Partners in Health calls for community health worker networks fight ebola

Leave it to Dr. Paul Farmer to use the word “optimistic” in reference to the Ebola epidemic. Writing in the Globe op/ed section, he and Joia Mukherjee, chief medical officer of Partners in Health, call for the kind of community health worker programs they use to fight another raging epidemic — drug-resistant tuberculosis.

Community care could, when coupled with infection control, stop the epidemic. Of course, the region needs more treatment units for the sort of care that can only be provided in an in-patient setting. And hospital care can be improved long-term only by training and equipping Sierra Leoneans and Liberians: the staff and the “stuff” required to save lives. But it also needs to provide the tools that smaller clinics and front line health workers need to fight the virus in their neighborhoods and villages…

Years ago, when Partners in Health first engaged in fighting another deadly epidemic — drug-resistant tuberculosis — our colleague Jim Yong Kim (now president of the World Bank) and others referred to it as “Ebola with wings.” We learned then, in settings from the slums of Lima to the mountains of Lesotho, that community-based care, delivered in large part by community health workers, was not only safer than facility-based care, it was also more effective. This was true when caregivers had the staff, stuff, space, and systems required to prevent, diagnose, and treat tuberculosis with the tools of the trade. “Community-based care” does not mean “community-based no care”: that, we’re providing already, and at large scale

Cats, dogs and bacon to make you laugh, then think at the 2014 #IgNobel awards

2014-Ig-Nobel-poster-150Much for pet and bacon lovers at this years Ig Nobels, which were awarded Thursday night. Go to the source for worldwide coverage  or check out Carolyn Y. Johnson’s blog post for the Boston Globe.  

Thursday night at Harvard University, Nobel laureates took the stage to hand out the Ig Nobels, a satirical version of the Nobel prizes, which will be announced in early October. This year, the prizes were awarded in 10 disciplines, ranging from the physics prize for at last explaining why banana peels are slippery, to the medicine prize for using strips of cured pork to stop a gushing nosebleed

 Public Health: The award was split between two teams for an investigation of the mental hazards of owning a cat.

Czech researchers chronicled personality changes in young cat ladies and documented a decline in I.Q. and adventure-seeking behavior by men who were infected by toxoplasmosis, a parasite commonly found in cat excrement. A US team scoured medical records from 1.3 million patients and found that depression was relatively common among women who had reported being bitten by cats, and that screening those who had bitten by pets might be fruitful.

 Biology: A team of Czech and German researchers are being honored for their finding that when dogs poop and pee, they prefer to squat with their bodies facing in a north-south line. Even silly results aren’t trivial to arrive at: the team observed 70 dogs, from 37 breeds. That’s nearly 2,000 defecations and 5,582 urinations over two years of smelly observation.

Also, a nod to Our Lady of Perpetual Condensation:

 Neuroscience: In “Seeing Jesus in Toast,” a team from China and Canada have clinched the neuroscience prize with an exploration of a phenomenon called face pareidolia, in which people see nonexistent faces. First, they tricked participants into thinking that a nonsense image had a face or letter hidden in it. Then, they carefully monitored brain activity in the participants they managed to convince, to understand which parts of our minds are to blame.

 

 

Will reporting requirements slow the spread of malpractice reform?

downloadA recent HHS ruling applies to a Massachusetts malpractice law promoting a new approach to dealing with medical errors.

From Health Leaders Media. 

Hospitals and health systems—not state lawmakers—will have to review their malpractice resolution programs in response to a recent Health and Human Services Department opinion on malpractice laws in Oregon and Massachusetts.

Both state programs encourage doctors to disclose medical errors, and to apologize and work with patients on potential out-of-court settlements. In response to a complaint about the Oregon law, HHS has ruled that payments under the programs need to be reported to the National Practitioner Databank.

New Hampshire recently adopted a similar approach and doctors in Georgia are working on a proposal. However, much of the activity in what one researcher calls “second-generation” malpractice reform is occurring at the hospital level, not at the state house level.

The programs go by different names: medical injury dispute resolution, sorry laws, disclosure and early offer, communication and resolution.

Supported by evidence? Mobile health screening gets scrutinized

My latest for HealthLeaders Media looks at Public Citizen charges that a health screening program overstates the promise of its services. Public Citizen takes issue with company claims that cardiac screening saves lives. After issuing am initial statement criticizing Public Citizen as proponent of “government-run health care”, HealthFair now says it wants to work with regulators to ensure the accuracy of its advertising.

The debate over screening for heart disease and other conditions is playing out in a consumer group’s campaign to get hospitals to cut ties with the mobile screening company HealthFair Health Screening.

Last week, Public Citizen expanded its campaign by asking the Federal Trade Commission to investigate whether HealthFair’s promotional materials amount to deceptive advertising.A handful of hospitals have discontinued their relationships with Florida-based HealthFair after Public Citizen’s Health Research Group (HRG) accused the company of “fear-mongering.” In June, Public Citizen contacted HealthFair’s hospital clients and The Joint Commission to complain that company overstates the health benefits of its screening programs.      

Memory altering research the stuff of sci-fi, cinema and Sherlock

In the BBC’s Sherlock, the title character –played by Benedict Cumberbatch — often resorts to his “mind palace” to piece together nebulous memories.

In the film Eternal Sunshine of the Spotless Mind, a character played by Kate Winslet goes to a clinic to get  painful memories of a relationship erased.

.photoA bit of a stretch, but add Frank Booth’s gas sniffing psycho from the film Blue Velvet, and you pretty much find nods to all the research Carolyn Y. Johnson talks about in her Globe column this morning. 

In research published Wednesday in the journal PLOS ONE, McLean Hospital researchers took rats that had learned to fear a tone because it was followed by a foot shock and erased the negative memory, by having them breathe xenon gas. In a separate study, Massachusetts Institute of Technology scientists reported in the journal Nature they were able to use cutting-edge genetic tools to alter the emotional context of a memory, allowing them to replace the negative memory of receiving a mild electric shock with the pleasurable one of mingling with mice of the opposite sex.

That adds to a body of research from MIT over recent years that has shown that administering a drug can wipe out a negative memory in mice, or that it is possible to trigger an existing memory or plant a false one using genetic manipulation.

 

 

The Boston Globe series that Steward Health took to court — before the stories ran

The Globe’s narrative story about one man’s struggles with his mental health care is running this week. And the company that runs one of the hospitals where he was treated was not allowed to read it first.ssLast week:  

A Suffolk Superior Court judge ruled Thursday that Steward Health Care System has no right to review the reporting or records collected by The Boston Globe for a yet-to-be-published article about a man’s journey through the mental health care system.

Judge Jeffrey Locke said the for-profit health care company may comment broadly to the newspaper and answer limited questions on the patient’s care without violating medical privacy laws.

Steward, in a suit filed against the Globe Wednesday, asked the court to permit release of the patient’s private medical records, which the company said it needed to rebut a Globe story that is scheduled to be published this weekend.

The hospital chain also served papers to the man profiled in the story. Read the full story above a full run-down of the legal contortions hospital lawyers performed to argue that they were not going after the patient or trying to repress the story.

This is more about more than a thin-skinned story subject.  Health care reporters seeking comment or information for stories can come up against overly broad interpretations of patient privacy laws.  Worth watching.

Finally, a question: What would The Cheescake Factory do? 

 

NYTimes story on #readmission prevention coaches features Rhode Island program

From the NY Times New Old Age Column:

The transitions coach ducks into your mother’s hospital room for a brief introduction before she’s discharged. The coach explains that her job is to help keep patients safe at home and asks if she can call to set up a home visit.

Health researchers know that transitions — the hand-offs from one setting to another, as in hospital to home — often go awry.

“It’s so abrupt,” said Dr. Eric Coleman, a geriatrician at the University of Colorado, Denver (and a certified McArthur Foundation genius). “For three days people do everything for you, and then, 11 minutes before you leave, they turn the tables. ‘Nowyou take over.’ ”

Your parent is often sleep deprived and medicated at the time; little wonder that nationally, about one Medicare patient in five returns to the hospital within a month…

To lower that figure, Dr. Coleman began developing the Care Transitions Intervention program 15 years ago. If patients agree, a coach comes to their homes two to four days after discharge. She’s not there to change dressings or help them bathe; home health nurses or aides do that. Instead, over 45 minutes to an hour, the coach — generally a nurse, sometimes a social worker or other health care professional — asks about patients’ goals as they recover.

Here’s the RI program mentioned in the story.

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