Health and Disability

Understanding and honoring patients' medical decisions can be made difficult due to conflicting state laws, a new study has found. Researchers anticipate the issue will grow along with the nation's booming senior population.

In a first-of-its-kind study of medical decision-making rules, researchers with Beth Israel Deaconess Medical Center, the Mayo Clinic and the University of Chicago reviewed laws from all 50 states regarding the medical choices of patients. Their findings, published Thursday in the New England Journal of Medicine, show a conflicting system of rules that's difficult to navigate and may impede honoring patients' wishes.

Thirty states require the “alternative decision makers” of patients to contain an ability to make difficult medical decisions, such as withdrawing a feeding tube or other life-sustaining treatment. But there's no way to assess that ability, the review said. Thirty-five states employ a “surrogacy ladder,” which creates a hierarchy of people able to make medical decisions when patients don't have a power of attorney. But even those systems vary when it comes to the types of decisions surrogates can make.

"One important message from this study is that, in the absence of a clearly identified spokesperson, the decision-making process for incapacitated patients may vary widely depending on where they live,” said senior researcher Daniel B. Kramer, M.D., MPH, in a release on the study.

The study also found states varied in how they defined an appropriate decision maker. Some require surrogates to have an in-depth knowledge of a person's beliefs, while others only require the decision maker be an adult.

Everything you want to know (or maybe forget?) about the American Health Care system....

https://goo.gl/f7Wrej

How well is the U.S. health system performing? Explore a variety of indicators of health spending, quality of care, access, and health outcomes. For more, see our brief and tutorial video.

• Health Spending
• Quality of Care
• Access & Affordability
• Health & Wellbeing

‘Music Remembers Me’ is an Australian first how-to guide about the transformative effects of music written by Dr Kirsty Beilharz.

Dr Beilharz, a former Young Australian of the Year finalist, is a Visiting Fellow at the University of Edinburg, applying music research in the contexts of restorative and palliative care.

Her new book is the result of a research project involving more than 700 aged care residents, bringing to life their experiences with music and helping families and carers understand why someone who can no longer speak may be able to sing along to a favourite song.

Musical therapy has long been known to help people with dementia, as music can reach parts of the damaged brain and facilitate cognitive function in a way other forms of communication can’t.

A 2015 study by researchers at Angela Ruskin University showed that patients given music therapy showed improvements in both their dementia symptoms and general wellbeing.

Dr Beilharz hopes the book will “fill a gap” by providing information about medical research for the everyday person, ultimately putting power back in the hands of families and carers.

It traces the impact of individually tailored playlists on individuals from the early to the advanced stages of dementia, recording how the therapy provided dignity, reminiscence, and liveliness, and even restored speech.

Old news, but worth repeating.....

https://goo.gl/oMkXUa 

Grapefruit causes problems when taken with certain medications.

As little as one cup of juice or two grapefruit wedges can alter the way your medicines work. When taken with medicine, grapefruit can delay, decrease, or enhance absorption of certain drugs; as a result, the patient does not receive the prescribed dosage of the medication. If the label on your medicine reads “DO NOT TAKE WITH GRAPEFRUIT” or has similar words, heed the warning. It can save you a bushel of problems.

How it does or doesn’t work

Depending on the active ingredient, grapefruit can reduce the effectiveness of a drug or worse, create potentially dangerous drug levels in the body. Grapefruit can interfere with transporters in the intestine that help absorb drugs. When this happens, less of the drug reaches the bloodstream and the patient receives no benefit. 

Grapefruit can also interfere with enzymes that break down drugs in your digestive system. This can result in the body absorbing too much of the drug, which can potentially cause serious problems. 

Help may be on the way

Scientists are currently working on breeding hybrid grapefruits that will be safe to mix with medications. In the near future you may be able to enjoy these tasty mounds without compromising your safety. But until the new fruit containers start to arrive, follow these tips:  

Labels for type 2 diabetes drugs containing canagliflozin (Invokana, Ivokamet, Invokamet XR) will now carry a boxed warning about increased risks of leg and foot amputation, the FDA said Tuesday.

Lower-limb infections, gangrene, diabetic foot ulcers, and ischemia were the most common precipitating factors for amputations in the studies, the FDA said. Patients with previous amputations were more likely than others to need additional ones during the trial.

Notably, patients in the two trials were included only if they had cardiovascular disease or risk factors for it other than type 2 diabetes. However, the new warning applies to all patients regardless of cardiovascular risk.

There's more grim news about inequality in America.

New research documents significant disparities in the life spans of Americans depending on where they live. And those gaps appear to be widening, according to the research.

"It's dramatic," says Christopher Murray, who heads the Institute for Health Metrics and Evaluation at the University of Washington. He helped conduct the analysis, published Tuesday in JAMA Internal Medicine.

Health experts have long known that Americans living in different parts of the country tend to have different life spans. But Murray's team decided to take a closer look, analyzing records from every U.S. county between 1980 and 2014. 

"What we found is that the gap is enormous," Murray says. In 2014, there was a spread of 20.1 years between the counties with the longest and shortest typical life spans based on life expectancy at birth.

In counties with the longest life spans, people tended to live about 87 years, while people in places with the shortest life spans typically made it to only about 67, the researchers found. 

The discrepancy is equivalent to the difference between the low-income parts of the developing world and countries with high incomes, Murray notes.

For example, it's about the same gap as the difference between people living in Japan, which is among countries with the longest life spans, and India, which has one of the shortest, Murray says. 

The U.S. counties with the longest life expectancy are places like Marin County, Calif., and Summit County, Colo. — communities that are well-off and more highly educated.

Counties with the shortest life expectancy tend to have communities that are poorer and less educated. The lowest is in Oglala Lakota County, S.D., which includes the Pine Ridge Native American reservation.

Many of the other counties with the lowest life expectancy are clustered along the lower Mississippi River Valley as well as in parts of West Virginia and Kentucky, according to the analysis.

There's no sign of the gap closing. In fact, it appears to be widening. Between 1980 and 2014, the gap between the highest and lowest life spans increased by about two years.

"With every passing year, inequality — however you measure it — has been widening over the last 34 years," Murray says. "And so next year, we can reliably expect it'll be even more than 20."

The American Health Care Act (AHCA), which has passed the House of Representatives, contains a controversial provision that would allow states to waive community rating in the individual insurance market. In this brief we estimate the number of people with pre-existing conditions who might be affected by such a policy.

How the State Waiver Provision Works

Under the provision, insurers in states with community rating waivers could vary premiums by health status for enrollees who have had a gap in insurance of 63 or more consecutive days in the last year. The higher (or lower) premiums due to health status would apply for an entire plan year (or the remainder of the year in case of people signing up during a special enrollment period), at which point enrollees would be eligible for a community-rated premium unrelated to their health.

States waiving community rating would be required to set up a mechanism to subsidize the cost of high-risk enrollees, such as a high-risk pool, or participate in a reinsurance arrangement that makes payments directly to insurers. States are not required to set up an alternative source of coverage for people who face higher premiums based on their health.

The bill makes $100 billion available to all states for a variety of purposes, including high-risk pools, reinsurance programs, and cost-sharing subsidies. An additional $15 billion is made available for a federal invisible risk-sharing program, which would be similar to a reinsurance arrangement. Another $15 billion is earmarked for spending on maternal and newborn care, mental health, and substance abuse services for the year 2020.  The AHCA also allocates $8 billion over five years to states that implement community rating waivers; these resources can be used to help reduce premiums or pay out-of-pocket medical expenses for people rated based on their health status.

I’m a surgeon. I’d like to think that I’m resilient and well-adjusted, having gone through medical school and rigorous surgical training. I’ve been a doctor for 13 years and much of that period has been spent training to be as good a surgeon as I could ever be. I have great family support, a physician wife who understands my work and I’ve never been diagnosed with a mental illness.

Last night on Saturday Night Live, a spoof advertisement for an “Alexa Silver” poked gentle fun at how an Alexa speaker could be used with the elderly to do things like listen to their long, rambling stories (and respond with “uh-huh”), as well as answer questions even when addressed as “Alaina,” “Allegra,” “Aretha,” or other names.

The hack’s creator, Brett Krutiansky, a computer science student at Northeastern in Boston, says he came up with the idea for “Elderly Alexa” because both of his grandparents need additional care. His grandfather suffers from dementia and his grandmother has trouble seeing, and both have vertigo.

His mother is continually worried and stressed about her parents’ well-being — sometimes frantically calling neighbors when she can’t reach them at home. Krutiansky says he’s offering his hack as a Mother’s Day gift to help ease her mind.

The voice app he built — or “Alexa Skill,” in Amazon’s lingo — is enabled on an Echo speaker, offering an interface between families and their loved ones who need extra care.

Through “Elderly Alexa,” the elderly can ask Alexa what medicine they need to take and what they’ve already taken by saying “Alexa, medicine.” This also triggers an AWS Lambda event that emails their family members tracking their care.

Alexa will respond to users’ questions about medication by telling them the name of the medication they need to take, dosage and time of day it needs to be taken.

She will then ask if they had already taken the medication. Whether the user answers “yes” or “no,” an email is sent to the family member tracking their care.

In addition, the family member can send back the next item on their to-do list in an accompanying iOS app or call them to remind them about their medication. The idea is that, if this daily email doesn’t arrive, the family member will know something could be wrong and can network with others in a group chat room to discuss. For instance, a family could decide who’s driving over that day to check in on mom or dad.

Of course, Krutiansky notes, the Alexa Skill could be used with anyone needing additional care — not just the elderly.

The project was built using the following technologies: AWS (DynamoDB, Lambda & SES), Node JavaScript for the Alexa code, Swift for the iOS app and PubNub APIs for the chat room.

Following the hackathon, Krutiansky says he will work to make the chat system more user-friendly, will improve the push notification system and will introduce reminders for the list in the iOS app so care providers can also remember what they need to do.