lightweight, economical and comfortable device available that offers migraine patients a method of treatment that is neither drug-based nor invasive.

A self-adhesive electrode is placed on the forehead and the device is positioned on this electrode, worn like a pair of glasses. Highly precise impulses are transmitted through the electrode to the nerve endings of the upper branch of the trigeminal nerve.

The Cefaly(R) medical device is available on the European market and in Canada; FDA approval for USA is expected in the coming months.

Language is bad, but idea is sound....

http://goo.gl/qT1hLs

Now, the company Wellsense has developed an alert monitor that can track pressure points on a person’s body and assist caregivers in adjusting the patient’s position every few hours to prevent bedsores. The Monitor Alert Project (MAP) is a monitor-connected mattress that illustrates the likely bedsore spots on the patient’s body. On its website, Wellsense describes the project: “The Map System is the first ever, Continuous Bedside Pressure Mapping System (CBPM). Used seamlessly on any existing bed, MAP allows caregivers to place and position patients using actual pressure distribution data. The MAP System provides instant feedback to guide caregivers through off-loading pressure accurately.”

Though it’s a preventable problem, up to 60,000 Americans die from bedsores every year, and nearly 2.5 million are affected. A 2012 study published in the Journal of the American Geriatrics Society found that older people who developed bedsores during their time in the hospital were more likely to die, to stay longer in the hospital, and to be readmitted within 30 days of their discharge.

http://goo.gl/l6jvha

Ernie Ciccotelli was trying to do a good deed when he donated a kidney to his brother. But within days of the surgery, his incision was oozing green fluid and his guts were rotting.

Ciccotelli said he was almost killed by an infection, and the follow-up surgeries and months of disability nearly ruined his fledgling legal practice. So he looked for a malpractice attorney who would help him file a case against the hospital.

That’s when he ran into a problem faced by many who are harmed in a medical setting: Attorneys refuse their cases, not because the harm didn’t happen but because the potential economic damages are too low.

It’s estimated that hundreds of thousands of patients a year suffer some type of preventable injury or die while undergoing medical care. For many of these patients or surviving family, a lawsuit is the only hope to recover losses, learn the truth about what happened and ensure the problem is corrected.

Most people have no idea how much variety there is in "brain death" standards, or how organ transplant income and surgical reputation can play into supposedly "objective" decisions about end of life care.

http://goo.gl/yLdA43

With all due respect, I’d like to suggest that almost every bioethicist weighing in on this story hasadded to the ignorance and confusion surrounding brain death.

There’s a lot the public should know in order for us all to have an informed and rational discussion about brain death and how to talk about it.  In 2012, I wrote an op-ed with NDY President and CEO Diane Coleman that was published in the Wall Street Journal.  We described one major problem with the statutes regulating brain death:

...There have also been repeated claims that there is “no recovery from brain death,” which evades the reality of those individuals who have been determined to be brain dead and “miraculously” recovered.

In 2008, there was the “miraculous” story of Zack Dunlap, who showed signs of movement shortly after being declared brain dead and being readied for organ harvesting.  His recovery at the time was hailed as a miracle – and the hospital staff that made the declaration didn’t seem to inclined to argue.  Here was my take at the time:

http://http//goo.gl/P7zPUU

It finds that health plan cost-sharing is a primary contributor to medical debt.  Even relatively modest cost sharing can prove unaffordable because expenses often are unexpected and most Americans have less than $3,000 on hand to cover such costs.

For many, unaffordable cost-sharing may be compounded by other factors:

• Out-of-network expenses may also arise, often inadvertently for people who are hospitalized when hospital-based providers aren’t in the plan network
• Health care providers tend to promptly refer patients who can’t pay to collections
• Patients may use credit cards to pay unaffordable medical bills, which increases debt
• Illness often triggers income loss, further aggravating affordability problems
• People facing health issues may have trouble tracking medical expenses and resolving billing problems on their own.
• Medical debt is also linked to housing instability, reduced retirement savings, damaged credit, bankruptcy and barriers to accessing care.

This means a small a cognitive load as possible, essentially daydreaming and drifiting......

http://goo.gl/L7UCkZ

In the study of 335 children and young adults, ages 8 to 23, those reporting the greatest levels of cognitive activity (including homework, playing video games, doing crossword puzzles, text messaging and online activities) after a concussion took the longest to fully recover from their symptoms — approximately 100 days on average, compared to approximately 20 to 50 days for patients reporting lesser levels of activity.

Cognitive activities were defined as "activities that require you to think harder than usual" and study participants were grouped according to the average amount of cognitive activity — from complete cognitive rest to a full schedule — that they reported doing between each visit to a concussion clinic.

Sappy Language, but Good Support....

http://goo.gl/fu6nNY

But a grassroots nonprofit group founded by people with disabilities helping other disabled people cope with disaster knew what to do.

Portlight Strategies of South Carolina, which has helped thousands of hurricane, tornado and tsunami victims since 1997, set up shop in New Jersey last spring. The Hildebrandts are among the 130 New Jerseyans with disabilities Portlight has helped return to their homes and resume their lives.

A $3,000 grant from Portlight paid most of the cost of installing a self-operated chair lift that runs up the side of the Hildebrandts’ home and hoists him from the ground to their new deck, his wife said.

http://goo.gl/mS6LQ5

Perhaps Theresa's most important insight into dementia care concerns the power of ritual, and it came from the care of her own grandfather. As his dementia progressed, he became less alert and more confused. A devout Catholic, however, he kept attending weekly Mass. Though Theresa's father was nearly mute much of the time, at services he happily recited familiar prayers and joined in the hymns. Each time the service began, he would become calmer and less agitated, less confused and more focused. The ritual seemed not only to evoke special memories and feelings–it brought him back, as well.

Theresa and her colleagues now invite patients to participate in such rituals on a regular basis. One of the key words here is "participate." They do not passively sit back and watch or listen as someone else recites prayers and sings hymns. They are invited and encouraged to join in the service. Some, typically those in the early stages of their disease, are able to participate fully, even engaging in discussions about the meaning of what they are doing. For others at later stages, participation may mean singing, ringing bells, or simply tapping feet and clapping hands.