Health and Disability

In 2012 hundreds of prescription drugs were in short supply in the United States. Over 80 percent of these drugs were generic and many were commonly used as anti-infective, anesthesia, and chemotherapy agents (ASPE 2011; Woodcock and Wosinska 2012). That same year, the Food and Drug Administration (FDA) was given new and expanded powers to monitor and resolve shortages under the Food and Drug Administration Safety and Innovation Act (FDASIA).

A nice recent piece in Health Affairs evaluates trends in drug shortages before and after the passage of FDASIA and by an acute versus non-acute care drug categorization. Using 2001-2014 data from the University of Utah’s Drug Information System (UUDIS), which contains the universe of shortages reported to the American Society of Health-System Pharmacists and is the primary data used innumerous government reports, the paper demonstrates an increase in the number and duration of acute care drug shortages since 2012, despite a decline in the number of new drug shortages over the same period.

Figure 3. Geographic Variation In Google Search For “Drug Shortage”

 

The Michigan Protection and Advocacy Service – a state-appointed group assigned to investigate allegations of abuse and neglect against people with disabilities -- filed federal lawsuits against Crestmont Nursing Care Center, Inc. and Fenton Healthcare, 512 Beach Street.

In the Crestmont lawsuit, the advocacy service claims it learned Feb. 26 of allegations of possible abuse or neglect of approximately 10 patients at the Trealout Drive nursing home after licensing surveys from May and November 2015, according to the lawsuit.

In the second lawsuit, the advocacy service claims it learned Feb. 24 of allegations of possible abuse or neglect of a resident at the Fenton Healthcare nursing home on Beale Street after licensing surveys from October 2015, according to the lawsuit.

The survey showed the nursing home resident may have been subject to abuse and neglect relating to the improper administration of psychotropic medications and failure to provide appropriate social services, the lawsuit alleges.

A survey of nearly 1,000 nursing homes in the U.S. found little consistency across facilities of policies implemented to prevent urinary tract infections (UTIs), according to a new study presented at the 43rd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC).

Led by Patricia Stone, PhD, RN, FAAN, researchers from the Center for Health Policy at Columbia University School of Nursing surveyed nursing homes across the U.S. in 2014. Responses from 955 nursing homes with 88,135 residents were linked to infection data from the Centers for Medicare & Medicaid Services to identify policies and practices associated with lower UTI prevalence. According to the study, 5.4 percent - or more than 4,700 nursing home residents - suffered from a UTI every month. If a resident had a catheter, they were four times more likely to get a UTI than if they did not have a catheter at all. However, more infections were not associated with catheter use than those that were.

"UTIs are the most common infection in nursing homes, and we wanted to determine what policies and procedures would help these facilities lower UTI prevalence," said the study's lead author Carolyn Herzig, PhD, MS, project director, Columbia University School of Nursing. "What was particularly interesting about this study was that there were more UTIs that were not associated with catheterization than those that were. This means that a larger focus should be placed on identifying practices to prevent UTIs regardless of catheter placement."

The study examined nine UTI prevention policies and found the following policies were associated with lower infection prevalence:

Nursing homes that had a policy for using portable bladder ultrasound scanners to determine if all of the urine was being voided were 10 percent less likely to have high rates of UTIs that were not associated with catheter use. Only 22 percent of surveyed facilities had this policy.

Nursing homes that had a policy in place for cleaning the urine collection bag attached to the resident's leg were 20 percent less likely to have high rates of catheter-associated UTIs. Yet only 44 percent of surveyed facilities had this policy in place.

Nursing homes with infection preventionists on staff who took a national course through APIC were 20 percent less likely to have high rates of UTIs. However, only 9 percent of respondents had taken an APIC training course.

What Is the Low FODMAP Diet?

FODMAP stands for “Fermentable Oligosaccharides,Disaccharides, Monosaccharides And olyols. These fermentable short-chain carbohydrates are prevalent in the diet.

• Oligosaccharides: fructans and galactooligosaccharides (GOS)
• Disaccharides: lactose
• Monosaccharides: fructose
• Polyols: sorbitol and mannitol

Researchers suggest that the small intestine does not absorb FODMAPs very well. They increase the amount of fluid in the bowel. They also create more gas. That’s because bacteria in the colon they are easily fermented by colonic bacteria. The increased fluid and gas in the bowel leads to bloating and changes in the speed with which food is digested. This results in gas, pain and diarrhea. Eating less of these types of carbohydrates should decrease these symptoms.

So far, studies have shown that a low FODMAP diet improves IBS symptoms. One study even found that 76% of IBS patients following the diet reported improvement with their symptoms.

Eat Less Of These Foods

• Lactose
  • Cow’s milk, yogurt, pudding, custard, ice cream, cottage cheese, ricotta cheese and mascarpone
• Fructose
  • Fruits, such as apples, pears, peaches, cherries, mangoes, pears and watermelon
  • Sweeteners, such as honey and agave nectar
  • Products with high fructose corn syrup
• Fructans
  • Vegetables, such as artichokes, asparagus, Brussels sprouts, broccoli, beetroot, garlic and onions
  • Grains such as wheat and rye
  • Added fiber, such as inulin
• GOS
  • Chickpeas, lentils, kidney beans and soy products
  • Vegetables, such as broccoli
• Polyols
  • Fruits, such as apples, apricots, blackberries, cherries, nectarines, pears, peaches, plums and watermelon
  • Vegetables, such as cauliflower, mushrooms and snow peas
  • Sweeteners, such as sorbitol, mannitol, xylitol, maltitol and isomalt found in sugar-free gum and mints, and cough medicines and drops

Eat More Of These Foods

• Dairy: Lactose-free milk, rice milk, almond milk, coconut milk, lactose-free yogurt; hard cheeses such as feta and brie
• Fruit: Bananas, blueberries, cantaloupe, grapefruit, honeydew, kiwi, lemon, lime, oranges and strawberries
• Vegetables: Bamboo shoots, bean sprouts, bok choy, carrots, chives, cucumbers, eggplant, ginger, lettuce, olives, parsnips, potatoes, spring onions and turnips
• Protein: Beef, pork, chicken, fish, eggs and tofu
• Nuts/seeds (limit to 10-15 each): Almonds, macadamia, peanuts, pine nuts and walnuts
• Grain: Oat, oat bran, rice bran, gluten-free pasta, such as rice, corn, quinoa, white rice, corn flour and quinoa

Arizona Governor Doug Ducey signed a bill (S.B. 1363) into law, on May 17, 2016, requiring private health plans to pay for telemedicine services across the whole state rather than only services received in rural areas of the state.

Currently, 29 states plus the District of Columbia have telehealth commercial insurance laws requiring commercial health insurance companies cover services provided via telehealth to the same extent those services are covered if provided in-person. Continued expansions in reimbursement mean providers can enhance telehealth offerings, both for the immediate cost savings and growing opportunities for revenue generation, to say nothing of patient quality and satisfaction. Commercial insurance reimbursement is among the five telemedicine trends driving health care transformation in 2016 and beyond.

patients are not customers, and if we treat them as such, we risk converting healthcare into a neoliberal market system. Customers have vastly different expectations and roles in a systems that recognizes the customer-supplier relationship. Rather than elevating “patient experience” this role transformation risks the destruction of human caring in the organization and the larger social system.

 In Design for Care five contexts of participation are identified:

• The patient as health seeker, a self-directed agent responsible for his or her own health and well-being
• The patient as a participant in the healthcare system and subject to the rules and roles this entails
• The patient as a customer of a service, who seeks and pays for treatment directly
• The health seeker or patient as a subject of user research for innovation
• The patient as a person under care, located in a community in a particular society and culture.

Researchers uncertain whether supplementation would help prevent migraines.

A high percentage of children, teens and young adults with migraines appear to have mild deficiencies in vitamin D, riboflavin and coenzyme Q10 — a vitamin-like substance found in every cell of the body that is used to produce energy for cell growth and maintenance.

These deficiencies may be involved in patients who experience migraines, but that is unclear based on existing studies.

“Further studies are needed to elucidate whether vitamin supplementation is effective in migraine patients in general, and whether patients with mild deficiency are more likely to benefit from supplementation,” says Suzanne Hagler, MD, a Headache Medicine fellow in the division of Neurology at Cincinnati Children’s Hospital Medical Center and lead author of the study.

Clinical trial suggests chemo and blood stem cell combination therapy should be considered for people with early, aggressive MS.

A clinical trial published in The Lancet, a top medical journal, shows that an intensive procedure that completely wipes out the immune system and then regenerates a new one using blood stem cells can eliminate all signs of damaging brain inflammation in people with early, aggressive multiple sclerosis (MS), and facilitate lasting recovery.

Led by Dr. Harold Atkins and Dr. Mark S. Freedman of The Ottawa Hospital and the University of Ottawa, the trial included 24 participants who were followed for up to 13 years. The $6.47 million trial was funded by the MS Society of Canada and its affiliated Multiple Sclerosis Scientific Research Foundation. The research was also supported by The Ottawa Hospital Foundation, The Ottawa Hospital Department of Medicine and Canadian Blood Services.

“Our trial is the first to show the complete, long-term suppression of all inflammatory activity in people with MS,” said Dr. Atkins, a stem cell transplant physician and scientist at The Ottawa Hospital, and associate professor at the University of Ottawa. “This is very exciting. However, it is important to note that this therapy can have serious side effects and risks, and would only be appropriate for a small proportion of people with very active MS. People with MS who have had significant disability for a long time would likely not benefit.”

New research from Umeå University in Sweden indicates that dispensed medication for psychiatric diagnosis can be related to air pollution concentrations. The study covers a large part of the Swedish population and has been published in the journal BMJ Open.

More and more studies show that the brain and human cognitive development are affected by pollution.

In a new study conducted by a research team at Umeå University, the correlation between exposure to air pollution in residential areas and children’ and adolescents’ psychiatric health was studied. The study was performed by looking at register-based data, where dispensed medications of all Swedes are registered, together with Swedish National Register data of air pollution concentrations. The entire population under 18 in the Swedish counties of Stockholm, Västra Götaland, Skåne and Västerbotten were studied.