Thursday, 22 May 2014

Princess Health and Princess Health andPsychiatric patients' demand for emergency-room care presents a problem the Affordable Care Act won't solve.Princessiccia

Princess Health and Princess Health andPsychiatric patients' demand for emergency-room care presents a problem the Affordable Care Act won't solve.Princessiccia

Psychiatric patients' demand for emergency-room care has been a concern in hospitals, and it's going to get worse. Even though ERs are not properly equipped to help psychiatric patients, people still often go there with psychiatric concerns. Most ERs simply lack room to deal with such situations. According to a survey, 84 percent of emergency physicians say they have psychiatric patients "boarded" in their emergency departments awaiting transfer to a mental-health facility, Adrianna McIntyre writes for Vox.

"People having a mental-health crisis seek care in emergency departments because other parts of the health care system have failed them," said Alex Rosenau, president of the American College of Emergency Physicians.

A psychiatric patient who shows up to the emergency room may require immediate care at the hospital, and sometimes there isn't an open bed in the right department. Those shortages often necessitate psychiatric patients to wait in the emergency room, or board, until space elsewhere opens for them. Both the closure of psychiatric facilities and diminished state funding have contributed to the issue. "Between 1955 and 1997, total state spending on mental health fell 30 percent, a period during which most health spending grew rapidly," McIntyre writes.

If hospitals don't figure out how to deal with the problem, it's going to get worse. In fact, experts say the implementation of the Patient Protection and Affordable Care Act will only exacerbate the problem. Some studies reveal that insured patients are more inclined to go to the emergency room�even for non-urgent issues�because the cost usually isn't as high. Lower-income people are even more likely to do that, and this population will comprise many of the newly insured citizens.

Though hospitals want people to use the health system properly, they also want to make sure patients do visit the ER when it really is necessary. "We don't want to impose any barriers on people going to the emergency room," said Hans House, a clinical professor at the Iowa University Carver College of Medicine. "We don't want people to be afraid to go to the ER."

The Affordable Care Act has provided more funding for reimbursement of emergency psychiatric care in Medicaid, a service the public program doesn't generally cover. However, this doesn't address the lack of space in emergency departments. "We know that a lack of psychiatrists available and staffing patient beds is a barrier," House said. "That's a personnel issue." (Read more)

Princess Health and Princess Health andUK College of Medicine graduate Ashley Loan makes commitment to practice emergency medicine in rural Kentucky .Princessiccia

Ashley Loan
Ashley Loan graduated from the University of Kentucky College of Medicine on May 17 and plans to practice emergency care medicine in rural Kentucky, Elizabeth Adams reports in a UK press release.

Loan began working toward her goal four years ago as one of 10 graduating students who participated in UK's Rural Physician Leadership Program, where she believes her roots in Greenup County prepared her for a future responding to medical emergencies in rural Kentucky, Adams reports.

Loan told Adams that her earliest experiences in emergency medicine were watching her mother, Elizabeth Loan, respond to accidents in the farming community because she had an associate's degree in nursing and was the most educated health care provider within a 10-mile radius of the Loan farm.

Her daughter recalled that when the neighbor's son went into a diabetic coma, her mother rushed to their house to administer sugar. Another time, her mother administered CPR to a farmer who was pinned under a tractor until the emergency responders arrived.

"There have been a lot of instances when my mom was the sole health care provider," Loan said.

Loan told Adams that she understands cultural characteristics that influence health in rural populations, such as an attitude of self-reliance that results in attempts to self-medicate or postpone visits to the doctor. It's often difficult for doctors from urban environments to appreciate those cultural variances.

"I get why people don't go to the doctor�rural people are raised to take care of themselves," Loan said. "Before they come to the doctor, they've tried a few things."

Loan told Adams she also understands first-hand some of the health challenges found in rural communities. Her father, a longtime tobacco farmer and user, suffers from chronic obstructive pulmonary disease.

Kentucky has the nation's highest rate of COPD, 9.3 percent of the population, according to the federal Centers for Disease Control and Prevention. Tobacco use is the primary cause, but air pollution and genetics can also play a role.

Loan told Adams that growing up in a rural area isolated from hospitals fueled her desire to deliver more efficient emergency medical care to rural communities. She said she "enjoys the challenge of being the first doctor on the trauma scene and 'Macgyver-ing' her way through emergencies with limited resources."

"I love the fact that patients who come to the emergency department are the sickest patients you are going to see," Loan said. "You lay your eyes on them; you have no previous notes�you are the person who has an hour before the patient crashes to figure out what's going on."

Loan's experience in the Rural Physician Leadership Program allowed her to gain more hands-on experience with patients because of the hospital's smaller medical staff and fewer residents in the program, Adams reports. She has delivered more than 10 babies, assisted attending physicians with bowel surgery and helped stabilize a coding patient in the emergency department.

During her stint, Loan participated in a clerkship and lectures at St. Claire Regional Hospital in Morehead. Dr. Phillip Overall, the emergency clerkship director at the hospital, told Adams that Loan has already demonstrated the calm and decisive qualities needed in an emergency-room doctor.

"She is able to think very quickly on her feet and subsequently provide excellent patient care," Overall told Adams. "We take care of critical patients on a daily basis, and she is absolutely able to step back and assess the entire situation calmly and come up with a plan to take care of the patient."

The assistant dean who recruited Loan to the Rural Physician Leadership Program, Dr. Anthony Weaver, said that rural practices and hospitals need physicians who are committed to living and working in small towns. Loan's closeness to her family and ability to "have conversations with anyone about just about anything" made her an ideal candidate for the program, he told Adams.

"Ashley Loan has the intelligence and drive to succeed as a physician, but more importantly, she cares about her family and her neighbors," Weaver said. "Improvements in the health of rural Kentucky will come from people like Ashley."

Loan also received a certificate in health systems leadership upon graduation from medical school and will work toward a master's in business administration during her medical residency, which she is also completing at UK. Loan aspires to serve as the director of a rural emergency department.

Loan was once a high-school girl who wanted to escape rural Kentucky. Now, she not only has committed to practicing medicine in rural Kentucky, but she and her fianc� Ryan Brown have bought an 87-acre farm in Greenup County and built a house there. She plans to raise beef cattle when not practicing emergency medicine in a nearby hospital or responding to emergencies, Adams writes.

"I'm definitely a small-town person," Loan told Adams. "I feel an obligation to come back and serve the people who have really believed in me for so long. It makes my day when someone says, 'You are coming back here?' I'm Ashley�I'm the girl who sold corn with her dad on the side of the road�they trust me, and I like that." (Read more)

Wednesday, 21 May 2014

Princess Health and A New Understanding of an Old "Obesity Gene". Princessiccia

As you know if you've been following this blog for a while, obesity risk has a strong genetic component. Genome-wide association studies (GWAS) attempt to identify the specific locations of genetic differences (single-nucleotide polymorphisms or SNPs) that are associated with a particular trait. In the case of obesity, GWAS studies have had limited success in identifying obesity-associated genes. However, one cluster of SNPs consistently show up at the top of the list in these studies: those that are near the gene FTO.

As with many of the genes in our genome, different people carry different versions of FTO. People with two copies of the "fat" version of the FTO SNPs average about 7 pounds (3 kg) heavier than people with two copies of the "thin" version, and they also tend to eat more calories (1, 2).

Despite being the most consistent hit in these genetic studies, FTO has remained a mystery. As with most obesity-associated genes, it's expressed in the brain and it seems to respond somewhat to nutritional status. Yet its function is difficult to reconcile with a role in weight regulation:
  • It's an enzyme that removes methyl groups from RNA, which doesn't immediately suggest a weight-specific function.
  • It's not primarily expressed in the brain or in body fat, but in all tissues.
  • Most importantly, as far as we know, the different versions of the gene do not result in different tissue levels of FTO, or different activity of the FTO enzyme, so it's hard to understand how they would impact anything at all.
An important thing to keep in mind is that GWAS studies don't usually pinpoint specific genes. Typically, they tell us that obesity risk is associated with variability in a particular region of the genome. If the region corresponds to the location of a single gene, it's a pretty good guess that the gene is the culprit. However, that's not always the case...

Read more �

Princess Health and Princess Health andSun exposure can damage eyes; sunglasses decrease risk .Princessiccia

Sunscreen, sunglasses. This should be your mantra as you step into the great outdoors this summer.

Your skin needs protection from the damaging rays of the sun but so do your eyes, says the Kentucky Optometric Association.

�People spend a lot of time outdoors in the summer, so too much exposure to the sun is common,� Dr. Lynn Shewmaker, an optometrist with offices in Fort Mitchell and Dry Ridge says in a news release. �Sunglasses are more than just a fashion accessory because overexposure to ultraviolet rays fast forwards aging of the eyes and increases the risk for serious diseases.�

The Optometric Association reports that the sun�s UV radiation can cause cataracts; cancer of the eyelids and skin around the eyes; benign growths on the eye�s surface; and what is commonly known as snow blindness, which is a temporary but painful sunburn of the eye�s surface. Long-term exposure can cause damage to the retina, a lining of the eye that is used for seeing.

Extended sun exposure can also create visibility problems for drivers. �Spending just two or three hours in bright sunlight can hamper the eyes� ability to adapt quickly to nighttime or indoor light levels,� Shewmaker said in the release. �This can make driving at night after spending a day in the sun more hazardous.�

Long-term sun exposure is also a risk factor for macular degeneration, a disease that destroys the part of your vision that allows you to see objects clearly, says the release.

Wearing a wide-brimmed hat or cap can block about 50 percent UV radiation from the eyes, which is not enough protection, according to the release. You must also wear sunglasses.

The Kentucky Optometric Association recommends choosing lenses that:
� Block 99 to 100 percent of both UV-A and UV-B radiation
� Screen out 75 to 90 percent of visible light
� Are perfectly matched in color and absorption and are free of distortion and imperfection
� Are gray for proper color recognition.
In addition, Shewmaker said some contact lenses also can block out both UV-A and UV-B radiation.

Infants� and children�s eyes also need to be protected from the sun at all times especially because they tend to spend more time in the sun than adults.

Monday, 19 May 2014

Princess Health and Princess Health andConway funnels $1.5 million in drug-company settlements to develop prevention and treatment plan for kids' substance abuse.Princessiccia

Princess Health and Princess Health andConway funnels $1.5 million in drug-company settlements to develop prevention and treatment plan for kids' substance abuse.Princessiccia

With two lawsuit settlements from drug makers, Attorney General Jack Conway is giving the University of Kentucky $1.5 million over two years to develop a comprehensive plan for the prevention and treatment of substance abuse by adolescents.

�Adolescent substance use is at epidemic proportions,� Conway said in a press release. �A 2011 study from the Centers for Disease Control documented that 66 percent of Kentucky kids have used alcohol, 37 percent have used marijuana, and 19 percent have abused prescription drugs. This grant will allow us to explore all of the resources available to Kentuckians to fight this growing problem.�

The grant is intended to address all aspects of adolescent substance abuse, including community and physician outreach and education, treatment plans, and outcomes measurement. Funding of $19 million from the $32 million in settlements is already being used to create a program that addresses every stage of adolescent substance abuse, KY Kids Recovery.

"Our goal is to develop a start-to-finish plan with elements that offer evidence-based treatment, reach out to teachers, families, primary care providers and pharmacists, and target resources to communities with the highest need," said Dr. Catherine Martin, director of the new program and UK's Division for Child and Adolescent Psychiatry. �The program will utilize only treatments with a proven track record of success.�

The settlement is also providing $500,000 to complete construction of a Recovery Kentucky center in Ashland, $2.5 million for almost 900 scholarships over two years to Recovery Kentucky centers, and $560,000 to create 14 drug-free homes for people completing and transitioning out of residential substance abuse treatment programs.

In addition, the following entities will receive funds over the next two years from the settlement:
� $6 million to administer and upgrade KASPER, Kentucky�s electronic prescription drug monitoring program.
� $600,000 over two years to support substance abuse treatment for pregnant women by Chrysalis House in Lexington.
� $400,000 over two years to support substance abuse treatment for pregnant women by Independence House in Corbin.
� $1 million to develop a school-based substance abuse screening tool with the Kentucky Department of Education to intervene with at-risk children before they enter judicial or social services systems.
� $250,000 to create a database to evaluate outcomes of juvenile treatment.
Princess Health and Princess Health andIncreasingly common heroin addiction overwhelms agencies.Princessiccia

Princess Health and Princess Health andIncreasingly common heroin addiction overwhelms agencies.Princessiccia

Jails, treatment facilities, drug courts and hospitals are struggling to provide the necessary help as more Kentuckians become addicted to heroin, Chris Kenning writes for The Courier-Journal: "In a state that already had a shortage of drug-treatment options, the heroin problem is badly outstripping Kentucky's ability treat it." A Kentucky Health Issues Poll found that 9 percent of Kentuckians and 15 percent aged 18 to 29 reported awareness of a family member of friend struggling with heroin.

"We're just bursting at the seams," said Karyn Hascal, who is head of The Healing Place, a Louisville drug-treatment center. "I've been around 35 years, and I've never seen anything hit this fast and this hard." Though heroin users were few and far between several years ago, now they take up 90 percent of The Healing Place's detox beds.

The Louisville jail deals with 30 to 90 inmates every day. It has hired four around-the-clock detox nurses, started new detox dorm programs and added training officers since 2012, and "increased our inmate health-care budget by hundreds of thousands of dollars," said Metro Corrections director Mark Bolton.

Heroin may be "the most addicting drug there is," said Dr. Christopher Stewart, an addiction psychiatrist and medical director at the Jefferson Alcohol and Drug Abuse Center. Heroin crosses the blood-brain barrier and becomes morphine, "binding to opioid receptors in the brain and sparking an intense rush of pleasure and euphoria�one that's far more sharp and immediate than opiate pills," Kenning writes. People become immune to its effects and need to take more of it, and withdrawal symptoms include pain, vomiting, insomnia, spasms and cravings.

While longer-term treatment for severe addictions often includes patient resident programs including counseling, Kentucky lacks this kind of care. "There are not enough open-entry detox and treatment beds in this community�I'm talking non-insurance beds," Bolton said. Dr. Eric Fulcher, an emergency room doctor said that providing emergency treatment for heroin addicts has become "the new normal" at Sts. Mary and Elizabeth in the South End. "We're so used to it, we're almost numb to it."

Although the former director of the Office of National Drug Control Policy, Gil Kerlikowske, recommended the increased availability of naloxone, used to counteract heroin overdoses, the General Assembly didn't pass a bill "that in part would have made naloxone more widely available, along with other heroin-related measures," Kenning writes.

Jefferson District Judge Stephanie Pearce Burke said that "heroin use is present in more than three-quarters of her cases." Something has to be done. "People still have the idea that it's a drug from the '60s and homeless people in the park," she said. "But the face of heroin has changed. It's suburban teens and middle-class housewives, too." (Read more)
Princess Health and Princess Health andForum hears ideas for improving long-term care in Kentucky.Princessiccia

Princess Health and Princess Health andForum hears ideas for improving long-term care in Kentucky.Princessiccia

People gathered at the Lexington Senior Citizens Center May 16 to discuss problems with long-term care and potential ways to improve it, at an event organized by the Nursing Home Ombudsman Agency of the Bluegrass. Gov. Steve Beshear requested that such forums occur across Kentucky.

Attendees split into groups to discuss various topics regarding care of the aging in Kentucky. DG Gridley, founder of Grace Place, said that when she gets older, she would like to continue living in her own house but go to a facility during the day. Grace Place, staffed by medical professionals, is a health club for seniors. Several attendees said care in a nursing home should be based the preferences of each resident. For example, if the requirements were that each resident get a bath twice per week, and one resident wants a bath every day, he or she should be able to do that.

Some attendees encouraged others to speak up when they think elders are not being properly cared for. If something seems out of line, investigate, but people should also share positive stories, they said. Discussing such topics will help get people involved in such issues, some said.

Do you have complaints or comments about long-term care in Kentucky? Do you have suggestions to improve care for the aging population? Send your comments to nhoa@ombuddy.org. Comments will be sent to Beshear. All submissions must be sent by Aug. 31.

Forum attendees addressed these questions:

1. What does quality care mean to you? What does quality care look like, feel like? What are the key components to quality care? Who is responsible for good quality care in each of the settings?

2. If you have used a facility (assisted living, personal care, adult day and nursing homes) what did you like the most? The least? If you could make one improvement in a facility placement, what would it be?

3. What are the qualifications of a good caregiver regardless of the setting? How does staff impact care? Is staff education and training important? What topics/techniques should staff learn to address or demonstrate proficiently?

4. In a facility, is the number of staff persons on duty important, or is the quality of the staff more important? Why do you feel that way?

5. Where do you believe abuse and neglect are most prevalent? Knowing the definitions of abuse, neglect and exploitation which do you think is the biggest threat to the elderly and why? What might reduce these threats and help the elderly live safer higher quality lives?

6. Community involvement aids facilities, caregivers and providers in ensuring quality care and quality living for Kentucky's vulnerable citizens. How can members of our community be more involved in ensuring quality living and quality care for the elderly and individuals with disabilities?