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Saturday, 30 April 2016

Princess Health and JAMA LAYS AN EGG. Princessiccia

Princess Health and JAMA LAYS AN EGG. Princessiccia

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JAMA LAYS AN EGG 

Three months ago I took JAMA to task over a Viewpoint opinion piece about conflict of interest. The authors proposed dancing around the reality of financial conflict of interest in medicine by talking instead about confluence of interest. I countered with a proposal for the term competing interests, which would not paper over the problem. In that post I also included a letter I had sent to JAMA in response to the opinion piece, but which JAMA had declined to publish. I questioned whether JAMA had deep sixed all the critical replies it received.

Now I can report that, in the April 26, 2016 print edition, JAMA has finally published one critical letter and a replyfrom the original authors. So JAMA didn�t deep six everything. This new correspondence appears 174 days after print publication and 214 days after on-line publication of the original Viewpoint article. That glacial delay is problematic � it disables meaningful dialogue.

The new critical letter is from a group in Europe, and it thoughtfully discusses weaknesses in the Viewpoint authored by Cappola and FitzGerald. These Viewpoint authors did not do justice to the critical letter in their reply. Moreover, they disclosed multiple potential competing interests, but they did not follow their own advice by clarifying why we should disregard those obvious competing interests. As we all know, the mere disclosure of competing interests does not by itself remove the problem. It can be a device for hiding in plain sight. Substantively, the reply from Cappola and FitzGerald is mostly hand waving and restatement of biased opinion, without real analysis or incisive thought.

The closing sentences of their reply letter illustrate these issues: �Everyone has biases. Rather than present these pejoratively, as a clash of values that undermines validity, it seems more constructive to mine the complexity of these biases, present them in an accessible fashion, and seek to determine whether they are confluent with the interests of patients, scientists, and regulators who might base their decisions on the results of a given piece of work.� The reference to complexity of biases concerns the matter of nonfinancial bias like fame and careerism in science. The reference to presenting biases in an accessible fashion concerns the ill-considered proposal to include a bias heat map on patients� consent forms. This idea rightly was panned by the European critics. Meanwhile, where did the compromised and disgraced key opinion leaders disappear to in all this wishful thinking? Where did the corrupt corporations disappear to? They paid billions of dollars in penalties for felony crimes and plea-bargained settlements. They have been airbrushed out of the Cappola-FitzGerald narrative. These authors come across like Bambi confronting Godzilla.


If this is the best that an associate editor of JAMA and a fellow of the Royal Society can do then JAMA needs a fix. This effort is too little and much too late.

UPDATE 05-03-2016
Apparently the link to my earlier post is inoperative. My apologies. Here is a link that should work.
http://hcrenewal.blogspot.com/2016/01/jama-jumps-shark.html 
Princess Health and April 30th, 2016 A Bomb In Need Of Defusing. Princessiccia

Princess Health and April 30th, 2016 A Bomb In Need Of Defusing. Princessiccia

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April 30th, 2016 A Bomb In Need Of Defusing

I really enjoyed my day off today. I slept in, I spent some time helping my oldest daughter finish up her and her husband's move, I prepared some great food and enjoyed a fabulous date night dinner with Kristin for her birthday.

Navigating the menu choices at the restaurant this evening was fairly simple. I did ask a couple of questions and made one special request in order to ensure I got what I needed instead of something I didn't. Neither one of us touched the basket of cheddar biscuits on the table. I remember times, years ago, when a second and third request for more was made.

The accountability and support system coupled with the non-negotiable elements of my personal plan supports this different perspective. It's a perspective that doesn't require the food to shoulder the responsibility for whether or not an event is considered a good experience. I certainly enjoyed the food I ordered, but the experience, the conversation and the laughs is what made it great. A basket (or two) of biscuits wouldn't have enhanced the evening in the slightest. For me, it would have had an opposite effect had I sacrificed the integrity of my maintenance plan.

We visited a traveling carnival after dinner and arrived just as they were closing everything down. We asked the Ferris wheel operator if he could accommodate one last ride tonight, adding that it was Kristin's birthday. He referred us to one of the co-owners, who turned out to be the sister of the other owner, whom I had as a guest on my radio show a couple of weeks ago. I don't think that connection made a difference as much as Kristin's birthday request. The answer was, "sure, why not?"

Then, when the ride ended, one of the carnival workers honored Kristin's birthday by presenting her with the last funnel cake of the evening, compliments of Ottaway Amusements. We graciously accepted the gift, both of us knowing full well that it didn't fit in either of our food plans--and I carried it to the car for her. Kristin said I was handling it as if it were a bomb. I wasn't tempted in the slightest, seriously, but I totally get it--I probably was carrying it as if it were a bomb in need of defusing. Defusing it meant throwing it away, but we couldn't just throw it away right in front of the people who generously and thoughtfully presented the gift!

First, we tried to give it away to some people in the parking lot, but they declined our offer. Without a trash can close by and also out of sight of the carnival vendors, we hadn't a choice--we had to give this sweet thing a ride. The car quickly became thick with the aroma of funnel cake, so down went the windows.

We ended up transporting this powdered sugar topped creation less than a mile away before we found a place to get rid of it. But instead of simply throwing it away, we set it in plain sight just outside of a big Saturday night college crowd hangout and then, we waited for someone--anyone to notice this perfectly untouched, still warm funnel cake--just sitting there, unattended. Not one person noticed the funnel cake. After several minutes and a few laughs from the close calls, we left--knowing full well it would eventually make it into the trash can just a few feet away.

We stopped by mom's place to say hi and get a quick hug before heading out of town for the forty-two mile trip back. But before we hit the highway, we checked on the funnel cake--and still, there it sat in the company of literally a hundred or two late night partying college kids who were completely oblivious to it or the slightly humorous circumstance that rendered it unwanted and abandoned.

Today's Tweet Stream:




































Thank you for reading and your continued support,
Strength,
Sean

Friday, 29 April 2016

Princess Health and April 29th, 2016 An Equal and Opposite Reaction. Princessiccia

Princess Health and April 29th, 2016 An Equal and Opposite Reaction. Princessiccia

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April 29th, 2016 An Equal and Opposite Reaction

Whenever I allow my schedule to get loaded and crazy, it requires me to get extra aware of how I'm feeling and what I'm doing. I've shared many times about my parallel streams philosophy and how I mustn't allow the life stream and the fundamental elements stream to cross. It's a seemingly complex, yet simple philosophy drawn from my experiences over years and years of weight loss attempts, many of which served as a source of education, rather than a source of consistent and sustainable results. 

Maintaining the integrity of my fundamental elements stream (calorie budget-abstinence from refined sugar-the accountability and support connections, etc.) while the life stream is a little (or a bunch) bigger than usual, means adjusting the embrace of both, in equal measure. For every action there's an equal and opposite reaction. Making sure those reactions are in harmony with my personal plan, is key.

If I didn't hold on to the fundamental elements stream a little tighter during a bigger life stream schedule, then I'd quickly fall into chaos. I've been there many times. I'd prefer to not go there again, if I can help it.

For me, it starts with setting some non-negotiable elements. Even at extreme life-stream levels--we're talking super long days, heavily involved projects and all that might include--I have my minimum non-negotiable elements of the fundamental elements stream. I will maintain the integrity of my maintenance plan calorie budget. I will remain abstinent from refined sugar. And I will consume a minimum 64oz water. I will log everything in MyFitnessPal and I will compose and send the accountability Tweets. That's the bare minimum, for me, come what may.

And once I've accepted and embraced those non-negotiable elements--then it changes my perspective completely. Instead of finding reasons why it can't work under extreme schedules and circumstances, I'm exploring solutions for how it can work, and work well.

It's rarely perfect and it doesn't need to be perfect. This has never been about perfection, clearly. It's about remaining consistent in my continued recovery. In my experience, striving for perfection is the quickest detour to self-loathing based disappointment. Accepting a certain amount of imperfection doesn't mean I sacrifice the integrity of my non-negotiable elements. It means I might go a little longer between meals than is optimal. It means my choices, although still "on-plan," may not be the best or what I would have preferred. It means I might spend way too many calories on half & half in my coffee. Examples of these imperfections have littered the last few days.

A perfect example happened tonight, when the plan called for me to prepare a late meal at home. I picked up some fresh salmon earlier today for tonight's meal--the plan was baked salmon, oven baked sour cream topped red potato slices and asparagus. Instead, I called an audible when the show went long and the time became a little too late. I relented on the original plan and called ahead for a special order from Ground Round Grill and Bar. Baked cod prepared without the drenching of butter or bread crumbs--seasoned simply with salt & pepper, asparagus grilled well with a minimal amount of extra-virgin olive oil and 1/2 an order of fried sweet potato fries (which I still count as 1.5 servings as a way to compensate for the frying).

Maintaining these non-negotiable elements coupled with staying connected with one on one and group accountability and support contacts makes for another successful day. And today, despite a schedule rivaling yesterday's extremes, was definitely another successful day.

My original plan for today included working harder to leave the studio a little earlier. When severe weather fired up early afternoon, it immediately extended my broadcast day. Suddenly, the adjustments to the schedule became imperative. I made the adjustments and it turned out just fine.

I've had three stand-up performances in the last two days. One was disguised as a speaking engagement--but make no mistake, it was stand-up comedy. Tonight's show was a big one. I opened for one of the best cover bands in the United States. Dead Metal Society plays 80's rock and roll--and they do it with the most authentic everything--the clothes, the hair, the lights, the fog--the experience, with spot on musicianship and vocal impersonations--it's simply unbelievable.

I had a great set despite a couple of hecklers I was told about afterward. I was focused on my set and landing my punchlines well. I accomplished just that without really noticing the two idiots in the crowd of approximately five hundred. Could I have acknowledged and handled the hecklers? Absolutely. But not in a twelve minute opening set. It wasn't my show. It was DMS's show, and their audience. My mission was to provide a little warm up entertainment, get some laughs--set a tone for a good time and introduce the band. Mission accomplished!

I'm hitting the pillow late--with a wonderful plan of sleeping in, without an alarm. That will be an awesome thing!

Today's Live-Tweet Stream:




































Thank you for reading and your continued support,
Strength,
Sean
Princess Health and Back to Paper After U.S. Coast Guard EHR Debacle: Proof of Hegel's Adage "We Learn From History That We Do Not Learn From History"?. Princessiccia

Princess Health and Back to Paper After U.S. Coast Guard EHR Debacle: Proof of Hegel's Adage "We Learn From History That We Do Not Learn From History"?. Princessiccia

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I have become blue in the face writing about healthcare information technology mismanagement over the years.  In fact, the original focus of my 1998 website on health IT (its descendant now at http://cci.drexel.edu/faculty/ssilverstein/cases) was on HIT project mismanagement.

If this industry actually had learned anything from history, I would not be reading nor writing about brutally mismanaged HIT endeavors in 2016.  Sadly, that is not the case.

The Coast Guard, founded by Alexander Hamilton, has this as its motto and mission:

http://www.gocoastguard.com/about-the-coast-guard
Semper Paratus - Always Ready.

The Coast Guard is one of our nation's five military services. We exist to defend and preserve the United States. We protect the personal safety and security of our people; the marine transportation system and infrastructure; our natural and economic resources; and the territorial integrity of our nation�from both internal and external threats, natural and man-made. We protect these interests in U.S. ports and inland waterways, along the coasts, on international waters.

We are a military, multi-mission, maritime force offering a unique blend of military, law enforcement, humanitarian, regulatory, and diplomatic capabilities. These capabilities underpin our three broad roles: maritime safety, maritime security, and maritime stewardship. There are 11 missions that are interwoven within these roles.

It seems the Coast Guard personnel need personal protection from the HIT industry, for the motto of that industry, sadly appears to be something like "Stupra Acetabulus" (Screw the Suckers).

From Politico, one of only a few publications that in recent years has taken a critical approach to this industry and pulls no punches:

http://www.politico.com/story/2016/04/ehr-debacle-leads-to-paper-based-care-for-coast-guard-servicemembers-222412
EHR debacle leads to paper-based care for Coast Guard servicemembers
By Darius Tahir
04/25/16

The botched implementation of an electronic health records system sent Coast Guard doctors scurrying to copy digital records onto paper last fall and has disrupted health care for 50,000 active troops and civilian members and their families.

Five years after signing a $14 million contract with industry leader Epic Systems, the Coast Guard ended its relationship with the Wisconsin vendor, while recovering just more than $2.2 million from the company. But it couldn�t revert back to its old system, leaving its doctors reliant on paper.

This state of affairs is simple inexcusable.  It represents gross negligence and severe multi-axial incompetence at best - but likely primarily not by the Coast Guard, whose core competency does not include HIT.

There�s no clear evidence the EHR disaster has harmed patients, and a Coast Guard spokesman said the use of paper records hasn�t affected �the quality of health care provided to our people.�

Proof by lack of evidence is not reassuring in a debacle of this kind.  However, the Coast Guard admits that paper records aren't the clear and present danger the IT pundits make them out to be.

Politico is skeptical of the claim:

That seems unlikely. Without digital records, if a patient goes outside a Coast Guard clinic, it can take weeks for the paper record to follow him or her back to the Coast Guard, says Michael Little of the Association of the United States Navy. And since the Coast Guard primarily provides outpatient, rather than hospital, services, many of its patients seek outside care.

�It�s one thing if you�re doing paper-based [care] in Ohio, but what about if you�re on paper records in [an] icebreaker or cutter in Alaska, and you need your gall bladder removed?� said Little, the organization�s director of legislative affairs.

In this case, I disagree that the lack of records is so dangerous.  There's the telephone, FAX machines, the patient himself or herself, and the hand-carried note.  Used with care, those serve care reasonably well. 

With the Department of Veterans Affairs weighing whether to buy a top-of-the-line commercial electronic health record and the Pentagon beginning a multibillion-dollar EHR implementation, the Coast Guard case displays how poorly the process can go for the government, even when the biggest names in health IT are involved.

Not just the government.  I'd also argue that this shows that the "biggest names" are, at best, overextended, and at worst, badly needing external investigation as to their software development, customization, implementation and support practices, as well as hiring practices (e.g., see my August 15, 2010 post "EPIC's outrageous recommendations on healthcare IT project staffing"
at http://hcrenewal.blogspot.com/2010/08/epics-outrageous-recommendations-on.html) and contracting.

Reversion to a purely paper-based system is a rare event in the recent annals of electronic records, said Thomas Payne, a health IT expert at the University of Washington. �I can think of examples where that has happened, but in the last decade that is much less common.�

I believe that is because of the general invisibility of, and immunity from, the risks and harms that occur from "making do" with bad health IT due to financial pressures.  Hence one sees hair-raising examples like I wrote of at my Nov. 17, 2013 post "Another 'Survey' on EHRs - Affinity Medical Center (Ohio) Nurses Warn That Serious Patient Complications 'Only a Matter of Time' in Open Letter"at http://hcrenewal.blogspot.com/2013/11/another-survey-on-ehrs-affinity-medical.html where going back to paper to allow a complete rethinking of the EHR implementation would likely have been the safe response.

See also, for example, my July 2013 post "RNs Say Sutter�s New Electronic System Causing Serious Disruptions to Safe Patient Care at East Bay Hospitals" at http://hcrenewal.blogspot.com/2013/07/rns-say-sutters-new-electronic-system.html (there are links there to still more examples).

The Coast Guard is tight-lipped about the causes, timeline and responsibility for the debacle. �Various irregularities were uncovered, which are currently being reviewed,� a spokesman said.

The causes are all covered at http://cci.drexel.edu/faculty/ssilverstein/cases/, and have been since the late 1990s.  In the alternative, the book "Managing Technological Change: Organizational Aspects of Health Informatics" (http://www.amazon.com/Managing-Technological-Change-Organizational-Informatics/dp/0387985484) by Lorenzi & Riley does likewise for an even longer period, since the mid 1990s - for those willing or able to learn from history and from the pioneers

There�s no shortage of candidates: the service relied on five separate vendors to build the new system, and its own planning seems to have been at fault.

Lawmakers are looking into the matter, said a spokesman for the Senate Appropriations Committee, which is �monitoring the situation."

This is symptomatic, in my view, of the fact that there are a lot of "Beltway Bandit" IT consultant companies doing business, few of them very good.

Bungled implementation, followed by chaos

In September 2010, the Coast Guard bid out the contract to Epic Systems, then added an array of other contracts to software vendors and consultants to help implement it. Since 2010, the agency spent, on net, just more than $34 million on health IT.

In a January 2011 speech, Coast Guard Chief Medical Officer Mark Tedesco cited the success of Epic installations at Kaiser Permanente and Cleveland Clinic. He predicted that the Epic implementation would improve the health of its population and save money.

�Overall it�s a cheaper system for us to run than to upgrade to [the next generation military EHR], because of what that would�ve meant to us infrastructure-wise and support-personnel wise,� he said.

It's stunning to think what this says about the next-generation military EHR.  The previous one was not very good, either (see my June 4, 2009 post "If The Military Can't Get Electronic Health Records Right, Why Would We Think Conflicted EHR Companies And IT-Backwater Hospitals Can?" at http://hcrenewal.blogspot.com/2009/06/if-military-cant-get-electronic-health.html). 

Trouble, apparently, struck quickly. The solicitation for the EHR contract envisioned rolling out the software within six months at two to three pilot sites, before deploying it to a total of 43 clinics and the sickbays aboard the Coast Guard�s fleet.

That didn�t occur; the system never deployed to any clinic or cutter, said Eric Helsher, an executive with Epic. The next missed deadline was March 2012, which Trent Janda � the Coast Guard doctor serving as project leader � announced in a summer 2011 newsletter of the Uniformed Services Academy of Family Physicians.

One can only wonder what penalties the contract called for if the goals and timelines were not met.  That software was not deployed even to any pilot sites is nearly unimaginable to me.

As Janda set the new goal, he acknowledged there had been �multiple hurdles and delays,� and explained that the service had expanded its ambitions.

�Immediately upon award of the contract, we began a comprehensive analysis of the clinical workflows and existing information systems,� Janda wrote. �Many of the weaknesses became apparent as we compared ourselves to industry standards and best practices. Frequently, a weakness would lead to others, ultimately leading to the need for an additional system. The work-flow analysis quickly grew into a system wide re-engineering project like a snowball rolling down the mountainside.�

This sounds like a groundbreaking level of project mayhem and chaos, even for HIT.

The comment reveals that the agency failed to do necessary advance planning, says Theresa Cullen, an informatics executive with the Regenstrief Institute who formerly worked with Veterans Health Affairs and the Indian Health Service.

�They should have done a full needs assessment,� she said. �One would have normally done the workflow evaluation prior to the release of the RFP.�

If true, I believe it was an obligation of EPIC and the multiple contractors to have pointed that out to their future customer, and adjusted their bids accordingly, taking into account the time and resources needed for this type of work - or not placed a bid at all.  Such deficiencies and what they mean towards project progress and failure are obvious - to anyone who's learned from history.

... Cullen also found it odd that the Coast Guard didn�t hire consultants to implement the new system until September 2012. The service ended up hiring Leidos, which also maintained its old EHR.

The Coast Guard further complicated the process by deciding to team up with the State Department. Its original request was complicated enough, with installations spanning six time zones. The partnership with State meant implementing across 170 countries. (A spokeswoman for State said the agency was investigating its options, but refused additional comment).

The sheer number of sites led Cullen to question whether Coast Guard and State had devoted enough resources to the project. Between Epic and Leidos, the project was budgeted for roughly $31 million. That was �an inadequate amount of funding for what you�re asking to do,� she said. Consultants receive roughly $100 an hour, and Epic�s work with clinicians is time-consuming.

Again, those hired knew, should have known, or should have made it their business to know that under such conditions, if true, project failure was the predictable outcome.  They are supposed to be the HIT experts, after all, not the Coast Guard.

While a very efficient health care system could implement the EHR, she said, the Coast Guard lacks that reputation. She speculated that Epic intentionally underbid the contract. (Epic�s Helsher said that �the contract was viable and we were fully motivated to lead a successful install.�)

Someone is right, and someone is wrong.  I leave it to the reader to decide who was correct and who wasn't.

Anecdotes of further delays pepper various newsletters and reports from 2012 through 2015. Server failures scuttled a pilot rollout in 2014, then developed into deeper problems, and last July the systems started failing on a more regular basis.

Perhaps the "anecdotes" need to be turned into "teachable moments" through legal discovery by federal law enforcement.

The Coast Guard advised retirees and dependents that month that, due to incompatibility between its EHR and the Department of Defense�s new medication reconciliation system, they couldn�t get their prescriptions filled at Coast Guard clinics.

Around Labor Day, Coast Guard health care personnel were directed to copy information from electronic files onto paper, for fear of losing their data.

That is just about the most pathetic sentence I've ever had to read in my 24 years in Medical Informatics.

... doctors are frustrated. One complained in the Uniformed Services Academy of Family Physicians newsletter of �unique challenges which seemed to revolve around many electronic record keeping changes.� �The question we pose is, how is this affecting shipboard life?� Little said. �This is the most important thing that�s happening right now in the Coast Guard.�

My advice to the Coast Guard is to treat the IT invaders and consultants as it would a invading maritime fleet from a hostile nation.

The vendors who worked with the Coast Guard either don�t know what went wrong, or aren�t telling. Leidos � also the lead company implementing the Pentagon�s EHR project � declined comment, as did Lockheed Martin, which was contracted to implement access to the EHR through mobile devices, and Apprio, which was to provide credentialing services.

I believe they have a very good idea of "what went wrong", and aren't telling (per the Fifth Amendment)?  If they have "no idea" what went wrong, what, I ask, are they doing in the IT consulting business?

... The EHR giant [EPIC] says it�s not entirely clear why the Coast Guard pulled the plug. But the situation wasn�t Epic�s fault, company executive Eric Helsher said.

They pulled the plug out of fear for their members' well-being, hopefully.

It seems everyone seeks to escape culpability, with the blame placed on the customer.

The Coast Guard spokesman said the decision was �driven by concerns about the project's ability to deliver a viable product in a reasonable period of time and at a reasonable cost.�

It seems there's still some who don't continue down the sunk-cost fallacy road (https://www.logicallyfallacious.com/tools/lp/Bo/LogicalFallacies/173/Sunk_Cost_Fallacy) and are willing to walk away from bad HIT.

... In general, software contracts deserve more scrutiny, said Kingston, who served on the House Appropriations Committee. �These things don�t get the scrutiny a weapons system does.�

Considering the reputation of military costs, that's saying quite a lot.  The lesson that should have been learned from history is that HIT is both exploratory, and a relative free-for-all.

Caveat emptor.

One last piece of (free!) advice for the Coast Guard leadership.

Read this paper:

Pessimism, Computer Failure, and Information Systems Development in the Public Sector.  (Public Administration Review 67;5:917-929, Sept/Oct. 2007, Shaun Goldfinch, University of Otago, New Zealand).  Cautionary article on IT that should be read by every healthcare executive documenting the widespread nature of IT difficulties and failure, the lack of attention to the issues responsible, and recommending much more critical attitudes towards IT.  linkto pdf

That may be the most valuable learning experience of all for their next attempt to implement EHRs.

-- SS

Princess Health and Suicide rates are rising in the U.S.; experts attribute high rate in rural Ky. to poor mental health access, stigma and 'gun culture'. Princessiccia

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By Melissa Patrick
Kentucky Health News

After a decade of decline, suicide is becoming more common in the United States, increasing by 24 percent from 1999 through 2014, according to the federal Centers for Disease Control and Prevention.

The CDC report looked at cause-of-death data between 1999 and 2014 and found that suicide rates increased for both males and females in all age groups from 10 to 74.

Graph: CDC Age-adjusted suicide rates by sex
Overall, the suicide rate increased from 10.5 per 100,000 people in 1999 to 13 per 100,000 in 2014, showing a steady 1 percent annual increase through 2006 and a 2 percent annual increase after that.

And while the suicide rates for males continues to be higher than those for females, the report notes that the gender gap is narrowing. Among females, the rate of increase was 45 percent, compared to 16 percent for males.

Suicide rates for middle-aged women aged 45-64 were the highest, in both 1999 (6 per 100,000) and 2014 (9.8 per 100,000), showing a 63 percent increase. In females, the largest increase occurred among girls 10-14 (200 percent), though the actual number of suicides in this group was relatively small, tripling from 0.5 per 100,000 in 1999 to 1.5 in 2014.

For men, suicide rates were highest for those 75 and over, with approximately 39 for every 100,000 men in 2014. However, men 45-64 had the greatest increase among males, increasing from 20.9 per 100,000 in 1999 to 29.7 in 2014, a rise of 43 percent.

In 2014, poisoning (34.1 percent) was the most common method of suicide in females and firearms (55.4 percent) was the most common in males.

The CDC report didn't address why suicides are up, but several studies offer clues about possible reasons among the middle-aged, including a study published in 2015 in the American Journal of Preventive Medicine that found that "job, financial, and legal problems" are most common in adults aged 40-64 who had committed suicide, and a 2011 CDC study which found that suicide rates increased during periods of economic recession and declined during economic growth among people aged 25-64 years.

Rural areas have highest suicide rates

Suicide is the 10th leading cause of death in the nation and the state, and with nearly 700 Kentuckians dying by suicide annually, Kentucky is one of the top 20 states for it.

Suicide is more prevalent in rural areas, where the rate is almost twice as high as in urban areas (17.6 suicides per 100,000 vs. 10.3 per 100,000), according to a separate CDC study.

"The myth is that suicide is an inner-city, urban problem, but the reality is that it is not," Melinda Moore, a licensed psychologist and assistant professor at Eastern Kentucky University, said in a telephone interview.

Moore, also the chair of the Kentucky Suicide Prevention Group, attributed some of the increase in suicide rates in rural Kentucky to its "gun culture."

"We have a culture that is very familiar with guns and that familiarity, unfortunately, can really lead to people using very lethal means when they are suicidal," she said.

And when you add gun culture to economic distress, which is common in much of rural Kentucky, it can be a "cocktail for disaster" for those who are suicidal, she said.

Another challenge is the lack of access to mental-health care in rural Kentucky, Moore said, noting that even if people have access to mental-health providers, many providers aren't trained to work with suicidal people. She said this should be improving, since the state now requires all behavioral health providers get suicide training when they renew their licenses.

Julie Cerel, psychologist and associate professor in the University of Kentucky College of Social Work, attributed the increase in rural suicides to several things, including the Gun culture, lack of access to mental-health care and the stigma that surrounds mental-health issues that deters people from seeking help.

Cerel, also president-elect of the American Association of Suicidology, said one reason for the national increase in suicides could be that coroners have become better trained on how to report them. She said that is very important, because people who were close to a person who died by suicide need to know so that they can seek their own mental-health support.

Cerel said 47 percent of Kentuckians knew someone who died by suicide, "and people who are exposed to suicide, especially if it is someone close to them, are more likely to have their own depression and anxiety and thoughts of suicide."

What should you do if you have suicidal thoughts or are concerned about someone?

Moore and Cerel said the first line of defense, especially in areas that don't have great mental-health resources, is to call the national suicide-prevention lifeline, 800-273-TALK (8255). This is a free, 24/7 service that can provide suicidal persons or those around them with support, information and local resources. It also offers a website at www.suicidepreventionlifeline.org .

Moore said community mental health centers are also great resources for those who are suicidal in rural Kentucky, and Cerel stressed the importance of telling someone if you are having suicidal thoughts, including your primary health-care provider.

Thursday, 28 April 2016

Princess Health and April 28th, 2016 These Numbers. Princessiccia

Princess Health and April 28th, 2016 These Numbers. Princessiccia

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April 28th, 2016 These Numbers

Today has been a very long day. It's been a great day, but wow--long.

Today's schedule was tight. Morning show from 6am-9:15am, post show duties and production until 11am, doctor's appointment at 11:15am, speaking event/stand-up at AMBUCS at noon, back to the studio by 1:30pm, production until after 3pm, home by 3:30pm, a very short nap with 38 alarms set (okay-that's an exaggeration--but I did have 3 set), Ponca City Baseball press-box PA announcing of the seniors for senior night at 5:00pm, followed by a 25 minute stand-up set at the Hospice of North Central Oklahoma Volunteer Recognition/Awards Banquet.

I was offered dinner at the banquet, but I've never been able to eat before a performance, so I declined and opted for water until a later dinner. Honestly, I didn't plan well today. It was nearly eight hours between lunch and dinner, with nothing but coffee and water in between. I usually plan a little better than that, but I was okay--it was the exception, not the rule.

I spent way too much time wandering around the store figuring out dinner. In hindsight, I should have opted for a meal out, but I have this unwritten rule whereby, if I'm home--meaning, not traveling, I don't eat out twice in one day. My lunch was takeout, so this unwritten rule (one I've only broken a few times in two years) required a home cooked/prepared meal. The plan was simple--it was going to be salmon, until I arrived to find the seafood counter closed. I was literally a few minutes too late. Had I not stopped for a decaf coffee, I would have made it in time to that part of the store. The decaf was a compromise. I've never ordered a decaf that I can remember--but I wanted coffee--and I didn't want the caffeine--so I tried it and, not bad, really.

I settled on a turkey cheeseburger and fresh cut sweet potato fries for dinner. It was incredible!

My doctor's visit today was a lot of fun. Keep in mind, being near, at or above 500 pounds for almost two decades, I've had more than my share of horrible "these numbers will eventually kill you" type doctor visits. Today wasn't one of those. It was the exact opposite--and I'm immensely grateful. I'll recap the numbers and call it a night:

Blood pressure today was 130/74

My pulse: 54

Blood sugar: 86

Kidney and Liver function was in the optimal range

Total Cholesterol: 156 (down from 164 last year and 190 in 2014) (Optimal range: 100-200)

HDL (the good) Cholesterol: 43 (same as last year) (Optimal range: 40-125)

LDL (the bad) Cholesterol: 103 (down from 112 last year and 137 in 2014) (Optimal range: 0-129)

Triglycerides: 50 (Optimal range: 30-150)

Thyroid Stimulating Hormone: 1.898 (Optimal range: .300-5.000)

The only thing that was slightly low and in need of improvement was my protein level.

My protein total: 6.6 (optimal range is 6.7-8.2)

Albumin: (I have no idea what this is-but it's a protein number of some sort) 3.9 (optimal range 4.2-5.1)
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Bottom line: I'm VERY blessed. These numbers are beyond incredible. I'm grateful.

Whenever the doctor says- "Okay, everything looks great, try to eat a little more protein. I'll see you back here in a year." That's truly a wonderful thing.

I made it one more day. I maintained the integrity of my calorie budget, I remained abstinent from refined sugar and I exceeded my water goal. That's enough for today.

Oh--and I had the pleasure of seeing my friend Lance from the Opportunity Center. One of the AMBUCS brought him to the midday meeting where I was speaking. Lance is one of the most amazing people I know because of his natural happiness and enthusiasm for life despite incredible challenges. He listens to my radio show every day. Thank you, Lance, for being there!!
photo lance and me_zpszmvltas7.jpg

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Thank you for reading and your continued support,
Strength,
Sean

Wednesday, 27 April 2016

Princess Health and April 27th, 2016 Toward Dreamland. Princessiccia

Princess Health and April 27th, 2016 Toward Dreamland. Princessiccia

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April 27th, 2016 Toward Dreamland

I'm still playing catch up on rest after yesterday's super-long day. I couldn't keep from a good nap this afternoon and now, I just took some melatonin and I'm ready for it to assist in escorting me toward dreamland very soon.

I have a doctor's appointment in the morning. I'll be meeting with Dr. Wilcox to go over the complete profile of numbers from last weeks blood lab workup. I love my doctor for many reasons--and mainly because he makes/takes the time to explain things well. I look forward to sharing the numbers in tomorrow night's edition. The numbers are extra interesting to me considering the records I've kept via MyFitnessPal and Twitter the last two years. I suppose it offers a clearer cause/effect understanding type dynamic. I have high hopes for great numbers. We'll see!

The next couple of days will be busy. Aside from regular morning show/production duties, I'm the guest speaker at AMBUCS immediately after my visit with the doctor, then I'm the guest stadium announcer late tomorrow afternoon for the high school baseball team senior night introductions. Immediately after the baseball team introductions, I'll be doing an opening stand-up performance at the Oscars themed Hospice Volunteer Awards Banquet--then Friday afternoon, I'm joining family in helping my oldest daughter and her husband move into their new house...followed by another opening stand-up comedy performance for the Arts and Humanities Council's Dead Metal Society rock and roll concert!

The good news--my weekend is fairly clear of set obligations--and to me, that means more opportunities to catch up on some projects needing my attention and of course, extra rest!!!

Speaking of rest--I'll allow the Tweets to take it the rest of the way tonight. I'm hitting the pillow!

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Thank you for reading and your continued support,
Strength,
Sean
Princess Health and UnitedHealth will leave Ky. next year, leaving much of the state with only one or two choices for health insurance on exchange. Princessiccia

Princess Health and UnitedHealth will leave Ky. next year, leaving much of the state with only one or two choices for health insurance on exchange. Princessiccia

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UnitedHealth Group Inc. won't be participating in Kentucky's individual insurance plans offered through the Affordable Care Act marketplace next year, which could leave about 20 percent of the state with just one insurer to choose from for next year and another 22 percent with only two choices, according to an analysis by the Kaiser Family Foundation.

Including Kentucky, this brings the number of states the health insurer is quitting next year to 26, Zachary Tracer reports for Bloomberg.

"The company plans to halt sales of individual plans in Kentucky for 2017, both inside and outside the state�s Affordable Care Act exchange, as well as the small-business exchange," United said in a letter dated March 28 to the state�s insurance department, Tracer reports. Bloomberg noted that it obtained the letter through an open-records request.

United warned in November that this would likely happen after reporting that "low enrollment and high usage cost the company millions of dollars," USA Today reported.

�UnitedHealthcare�s intent to withdraw from the market was not unexpected,� Doug Hogan, a spokesman for the state Public Protection Cabinet, which oversees the state�s insurance regulator, said in an e-mail to Bloomberg. �Insurers across the country have been losing hundreds of millions of dollars in the Obamacare exchanges and can no longer sustain such heavy financial losses.�

The administration of Republican Gov. Matt Bevin is shutting down the state's Kynect exchange and moving its 100,000 or so users to the federal exchange, but plans on that exchange are offered state by state.

Bloomberg says it has confirmed that United is leaving at least 26 of the 34 states where it sold 2016 coverage, but will continue to offer small-business plans off the exchange. New York and Nevada confirmed for Bloomberg that United plans to sell ACA plans in those states next year. The company has also filed plans to participate in Virginia.

Tuesday, 26 April 2016

Princess Health and April 26th, 2016 100% Chance. Princessiccia

Princess Health and April 26th, 2016 100% Chance. Princessiccia

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April 26th, 2016 100% Chance

Today was one of those days that refused to stop. Part of my job is doing on-air weather coverage when storms threaten our listening area. The forecast this morning was calling for a 100% chance of severe storms. In several ways, the reaction to the forecast was unprecedented. We had school districts in our state closed by the threat. Cancellations of community activities came into our studios right and left throughout the day. Everyone was convinced, this would be the worst storm outbreak in a very long time. It wasn't good for some in this region. However, for the most part, our area was spared the worst. The added studio duties called for a sixteen hour day for me.

I planned well, made sure I had what I needed when I needed it--I leaned on coffee a little to help keep me alert and made it through, very well. I stayed connected with a couple of support buddies, I maintained the integrity of my maintenance calorie budget, I remained abstinent from refined sugar and I exceeded my water goal by 8oz. I'm calling it a successful day.

I'm letting the Tweets take it the rest of the way! It's time to sleep. The alarm is set for 4:30am, morning show at 6am. Luckily, no severe weather for our area in tomorrow's forecast!

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Thank you for reading and your continued support,
Strength,
Sean

Princess Health and More than 100 at SOAR Substance Abuse Roundtable committed to work on prevention and treatment efforts in region. Princessiccia

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By Melissa Patrick
Kentucky Health News

More than 100 people attended the Shaping Our Appalachian Region Substance Abuse Roundtable April 7 to learn about current research and emerging opportunities associated with substance abuse and intravenous drug use in region, according to a SOAR news release.

SOAR is a bipartisan effort to revitalize and diversify the economy in Kentucky's 54 Appalachian counties. It has advisory councils for each of its 10 areas of focus, one of which is community health and wellness.

That council's chair, former state health commissioner Dr. William Hacker, facilitated the roundtable at Natural Bridge State Resort Park.

As part of the solutions-driven discussion, Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, told the attendees that it is important to ask the right questions when gathering information about drug abuse to accurately depict what is going on in the region.

�When you ask people if they have a problem with prescription drugs they, of course, say no,� Zepeda said. �When you ask them if they know someone, like a family member or friend, that answer is very different.�

The group also discussed the importance of getting accurate data about substance abuse and overdose into the right hands to make progress on these issues.

�We want to get data into the hands of legislators and those who can do something about prescription-drug overdose,� said Dana Quesinberry, public-health-policy and program evaluator for the Kentucky Injury Prevention and Research Center at the University of Kentucky. �Sitting in a repository, it doesn�t do anything for anyone.�

The roundtable members also discussed needle-exchange programs, authorized under the state's 2015 anti-heroin law. The program is meant to slow the spread of HIV and hepatis C, which are commonly spread by sharing of needles among intravenous drug users.

�We�ve seen a switch from using pills as an opioid to using intravenous methods,� said Greg Lee, the HIV/AIDS continuing-education program director for the state Cabinet for Health and Family Services.

Clark County Health Director Scott Lockard said the federal Centers for Disease Control and Prevention issued a "wake-up call" with its report identifying 54 Kentucky counties as being among the 220 most vulnerable in the nation for the rapid spread of HIV and hepatitis C infection among intravenous drug users. Most of the counties, and eight of the top 10, were Appalachian.

"We are potentially on the leading edge of one of the biggest public health crises to hit our state," Lockard said in an e-mail to Kentucky Health News. "It will take a combined effort across sectors to prevent an HIV outbreak in the SOAR region such as the one that occurred in Scott County, Indiana," just north of Louisville.

Although many Kentucky county officials are talking about needle-exchange programs, so far only Louisville and Lexington and the counties of Boyd, Carter, Clark, Elliott, Franklin, Grant, Harrison, Jessamine, Knox, Pendleton and Pike are either operating or have approved such programs. Of these, Boyd, Carter, Clark, Elliott, Knox and Pike are part of SOAR.

The news release noted that participants left the discussion with a commitment to continue the conversation and to build a strategic plan to address substance abuse issues in the region, with a focus on clinical practices, health systems, drug screenings and other best practices.

Monday, 25 April 2016

Princess Health and April 25th, 2016 Beautiful Harmony. Princessiccia

Princess Health and April 25th, 2016 Beautiful Harmony. Princessiccia

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April 25th, 2016 Beautiful Harmony

It was the last ten minutes of my radio show when I noticed guests making their way into our studio lobby. Did I miss a scheduled interview? I didn't think so-- and what's this? They're carrying boxes! Just then, I realized--it was the Perkins Restaurant and Bakery crew, a good client of ours, bringing edible gifts!! And they brought them directly into the KPNC studio, loading the counter with pies and muffins until the thick smell of sugar filled the room.

Years ago, I would have quietly grabbed one of the pies and put it aside for a private rendezvous, later--away from any possible witnesses, when I could devour until pleasure transformed into discomfort.

I didn't do that today. The peace, clarity, balance and stability my plan, with its abstinence from refined sugar, provides--is worth more to me than any expertly crafted pie or muffin, or several.

And these were seriously works of art (check out the Live-Tweet Photos below). And I can appreciate that part of it--and I can joyously decline partaking while feeling happy for the others who excitedly scooped up the bakery compliments.

I'm so grateful that I've reached a point in my abstinence where a situation like this isn't much of a threat. BUT--that doesn't mean I don't take precautions.

One of the things I embrace each day is this: My continued success is NEVER a guaranteed thing. I do not use the word "never" when I talk about my continued abstinence from refined sugar. I simply say, I hope and pray I never go back there. Okay, so maybe I do use the word "never," but in a very different way. There's no question about how refined sugar affects me. I'm fully aware--yet, I'm never beyond relapse. So, I do what might seem to be little things that bring big support. 

I share the situation. The below tweets concerning this kind circumstance (and it was a very kind and generous gesture--and it was well received) might seem like simple, somewhat casual, slightly serious--slightly humorous, tweets--but on a deeper level, it was my way of sharing the situation. I also texted a support buddy--not to say, "I'm in trouble," because I didn't feel that way--it was to simply share the situation. And those acts of sharing create an even stronger resolve, in beautiful harmony with my plan.

Within fifteen minutes the studio was clear of the bakery items. A couple of pies were immediately delivered to clients in close proximity, the rest were claimed by colleagues planning to surprise their families with an amazing dessert.

I made my way upstairs for a mid-morning coffee and a banana with 16g natural peanut butter. I love the coffee even more when it's coupled with peanut butter!
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After a full day at the studio, I made my way to the store to grab a few ingredients for tonight's dinner plans. I made it home in time to seize a very controlled forty-five minute nap before jumping up and getting on the Monday night teleconference support group I co-facilitate with Life Coach Gerri and Kathleen Miles.

Then, it was time to try another recipe from Joy Bauer's newest book!

I decided on the fettuccine alfredo!  

The picture in the below dinner Tweet doesn't do it justice! Every bite was cheesy delicious. Oh my-- easy-easy-easy, and incredibly delicious.

I live alone, so, most of the time I cook for just me. I cut the recipe into fourths and it was more than enough for one. I also added 4.4oz of chicken and 2oz sliced mushrooms.

I allowed the sauce to thicken a little too much-- I think the picture would have had more color otherwise. I didn't completely "nail it," but still, the flavors were alive with every bite!

The calorie count of the dish without the chicken and mushrooms added was 452, 88 calories over the recipe nutrition information. I attribute this to using 3oz pasta--remembering that I quartered the recipe--instead of one fifth, per the recipe breakdown.

Adding the chicken and mushrooms brought the entire meal in at just under 600 calories--fitting nicely in my weight maintenance calorie budget.

I chose this recipe for a reason. If you're a regular reader of this blog and/or you follow the Tweet stream, you know I occasionally prepare a similar dish using whole grain pasta, mixed veggies, mushrooms and sometimes chicken, other times just vegetables. Every time I've prepared it, I've always used the heavily processed jar of reduced calorie alfredo. Of course I scan the ingredients list for "sugar" or any synonyms of refined sugar--but still, I'm never really satisfied with the long list of things I can't pronounce in the ingredients list.

Now--I'll never need to buy another jar of heavily processed reduced calorie alfredo sauce, ever again! Thank you, Joy!

And seriously, this super-simple recipe using real ingredients tastes much better than any jar stuff I've tried! It's a keeper--and now I've added another item to the variety of my available choices!

The parmesan, the creaminess and flavor of the cream cheese/milk base, and the sea salt/back pepper---oh my...it made for a fantastic dinner experience!
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I'm caught up with shipping outstanding orders of Transformation Road and mp3 unabridged audio editions. If you've been patiently waiting for yours, thank you! All three of you will be receiving your copies within two days! :)

I sincerely appreciate everyone who has ordered copies of my book lately in various e-reader formats, the Audible.com audio version and in paperback via various booksellers, and mostly Amazon.com. I've always offered a way for you to order directly from me instead of these options--but now, temporarily, that direct option via my website is unavailable while transformationroad.com undergoes a total reconstruction. In the meantime, you can still order a copy directly from me by simply emailing your request to transformation.road@gmail.com. When you do, I'll email you an invoice and ship your copy! And by the way--the unabridged audio version mp3 disc with free shipping anywhere in the world, is still available as a complimentary gift with your donation of at least $20 to the DDWL! You can find the donation link in the upper left hand corner on the web version of this blog.

I finished up tonight by staying in with an excellent body weight strength training routine in my living room. It took all of twelve minutes to get in a very nice, focused workout. It's getting more and more difficult to justify not doing this--when it takes so little time.

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Thank you for reading and your continued support,
Strength,
Sean
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