It's the Time of Year...To Take Grandpa to the ER?

Ah, the holidays. They're a time for gathering together, enjoying homemade goodies...and taking Grandpa to the ER?

Dr. Tamara Kuittinen, director of medical education in the Department of Emergency Medicine at Lenox Hill Hospital in New York, is reporting that, over the years, she and her colleagues have seen definite increases in the numbers of elderly patients seeking treatment at the emergency room during the holidays. They attribute this to two causes:

1. Relatives often don't stay up-to-date with their loved one's health throughout the year. When they get together for the holidays, they're shocked at their elderly family member's condition.


2. Children of aging parents aren't totally aware of how the normal aging process takes its toll.

In both of these situations, Kuittinen said, family members might become alarmed and rush their loved one to the hospital, sometimes needlessly.

Dr. Kuittinen and her colleagues recommend taking the following steps throughout the year to help relatives keep track of their loves ones' health:

• Maintain a database of up-to-date critical medical information about your loved ones.
• Make sure your loved one has easy access to emergency contact numbers.
• Discuss the possibility with your loved one of creating a living will or healthcare proxy.

The doctors also suggest contacting the loved one's physician for advice before taking them to the emergency room to avoid the risk of being exposed to infections or unnecessary tests.

OSHA: Yes, You Need Respirators

OSHA has issued a new compliance directive designed to minimize or eliminate high-risk exposures to H1N1. The directive very closely follows the CDC's guidance.

According to the directive's news release, "In response to complaints, OSHA inspectors will ensure that healthcare employees implement a hierarchy of controls, and encourage vaccination and other work practices recommended by the CDC."

The release continues, "Where respirators are required to be used, the OSHA Respiratory Protection standard must be followed, including worker training and fit testing."

OSHA is backing the CDC's recommendation that respiratory protection that is at least as protective as a fit-tested disposable N95 respirator be used by healthcare employees who are are in close contact (within six feet) of people who have suspected or confirmed H1N1.

If respirators are not commercially available in a given area, employers will be considered in compliance if they can demonstrate that a good faith effort has been made to acquire them. If inspectors determine that a facility has not technically violated an OSHA requirements, but could implement additional measures to better protect employees, they may provide a "hazard alert" letter that outlines suggested measures to further protect employees.

Need Another Reason to Treat Sleep Apnea? How about a Better Golf Score?

A new study, presented at the CHEST 2009 meeting in San Diego, has found that golfers with sleep apnea can shave strokes off their golf game as well as improve their overall health by treating the medical problem.

In the study, participants who received nasal positive airway pressure (NPAP) lowered their golf handicap by as much as three strokes. The study's authors note that sleep apnea can cause sleepiness, fatigue and cognitive impairment, all of which can affect a golfer's game.

To truly be effective, NPAP needs to be used regularly. Studies have reported that men comply with treatment only about 40 percent of the time. However, the current study's authors reported a compliance rate above 90 percent, something they attribute largely to the participants' desire to improve their golfing. This apparently outweighs discomfort, inconvenience, cost, noise and embarrassment, all of which are commonly cited reasons for noncompliance.

Congratulations to Team Mather!

Congratulations to Team Mather, who were crowned the victors at this year's AAHSA Chef Challenge!

The contest featured chefs from Aramark, Morrison, Mather and Sodexo and took place over the course of three days. Each day, contestants had an hour to create a three-course meal using a secret ingredient.

The Mather Pavilion is located in Evanston, Illinois, a suburb of Chicago.

Let's Stomp Out Smoking!

Good luck to those taking part in the Great American Smokeout today! Stay strong!

FDA Zeroes in on Fraudulent H1N1 Products

The FDA is warning that consumers shouldn't always believe what they read online - especially when it comes to H1N1 products. So far, the agency has been alerted to 143 products that fraudulently claim to diagnose, prevent or cure H1N1.

Consumers can click here to view a list of products that "are or were illegally marketing unapproved, uncleared or unauthorized products in relation to the 2009 H1N1 Flu Virus."

The products listed on the site aren't necessarily ones that the FDA hasn't approved - they're just not approved for uses related to H1N1.

Today is World COPD Day!

Today is the eighth annual World COPD Day! The goal of the day is to spread awareness about COPD and and improve COPD care througout the world. To learn more, click here.

FDA: Be Vigilant with Negative Pressure Wound Therapy

The FDA has issued a public health notification about the potential complications, especially bleeding and infection, associated with negative pressure wound therapy. According to the notification, the FDA has received reports of six deaths and 77 injuries associated with NPWT.

Rather than steer healthcare practitioners away from NPWT, however, the FDA is advising that they remain vigilant about following manufacturers' instructions and carefully select the patients who receive treatment. Caregivers should also be prepared to immediately address any complications that might arise from NPWT.

While NPWT is commonly used to manage wounds, burns, ulcers, flaps and grafts, there are a number of situations in which it should not be used. Those include:

• Necrotic tissue with eschar present
• Untreated osteomyelitis
• Non-enteric and unexplored fistulas
• Malignancy in the wound
• Exposed vasculature
• Exposed nerves
• Exposed anastomotic site
• Exposed organs

If you suspect that a reportable adverse event related to an NPWT system has occurred, the FDA urges you to follow the reporting procedure established by your facility.

To view the notification in its entirety, click here.

What Do You Think of the New Breast Cancer Screening Recommendations?

The U.S. Preventive Services Task Force has turned conventional wisdom about breast cancer screening on its ear with its new recommendations.

The recommendations include:

• Recommending against routine mammograms for women between 40 and 49 years old (This is a "C" recommendation, which has this definition: "The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.")
• Mammograms every two years for women between 50 and 74 years old (This is a "B" recommendation: "The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.")
• Recommending against clinicians teaching patients to perform breast self-exams. (This is a "D" recommendation: "The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits."

The task force also notes that current evidence is insufficient in order to assess the additional benefits and harms of performing mammograms on women 75 years or older, clinical breast examination beyond screening mammography in women 40 years and older and digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.

The task force also notes that "the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."

This is a big change from current recommendations. What do you think? Will these recommendations help or harm the quality of care that patients receive? Or will the difference be negligible? We'd love for you to weigh in!

Wound Care Clinics in SNFs? Not a Bad Idea, Experts Say.

Many skilled nursing facilities already offer rehabilitation services - so is it crazy to think that freestanding wound-care clinics are far behind? Not really, according to an article in McKnight's Long-Term Care News.

Some experts believe that SNFs are in a great position to establish themselves as wound care specialists "based on the volume of cases, experience in detecting nuances of pressure ulcers and success rates in healing advanced wounds," according to the article.

The article encourages any SNF thinking about creating a commercial wound care segment to think about what really constitutes a quality program: "clinical expertise, full complement of products, innovative treatment options, high-caliber staff training methods and consistently excellent outcomes."

According to the article, other things that SNFs should examine when they consider creating a wound care clinic include:

• Is the clinical team able to handle additional patients?
• Does the facility have the right skilled staff? Experts recommend having a physician team that includes a surgeon, podiatrist and dermatologist.
• Are you using wound care products that maximize value without sacrificing clinical efficacy? Some products might cost more, but if they deliver results in five days rather than 10, they create savings in staff time.
• Do you have protocols in place to measure the results of your facility's wound care? If so, you can use these results to connect with key referral sources in hospitals and the physician community.

To view the article in its entirety, click here.

ProMed's Cookie Monsters

ProMed held a cookie competition today! We had 15 awesome entries, but in the end one cookie garnered the most votes and was declared the winner. And which cookie was that, you ask? Well, you're just going to have to wait for the debut issue of Embrace. We'll be publishing the winning cookie recipe and a short bio of the chef!

AHCA: Treat Chronic Pain as a Public Health Crisis

The AHCA is supporting a new report that calls on government agencies, the medical community and Congress to treat chronic pain as a public health crisis.

The report recommends that federal, state and local agencies adopt a fairer regulatory approach toward controlled prescription drugs. States are being tasked with striking a balance between reducing drug abuse and addressing unrelieved pain.

According to the report, many states still have laws with outdated requirements that reflect "poor medical practice."

We Had a Great Time Meeting You at AAHSA!

Team ProMed thanks all of you who stopped by our booth at AAHSA! We had a wonderful time and the convention, and the highlight was meeting and talking to so many of you. We also wanted to share a few of the pictures we took. As you can see, Captain Compliance was a popular attraction at the show!

Can Statins Help Prevent Flu Death?

This might be the one time that having high cholesterol works to your favor.

An Oregon Public Health Division study of 2,800 patients during the 2007-'08 flu season found that people who were taking statins to manage cholesterol were twice as likely to survive the flu than those who weren't taking the drugs.

The reason? A lot of damage caused by the flu comes from inflammation, a condition that statins have long been known to reduce.

The report went so far as to suggest that statins might be a good treatment for influenza, and one that could be less expensive than treatments like Tamiflu.

The study was presented at the 2009 annual meeting of the Infectious Diseases Society of America. The meeting was held October 29-November 1 in Philadelphia.

Study: Lifestyle Changes Can Reduce Dementia Risk

A new study is casting doubt on the theory that there's little people can do to halt the development of Alzheimer's disease if they're genetically predisposed to it.

Researchers found that while 60% of an individual's risk of developing Alzheimer's is genetic, the rest of the risk might be due to changeable lifestyle factors. Specifically, high blood pressure, clogged arteries and pro-inflammatory cytokines were cited as potentially contributing to Alzheimer's development.

As one of the researchers put it, "It is important to realize that early interventions could prevent late-onset Alzheimer's disease."

The study was published in the November 2009 issue of Archives of General Psychiatry.

Come Visit Us at AAHSA!

We loved seeing current customers and meeting new people on Day 1 of AAHSA! Stop by the ProMed booth (#2666) and find out what we're all about!

Time is Ticking for Illinois Admininstrator License Renewal and CEUs

Illinois nursing home administrators who haven't already renewed their licenses might need to hurry up. The two-year renewals, issued through the Illinois Department of Financial and Professional Regulation, are due November 30.

Administrators renewing their licenses are required by law to obtain 36 CEUs between December 1, 2007 and November 30, 2009. Administrators who obtained their first administrator's license after December 1, 2007 will be allowed to renew their licenses without the CEUs, but they will have to get the CEUs for future renewals.

Information on how to renew a license can be found here. Licenses can be renewed online using a Visa, Mastercard or Discover card.

Aggressive Osteoporosis Prevention Plans Could Drop Hip Fracture Rate by 25%

A study at Kaiser Permanente found that more active disease management could potentially cut the rate of hip fractures in the U.S. by at least 25%. The study, published in the Journal of Bone and Joint Surgery, found that the key to this prevention is orthopaedic surgeons taking a more active role in osteopororis disease management.

The current rate of treatment after a fragility fracture is only 20%. Comparatively, treatment at Kaiser Permanente in Southern California is now 68%. Kaiser Permanente's Healthy Bones Program identifies at-risk patients using Kaiser Permanente HealthConnect, the world's largest civil electronic health record database. A multidisciplinary team, including orthopedic surgeons and providers from endocrinology, family practice, internal medicine, rheumatology, gynecology, physical therapy, disease/care management, radiology and nursing education ensures that at-risk patients get the bone density screenings and medications they need.

“The most important thing an orthopedic surgeon should know about osteoporosis/fracture prevention is that we can take action that helps to prevent hip and other fragility fractures,” said Dr. Richard Dell, the study's lead author. “Simple steps like suggesting calcium and vitamin D for all your patients and bone mineral density testing in patients at higher risk for osteoporosis should be considered part of your daily practice.”

Help Noah Have a Special Last Christmas

We're touched by Noah Biorkman's story. This five-year-old has terminal cancer and isn't expected to survive through the holidays. His family is trying to gather as many Christmas cards as possible for him to help make his last Christmas special. Can you send a card and bring a smile to his face? Cards can be sent to:

Noah Biorkman

c/o 99.5 WYCD

2201 Woodward Heights Blvd.

Ferndale, MI 48220-1511

(photo: wycd.com)

Unused Medicines: To Flush or Not To Flush?

The FDA recently launched a new Web page designed to let consumers know which unused medicines are safe to toss out with the trash and which need to go down the sink or toilet.

According to the site, almost all medicines can be safely thrown out with household trash after they are mixed with something unpalatable (i.e., kitty litter or used coffee grounds) and sealed in a container such as a plastic bag. However, there are some medicines that are especially harmful or even fatal in a single dose if they are taken by someone other than the person for whom the medicine was prescribed. These medicines should be flushed down the toilet or rinsed down the sink to eliminate the possibility that they could be swallowed by a child, pet or other household member.

You can also contact your local government to find out if your community has a drug take-back program and which drugs are accepted.

Click here for a list of drugs that the FDA recommends flushing. You can also visit Drugs @ FDA for specific drug labeling product information. Click here for Drugs @ FDA.

New MRSA Strain Is Deadlier, More Focused on Elderly

Researchers at Henry Ford Hospital have found that a particular strain of MRSA is five time more lethal than other strains - and it seems to be targeting older patients.
The strain is also more resistant to vancomycin, the potent drug used to treat MRSA.

The average age of patients with the strain, known as USA600, is 64. The average age of patients with other MRSA strains is 52. According to the study, USA600 has unique characteristics that could possibly be linked to the high mortality rate. The study found that 50 percent of patients who were infected with the strain died within 30 days, compared to 11 percent of patients with other strains of MRSA.

The majority of MRSA infections occur in hospitals and other healthcare settings, but a growing number are being acquired by otherwise healthy people outside of those settings.

NAWC Launches Redesigned, Reinvigorated Web Site

The National Alliance of Wound Care has launched its redesigned Web site, and it's packed to the gills with timely, valuable info for wound care certified (WCC) nurses.

One of the site's hottest additions is its Job Resource Center, which allows users to post their CVs anonymously for employers who are looking to hire WCCs. It also offers a glimpse at open positions.

Other site features include:
- A new look and user-friendly design
- Instant WCC certification verifications
- A networking search that connects WCCs
- Answers to FAQs
- Links to wound care resources
- Downloadable handbooks for certification and recertification candidates

America's Best Nursing Homes Named

U.S. News & World Report has released its annual ranking of America's Best Nursing Homes. How does your facility measure up?

Residents Have Achy Knees? Try Tai Chi!

A recent study conducted at Tufts revealed that tai chi can reduce pain and improve physical function, self-efficacy, depression and health-related quality of life for seniors with knee osteoarthritis.

The study examined 40 patients with a mean age of 65, all of whom had knee osteoarthritis. The subjects who were randomly assigned to 60 minutes of tai chi twice weekly for 12 weeks reported a significantly greater reduction in pain than those assigned to the control group.

Congrats to Gary Hill, a Team ProMed First-Time Grandfather!

Team ProMed would like to congratulate Gary Hill, Senior Key Accounts Manager, on becoming a first-time grandfather! His grandson, Landyn, was born on October 30 and weighed in at 8 pounds, 7 ounces. His proud parents are Meghan and Brent Miller.

Congratulations to Gary and Landyn's entire family!