Consider Smart Choices rather than Smart Toys this Christmas

Have you finished your Christmas shopping yet or are there still some people left on your nice list?!?

With only 8 shopping days left, SRxA’s Word on Health wants to help you make smart gift choices for the little people in your life.   Bridget Boyd, MD, a pediatric safety expert at Loyola University Health System offers up the following tips to ensure you bring joy, not tragedy, on Christmas morning.

“Christmas is a wonderful time of year, but it can quickly turn tragic if we’re not careful,” says Boyd. “Sometimes in our attempts to make Christmas extra special for our kids and grandkids, safety can get lost in the mix.”

Shopping for infants and toddlers can be difficult since many toys are labeled appropriate for ages 3 and up. Though it may limit the options, Boyd said following age-appropriate guidelines is important for keeping kids safe.

“Age labels are monitored closely and should be taken seriously. Choking and strangulation hazards can mean life or death to a child,” said Boyd. “Most people do follow the guideline to avoid small parts that might be choking hazards, but there are some safety tips that aren’t as obvious.”

She suggests when opening gifts to watch out for ribbons that could be a strangulation hazard and to try to keep older children’s gifts away from younger children so there is not accidental ingestion of a small part. Toys with strings are a choking hazard as well, especially those that are greater than 12 inches in length.

“If a child is under the age of 2, they are more than likely going to put whatever they are given in their mouth, so avoid items with paint, chemicals or small parts,” Boyd said. Small magnets and button batteries are some of the most hazardous. Magnets should be kept away from small children as they cause severe damage or even death if ingested.

“Button batteries are extremely dangerous so try to avoid gifts that include them. They also can be found in musical greeting cards, hearing aids and remote controls so make sure to keep an eye on your child around those items,” Boyd said. “Go to the emergency room immediately if a child has placed a button batter into their body. This includes swallowing as well as shoving up the nose or in the ear.”

Still, gift-giving safety isn’t just about swallowing hazards, it’s also thinking about the entire well-being of a child. “When thinking about what gift to give, try to find something that encourages children to use their imagination and get up and get moving,” says Boyd.

The American Academy of Pediatrics recommends children spend no more than two hours in front a screen a day. This includes video games, computers, phones and TVs. “So many young kids want cell phones, but is that really the best gift to give a child? Think about what is age-appropriate. There will be plenty of time to give phones and videos games in the future.”

And if you do give an electronic gift, supervision is key, especially if it involves the Internet.

Unfortunately, cyber predators and cyberbullying are becoming more common and pose a very real risk to children. If your child does receive a computer for Christmas, make sure you supervise their Internet use. The best place for a computer is in the family room.  There should be no screens, including computers, TVs or phones in a child or adolescent’s room. Screen time can interfere with sleep as well as distract them from participating in healthier activities for body and mind.

Whatever gifts you decide to give this holiday season, It’s also a good idea to periodically check consumer websites such as recall.gov and saferproducts.gov to ensure gifts are safe and have not been recalled.

Holiday Hellth!

For many of us the holidays mean family, feasting and fun.  But for our nation’s 18 million health care workers  – 28% of whom will be working on Thanksgiving, all celebrations will be placed on hold while they help those who are sick or injured.

And, as Christmas approaches, things don’t get any better.  The number of 911 calls and hospital visits spike as the temperatures plummet. For example, around 5,800 people are treated for holiday decorating injuries alone, each year. On top of this, the number one day for cardiac deaths is December 25th with December 26th and January 1st coming in a close second and third.

To raise awareness of the strain put on healthcare workers during the holiday season and some ways they can address it, Carrington College, has released these infographics:

Whatever you end up doing tomorrow, let’s not forget to say a word of thanks to our healthcare professionals. And if you do end up in their care be thankful they’re there.

Top Travel Tips To Ensure You Don’t Come Back With More Than You Left With

Passport. Check.

Tickets. Check.

Health. Huh?

That’s Right! For those of you planning to get away this summer, SRxA’s Word on Health reminds you get your health planning in before leaving for the airport.  While an overseas trip may appear to be “just what the doctor ordered” , it can also pose various health hazards, depending on the type of travel, length of stay and destination.

Significant changes in altitude, humidity and temperature can lead to illness, and in many parts of the world – especially developing countries and tropical locations – the risk of infectious disease is high.

“Not all countries are high-risk for travelers,” said Christopher Ohl MD, an infectious disease specialist at Wake Forest Baptist Medical Center in Winston-Salem, N.C. “Europe is generally safe, and so are Canada, Japan, Australia. But anybody planning to go to Mexico or Central America, the Caribbean, South America, Africa, most anywhere in Asia, or the Pacific islands should definitely look into what health risks they’ll encounter and what they’ll need to do to minimize their chances of getting ill.”

So where should you look for this information?  The Internet, of course, has a multitude of resources, some better than others, but you still need to be aware that even reputable sites such as those of the U.S. State Department, federal Centers for Disease Control and Prevention and World Health Organization offer only general information about the world’s countries and often do not include specifics about particular locations or activities within those countries.

For someone going to South Africa, there’s a big difference between staying in a modern hotel in Cape Town for a week and going on a two-week budget trip to Kruger National Park!

Because the details of an individual’s health, destination, activities, accommodations and mode of travel are important elements in determining health risk, a travel medicine specialist is probably the best person to consult

Travel clinics also stock the sort of vaccines and anti-malarial medications you’ll need and can advise on up-to-the-minute requirements.

In addition to administering shots and writing prescriptions, travel clinics also provide information on how to avoid insect-borne diseases, how to self-treat diarrhea and other common ailments, what to eat and drink and what to avoid eating and drinking and so on, all based on the person’s health status, where they’re going, what they’re going to be doing and how long they’re going to be there.

And because accidents, not diseases, are the most common cause of injury and death among travelers the clinic can also provide safety tips based on information from the State Department and authoritative foreign sources, such as whether there may be civil disturbances in a particular location, whether it’s advisable to travel at night or even “if it’s safe to rent a scooter.”

But don’t leave it until the last minute. Travelers, regardless of their age or the type of trip they’re planning should visit a travel clinic at least four to six weeks before departure, to allow sufficient time to get prescriptions filled and for vaccines to take effect. Even if the destination doesn’t call for any special shots, he said, a trip abroad presents a good opportunity to see that “routine” vaccinations such as measles-mumps-rubella, diphtheria-pertussis-tetanus, chickenpox and flu, are up to date.

And in the unfortunate event that you return home with something other than a suntan and souvenirs, travel clinics can also provide post-travel medical care. A number of diseases common overseas don’t present symptoms right away, some can even take months to develop, and they might not be recognized by a general practitioner.

Stay safe this summer!

 

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.

Is Your Doctor Burned Out?

Is life / work stressing you out?  Thinking about going to see your doctor for help?  Before making that appointment you may want to think again.

According to a national survey of physicians, released this week nearly 1 in 2 US doctors are themselves suffering from burnout.  That’s more than any other US workers.

Overtaxed doctors are not only at risk for personal problems, like relationship issues and alcohol misuse, but their job-related fatigue can also erode professionalism, compromise quality of care, increase medical errors and encourage early retirement – a potentially critical problem as an aging population demands more medical care.

Survey participants completed a 22-item Burnout Inventory questionnaire, which measured emotional exhaustion, depersonalization (treating patients as objects rather than human beings) and low sense of personal accomplishment. Of the 27,276 physicians asked to participate, 26.7% responded. They had to report only one symptom to be included among those reporting burnout.

Differences in burnout rate varied by specialty: While most people assume that the surgical or cancer specialties would be at highest risk, the researchers from the Mayo Clinic found that emergency medicine, internal medicine, neurology and family medicine reported the highest rates.

“Nearly 60% of physicians in those specialties had high levels of burnout,” says says lead author Tait Shanafelt MD. “This is concerning since many elements critical to the success of health care reform are built upon increasing the role of the primary care providers.”

On the other hand, doctors practicing pathology, dermatology, general pediatrics and preventive medicine had the lowest rates of burnout.

In other words, it’s the physicians on the front line of care who are most likely to burn out.

And that’s not all. When asked about emotional exhaustion, 37.9% of physicians reported signs, compared with 27.8% reported by other workers surveyed.

“The rates are higher than expected,”. Commented Shanafelt “We expected maybe 1 out of 3.

Being asked to see more patients and not having enough time to spend with them creates an atmosphere of being on a hamster wheel, says physician Jeff Cain, president-elect of the American Academy of Family Physicians.

While the current prevalence of burnout is alarming many predict it could get worse as health care reform takes hold and the medical profession has to take on the additional workload associated with the millions of patients who will be newly insured under the health care law.

While the Affordable Care Act will put more pressure on the front lines, this new study could be an important wake-up call. The country needs to hear to build multidisciplinary health care teams to meet the need and help unburden our poor put-upon physicians, so they in turn can help us.

The Doctor Won’t See You Now

US Pharma reps think they have it bad?  Then they should spare are thought for their poor beleaguered colleagues on the other side of the Pond!

According to an article in the industry journal PM Live,  time-pressured doctors in the UK are increasingly refusing to see pharmaceutical sales reps altogether.

A study undertaken by Doctors.net.uk in April 2012 surveyed more than 1,000 General Practitioner’s (GPs). They found that 52% of GPs did not see any pharmaceutical sales representatives in a typical week, while 26% saw only one pharma sales rep during that period.

Lack of time was the most common reason cited by GPs for not seeing pharma sales reps (38%). Other reasons included a practice “no-see” policy and a perceived lack of reps’ impartiality.

At the same time, they learned that doctors are turning to digital channels for independent product information. Nearly a quarter (23%) of the GPs surveyed said they preferred to find their own product information via independent online resources.

Doctors.net.uk said its findings follow earlier studies it conducted that show only 3% of doctors think online pharma resources are credible. Worse still 42% said they never visit pharmaceutical websites.

This research would appear to be in line with other trends among healthcare professionals.  European doctors’ use of iPads and other mobile devices is increasing and US pharma execs expect to increase their future spending on digital marketing channels.

SRxA can help Pharma companies to navigate the promotional maze and get the best bang for those pharma dollar bucks. Contact us today to find out more.

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?

Drugs That Can Land You in the Emergency Room

It’s midnight at the fire station and a call goes out for a patient who has overdosed. In addition to an ambulance and medic unit, police are dispatched.  As we stage for the police, to ensure that the scene is safe, we speculate as to what we’re going to encounter. Will the patient be conscious? What sort of emotional distress has driven them to this? Is it a serious attempt or a cry for help?  Will there be weapons?

As we mentally run through all types of scenarios, it’s doubtful that many of us have considered that our patient will be an 82 year old great grandmother armed with nothing more than her reading glasses and the remote control.

But increasingly that’s what we might find.  As Americans live longer, we have an increasingly frail population suffering from a greater number of chronic conditions, taking more medications than ever before. Among adults 65 years of age or older, 40% take 5 – 9 medications and 18% take 10 or more.

This type of polypharmacy is associated with an increased risk of adverse events. Older adults are nearly seven times as likely as younger persons to have adverse drug events that require hospitalization.

According to a recent article in the New England Journal of Medicine blood thinners and diabetes drugs cause most of the unintentional overdoses that lead to emergency hospitalization in older patients.

Researchers reviewed the records of 100,000 hospitalization events due to major drug side effects in people aged 65 and above from a representative sample of 58 hospitals.  Almost half, (48%) of adverse drug event (ADE)-related hospitalizations occurred in patients older than 80.

The drugs they looked at included prescription and over-the-counter medications, vaccines, and dietary supplements.

Adverse events were categorized as allergic reactions, undesirable pharmacologic or idiosyncratic effects at recommended doses, or unintentional overdoses.  Other effects included problems due to medication-delivery methods (e.g., choking) and vaccine reactions. Visits for intentional self-harm, drug abuse, therapeutic failures, and drug withdrawal were excluded.

Shockingly, just four medications accounted for more than two-thirds of emergency hospitalizations:

• warfarin (a blood thinner to prevent clots) – 33%
• oral antiplatelet agents (for heart attack prevention) – 13.3%
• insulin (for diabetes) – 13.9%
• oral hypoglycemic agents (for diabetes) -10.7%

Given that emergency hospitalizations caused by ADEs result in significant morbidity and enormous costs it’s not surprising that decreasing harm to patients and reducing costs by preventing re hospitalizations is a goal of the $1 billion federal initiative Partnership for Patients.

Achieving a 20% reduction by the end of 2013 may sound ambitious, but in fact there are a number of simple steps that we can take.

1. Make sure that everyone taking medications has an up-to-date list, including all prescribed drugs as well as vitamins, herbs, and OTC medicines. Copies of the list should be kept in their wallet and should be shared with all doctors they see so that the potential for drug interactions can be assessed and avoided.
2. Alert your loved ones that blood thinners and diabetic medicines account for 50% of hospitalizations due to ADEs. Blood thinners and diabetes medications should be regularly monitored by the primary care physician.
3. Encouraging medication compliance can lengthen a person’s lifespan. Too many times patients stop their medications due to a comment made by a well-meaning friend who has  read something on the Internet. Often the doctor is not informed and the patient may not understand the positive effects of the medication or the dangers of stopping them suddenly.

These small measures may not only save the life of your elderly loved-ones, but they may also  reduce your Word on Health bloggers’ middle of the night 911 dispatches.

Is prescription drug spending sky-rocketing out of control?

Are prescription costs raising your blood pressure?

According to the latest news and numbers from the Agency for Healthcare Research and Quality (AHRQ) they may well be.  Figures, just released, show that insurers and consumers spent $52.2 billion on prescription drugs for outpatient treatment of metabolic conditions such as diabetes, hypertension, high-cholesterol, obesity and thyroid disease.

The four remaining top therapeutic classes of outpatient prescription drugs were:

• Central Nervous System ($35 billion)
  • i.e. chronic pain, epilepsy, Parkinson’s Disease
• Cardiovascular drugs ($29 billion)
  • i.e. calcium channel blockers and diuretics
• Antacids, & other medicines for gastrointestinal conditions ($20 billion)
• Antidepressants, antipsychotics & other psychotherapeutic drugs ($20 billion)

In 2008, purchases of metabolic drugs by adults age 18 and older accounted for 22% of the total $233 billion spent to buy prescription drugs.

To put this number in perspective, $223 billion would buy you either 1,000 brand new 747 jumbo jets; 137 new space shuttles or 495 space shuttle missions!