Blog

Assuring Patients Can Receive Timely Quality Care

New York physicians continue to pay liability premiums that far exceed those in any other state. After liability premiums for New York physicians shot up 55-80% between 2003 to 2008 before the Legislature intervened to impose rate freezes in 2008 and 2009, medical liability premiums have continued to steadily rise. Many New York physicians continue to pay outrageous liability premiums that far exceed $100,000, and some even exceed $300,000! The cost of medical liability coverage for the 2014-15 policy year was:

• $338,252 for a neurosurgeon in Nassau and Suffolk counties;
• $186,639 for an OB/GYN in Bronx and Richmond counties;
• $132,704 for a general surgeon in Kings and Queens counties; and
• $134,902 for an vascular surgeon or cardiac surgeon in Bronx and Richmond counties.

Malpractice payouts in New York State continue to be far out of proportion to the rest of country. For example, in 2013, according to a report by Diederich Healthcare and reported in the March 15, 2014 Washington Post, New York State had by far and away the highest number cumulative medical liability payouts ($689,800,300), nearly two times greater than the state with the next highest amounts, Pennsylvania ($356,855,500), and far exceeding states such as California ($274,590,800) and Florida ($199,442,450). Additionally, New York State had by far and away the highest per-capita medical liability payments in the country, far exceeding the second highest state Pennsylvania by 57%, the third highest state New Jersey by 67%, and the fourth highest state Massachusetts by 74%.

We can no longer sustain such an expensive, inequitable, and fatally flawed medical liability adjudication system if we wish to assure that our healthcare system will be able to accommodate the demand that will inevitably come as our population ages and becomes more resource-dependent, as well as the nearly 1,000,000 newly insured patients who are starting to receive coverage through New York’s new health insurance Exchange. We need comprehensive reform of our flawed civil justice system and reduction in our medical liability costs, not legislation that increases costs and exacerbates existing problems.

We support legislation to create alternative systems for resolving medical liability cases, such as medical court or a Neurologically Impaired Infants No-Fault fund. We also strongly support legislation to enact medical liability tort reforms enacted in other states which would: place reasonable limits on non-economic damages; identify and assure qualified expert witnesses; eliminate joint and several liability; identify a physician supplying a Certificate of Merit; immunize statements of apology or regret; and provide immunity for physicians providing pro bono care.

Preventing Untenable Expansions of Liability MSSNY will continue to strenuously oppose any measure to expand the damages recoverable in medical liability actions, including legislation that would: • Create a “date of discovery” rule for New York’s statute of limitations for medical liability actions – Estimated to increase premiums by 15%;

• Expand “wrongful death” damages to permit “pain and suffering” – Estimated to increase premiums by 53%;
• Permit the awarding of pre-judgment interest – Estimated to increase premiums by 27%;
• Eliminate the current statutory limitations on attorney contingency fees in medical liability cases – Estimated to
increase premiums by over 10%;
• Prohibit ex-parte interview by defense counsel of the plaintiff’s treating physician;
• Change loss-share rules regarding non-settling defendants.
Enactment of any of these measures would have calamitous consequences on our health care system. Efforts to reform our medical liability adjudication system must be comprehensive!

Anorexia Nervosa – The Eating Disorder That Causes Weight Loss

Categorized as an eating disorder, anorexia nervosa is a disorder that causes the individual to lose a lot of weight over a brief period. The weight loss is very dramatic and affects the health of the person to a great extent. The Body Mass Index (BMI) is used in this regard to establish whether the affected person is in the healthy range for weight for the respective age and height.

Eating disorders such as anorexia nervosa make the patient fearful of weight gain even if they are tremendously underweight. These patients resort to all kinds of methods to keep extra pounds at bay, including exercising a lot, eating less or not eating at all, and throwing up frequently to make sure their stomachs stay empty.

The causes of anorexia nervosa

Researchers have still not been able to uncover the precise reason for the development of this condition. Yet many factors are known to play an important role in the etiology of this illness. Some of the reasons include genetics, a combination of environmental, and stress-related incidences, and social and cultural factors; such as having an unrealistic standard of beauty and perfection.

What is known is that when individuals become anorexic, they are doing so as a matter of control.  They are unable to manage certain factors in their life, so they choose to control their body. They govern their food intake so they can control something in their life.

Anorexia nervosa risk factors

Some of the risk factors for the development of anorexia include being too worried about putting on some pounds even if you are in the right range of weight, having a history of anxiety disorders in the family, feeling bad about your appearance, eating problems while young, 

The beginning of anorexia occurs in pre-teens or teenage years, especially in girls. You are likely to come across many anorexic girls who belong to a family of high achievers and have a set code of how life ‘should’ be.

The symptoms of Anorexia nervosa

There are some clear indicators of medical weight loss caused by anorexia nervosa. Certain signs indicate the presence of disorders such as anorexia (especially in youngsters). The signs include the urge to go to the toilet immediately after meals, drastic reduction of portion sizes, exercising even when injured, refusal to eat in front of others, resorting to diuretics to lose water weight, frequent use of diet pills or laxatives, yellow skin caused by lack of hemoglobin, poor judgment, and slow thinking and an increased tendency towards depression.

How to overcome Anorexia nervosa disease

In order to evaluate the extent and nature of medical weight loss in an anorexic patient, the tests carried out include serum electrolytes, urinalysis, albumin, total body protein, bone density test, thyroid function test, complete blood count, kidney function test, electrocardiogram, and liver function test.

The main focus of the medical practitioner should be making the patient understand that they have a clinical disorder that is ruining all aspects of their life. This is necessary because it is quite normal for patients with anorexia illness to deny the fact that they have a medical condition.

Building up the patient’s self-esteem and helping him/her get healthy will take some time. However, persistence will enable the patient to overcome the disease/ medical weight loss caused by anorexia.

For more information and how you can help, please visit the National Eating Disorders Association. Donations can be made here.

 

Senior Citizens are Living Longer, Better Lives

Happy Senior Citizens
Will the health care industry be able to keep up with the growing elder population?

According to a study from researchers at Harvard University, people are living longer due to major advancements in medical technology. In view of this, the aging population has been a source of great concern for the already-overworked healthcare industry. A study from the Hudson Valley Pattern for Progress found that hospitals in New York’s Hudson Valley region are not prepared to meet the demands of the aging population; however, a number of nursing homes are preparing for the additional patients that will be coming.

What the Study on Senior Care Suggested

Under lead advisor Daniel Z. Aronzon, MD, former chief executive officer of Vassar Brothers Medical Center in Poughkeepsie, the organization compiled a 92-page report entitled “Aging in the Hudson Valley: Is the Healthcare System Ready?”

According to the report, the region should prepare for a greater need for providers to handle the capacity and better facilitated end-of-life care, among other changes that will be necessary to continue providing quality care for the region’s population.

“Models of increased consolidation and integration in other parts of the country, which result in better outcomes and lower costs, provide valuable lessons in the Hudson Valley’s pursuit of better healthcare,” the authors wrote.

Costs of Upstate Health Care for Senior Citizens

The report also pointed out that the median daily cost for skilled nursing facilities in Hudson Valley could be as high as $405 for Putnam, Rockland, and Westchester counties.

Based on data from the New York State Department of Health’s Resident Health Care Facility Bed Need – 2016 report, Hudson Valley will have to increase beds in skilled nursing facilities by 93.10% in order to meet the growing needs.

Antibiotics Use Linked to Type 1 Diabetes

Type 1 diabetes is an autoimmune disease diagnosed in young adults and children, sometimes referred to as juvenile diabetes. Out of 30 million people diagnosed with diabetes in the US, only about 5 percent are diagnosed with type 1 diabetes. Type 1 is not understood very well, what we do know is that both genes and environment are a factor. Type 1 diabetes is known to have spiked following World War II and is thought to have been the after effect of food rationing during this time. Worldwide today, type 1 diabetes is increasing by 3 percent every year.

New Research is Discovering an Association Between Diabetes and Antibiotics

In the recent years, a rise in antibiotics prescriptions has also been linked to chronic illness as well as antibiotic resistance. One study even found that antibiotics have been prescribed to children about twice as often as they should be. From acne to viral infections, it seems that antibiotics overuse is a widespread problem.  

A recent study published in the Nature Microbiology journal this week has found the first link between type 1 diabetes and antibiotics use. The study took place at the New York University Langone Medical Center and was led by Dr. Martin Blaser.

In the study, one group of mice was given low dose antibiotics similar to the dose children receive and one group of mice was given no antibiotics. Over time, the gut bacteria of the mice given antibiotics showed huge change which also affected the mice’s immune system. The mice given antibiotics also developed type 1 diabetes. These results evidently show that doctors need to think twice before prescribing antibiotics to children. “They carry not only the risk of resistance, which is a cost to the whole community, but possibly health risks to the child,” said Blaser. This preliminary study shows that the findings will no doubt influence the future of pediatrics and the way in which antibiotics are prescribed. “We’re eager to see how these findings may impact the discovery of type 1 diabetes preventative treatments in the future and continued research in the area of vaccines,” said Jessica Dunne, the director of Discovery Research at Juvenile Diabetes Research Foundation.

The American Diabetes Association (ADA) has called it the ‘Perfect Storm’ and in one excerpt of their abstract, they state “the provision of antibiotics, such as fucidic acid, Colistin, and Bactrim, in BB rats after weaning (8,9) lead to diabetes prevention, whereas in our own efforts using the NOD mouse, a decreased frequency of type 1 diabetes was observed with the administration of doxycycline. The specific mechanisms of how such therapies modulate disease are unclear, but it is clear that changes in the microbiota affect the development of autoimmune diabetes in both animal models.”

Five Facts About the Zika Virus

 How does the virus spread?

The virus mainly spreads by the Ae. aegypti mosquito found in the tropical and sub-subtropical areas of the Americas. However, due to climate change, the mosquito species known as Ae. albopictus has been moving into North America as well, it’s been found as far north as the Great Lakes. This mosquito usually bites in the morning and late afternoon.

Which Areas are Affected?

The Zika virus is mostly found within the tropical equatorial belt. Historically, it has existed in parts of Central Africa, India, and Indonesia. The 2015-2016 outbreak has caused the most concern in Central America and northern regions of South America. Since the outbreak, Zika has been reported in Colombia, French Guiana, Mexico and Venezuela as well as many more South and Central American countries. Nations worldwide have strongly advised people to rethink any travel plans they’ve had for affected regions.

What is microcephaly?

Microcephaly is a neurodevelopmental disorder linked to the Zika virus, typically defined by the sufferer having a head circumference two or three standard deviations below the mean average for his or her age and gender. Microcephaly can cause abnormal growth of the brain and is especially dangerous for newborn babies. The condition often leads to severely impaired intellectual development and can cause problems with motor functions and speech development.

Who is in danger?

Pregnant women have been identified as particularly in danger of the virus. Some countries are already advising women to avoid becoming pregnant at all. In El Salvador, Jamaica, Colombia and Ecuador, women have been advised to delay conception until at least 2018. In the US, officials have specifically advised pregnant women to avoid travel to Zika affected countries.

How do you know if you’ve been infected?

Even though there is no specific test widely available to identify the Zika virus, the disease’s symptoms are similar to those experienced during Dengue or Yellow fever. If you’re at all suspicious that you have been infected with Zika, a blood or tissue sample must be sent to an advanced laboratory within the first week of infection. Initial symptoms are usually mild with only 1 in 5 people infected experiencing any notable difference including fever, rashes and joint pain.

 

 

Obama Considers New Best Practices for Nursing Homes

President Obama Speaking at the Conference on AgingThe federal government is considering a new rule that would improve the care and safety of the 1.5 million patients living in more than 15,000 long-term care facilities or nursing homes in the US.

The current requirements for Medicare and Medicaid participation have not been reviewed or updated since 1991. Since that time there has been extensive evidence-based research that has enhanced knowledge of resident safety and health outcomes.

“In light of these changes, we recognized the need to evaluate the regulations on a comprehensive basis, from both a structural and a content perspective,” according to the rule.

A proposed rule being considered by the Department of Health and Human Services would create best practices for nursing homes that participate in Medicare and Medicaid programs. The rule would require staff be properly trained on caring for patients with dementia and preventing elder abuse.

The rule also would require facilities improve their care planning and provide more food choices. Nursing homes would also be required to update infection prevention and control programs.

“These proposed changes are necessary to reflect the substantial advances that have been made over the past several years in the theory and practice of service delivery and safety,” HHS wrote in the rule. “These proposals are also an integral part of our efforts to achieve broad-based improvements both in the quality of health care furnished through federal programs, and in patient safety, while at the same time reducing procedural burdens on providers.”

President Barack Obama initiated the call for improved regulations at 2015 White Conference on Aging. The president is working to bring nursing facilities towards utilizing the current trends in medical technology.

In an excerpt from the deliverable, “The 2015 White House Conference on Aging is harnessing technology to bring today’s conversation to communities across the country.  Hundreds of watch parties are happening across every state in America and are being hosted by organizations such as AARP, the National Association of Area Agencies on Aging, Service Employees International Union (SEIU), the Diverse Elders Coalition, Leadership Council of Aging Organizations members, and numerous cities and counties.”

Many nursing homes are already on this course, but the new regulations will ensure that these rules are followed across the board.

 

Tests and Treatments Older Americans Should Question

The American Geriatric Society (AGS) has released an updated list of recommendations that will raise awareness about treatments and tests that may lack efficacy and even cause potential harm. The list is part of the ABIM Foundation’s Choosing Wisely campaign. More than 70 societies have released recommendations of test and treatments that patients and providers should question.

The updated list from AGS reflects new research on conditions affecting older adults, such as agitation, certain types of cancer, delirium, dementia, diabetes, and insomnia. Based on new research and insights, these topics may warrant deeper discussions on the appropriate healthcare choices, according to AGS.

“Providing high-quality care to older adults means recognizing and responding to the specific, evolving challenges and opportunities that we all face as we age,” Wayne C. McCormick, MD, MPH, AGSF, president of the AGS, said in a statement. “Since 2012, the AGS and the ABIM Foundation have worked together through Choosing Wisely to synthesize pressing updates from the geriatrics field in a format that is easy to understand—and apply—in everyday practice.”

AGS has updated 7 specific tests, treatments, or procedures based on emerging expert opinion. For instance, lung cancer screening have been added to the list of oncological screenings that should not be recommended for older adults without first considering life expectancy and the risks associated with testing, overdiagnosis, and overtreatment. In addition, when recommending moderate blood-glucose control for older patients with diabetes, medications other than metformin should be avoided.

AGS continues to recommend avoiding antipsychotics as the first choice treatment for behavioral and psychological symptoms associated with dementia. This guidance has been expanded based on new data. The AGS panel of experts determined that antipsychotics provide “limited and inconsistent benefits” and include the risk of oversedation, worsening memory problems, and increased likelihood of falls, strokes, and mortality.

The Society also added new guidance:

  • Pursuing oral-assisted feeding for patients with advanced dementia instead of a “percutaneous” feeding tube threaded through the skin into the stomach
  • Not using antibiotics to treat patients who have bacteria in their urine (a condition known as bacteriuria) unless certain urinary tract symptoms are present
  • Conducting a treatment regimen review before prescribing medication

“As the older adult population in the US continues to grow, it’s so important that geriatrics care principles reflect the latest science, evidence, and advice supporting quality health and care,” said Paul Mulhausen, MD, MHS, FACP, AGSF, who chaired the AGS Choosing Wisely Workgroup responsible for the list. “We are grateful to the ABIM Foundation for this opportunity to share timely recommendations that will help patients avoid unnecessary tests and procedures and support overall well-being.”

Zika May Cause Brain Damage in Adults Too

Most of the concern surrounding the Zika virus has centered around pregnant women and the birth defects that develop in babies who were infected in the womb. However, adult brain cells are not completely safe.

In rare cases, it was known that Zika was linked to Guillain-Barré syndrome, which can result in paralysis and death. People experiencing Guillain-Barré tend to recover about 6 to 8 weeks after symptoms, such as tingling and muscle weakness that spreads throughout the body, begin. Now, new research has found evidence that adult brain cells critical to learning and member may be at risk, as well.

“Based on our findings, getting infected with Zika as an adult may not be as innocuous as people think,” Joseph Gleeson, MD, adjunct professor at Rockefeller, head of the Laboratory of Pediatric Brain Disease, Howard Hughes Medical Institute investigator, and co-author of the study, said in a statement.

A study published in Cell Stem Cell found that mice infected with the Zika virus showed neural progenitor cells were susceptible to the virus. Most adult neurons are resistant to the virus, but some replenish and are vital for learning and memory. The researchers found that the virus may have the same ability to infect adult neural progenitor cells as it does regarding fetal neural progenitor cells.

The results of the research, conducted only in mice, are only a first step, though. More research is needed to find the effect on an adult brain and to see if the mice model translates to humans. The researchers are also looking to find if the damage to adult brain cells can result in long-term damage.

“Zika can clearly enter the brain of adults and can wreak havoc,” Sujan Shresta, PhD, study co-author and a professor at the La Jolla Institute of Allergy and Immunology, said in a statement. “But it’s a complex disease—it’s catastrophic for early brain development, yet the majority of adults who are infected with Zika rarely show detectable symptoms. Its effect on the adult brain may be more subtle, and now we know what to look for.”

Coffee Benefits Among Colon Cancer Patients

Hot coffee on a plate
Photo: Creative Commons

Cancer Prevention Overview

HealthDay, a popular medical health digital magazine reported that the Gastrointestinal Cancer Center at the Dana-Farber Cancer Institute did a study of about 1,000 patients and found that “Those who drank coffee regularly had a better disease-free survival, meaning they had a lower rate of having their cancer recur or of dying.”

And another study published by the National Institute of Medicine reinforced the concept that drinking coffee is beneficial in helping to reduce the risk of other forms of cancer as well.

The Coffee Colon Factor

Hot Coffee
Photo: Pixaby

In addition, Dr. Charles Fuchs who helped lead the study said “But I do think it would be reasonable to conclude that it could be the caffeine in coffee that is affecting the colon cancer pathway. It’s just that for now we can’t say for sure. We need to confirm these findings in other patient populations.”

He added that patients who drank other caffeinated beverages like soda had “a poorer outcome,” and decaf coffee and tea did not produce the same benefits.

And the Dana-Farber Cancer Institute stated that “Regular consumption of caffeinated coffee may help prevent the return of colon cancer after treatment and improve the chances of a cure.”.

The New York Times reported that colon cancer patients who consumed higher volumes of coffee each day “had a far lower risk of dying or having their cancer return than those who did not drink coffee.”, referring to the same research. The study showed promise that “significant benefits” began with two or three daily cups of coffee, and patients who consumed four or more each day “had half the rate of recurrence or death than non-coffee drinkers.”

Additional reports stated that the scientists said until additional research is conducted, “people should not begin drinking coffee if they aren’t already java drinkers,” and those who do drink it should not increase their intake.

Psychological Care of Aging People

Taking Care of the ElderlyWith aging, elderly people require a lot more attention and care. One of the most important areas of care is their psychological well being. It is not uncommon for senior citizens to be depressed, having mood disorders, feeling lonely or having other psychological problems. Additionally, they may be suffering from dementia. All these issues adversely affect their physical health. The whole process of mental and physical health deterioration ruins their healthy aging cycle, leaving them sad and unhappy. Things can me made much better for aging people by proper and attentive psychological care. Here is how we can go about it:

Understanding the Process of Aging

The process of aging is not easy. From complete independence, the person loses a lot of personal dependence and strength, and becomes reliant on others; sometimes even the most basic needs. The body does not work as fast as it used to, the senses depreciate, and the brain becomes weak. It is very difficult for the elderly to come to terms with all these changes, during which many are exposed to psychological issues. The ones taking care of aging people need to understand the process of aging. This will help them to look at their concerns and behavior from a much better and understandable perspective.

Be Considerate

The challenges that aging brings forth require a lot of patience from the care taker’s side. While taking care of an elderly, be considerate of their needs and the changes that they are going through. They would be going through decline in their sensory abilities, so keep that in mind while communicating with them and attending to them. Speak a bit louder, but politely. Hand them things carefully. Help them with eating, drinking and dressing if they need assistance with that.

Do Not Imply Yourself

They have lived a life on their own, and having to be told what to do may not be taken so well in aging. Leave some authoritative space for the elderly to make choices and decisions. Let them feel that they are still in power, they can decide. This will help them retain dignity and self respect and take aging process positively. Do not try to impose your decisions on them; instead ask them in a manner that they automatically make the right call.

Make Them Feel Included

The main reason why people are prone to psychological problems like depression, mood disorders, hallucinations, etc., is because they don’t feel included in their social surroundings. They are often ignored in conversations even if they were present in the same room. This leads to a lot of self doubt and speculation. They feel lonely and unwanted. So make them feel a part of family. Include them in conversations and seek their opinion just like you normally would ask any other person. Don’t discredit their input.

Aging is a challenging course. But with help from caretakers, it can be made easy for the people who are going through the process. It only requires consideration and empathy.