Health and Disability

Delivering lab results to ED physicians via their smartphones can help discharge patients from the emergency department faster, data shows.

The study, published online inAnnals of Emergency Medicine, found that chest pain patients in the ED whose attending emergency physicians received lab results delivered directly to their smartphones spent about 26 minutes less waiting to be discharged than patients whose lab results were delivered to the electronic patient record on the hospital computer system.

"For many patients, waiting for lab results that determine if they stay in the hospital or go home is the hardest part of the ER visit," study author Aikta Verma, MD, MHSc, of the University of Toronto in Ontario, Canada, said in a statement.

"Physicians who received troponin results on their smartphones made the decision to discharge their patients with chest pain a median of 26 minutes faster than physicians without troponin push-alert notifications."

Patients who come to the ED with chest pain have blood drawn to test for troponin levels, which, if elevated, indicate a heart attack. Physicians participating in the study were randomized to either receive push alerts directly on their smartphones about their patients' troponin lab tests or not receive them.

The authors wrote that they "retrospectively identified patients treated by participating physicians during the study period who were discharged from the ED with chest pain."

“A national database for children with medical complexity has been lauded as an opportunity for researchers to improve treatments, families to receive coordinated care and physicians to provide higher quality care,” the authors wrote. “However, the potential for discrimination against children with medical complexity and their families related to making their health information public creates concerns about the potential impact of passing the ACE Kids Act.”

Children with complex medical condistion make up approximately 0.5 percent of all U.S. children but account for almost one-third of all health care spending for children (about $100 billion). Additionally, in children’s hospitals, children with complex medical conditions account for more than half of hospital costs for all admissions and 85 percent of the costs for 30-day unplanned hospital readmissions. The complicated and multifaceted medical needs of these children require services from different specialties and, frequently, from different states. As a result, medical care for these children is often fragmented, the authors said. “Such fragmented care is problematic. Though children with medical complexity depend on comprehensive care, they have to navigate a health care system that struggles to effectively coordinate health care services. This lack of coordination likely contributes to the high rates of adverse events (such as medical errors) that children with medical complexity experience compared to all other groups of children.

The report on pacemakers looked at a range of implantable devices from four manufacturers as well as the "ecosystem" of other equipment used to monitor and manage them.

Researcher Billy Rios and Dr Jonathan Butts from security company Whitescope said their study showed the "serious challenges" pacemaker manufacturers faced in trying to keep devices patched and free from bugs that attackers could exploit.

They found that few of the manufacturers encrypted or otherwise protected data on a device or when it was being transferred to monitoring systems.

Also, none was protected with the most basic login name and password systems or checked that devices they were connecting to were authentic.

The human brain is much better than previously thought at discovering and avoiding disease, a new study led by researchers at Karolinska Institutet in Sweden reports. Our sense of vision and smell alone are enough to make us aware that someone has a disease even before it breaks out. And not only aware – we also act upon the information and avoid sick people. The study is published in the scientific journal Proceedings of the National Academy of Sciences (PNAS).

The human immune system is effective at combating disease, but since it entails a great deal of energy expenditure disease avoidance should be part of our survival instinct. A new study now shows that this is indeed the case: the human brain is better than previously thought at discovering early-stage disease in others. Moreover, we also have a tendency to act upon the signals by liking infected people less than healthy ones.

“The study shows us that the human brain is actually very good at discovering this and that this discovery motivates avoidance behaviour,” says principal investigator Professor Mats Olsson at Karolinska Institutet’s Department of Clinical Neuroscience.

By injecting harmless sections of bacteria, the researchers activated the immune response in participants, who developed the classic symptoms of disease – tiredness, pain and fever – for a few hours, during which time smell samples were taken from them and they were photographed and filmed. The injected substance then disappeared from their bodies and with it the symptoms.

Another group of participants were then exposed to these smells and images as well as those of healthy controls, and asked to rate how much they liked the people, while their brain activities were measured in an MR scanner.

They were then asked to state, just by looking at the photographs, which of the participants looked sick, which they considered attractive and which they might consider socialising with.

We are cereal boxes awaiting the convenience of providers to decide when they will deem to place us on their shelves....

https://goo.gl/e9CMMo

In 2014 Jess Jacobs, a director in an innovation lab, started blogging about her experience as she received treatment for two rare diseases. Jess was trained as a Six Sigma Green Belt. So unlike your average patient, she described one 12-hour wait in the ER as having a “7% process cycle efficiency.” Likewise, she determined that just 29% of her 56 outpatient doctor visits were useful. She made 20 visits to the emergency room and spent 54 days in the hospital across nine admissions, but her calculations showed that just 0.08% of that time was spent treating her conditions. “Stop wasting my time,” Jess wrote in one blog entry. “Stop wasting my life.”

Jess’s writing was unique, but her attitude wasn’t. Like many patients, Jess felt her providers were delivering very little quality of care when defined by the one metric that mattered most to her: time.

While Jess didn’t get her care at Kaiser Permanente, we are working to improve on this metric. But to do so, we have had to upend traditional paradigms and make saving our patients’ time a part of our standard quality measures.

For example, the average hip or knee replacement surgery in the United States requires a three-day stay in the hospital. This is largely because many hospitals are reimbursed for every day a patient is in a bed, and it’s easier for the care team to monitor the healing process if all of their patients are in one unit. The system was created by and optimized for surgeons and hospitals to provide safe care with good outcomes. But what about our patients?

The U.S. has one of the most sophisticated healthcare systems in the world, and invents more drugs than any other country in the world. It therefore stands to reason that, financial accessibility aside, U.S. hospitals should have access to any and all drugs they need to treat their patients—but this is not the case. In fact, hospitals around the world face shortages of the most basic medicines, threatening the lives of vulnerable patients.

The FDA maintains a database of drug shortages faced in the U.S., and it’s an alarming list. Three types of penicillin, including benzathine penicillin G, are listed as “currently in shortage.” Benzathine penicillin G is used to treat rheumatic heart failure, streptococcal infections, STIs, and other bacterial diseases. Other drugs on the shortage list include calcium chloride injections, epinephrine, sterile talc powder, saline, and sodium bicarbonate injections.

We spend 18 percent of our national gross domestic product on health care. As health care spending continues to grow and as we appropriately drive the health care system toward a payment system that rewards value instead of volume, it is imperative that we promote conversations on how to define value. To do this, it is critical that we first answer the question: value to whom?

Value in health care can mean different things to different stakeholders. Payer priorities may not match up with manufacturer concerns, and both may assess value entirely differently than public health entities. However, no matter which of these stakeholders is measuring value, it’s important that value assessments always robustly consider and measure what matters most to the ultimate consumers of health care: patients.

The patient perspective on value is of particular importance now, as patients are responsible for more and more of the costs of their care. Today, more than 1 in 4 Americans report facing challenges paying for their medical bills and about 79 percent of cancer patients report moderate to catastrophic financial burden related to their care. Low-income families often spend more than 20 percent of their after-tax income on out-of-pocket health care spending, even when enrolled in low- or no-deductible plans.

Seniors don't get a cardiovascular or mortality benefit from taking a moderate-dose statin for primary prevention, according to a post hoc subgroup analysis of ALLHAT-LLT.

An accompanying editor's note by Gregory Curfman, MD, of Harvard Medical School in Boston, acknowledged statin risks that "may be particularly problematic in older people" and concluded the ALLHAT-LLT results "should be considered before prescribing or continuing statins for patients in this age category."

The National Heart, Lung and Blood Institute (NHLBI) has released the COPD National Action Plan, which calls for multidisciplinary, national guidelines for the treatment and management of the disease.

"COPD is the third leading cause of death in this country. It is right behind heart disease and cancer," Kiley said, adding that unlike those diseases, COPD prevalence and deaths continue to rise.

"Here in the United States, 6.5% of the population has COPD. That amounts to about 16 million people," he said. "Look around this room. One in five people over age 45 has this disease. You know someone who has it. You may have it and not even know it."

Meilan Han, MD, of the Women's Respiratory Health Program at the University of Michigan in Ann Arbor, cited common barriers to the delivery of adequate COPD treatment and support, including lack of access to providers who understand the disease, lack of access to affordable medications, and lack of access to nearby treatment centers.

She added that the stigma surrounding COPD, which is largely a disease of smokers and former smokers, compounds the problem.

"This is a group of patients who have assumed that this is what they have to live with, and they don't speak out for themselves," she said. "What is clear is that we as society can no longer afford to brush this under the table and ignore this problem when it is the third leading cause of death in the United States."

She said it is important to challenge the misperception that COPD is a disease that only occurs in elderly men who smoked for decades.

"We have a lot of young individuals and a lot of women [with COPD]," she said. "These are people who need and want to be active members of society."

The finding of a common protein abnormality in these degenerative diseases supports a hypothesis among experts that abnormal deposition of proteins in many neurodegenerative disorders reflects an early change in these proteins.

“We have pinpointed a protein abnormality known as the ‘SOD1 fingerprint’ in regions of neuronal loss in the Parkinson’s disease brain,” said Associate Professor Kay Double who led the research published in Acta Neuropathologica.

“We believe this loss of neurons results from a combination of oxidative stress and a regional deficiency in copper, both of which occur specifically in vulnerable regions of the Parkinson’s disease brain.”

This new finding may offer hope to Parkinson’s disease patients, since therapies targeting abnormal SOD1 protein have resulted in substantial improvements in motor function and survival time in models of ALS, prompting their progression into human clinical trials in this disease. This new finding suggests that such therapies may also be useful to treat Parkinson’s disease.