Health and Disability

Consumers like the convenience and accessibility of urgent care clinics. But hospitals may have found another model that better meets the needs of patients: the “micro-hospital.”

While the state of Colorado prefers to call them "community hospitals," these licensed facilities offer emergency medical care, inpatient care, surgery, laboratory and radiology services, Michael Slubowski, president of CEO of SCL Health told Hospital & Health Networks. SCL, which is based in Denver, plans to open four locations in neighborhood settings with it's partner Emerus. The facilities are priced higher than urgent care centers, but less than a full-service hospital, and can treat a wider range of conditions because they have inpatient beds, he said.  

"Micro-hospitals like this are more suited for large urban and suburban metro areas," he told the publication. "This model would probably be too large and complex for a rural market. It definitely is a trend, among many trends occurring in healthcare, to create more accessible, cost-effective access points and alternative delivery models."

Most micro-hospitals operate 24 hours a day, seven days a week and usually have eight to 10 inpatient  beds for observation and short-stays, according to the Advisory Board. "No two micro-hospitals are exactly the same in their design or service mix, but one trend is becoming clear. Most health systems are using them as entry points into markets where demand would not be able to support a full-scale hospital," the Advisory Board noted in a recent report. 

The use of benzodiazepines and related drugs increases the risk of hip fracture by 43% in persons with Alzheimer's disease, according to a new study from the University of Eastern Finland. The hip fracture risk was investigated in community-dwelling Finnish persons with Alzheimer's disease. The results of the study were published in the Journal of the American Medical Directors Association.

In total, 21% of persons with Alzheimer's disease initiated benzodiazepine and related drug use during the study. During benzodiazepine and related drug use, 2.5 hip fractures occurred per 100 person-years whereas without drug use, the incidence was 1.4 hip fractures per 100 person-years. The use of benzodiazepines and related drugs increased the hip fracture risk especially during the first six months of drug use. There was no difference within the drug group, as benzodiazepines increased the hip fracture risk as much as benzodiazepine-related drugs.

Additionally, long-term hospital stays exceeding four months after hip fracture were more common in persons with Alzheimer's disease who used benzodiazepines and related drugs at the time of hip fracture than in persons who did not use such drugs.

For my mom, it started with a fire. She had decided to cook pasta for lunch and put water on to boil. Then she got distracted. Eventually, all of the water in her pot boiled away, and its contents went up in smoke, along with a dishtowel that happened to be lying nearby. It wasn’t a huge fire, and in theory, this was a mistake anyone could have made. But for my brother and me, it was the first sign that maybe she shouldn’t live alone anymore.

Food, or the lack of ability to prepare it, is one of the main reasons elderly people move into assisted living facilities each year. For some, the reasons are like my mom’s, where preparing meals on her own became dangerous. For others, it's a question of no longer being physically able to cook on their own. Both cases can result in seniors eating unhealthily—meals comprised of candy or snack foods—or nothing at all.

Now one startup is hoping to help the elderly by bringing food to them. Aptly named Chefs for Seniors, the service pairs senior citizens with their very own chef who comes to their home each week or every other week and prepares nutritious meals.

In case you haven’t read any previous blog posts, I have had many knee surgeries and last was a total knee replacement in 2016. My nerves are playing up and I get a lot of pain constantly and different types of pain, I am unable to walk and my muscles have wasted considerably and this has resulted in the knee clonking. Now this happens with knee replacements but because my nerves are hypersensitive, its agony every time it happens and this has led to me being housebound. I have asked for an amputation not because I believe I will be pain free, but because just being rid of that clonk will enable me to get about without that pain.

So I saw this psychiatrist, I told her that I am 100% okay, that I am happy despite the pain and yet it’s not totally correct. I thought that I needed to convince her that I was making this decision with a clear head so to speak. However maybe I messed up, maybe they need to understand that whilst this is the right decision and I am not asking because of any mental health issue, they need to understand that this has destroyed my life, that I get very down when I think that I might not be helped and that living with this is going to eventually break me or cause me to do something to force the amputation!

I have been told that I have another session with the psychiatrist and so I can say that I maybe wasn’t being totally honest, although she may have already figured that out!

The question is, what do they need? Do I need to prove this is a decision made with a clear head or does the fact that I hate this knee and I can’t carry on like this make the case any more likely to lead to amputation?

I have no expectations of being able to walk again, my other knee and my hips are too painful for that and damage to my shoulders from years of using crutches means I can’t use them any more.

Once in a while in my line of work, you catch a glimpse of genius.

In my role at the GE Foundation, I am lucky enough to meet pioneers with a global vision for health and sustainable development. What these leaders have in common is their unique ability to recruit others in their quest for societal change. Leadership begins with sharing a vision with many people in numerous communities from diverse walks of life.

This rare genius truly shines in Dr. Sanjeev Arora, the creator and founder of Project ECHO. In 2003 this collaborative learning model grew out of Dr. Arora’s frustration that he could serve only a fraction of patients in New Mexico with hepatitis C. At the time, he was one of the few liver disease specialists in the entire state of New Mexico, and arithmetically, he would never be able to care for those patients in time to have a difference in their health. So he conceived of and launched Project ECHO.

Simply put, Project ECHO is a new system for transferring specialty care knowledge to primary care providers. It’s medical rounds on steroids. At the start, a team of specialists with a deep knowledge of hepatitis C gathered virtually in a conference room at the University of New Mexico Health Sciences Center. In that conference room would be a video screen with a matrix of individual primary care providers who were sitting in their own offices and clinics across New Mexico. Each provider would, in turn, present their patients with hepatitis C and get guidance on caring for each patient from the experts at the university hub. Each of the other providers learned from every case presentation.

Now, 13 years later, Project ECHO is more than a model; it has become a movement. It encapsulates 94 academic and expert hubs worldwide (58 in the United States and the rest in 16 other countries), and it covers more than 60 complex conditions.

As payment and care delivery models shift in the United States from episodic, fee-for-service care toward population health and value-based reimbursement, health care leaders are focused more than ever on patient engagement as a key to driving down costs and improving outcomes. And yet, as so many of us know who have attempted to manage our own care or tend to sick family members, the U.S. health care system rarely feels like it’s been set up to help us succeed.

For patients who suffer from chronic or complex conditions, as a Mayo Clinic paper recently argued, the “burden of treatment” must be shouldered alongside the “burden of illness.” A 2012 study cited by the study’s authors estimated that the self-management of a chronic illness demands, on average, two hours of patient work each day — work that is often poorly supported, stressful, and frustrating in nature.

First, we need to acknowledge and account for all the patient work that now goes unrecognized and unsupported. This means grappling with the complexity of tasks patients take on as they seek care across an ever-expanding number of settings — work that varies widely depending on acuity level, disease state, demographics, insurance type, socioeconomic conditions, and so on.

Failure of the immune system during blood poisoning (sepsis) can be reversed by a specific sugar. This restores the ability of immune cells to respond effectively to infections. This week, researchers from Radboud University and Radboudumc published an article on this topic in Cell. These insights can lead to improved treatment of sepsis.

Sepsis is a life threatening complication during infections that occurs when the immune system is unable to gain control of the infection-causing microorganism. Afterwards, the immune system of many sepsis patients (30%-40%) becomes compromised. This can continue for several weeks to several months. As a result, the immune system can no longer respond to new infections, and sepsis patients have a high risk of additional complications and death due to a second infection. In an article that was published in the journal Cell, the molecular biologist Henk Stunnenberg of Radboud University, in cooperation with internist-infectiologist Mihai Netea and other colleagues at Radboudumc, shows that this immune paralysis can be reversed. This is good news for sepsis patients, for whom treatments are currently lacking in efficiency.

People with dementia are “routinely” deprived of their human rights, facing forced medication, institutionalisation and a denial of care and support.

A group of disabled campaigners with dementia spoke out this week as they launched a “ground-breaking” new booklet that highlights their battle for rights.

Our Dementia, Our Rights aims to “bring together in one place the facts about some of the key rights relating to dementia in the UK”.

Larry Gardiner (pictured), a spokesman for the Dementia Policy Think Tank (DPTT), which was set up in 2016 by a group of people with a diagnosis of dementia, launched the booklet at Disability Rights UK’s annual conference in north London.

He said that people with dementia are “routinely” subjected to a denial of their human rights, with forced medication “absolute routine”, and the prescription of psychoactive drugs to “treat the presentation of our condition rather than recognising the underlying problem, which is that our brain cells are dying”.

Gardiner said: “People with dementia are disproportionately affected by breaches of human rights.

“One of the examples is the way legislation can be used to deprive us of a voice in determining what happens to us.

“We have a degenerative condition that leads to death. We have a right to a life worth living before we die.”

He added: “We find it very difficult to access any form of social care support.

“When it becomes too expensive to support us, we go into a care home.

Leonard Cohen seemed to be at peace with the idea of his own mortality, and he wished only that death not be too “uncomfortable.” Cohen died in his sleep last week, and we can hope it was painless.