The Daily HIT

This applies to hospitals and institutions of all types.

A study this month in the journal Academic Pediatrics provides a pithy example of a persistent disconnect for the wellness movement in the healthcare workplace.

The study by researchers at the UCLA School of Medicine and the RAND Corp. examined the menus at 14 children’s hospitals in California and found that only 7% of the nearly 400 entrees were considered healthy.

“As health professionals, we understand the connection between healthy eating and good health, and our hospitals should be role models in this regard,” Lenard Lesser, MD, the primary investigator on the study, said in a media release.  ”Unfortunately, the food in many hospitals is no better—and in some cases worse—than what you would find in a fast food restaurant.”

Amidst the steady stream of bad news stories in the media, here’s a ray of sunshine:

A Denver, Co., public school has set the bar high for reconnecting the next generation of children with the food they eat. ABC 7 News in Denver reports that Denver Green School (DGS), an urban “innovation” school, has brought new life to an unused, one-acre athletic field by turning it into an organic garden — and the garden has been such a success in just eight months that the school is able to serve fresh produce from it to students in the cafeteria.”We have harvested over 3,000 pounds of produce from this ground,” said Megan Caley, the programs and outreach coordinator for Sprout City Farms (SCF), which partnered with DGS to create the garden. “Lots of salad greens and root vegetables, tomatoes, eggplant, peppers.”

The goal of SCF is to transform unused or underused urban land into thriving agricultural space, which can then be used to grow food for local residents. And the group’s partnership with DGS has been landmark in that it not only produces a plethora of fruits and vegetables, but it has also sparked a renewed interest among children in growing and eating them.

…

“It’s been extremely gratifying to see the kids out here,” said Chad Hagedorn, farm manager for SCF. “They are in constant awe and amazement of how food grows, and when they get to touch and really see how it happens, it’s a huge experience for them both educationally and emotionally.”

Besides inspiring children to eat the fruits and vegetables — and actually enjoy eating it — the DGS garden is also saving the school money by providing a continuous supply of healthy, organic produce at minimal cost. And because it is partially funded through a community supported agriculture (CSA) program where local residents can purchase weekly boxes of fresh produce, the program is financially viable in the long term.

It seems that this should be a normal part of geriatric health care evaluations.

“She couldn’t remember names, where she’d been or what she’d done that day,” Ms. Atkins recalled in an interview. “Initially, I was not too worried. I thought it was part of normal aging. But over time, the confusion and memory problems became more severe and more frequent.”

Her mother couldn’t remember the names of close relatives or what day it was. She thought she was going to work or needed to go downtown, which she never did. And she was often agitated.

A workup at a memory clinic resulted in a diagnosis of early Alzheimer’s disease, and Ms. Katz was prescribed Aricept, which Ms. Atkins said seemed to make matters worse. But the clinic also tested Ms. Katz’s blood level of vitamin B12. It was well below normal, and her doctor thought that could be contributing to her symptoms.

Weekly B12 injections were begun. “Soon afterward, she became less agitated, less confused and her memory was much better,” said Ms. Atkins. “I felt I had my mother back, and she feels a lot better, too.”

 

One more reason to eat a plant-strong diet:

The more antioxidants in a woman’s diet the less chance there is she’ll have a stroke, possibly due to the reduced oxidative stress and inflammation, according to the results of a long-term study in Sweden.

Among women with no history of cardiovascular disease at baseline, age-adjusted analysis showed that those with the highest intake of antioxidant-rich food had a 17% lower risk of total stroke when compared with those with the lowest antioxidant intake after an average 11-year follow-up, Alicja Wolk, DrMedSci, from the Karolinska Institute in Stockholm, and colleagues found.

In the cohort of women with cardiovascular disease upon entry, the age-adjusted model showed no significant relationship, but the fully adjusted model showed a significant 46% to 57% reduction in stroke risk among those in the quartiles with highest consumption of antioxidant foods compared with those with the lowest intake, according to the study published online in Stroke: Journal of the American Heart Association.

The multivariable adjustment included age, education, smoking, body mass index, physical activity, stroke, myocardial infarction, angina pectoris, atrial fibrillation, hypertension, hypercholesterolemia, diabetes, family history of myocardial infarction, aspirin use, dietary supplement use, and intakes of total energy, alcohol, and coffee.

This time from a hospital:

For three years, a small hospital east of Los Angeles has billed Medicare for the costs of confronting what appears to be a cardiac crisis of unprecedented dimension.

From 2008 through 2010, Chino Valley Medical Center in San Bernardino County claimed that 35.2 percent of its Medicare patients were suffering from acute heart failure – a dangerous, often-deadly breakdown in the heart’s ability to pump blood.

That’s six times the state average, according to a California Watch analysis of Medicare billing data.

…

In 2006, before Medicare began making bonus payments, the hospital reported no acute heart failure cases, records show. From 2008 through 2010, after the new reimbursement system was phased in, the hospital said it treated 1,971 Medicare patients for acute heart failure, according to the billing data.

This is a beautiful story of a high-schooler motivated by the desire to help others. This is the fundamental purpose of the healing arts.

IS advanced technical knowledge necessary to become an inventor? Look at the story of Katherine Bomkamp, and you will see that it isn’t.

Ms. Bomkamp, 20, came up with the idea behind the Pain Free Socket, a prosthetic device that is intended to ease phantom limb pain in amputees. The device, now awaiting a patent, works by applying heat to the amputee’s joint socket through thermal biofeedback. The theory is that as the nerve endings are warmed, the brain is forced to focus on the heat rather than send signals to the absent limb.

Now a sophomore at West Virginia University, Ms. Bomkamp was in high school when she began working on her invention. At the time, she had zero background in chemical or electrical engineering, which were essential to the creation of the device.

“It was all completely foreign to me. I had no interest in engineering before this,” said Ms. Bomkamp, who was a criminal-justice major at her magnet high school in Maryland. In college, she’s studying political science, with plans to attend law school.

Her experience shows how ambition, persistence and an ample supply of curiosity can lay the groundwork for achieving breakthroughs, even technological ones. (A bit of youthful pluck helps, too.) It also shows that drawing on other people’s experience and resources is often as good as, if not better than, doing everything yourself.

 

The big fourdrugs and drug classes are warfarin, oral antiplatelet medications, insulins, and oral hypoglycemic agents.

The study, published Thursday in the New England Journal of Medicine, highlights a couple of key issues doctors and patients need to be acutely aware of. The first is adverse reactions to medication, and the second is unintentional overdoses.

According to researchers, nearly 100,000 hospitalizations every year are linked to adverse drug events such as allergic reactions and unintentional overdoses. Nearly half, or 48.1 percent, of those hospitalized were adults 80 years old or older.

“These data suggest that focusing safety initiatives on a few medicines that commonly cause serious, measurable harms can improve care for many older Americans,” said lead study author Dr. Daniel Budnitz, director of the CDC’s medication safety program. “Blood thinners and diabetes medicines often require blood testing and dosing changes, but these are critical medicines for older adults with certain medical conditions.”

“Of the thousands of medications available to older patients, a small group of blood thinners and diabetes medications caused a high proportion of emergency hospitalizations for adverse drug events among elderly Americans,” he added.

The study comes as the Obama administration has sought to decrease the number of emergency room visits by upwards of 20 percent. The new healthcare law could results in nearly 32 million newly insured people visiting emergency rooms already crammed beyond capacity, according to experts on healthcare facilities. President Obama has urged preventative practices in order to lower the rate of emergency rooms visits.

This is a major story with implications for health reform’s potential to actually bend the spending curve, as its proponents have hoped: 

Sunday, a New York Times editorial confirmed that “Since January 2010 the growth in Medicare spending has actually slowed to an annual rate of about 4 percent, less than half the annual rate for the previous decade. No one is quite sure why, but one theory holds that hospitals are scrambling to squeeze a lot of fat out of the system even before the health care reforms pressure them to do it.”

 HealthBeat first reported the slowing of Medicare spending to 4 percent on August 12, noting that: ”While our elected representatives wrangle over slicing entitlements, virtually no one seems to be paying attention to an eye-popping fact: Medicare reimbursements are no longer accelerating at a break neck-pace. The new numbers should be factored into any discussion about healthcare spending:  From 2000 through 2009, Medicare’s outlays climbed by an average of 9.7 percent a year. By contrast, since the beginning of 2010, Medicare spending has been rising by less than 4 percent a year. On this, both Standard Poor’s Index Committee and the Congressional Budget Office (CBO) agree. (S&P tracks healthcare spending with the help of Milliman Inc., an independent actuarial and consulting firm.)

In that post, I quoted Zeke Emanuel, an oncologist and former special adviser for health policy to the White House Office:  “This is not mere chance: this is directly related to the initiation of health care reform.”  It is not the result of reform, Emmanuel emphasized.  The reform measures that will rein in Medicare inflation have not yet been implemented.  But, he explained, providers are “anticipating the Affordable Care Act kicking in.”  They can’t wait until the end of 2013: “They have to act today.  Everywhere I go,” Emanuel, added, “medical schools and hospitals are asking me, ‘How can we cut our costs by 10 to 15 percent?’

“This is doable, since there is so much fat in the system” added Emanuel, a doctor who is well aware of just how often pricey, but unnecessary tests and procedures hike medical bills, while exposing patients to needless risks.”

From the HealthLeader wellness site at University of Texas, Houston, a positive message:

In one of his first studies on gratitude, conducted with colleague Mike McCullough at the University of Miami, Emmons randomly assigned participants one of three tasks. Some were encouraged to feel gratitude indirectly, others to be indirectly negative and complaining, and a third group to be neutral.

Every week, participants kept a short journal. They briefly described either five things they were grateful for that had occurred in the past week, or the opposite, five daily hassles from the previous week that displeased them. The neutral group was asked to list five events or circumstances that affected them, but they were not told to accentuate the positive or negative. The results of this study at the end of 10 weeks:

• Participants in the gratitude group felt better about their lives as a whole and were more optimistic about the future than participants in either of the other control conditions—a full 25 percent happier.
• They reported fewer health complaints and even spent more time exercising than control participants.
• They had fewer symptoms of physical illness than the other two groups.
• The gratitude group exercised 1.5 hours more than the hassled group.

 

 

A fascinating article from the Washington Post:

This, it turns out, is nature’s way: The human cells that form our skin, eyes, ears, brain and every other part of our bodies are far outnumbered by those from microbes — primarily bacteria but also viruses, fungi and a panoply of other microorganisms.

That thought might make a lot of people lunge for the hand sanitizer, but that impulse may be exactly the wrong one. Researchers are amassing a growing body of evidence indicating that microbial ecosystems play crucial roles in keeping us healthy.

Moreover, scientists are becoming more convinced that modern trends — diet, antibiotics, obsession with cleanliness, Caesarean deliveries — are disrupting this delicate balance, contributing to some of the most perplexing ailments, including asthma, allergies, obesity, diabetes, autoimmune diseases, cancer and perhaps even autism.

“In terms of potential for human health, I would place it with stem cells as one of the two most promising areas of research at the moment,” said Rob Knight of the University of Colorado. “We’re seeing an unprecedented rate of discovery. Everywhere we look, microbes seem to be involved.”

That we are not only part of a larger, outer ecosystem but also contain a vast inner ecosystem needs to become a far more significant aspect of our health worldview.