Don’t Fall into a Fear of Falling This Fall

As we transition from summer to fall, don’t let a fear of falling keep you from being active.  That’s the alliterative advice of Helen Lach, Ph.D., associate professor of nursing at Saint Louis University School of Nursing.  And she should know!  Lach specializes in gerontological nursing, and has studied ways to prevent falls for more than 20 years.

“While falls can cause problems, we want people to be both cautious and still maintain an active quality of life,” Lach said. “You can’t get rid of all of the risk in your life. But older adults need to maintain their strength, function and activity to the level they are able.”

Lach recently wrote a review article that appeared in the Journal of the American Medical Directors Association that showed fear of falling is a significant problem in nursing homes.

“People in nursing homes tend to be frailer and have more health problems and physical limitations than older adults who are in the community,” Lach said.

“The fear of falling can stop some nursing home residents from doing anything, even participating in their own daily care. They become frozen in inactivity, which makes them depressed and bored. They get more out of shape, which creates more health problems that actually increase their risk of falling.”

Lach notes that the fear of falling is part of a cycle that can lead to a frailty and a downward spiral in health.

“As people do less, they become less able to engage in activities. They have difficulty moving around, and their gait and balance deteriorates. This puts them at an increased risk of falling, which unfortunately means the fear of falling actually becomes a self-fulfilling prophesy.”

It’s important that nursing home staff members recognize that about half of residents have such a deep fear of falling that they limit their activities, and develop a way to assuage those fears. Exercise programs offered in a safe and supportive environment can be valuable in helping residents feel better – both physically and psychologically.

Senior adults who aren’t in long term care facilities also may need to confront their fear of falling. Tai Chi, walking, weight training and simple exercises to increase muscle strength – such as practicing sitting and standing to strengthen leg muscles or standing on one foot with a chair at arm’s reach can make a world of difference.

Good Advice for all of us.

Healthy Trends for Digital Health

Doctors and patients are increasingly tapping, zooming, and clicking in a flurry of connectivity.  According to Fred Pennic author of HIT Consultant’s Mind Blowing HIT Stats and Trends:

• 85% of US Physicians own or use any smartphone professionally
• 62% of US physicians own a tablet
• 81% of physicians own an iPad
• 50% of tablet owning physicians have used their device at the point of care
• 39% of US physicians communicate online with patients via email, secure messaging, instant messaging, or online video conferencing
• Two-thirds of physicians use online video to learn and keep up to date with clinical information
• 88% of physicians would like patients to be able to track or monitor their health at home

Physicians spend an average of 11 hours online for professional purposes per week. And those with three screens (tablets, smartphones, and desktops/laptops) spend more time online on each device and go online more often during the workday than physicians with one or two screens.

In addition to communicating with patients, most doctors say they wish they could wirelessly access electronic medical records, prescribe, monitor both in- and out-patients and track patient referrals.

And it’s not just doctors. Patients and consumers are at it too!  Health related Google searches are up 47% from last year, and:

• 20% of patients would like to monitor their fitness & wellbeing
• 18% would like to allow a physician to remotely monitor a condition
• 80% of Internet users look online for health information
• 20% search for health related content on mobile devices
• 23% use social media to follow health experiences of friends

Even more mind-blowing…in 2012 consumers were willing to spend $14 Billion on digital health products. This included $700 Million on mobile health applications, $4 Billion on health related video games and $8.9 Billion on resources rating doctors & hospitals.

No word from Fred on how much of their health information people are getting from blogs such as Word on Health. But with thousands of views each day, and increase in readership of >100% versus 2011, we certainly seem to be part of this upwards digital healthcare trend.

Where do you get your healthcare information? We’d love to hear from you.

Doctors Deficient in Anaphylaxis Care

Having just returned from the American College of Allergy, Asthma and Immunology (ACAAI) annual meeting, we’re spoiled for choice of news. But among all the science there was one stand out shocker.  In a session on Sunday, physicians presented the results of a survey, sponsored by the Asthma and Allergy Foundation of America (AAFA). During this, they revealed that a disturbingly high proportion of primary care and emergency physicians don’t know how to treat anaphylaxis.

Interviews with 318 physicians indicated that:

• substantial numbers do not always provide epinephrine to patients – even those  they believe are having anaphylactic reactions
• they often fail to refer anaphylaxis patients for follow-up care
• they believe incorrectly that some patients should not receive epinephrine auto-injectors

Myron Zitt, MD, says the results reveal “likely deficiencies in physician knowledge,” and corroborate results from earlier chart review studies.

In the telephone-based survey, researchers conducted interviews lasting an average of 19 minutes with approximately 100 emergency room physicians, 100 allergists, 50 adult primary care physicians, and 50 pediatricians.

82% to 99% of respondents in each group said they had treated at least one anaphylaxis case.

Although epinephrine is supposed to be given to all patients having such reactions, about 10% of emergency room physicians and 20% of primary care and pediatric physicians said they had done something else.  These “something else’s” included prescribed another drug, sending the patient to a hospital, or an “other” action.

Prescribing of auto-injectors for patients to take home also was far from universal. Barely 60% of emergency room physicians said they did. In fact, emergency physicians were generally bad at all phases of follow-up care. They rarely referred patients for diagnostic tests, they almost never demonstrated use of an auto-injector, and seldom explained that auto-injectors have an expiration date.

Another disturbing finding from the survey, Zitt said, was that many physicians of all types – even the allergists – mistakenly believed that some patients should never receive epinephrine.

In the same session, Akhil Chouksey, MD, reported that anaphylaxis care in a major teaching hospital usually failed to meet guidelines established by a consortium of allergy societies including the ACAAI.  In a 10-year review of anaphylaxis cases only 15% met the standards of care recommendations i.e. that epinephrine be administered within 30 minutes of triage, that auto-injectors be prescribed at discharge, and that patients be referred to an allergist or immunologist for follow-up investigations and treatment.

The review also found that in 26% of cases in which anaphylaxis was definitively confirmed, the patients never received epinephrine.  Antihistamines, such as benadryl (diphenhydramine), were given in nearly all cases but epinephrine was omitted in one-quarter. In fact, epinephrine was only the third most commonly administered medication, with corticosteroids such as methylprednisolone, taking the second spot after antihistamines.

During the question-and-answer period, an audience member suggested that, when patients present with relatively mild symptoms, the treating physicians may decide that epinephrine isn’t needed at that point.  Zitt countered, that this was a very dangerous approach.

The national guidelines state explicitly that there are no absolute contraindications to epinephrine. Nevertheless, 16% of the pediatric allergists and 32% of the other allergists said there were such contraindications, as did 38% of adult primary care and emergency physicians.

Also common were beliefs that schools, restaurants, and ambulances always stock epinephrine. In fact, Zitt said, there are no general requirements for schools or restaurants to do so, and approximately half of all ambulances do not have epinephrine on hand.

Clearly there is much work still to be done in terms of education.  SRxA’s Word on Health suggests a first step would be to instill a healthy fear of anaphylaxis into doctors and the general public while simultaneously removing the fear of epinephrine.

Or as Dr Zitt says, “Give epinephrine first, ask questions later.”

Does Your Doctor ‘Get You’?

Does your doctor understand you? Does he (or she) know what you’re thinking? Does he really feel your pain? In short, does he care?

Seems this is something you should really care about. According to a study just published in Academic Medicine, patients of doctors who are more empathic have better outcomes and fewer complications.

Researchers from Thomas Jefferson University together with a team from Parma, Italy evaluated relationships between physician empathy and clinical outcomes among 20,961 Italian diabetic patients and their 242 physicians.

The study was a follow up to a smaller one undertaken at Thomas Jefferson University that included 891 diabetic patients and 29 physicians, and showed that patients of physicians with high empathy scores had better clinical outcomes than patients of other physicians with lower scores.

“This new, large-scale research study has confirmed that empathic physician-patient relationships is an important factor in positive outcomes,” said Mohammadreza Hojat, Ph.D., Research Professor in the Department of Psychiatry and Human Behavior and the Director of Jefferson Longitudinal Study at the Center.  “It takes our hypothesis one step further. Compared to our initial study, it has a much larger number of patients and physicians, a different, tangible clinical outcome, hospital admission for acute metabolic complications, and a cross-cultural feature that will allow for generalization of the findings in different cultures, and different health care systems.”

The Italian researchers used the Jefferson Scale of Empathy (JSE) –an instrument used to measure empathy in the context of medical education and patient care. The JSE includes 20 items answered on a seven-point scale (strongly agree = 7, strongly disagree = 1) and measures understanding of patient’s concerns, pain, and suffering, and an intention to help.

The primary outcome measure of the study was acute metabolic complications, including hyperosmolar state, diabetic ketoacidosis, and diabetic coma. These were used because they require hospitalization, can develop quickly, and their prevention is more likely to be influenced by the primary care physicians.

A total of 123 patients were hospitalized because of such complications. Physicians with higher empathy levels had 29 : 7,224 patients admitted to the hospital, whereas physicians with lower levels had 42 : 6,434 patients admitted.

There are many factors that add to the strength of the study. Firstly, because of universal health care coverage in Italy, there is no confounding effect of difference in insurance, lack of insurance or financial barriers to access care.

“What’s more, this study was conducted in a health care system in which all residents enroll with a primary care physician resulting in a better defined relationship between the patients and their primary care physicians than what exists in the United States,” said co-author Daniel Z. Louis.

According to the Centers for Disease Control and Prevention, over 25 million people in the U.S. population have been diagnosed with diabetes, with almost 700,000 hospitalizations per year. There are approximately 2 million new cases per year. Worldwide, the number of total cases jumps to 180 million.

“Results of this study confirmed our hypothesis that a validated measure of physician empathy is significantly associated with the incidence of acute metabolic complications in diabetic patients, and provide the much-needed, additional empirical support for the beneficial effects of empathy in patient care” said Dr. Hojat. “These findings also support the recommendations of such professional organizations as the Association of American Medical Colleges and the American Board of Internal Medicine of the importance of assessing and enhancing empathic skills in undergraduate and graduate medical education.”

Does your doctor get you? Let us know.

FDA Ad Study: Clarifying the Confusion

As a public health agency, the FDA encourages the communication of accurate health messages about medical conditions and treatment.  One way the pharma industry does this is through non-branded disease awareness communications. These are aimed at either the general public or health care practitioners and discuss a particular disease or health condition, without making mention of any specific drug.  Usually, they encourage consumers to seek, and health care practitioners to provide, appropriate treatment for the particular disease state.

This is helpful for under-diagnosed and under-treated diseases such as depression, hyperlipidemia, hypertension, osteoporosis, and diabetes. Some research has shown that consumers prefer disease awareness advertising. It’s considered more informative and less persuasive than full product advertising.

The pharma industry likes it too.  Disease awareness communications are not subject to the regulations and restrictions mandated by the FDA for prescription drug advertising.

But now, the FDA is concerned that disease awareness ads might confuse consumers. According to a Federal Register notice issued on June 20, the agency wants to know whether the public can distinguish between product claims and disease information, and how different types of information impact comprehension.

So worried in fact,  the Agency has planned a study entitled, “Experimental Study: Disease Information in Branded Promotional Material” to look into those questions.

The study will examine print ads for three conditions – COPD, lymphoma and anemia.

4,650 American adults will be divided into three groups and asked to review the ads electronically.

• One group will see information about the disease that avoids discussion of disease outcomes the drug has not been shown to address i.e.  “Diabetes is a disease in which blood sugar can vary uncontrollably, leading to uncomfortable episodes of high or low blood sugar.”
• Other participants will see disease information that mentions consequences of the disease that go beyond the indication of the advertised product, such as, “Untreated diabetes can lead to blindness, amputation, and, in some cases, death.”
• A third group will see drug product information only.

Disease information will be presented in different ways. For example, on alternating paragraphs, on separate pages or in different fonts and colors from product claims.

Specifically the study will address whether or not consumers are able to distinguish between claims made for a medication and general disease information when they see an advertisement for a drug.  For example, if an ad for a drug that lowers blood glucose, mentions diabetic retinopathy do consumers  think the drug will prevent the affliction, even if no direct claim is made?

The Agency says: “If consumers are able to distinguish between disease information and product claims in an ad, then they will not be misled by the inclusion of disease information in a branded ad. If consumers are unable to distinguish these two, however, then consumers may be misled into believing that a particular drug is effective against long-term consequences.”

SRxA’s Word on Health looks forward to seeing the results. Given that warning letters have been issued in the past over ads that contain mixed messages, this is an opportunity for the FDA to revisit its stance toward such advertising, reduce consumer confusion and, most importantly, learn how best to disseminate useful health information.

Whoa, whoa, whoa, whoa – Washing at the Handwash!

A few years ago the Centers for Disease Control and Prevention (CDC) estimated that about 1.7 million patients get a hospital acquired infection each year. Of these, 99,000 die. More recently they estimated that infections develop in about 1 to 3 out of every 100 patients who have surgery.

Separately, a new study just presented at the annual meeting of the Association for Professionals in Infection Control and Epidemiology (APIC) found that preventing further complications in patients who develop infections after hip or knee replacement surgery could save the U.S. health-care system as much as $65 million a year.

Hardly surprising then, that the pressure is mounting to reduce hospital-acquired infections. Some of this is being driven by Medicare who has started reducing  payments for hospital readmissions.

Infection-prevention specialists are now focusing on new practices and products to minimize patient exposure from the environment as well as from medical procedures and surgical instruments.

For example, Baycrest Geriatric Healthcare System in Ontario, were able to reduce the rate of transmission for the staph infection MRSA by 82% over a 33-month period by bathing patients daily with germ-killing cloths.   The cloths are presoaked with a powerful antimicrobial agent – chlorhexidine gluconate, which reduces organisms on a patient’s skin and leaves a residue that lasts up to six hours.  Baycrest, also screens all patients on admission to determine if they are colonized with MRSA on the skin, indicating the organism is present on the body but not yet causing an infection.

Many other innovative  infection-prevention ideas were suggested at the APIC “film festival”, which featured short videos including music, drama, dance, humor and animation to promote adherence to best practices.

SRxA’s Word on Health particularly liked the winning video “Scrub-A-Dub Dub”, which features Jerry Herman a former patient from the All Children’s Hospital in St. Petersburg, FL, along with his twin brother, Josie.

The 10-year-old, who spent several months in the ICU, almost totally paralyzed by Guillain-Barré Syndrome, reinforces proper hand-washing technique among staff, patients and families.

Can a hip-hop song improve health?  We think maybe it can.

A Question of Health

As we’ve said before, and will doubtless say again – the more patients become more actively involved in their own health, the better the outcome.

So we were pleased to learn of a new public education initiative from the U.S. Agency for Healthcare Research and Quality (AHRQ), which encourages patients to have more effective two-way communication with their doctors and other clinicians.

The “Questions are the Answer,” campaign features a website packed with helpful advice and free educational tools for doctors and patients. Among the offerings:

• A 7-minute video featuring real-life patients and clinicians who give firsthand accounts on the importance of asking questions and sharing information. The video has been designed for use in a patient waiting room area and can be set to run on a continuous loop
• A brochure, titled “Be More Involved in Your Health Care: Tips for Patients,” that offers helpful suggestions to follow before, during and after a medical visit
• Notepads to help patients prioritize the top three questions they wish to ask during their medical appointment.

In addition, the site has a series of patient and clinician videos in showing how simple questions can help you take better care of yourself, feel better, and get the right care at the right time. In one of these, Rachelle Toman, M.D., Ph.D., a family physician from Washington D.C., says if you are happy to ask your doctor and grocery store clerk a question, then why not your healthcare provider?

“Patients need to come forth with questions, and providers need to be open about asking their patients questions, and asking their patients to ask questions,” she continues.

Put simply, questions allow doctors to take better care of you.

Are you ready to become an active member of your health care team and get your questions answered?

Spanx Takes a Spanking

Spanx has been in the news a lot lately. First, Forbes magazine announced that Sara Blakely, founder of the women’s slimming undergarments company, had joined the billionare’s club this year. At age 41, and having started her business at home with just $5,000, Blakely is now the world’s youngest self-made female billionaire.

Last month, Oscar winning actress Octavia Spencer, hit the headlines when she revealed, what she’d not been revealing!  Turns out, when she took home the SAG Award for Outstanding Actress in a Supporting Role for The Help, she’d been wearing three pairs of Spanx under her gown.

Now it seems the trend has spread from the red carpet to the green turf. This week, ConsumerReports.org warned of the dangers of teens in Spanx. The on-line watchdog reported the tale of a 15-year-old high school soccer player who was recently referred to her doctor because of numbness, tingling, and discomfort in her left thigh that had bothered her for a few weeks. The diagnosis: a compressed nerve in her pelvis. The likely cause: Spanx. While doctors have previously warned of the health dangers associated with skinny jeans, such as  fertility problems , bladder infections , and blood clots the doctor in question was surprised that a girl so young and fit would wear Spanx. It turns out that her entire team wears them under their soccer uniforms.

Body slimmers are the latest fad to hit the athletic fields. Sold in an assortment of bright colors, they appeal to teenage girls who play soccer, lacrosse, and softball. However, in an attempt to conceal their spandex, these girls are rolling down the waistline of their Spanx and unwittingly pressing a tight band of Lycra into their groins. The result: injuries normally associated with direct trauma or repetitive stretching and contraction of the groin muscles. The treatment: in this case, the doctor advised his patient to ditch the Spanx, and retire her skinny jeans. Not that Sara Blakely needs to worry, according to Forbes, her billion dollar business is set to at least double in size in the coming years.

Improving Inhaler Instruction

Many of us have never been properly trained on how to do or use certain things we really should be good at. Putting on condoms and wearing seat belts are just two that come to mind.  And when we get them wrong, the health consequences can be serious.

The same goes for asthma inhaler use.  Do you shake the device first? Did you breathe in with sufficient force? Did you press the canister at the right time?

Improper use of inhalers is a serious and expensive problem. In the US, 3 patients are admitted to the emergency room with asthma every minute, that’s >5,000 people a day!  Worse still, according to the Asthma and Allergy Foundation of America, 11 people die from asthma every day.

One study estimated up to 94% of patients use their inhalers incorrectly.  The most common mistakes include failure to exhale before actuation, failure to breath-hold after inhalation, incorrect positioning of the inhaler, incorrect rotation sequence, and failure to execute a forceful and deep inhalation. Those of us in healthcare have even seen patients who fail to take the cap off the inhaler before use, and others who use it nasally rather than orally.

This is hardly surprising given that many patients never receive instructions on how to use their inhalers and even those that do, are not routinely followed.  And let’s face it, some of these devices could use training wheels.

Enter the T-Haler, a digital asthma inhaler training device  developed by researchers at Cambridge Consultants.

Patients with asthma can use the inhaler and, via interactive software linked to the wireless device, get real-time visual feedback on the areas that need improving.

Specifically, whether patients have shaken the device before breathing in; whether they use sufficient force when breathing in; and whether they press down the canister that releases the drug at the optimal time. Click here to see a video of the T-haler in action.

Although still a conceptual product, the company says it has been designed as a training device to be available at pharmacies, schools, and clinics for children and adults alike.

They performed a study on 50 people aged 18 – 60 who had no prior experience with either asthma or inhalers and were given no instruction on how to use an inhaler. When tested, about 80% of the participants used an inhaler incorrectly.

They were then given the T-Haler with no further instruction and told to begin. A three-minute on-screen tutorial guided them through the proper use of an inhaler, and the success rate tripled to more than 60%.

“Without any human direction beyond the word ‘go’, participants went from around a 20% success rate without training to a success rate of more than 60% after only three minutes with the T-Haler device,” said Kate Farrell, a senior design engineer, in a news release. “This is more than twice the compliance rate we have seen in other studies with trained participants. Interestingly, a week later, 55 percent were still correctly using the device-showing that they retained what they learned.”

Whether the T-Haler itself will ever make it to market remains to be seen, but the concept of a 3-minute training device seems a no-brainer when it comes to properly using a device that may very well save the lives of the estimated 235 million asthma sufferers worldwide.

Who’s to blame for your allergies?

Are you one of the 35 million Americans who suffer from seasonal allergies? If so you’re probably not cheering the official end of winter.  But before you start blaming Persephone – goddess of Spring, for your symptoms you may want to look a little closer to home.

Many of the everyday things you’re doing, from what you eat to how you clean your home may be interfering with relief from your stuffy nose, sneezing, sniffling or other symptoms.

“People with spring allergies often don’t realize how many things can aggravate their allergy symptoms so they just muddle along and hope for an early end to the season,” says allergist Myron Zitt, M.D.“But there’s no reason to suffer. A few simple adjustments in habits and treatment can make springtime much more enjoyable.”

The American College of Allergy, Asthma and Immunology (ACAAI) advises people with spring allergies to be on the lookout for five things that can aggravate suffering.

1. Eating fruits and vegetables – Many people with seasonal allergies also suffer from pollen food allergy syndrome (also called oral allergy syndrome), a cross-reaction between the similar proteins in certain types of fruits, vegetables and the allergy-causing pollen. 1:5 people with grass allergies and as many as 70% of people with birch tree allergies suffer from the condition, which can make your lips tingle and swell and your mouth itch.

If you’re allergic to birch or alder trees, you might have a reaction to celery, cherries or apples. If you have grass allergies, tomatoes, potatoes or peaches may bother you. Usually the reaction is simply annoying and doesn’t last long. But up to 9% of people have reactions that affect a part of their body beyond their mouth and almost 2% can suffer a life-threatening anaphylactic reaction.

2. Using the wrong air filter – Using an air filter to keep your home pollen-free is a good idea, but be sure it’s the right kind. Studies show inexpensive central furnace/air conditioning filters and ionic electrostatic room cleaners aren’t helpful – and in fact the latter releases ions, which can be an irritant. Whole-house filtration systems do work, but change the filters regularly or you could be doing more harm than good.

3. Opening your windows – When your windows are open, the pollen can drift inside, settle into your carpet, furniture and car upholstery and continue to torture you. So keep your house and car windows shut during allergy season.

4. Procrastinating – You may think you can put off or even do without medication this spring, but the next thing you know you’re stuffed up, sneezing and downright miserable. Instead, get the jump on allergies by taking your medication before the season gets under way.

5. Self medicating – Perhaps you’re not sure exactly what’s making you feel awful so you switch from one medication to the next hoping for relief.

This spring, your best bet is to see an allergist, who can determine just what’s triggering your symptoms and suggest the most appropriate treatment.