Health and Disability

Most Ménière’s patients in the United States are undiagnosed. In fact, there may be as many as 5 undiagnosed patients for every known case.¹

Symptoms
Vertigo can last hours at a time and poor balance may persist afterward. Hearing loss tends to be one-sided at first, may remit and recur, and some patients will develop progressive, severe, permanent hearing loss. Continuous low-pitched tinnitus often accompanies the hearing loss. A sensation of fullness in the ears develops shortly before, at the onset, or during episodes.²
At episode onset, patients may suffer from sudden “drop attacks,” which are periods of strong sensation of directional tilting causing patients to overcompensate and fall in the other direction.
 
Providers should counsel patients to avoid driving or pull over if an episode is impending.
Fluid build-up in the inner ear (endolymph) precipitates the disease episodes and contributes to progressive hearing loss. Increased semicircular canal pressure impacts balance and fluid build-up in the cochlea, causes hearing loss. Patients are often unaware of the initial cause of their disease. The most common causes include genetics, trauma, and viral illnesses (eg, common colds, measles, or mumps). Episodes may be clustered, predictable and periodic, or years apart.
Ménière ’s disease is likely related to migraines in many patients because both are often inherited and share triggers, and some Ménière ’s patients experience aura, photophobia, and headache during episodes.³ A sizable minority of providers call migraines with Ménière’s-like symptoms “migrainous vertigo.”

Episode Triggers and Prevention
Salty foods, caffeine, nicotine, and stress are the most common dietary and lifestyle triggers.⁴ Smoking cessation is particularly important in this population. Pharmacists should remind smokers with Ménière ’s disease that quitting will improve disease control. Low sodium hypertension-directed diets (eg, using DASH instead of salt) aid Ménière ’s disease control. Sodium consumption below 2000 mg per day will manage most patients’ symptoms, and a 1500 mg target is effective for almost everyone.² Alcohol, caffeine, and smoking reduction or cessation, as well as stress relief, are all healthful overall lifestyle interventions.

Oral Treatment
The most commonly used maintenance medications for Ménière’s disease are diuretics, such as Diamox Sequels (acetazolamide extended-release capsules) and Dyazide (triamterene/HCTZ).² These medications relieve the inner ear fluid build-up thereby reducing vertigo frequency and avoiding hearing loss progression. Acetazolamide (a carbonic anhydrase inhibitor) alkalinizes urine, encourages kidney stone formation, and increases ammonia reabsorption and hypokalemia risk.⁵ The usual counseling points of Dyazide for hypertension apply to its use in Ménière’s disease. Little evidence exists investigating similar regimens. The single double-blinded cross-over study supporting Dyazide found no impact on hearing loss, but patients expressed an unspecified preference over placebo.⁶ Loop diuretics are less favored because of their ototoxic effects.......

Study upon study shows the myriad ways human connection plays a valuable role in positively supporting a person’s physical and mental health. 

Having strong social ties has been shown to:

• Dramatically lower rates of disease and premature death. Those who lacked supportive relationships had a fourfold increased risk of dying six months after open heart surgery.
• Improve our long-term happiness. People’s happiness correlates to the happiness of others with whom they are connected – and people who are surrounded by happy people are more likely to be happy in the future.
• Decrease stress during major life transitions. Higher levels of happiness and optimism were associated with lower levels of stress and greater increases in perceived social support during life transitions.
• Support recovery. One study showed that higher scores on the Recovery Assessment Scale were related to both social support as well as engagement in activities.

Fewer patients have died due to hospital-acquired conditions over the past five years and hospitals saved more than $28 billion in healthcare costs during the same time period, according to a new federal government report.

The U.S. Department of Health and Human Services credits the 21 percent decline in hospital-acquired conditions in part to the provisions of the Affordable Care Act.

“The Affordable Care Act gave us tools to build a better healthcare system that protects patients, improves quality, and makes the most of our healthcare dollars and those tools are generating results,” said HHS Secretary Sylvia M. Burwell in the announcement. “Today’s report shows us hundreds of thousands of Americans have been spared from deadly hospital-acquired conditions, resulting in thousands of lives saved and billions of dollars saved.”

Indeed, the report, “National Scorecard on Rates of Hospital-Acquired Conditions,” by the Agency for Healthcare Research and Quality, finds that roughly 125,000 fewer patients died during 2010 to 2015. In total, hospital patients experienced more than 3 million fewer hospital-acquired conditions, such as adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers and surgical site infections, during that time period.

Mitsubishi Tanabe Pharma Corporation (Head Office: Osaka; President & Representative Director, CEO: Dr. Masayuki Mitsuka) has presented data that show patients with amyotrophic lateral sclerosis (ALS) given edaravone intravenously in 10-14 day cycles for 48 weeks experienced significantly less functional loss as measured by the ALS Functional Rating Scale-Revised (ALSFRS-R). The data were presented at the 27th International Symposium on ALS/MND in Dublin, Ireland.

In the 48-week study, a 24-week double blind placebo controlled phase was followed by a 24-week open label active treatment phase. Data previously presented at the 2016 Annual Meeting of the American Academy of Neurology, showed edaravone met the primary efficacy endpoint of mean change in the ALSFRS-R at 24 weeks. The frequency of serious adverse events was similar to placebo.

"These findings suggest that intervention with edaravone may provide a treatment option to people living with ALS when therapy is promptly initiated," said Joseph M. Palumbo, MD, Vice President, Medical Sciences and Translational Research, Mitsubishi Tanabe Pharma Development America, Inc.

Discovered by Mitsubishi Tanabe Pharma Corporation (MTPC), edaravone is described as a free radical scavenger that is believed to relieve the effects of oxidative stress, a likely factor in the onset and progression of ALS. Oxidative stress is thought to be an imbalance between the production of free radicals and the ability of the body to counteract or detoxify their harmful effects. In patients with ALS, there are consistent increases in oxidative stress biomarkers.

Rutgers neuroscientists have established that problems controlling bodily movements are at the core of autism spectrum disorders and that the use of psychotropic medications to treat autism in children often makes such neuromotor problems worse.

The findings, published recently in Nature Scientific Reports, are contrary to the conventional medical understanding of autism – that it is a mental illness and that neuromotor problems, while often occurring at the same time as autism, are not at its biological core.

“For the first time, we can demonstrate unambiguously that motor issues are core issues that need to be included in the diagnosis criteria for autism,” says Elizabeth Torres, an associate professor of psychology in the School of Arts and Sciences and co-author of the study. Her co-author, Kristina Denisova, a former Rutgers graduate student in psychology, is now an assistant clinical research professor at Columbia University.

According to Torres, psychotropic drugs are routinely prescribed for children on the autism spectrum, even though they’re designed for adults. “Our findings underline the need for clinical trials to determine the effects of these medications on the children’s neuromotor development,” she says. “Doctors should think twice about prescribing such medications for children and parents should insist that they think twice.”

The MRI machine records the movement, but researchers routinely correct, or “scrub” their scans to eliminate data from involuntary movement.  Torres believes that information about the brain gets lost this way, so she and Denisova approached the data differently from other researchers.

“We didn’t start with a hypothesis to test, which is the way this research is usually done,” Torres says. “Instead, we let the data reveal any trends there might be among the subjects we were studying. We asked ourselves, ‘What could these involuntary movements, which researchers usually consider a nuisance, tell us about autism?’”

The data told them that, while everyone moved during fMRI scans and people with autism moved much more, those who were taking psychotropic medicines moved even more than those who were not taking such medicines. “It wasn’t just that they moved more, it was that their patterns worsened over the session,” said Torres. For people with autism taking more than one psychotropic medicine – anti-convulsants and anti-depressants, for example – the amount of movements and the detriment in their patterns were greater still.

“The question is now that we know this, what are we going to do?

A team of researchers from the University of Pittsburgh has found that insomnia is highly prevalent in adults with asthma and is also associated with worse asthma control, depression and anxiety symptoms and other quality of life and health issues. The study results are published in the current issue of the journal CHEST.

Despite the current uncertainty surrounding the fate of the Affordable Care Act (ACA), health care leaders must not let debates over access detract from what needs to happen regardless of the legislation’s fate: Their organizations must improve the value of care they deliver. When the ACA was passed, in 2010, many observed that although the ACA expanded access to health care, it did less to address the equally critical issue of improving the delivery of that care. Regardless of whether the ACA is repealed, this challenge remains.

Our suggestion for a starting point to measure outcomes is simple, easy, and inexpensive: Ask the patient. For many years, health care providers have worked to collect so-called patient-reported outcomes measures, or PROMs, which are measures of function and health status reported by patients. The widespread and consistent use of PROMs, however, has proven to be elusive for a range of reasons, including the complexity of the measures tracked and the varying reliability of patient assessments on many measures.

“The Elements of Value,” an article in the September 2016 issue of Harvard Business Review, discusses the role that product or service quality plays in customer advocacy. The article states: “Across all the industries we studied, perceived quality affects customer advocacy more than any other element. Products and services must attain a certain minimum level, and no other elements can make up for a significant shortfall on this one.” What this suggests is that patient-reported satisfaction may be a reasonable proxy for quality. But what does it reliably tell us about clinical outcomes?

Another recent HBR article by authors from the Geisinger Health System, which offers a satisfaction guarantee to patients, acknowledges that “critics of programs that improve patient satisfaction will often imply that there is a false equivalence between efforts geared towards improving quality and those aimed at improving patient experience — that quality efforts are in some way superior.” The authors challenge this critique, noting, “[Recent] strong evidence [see this article and this one] suggests that improved patient satisfaction is in fact correlated with better health outcomes and quality: Increased satisfaction is associated with decreased length of hospital stay, lower readmission rates, reduced mortality, and fewer minor complications.”

A severely brain injured woman, who recovered the ability to communicate using her left eye, restored connections and function of the areas of her brain responsible for producing expressive language and responding to human speech, according to new research from Weill Cornell Medicine scientists.

The study, published Dec. 7 in Science Translational Medicine, began 21 months after Margaret Worthen suffered massive strokes, and her continuing recovery was tracked for nearly three years. The research signifies the first time that scientists have captured the restoration of communication of a minimally conscious patient by measuring aspects of brain structure and function before and after communication resumed. It also raises the question of whether other patients in chronic care facilities who appear to be minimally responsive or unresponsive may harbor organized, higher-level brain function.

In a victory to health care providers waiting on lengthy appeals decisions, a federal judge ordered the Department of Health and Human Services (HHS) to eliminate its backlog of Medicare appeals claims in the next few years. The order comes after a damning report revealed a shockingly large backlog of Medicare claims appeals cases, with many stemming from home health.

Health care providers that receive fee-for-service claims denials can appeal those decisions. Over the past few years, the number of appeals filed by health care providers has exploded. In 2015, 123 million Medicare fee-for-service claims were denied, of which 3% were appealed.

As a result of ballooning appeals claims and growing frustration among health care providers waiting for appeals to be processed, the American Hospital Association and other affiliated entities filed suit.