Fight Kidney Stone Development with Calcium, Water

"Kidney stones." The words are enough to make you cringe - and now a new study has found that older women whose diets include too little calcium or water (or too much salt) are at an increased risk of developing them.

Kidney stones develop when a person's urine contains more crystal-forming substances than can be diluted by available fluid. These substances can include calcium, uric acid and oxalate.

The researchers gathered data from more than 78,000 U.S. women in their 50s and 70s. They found that the risk of developing first-time kidney stones declined as calcium or fluid intake climbed. On the other hand, the odds went up with higher sodium intake.

Since calcium is one of the substances that can cause crystals to form in the kidneys, it might be surprising that increasing calcium can lower kidney stone risk. However, recent studies have found that dairy foods actually protect against kidney stone development - although calcium supplements might not be wise for known "stone formers."

To learn more, click here.

ObamaCare: What Now?

The three days of argument on the constitutionality of "ObamaCare" are over. So what happens now?

On Friday, the Supreme Court justices will hold a weekly conference. These are done behind closed doors and the meeting is not recorded for public release. By the end of the conference, they will have cast tentative votes on all of the issues that were presented during the arguments - namely, the individual mandate, what parts of the law (if any) can still stand if the mandate is void and the expansion of the Medicaid program.

Based on how the votes fall, different justices will be assigned to write the majority opinion (it's possible there might be several majority opinions because there are several different items up for debate). After these opinions are drafted, they'll be circulated among the justices. If any proposed opinion gets five votes, it becomes the majority opinion of the court.

Since the Supreme Court still has more than 30 other cases to issue rulings on this term, it's likely that ObamaCare will be one of the last. The court's 2011-2012 term ends on June 25 and all rulings will be announced by then.

To learn more, click here.

Supreme Court Wrapping Up "ObamaCare" Hearing: What to Expect on Day Three

Today is the final day that the Supreme Court will be hearing arguments on constitutionality of "ObamaCare." On the agenda for today: a game of "What if?" Specifically, the justices will hear arguments on what would happen if the court strikes down the healthcare law's core provision that requires all Americans to purchase health insurance.

The healthcare law does not contain a "severability clause" that would allow the law to stay in force even if part of it is declared unconstitutional. The Obama administration argued in its brief that the high court should hold that only two provisions of the law can't be severed from the individual mandate. Those two provisions are:

1. The "guaranteed issue" - that insurance companies are required to offer coverage to anyone, no matter how seriously ill, and
2. "Community rating," which prevents insurance premiums from varying according to an individual's health characteristics or status.

The states, on the other hand, are arguing that removing the individual mandate would remove "a large coherent whole to preserve the small discrete parts" and that the court should strike down the law and send it back to Congress for rebuilding.

The court will also hear arguments on the constitutionality of Congress's expansion of the joint federal-state Medicaid program. Previously, the states were only required to offer Medicaid to low-income people in set categories: families with dependent children, the elderly, the blind, the disabled, children and pregnant women. Under the new law, states would be required to cover all individuals under 65 with incomes up to 133 percent of the poverty level.

To follow along with the proceedings, click here.

Day 2 of Supreme Court "ObamaCare" Hearing: What to Expect

Today is arguably the biggest day of the three days the Supreme Court has set aside to hear arguments on "ObamaCare." MSNBC put it this way: "The outcome of Tuesday's argument could demolish the entire law or cement it for decades to come."

At the center of the debate is the question that has plagued ObamaCare since it was introduced: Does Congress have the power to force individuals to purchase health care, a product they otherwise would not have purchased? It's anticipated that the two sides will focus on the extent of Congress's reach under their power to regulate interstate commerce.

Paul Clement, who is arguing on behalf of the states, said in his brief that "the Commerce Clause does not grant Congress the power to compel individuals to enter into commerce."

Solicitor General Donald Verrilli, who is representing the Obama administration, countered in his brief that the minimum coverage provision (which would require individuals to purchase insurance) "regulates economic activity that substantially affects interstate commerce. Its links to interstate commerce are tangible, direct and strong. It is therefore well within the established scope of Congress's power."

To follow along with the arguments, click here.

Supreme Court Takes Up "ObamaCare"

The eyes of America will be on the Supreme Court this week as the justices begin hearing arguments on the constitutionality of "ObamaCare." Here's what's expected to happen:

• Today (Monday) is the first of three days of oral arguments. The justices will hear 90 minutes of arguments over whether the Anti-Injunction Act (an obscure 19th century law) means that the court can't pass judgment on a law until its key provisions go into effect, which would happen in 2014. (Both sides agree that the issue should be settled now.)
• Tomorrow, the justices will hear arguments about the constitutionality of the individual mandate (requiring all Americans to purchase health insurance).
• On Wednesday, they will discuss whether "ObamaCare" can still exist if the individual mandate is found to unconstitutional (this is the so-called "severability" issue). They'll also look at whether the federal government can force states to increase Medicaid spending.

The court's decision could have incredible ramifications, with the Wall Street Journal noting, "In taking up President Barack Obama's health overhaul Monday, the Supreme Court wades into an issue that not only could sway this fall's elections but also could help define for generations what Congress is and isn't entitled to do."

To follow along with the proceedings, click here.

House Cuts Medicare Independent Payment Advisory Board

Calling it a "rationing panel," the House of Representatives voted on Thursday to repeal the Independent Payment Advisory Board.

The board would have been tasked with controlling Medicare costs. While both sides of the aisle agreed that Medicare costs need to be reined in, they weren't able to come to an agreement on how that should happen.

It is expected that the IPAB repeal bill will now either die in the Senate or eventually be vetoed by President Obama.

To learn more, click here.

An Aspirin a Day Keeps Cancer Away?

Many people already use a daily aspirin regimen in an effort to help prevent heart attacks, and now it looks like that strategy might have another benefit - preventing cancer.

According to the National Cancer Institute, three studies have shown evidence that nonsteroidal anti-inflammatory drugs (NSAIDs) hold promise in helping to prevent cancer. Specifically, taking an aspirin every day can lead to a reduced incidence of cancer.

Although it is not completely clear why this is the case, the researchers speculated that the effects of aspirin on platelets may be important for preventing cancer development. Platelets are affected by very low doses of aspirin.

To learn more, click here.

Get Prepared for April 1 MDS Updates!

CMS has announced that changes and clarifications are coming to the MDS 3.0 and will go into effect on April 1, 2012. So what do you need to know?

The changes contain:

• New definitions for planned and unplanned discharges
• Adjustments to Section Q that reduce the frequency of questions about a resident's preferences on returning to the community
• Less frequent edits to the resident assessment instrument (RAI)

To download the MDS 3.0 RAI Manual (v1.08), click here.

Protect Those Bony Prominences!

Although pressure ulcers develop most commonly on the sacrum, they can actually form anywhere that tissue is under constant pressure. That’s why it’s important that your pressure ulcer prevention arsenal contains support surfaces and devices. 

Tissue that is closest to the bone is often the first to undergo necrosis, so it makes sense that pressure ulcers are commonly located over bony prominences. These can include the sacrum, heel, the greater trochanter (on the upper extremity of the femur), ischial tuberosity (commonly known as a “sitting bone”), fibular head (a bone on the interior of the knee), scapula (shoulder blade) and malleolus (ankle). These areas should receive special attention when developing a pressure ulcer prevention strategy.

Heels and elbows can be particularly tricky when it comes to pressure redistribution because they have relatively little surface area, but heel and elbow protectors have been shown to reduce friction and shearing as well as help keep bony prominences from rubbing together.¹

When choosing a support surface or device, it’s important to match the device’s therapeutic benefit with the resident’s specific needs. For example, static pressure redistribution devices (including solid foam, convoluted foam and gel mattresses) may be indicated when a resident is at risk for pressure ulcer development or delayed healing. On the other hand, dynamic pressure reduction surfaces are helpful when¹:

1. The resident can’t move from position to position without putting weight on a pressure ulcer;
2. The resident completely compresses static devices that still have their original integrity or
3. The resident’s pressure ulcer is not healing as expected and it’s been determined that pressure could be contributing to the delay in healing.

Reference

1. Centers for Medicare & Medicaid Services. State Operations Manual. Appendix PP – Guidance to Surveyors for Long Term Care Facilities. Rev. 70, 01-07-11.

CMS Issues Final Rule on Medicaid Eligibility Requirements

CMS has clarified the eligibility and income standards for the expansion of Medicaid under the Affordable Care Act (AKA "Obamacare"). Starting in 2014, Medicaid will be available to those between 19 and 64 who have incomes up to 133 percent of the federal poverty level (currently, that's $14,845 for an individual and $30,656 for a family of four).

The rule also states that people who have disabilities or need long-term services and support may enroll in an existing Medicaid eligibility category to make sure that they find coverage that best fits their needs.

The federal matching rate (the figure that the government will pay each state under the ACA) still remains to be determined and should be released later this year. Medicaid currently pays for more than 40 percent of the long-term care delivered in nursing homes.

To read the final rule, click here.

St. Patrick's Day Trivia

St. Patrick's Day is tomorrow! In honor of the "greenest" holiday of the year, we've rounded up some bits of trivia for you to share with your residents during your St. Patrick's Day party.

• St. Patrick was not actually Irish by birth. He was a Romano-Britan Christian missionary born in England.
• The first official St. Patrick's Day parade took place in New York City in 1762.
• An estimated 13 million pints of Guinness will be consumed around the world on St. Patrick's Day.
• Although it's customary to wear green on St. Patrick's Day, the color was long considered unlucky in Ireland. Folklore held that faeries were fond of stealing people, especially children, who wore too much green.
• Although St. Patrick is credited for driving dangerous animals, especially snakes, out of Ireland, this is unlikely. Snakes have never been native to Ireland. Instead, snakes were probably representative of druidic religions, which started to vanish from Ireland after St. Patrick planted the seeds of Christianity.
•  As recently as the 1970s, pubs in Ireland were required to be closed on St. Patrick's Day because it is a national religious holiday.
• On St. Patrick's Day, workers in Chicago use 40 pounds of vegetable dye to temporarily dye the Chicago River green.

Oh, and if you raise a pint with your friends on St. Patrick's day, be sure to toast by saying "Slainté!" (pronounced SLAN-cha). It's the Irish word for "health."

CMS Seeks to Pair Nursing Homes with Partners to Reduce Hospital Readmissions

CMS has announced that it is earmarking $128 million for groups that collaborate with nursing homes to create programs that prevent residents from going back to the hospital within a month. Under the plan, physician groups, accountable care organizations and other independent entities would be eligible for the grants.

CMS noted that as many as 45 percent of hospital readmissions from nursing homes could be prevented. If the program succeeds, facilities will be better equipped to reduce hospitalizations and manage the conditions that fuel them.

If selected, organizations would work with a minimum of 15 nursing homes as part of the four-year initiative. Applicants must submit evidence-based proposals to CMS to be considered

To learn more, click here.

Happy Pi Day!

Let's join math enthusiasts around the world in celebrating Pi Day! Pi, or , is the symbol for the ratio of the circumference of a circle to its diameter. Through the use of computers, Pi has been calculated to more than 1 trillion digits past the decimal, but it's Pi's first three digits - 3.14 - that led March 14 to be declared "Pi Day."

We think that Pi Day is best enjoyed with a pie of some sort, whether it's sweet like cherry pie or savory like a pizza pie. We bet your residents will agree that it's a delicious reason to celebrate!

Connection Found Between Red Meat Consumption, Early Death

"Put down the steak if you want to live!"

Okay, maybe we don't need to be that dramatic. During a new study, Harvard researchers found that the risk of dying at an early age rises in lock step with red meat consumption. To counteract this, the researchers recommend swapping some red meat for fish, nuts, whole grains and other healthy sources of protein.

Data from the study revealed that each additional serving of red meat per day was associated with a 13% higher risk of dying young (whether it's from heart disease, cancer or any other cause). Processed red meats were even more dangerous, with additional daily intake of items such as hot dogs, salami and bacon being associated with a 20% higher risk of death.

The researchers recommend that we limit our consumption of red meat to two to three times per week and try to eliminate processed red meat altogether.

To learn more, click here.

ProMed Easter Closure Notice

Professional Medical will be closed on Friday, April 6, 2012, in honor of Good Friday/Easter. Orders that are placed by noon on Monday, April 2 will be delivered by Thursday, April 5. Orders placed after noon on April 2 will be delivered the following week.

If you have any questions at all, we invite you to contact our Customer Care team at 800.648.5190.

Older Adults Report Greater Satisfaction from Sleep

Here's some good news for us on the weekend that we're set to lose an hour. Researchers have found that a person's quality of sleep, or at least their perception of it, improves with age.

The researchers were originally trying to confirm the belief that difficulty sleeping increases with age. Instead, after randomized telephone surveys with 155,877 adults, they discovered that the opposite was actually true.

Even if sleep among older Americans is actually worse (in terms of sleep disturbances and residual tiredness) than younger adults, the older people actually feel better about the sleep they are getting.

To read the study's abstract, click here.

C. diff Rates Skyrocket

A new report from the CDC shows that Clostridium difficile, or C. diff, has reached unacceptably high rates. Between 1999 and 2000, only 3,000 C. diff-related deaths were reported. That figure climbed to 14,000 between 2006 and 2007.

C. diff is particularly worrisome for long-term care. Seventy-five percent of facility-acquired cases first show up in nursing homes and more than 90 percent of deaths occur in people 65 and older.

The CDC recommends taking the following six steps to halt the spread of C. diff in your facility:

1. Prescribe and use antibiotics carefully.
2. Test for C. diff when residents have diarrhea while on antibiotics or within several months of taking them.
3. Immediately isolate residents with C. diff.
4. Wear gloves and gowns when treating residents with C. diff. Keep in mind that hand sanitizer does not kill C. diff and handwashing may not be sufficient.
5. Clean room surfaces with bleach or another EPA-approved, spore-killing disinfectant.
6. If the ill resident is transferred, notify the new facility that the resident has C. diff.

To read the CDC report, click here.

Study: Recession Led to Job Loyalty among Nurses

According to a new study from the Robert Wood Johnson Foundation, the recent recession has led to registered nurses being more loyal to their employers. However, this loyalty shouldn't be confused with job satisfaction. Instead, it is more likely that nurses are staying in their current jobs until the economy improves.

The nurses who did leave their jobs during the study period said the following could have convinced them to stay:

• 32%: Management could not have done anything to keep them from leaving
• 12%: Improved management
• 11%: Change in shift or hours
• 8%: Better pay
• 3%: Better benefits
• 1%: Bonus or cash incentive to stay

To read the study, click here.

Happy 100th Birthday, Oreo!

Here's a sweet celebration to share with your residents! Today marks the Oreo cookie's 100th anniversary. Consumers spend $1.5 billion worldwide on Oreos every year, making them the best-selling cookie brand of the 21st century. Why not crack open a package of Oreos and share them with your residents? (With a tall glass of milk, of course.)

Oreos have some pretty interesting cream flavors around the world. Would you try these?

• China: Green Trea Ice Cream Oreos
• Indonesia: Blueberry Ice Cream Oreos
• Argentina: Dulce de Leche and Banana Oreos
• Canada: Strawberry Milkshake Oreos
• Japan: Lemon Ice Oreos
• Chile: Chocolate and Dulce De Leche Oreos

To learn more about Oreo's birthday celebration, click here!

IA Lawmakers Push for All Direct Caregivers to be Licensed

Lawmakers in Iowa are considering legislation - championed by the Iowa chapter of AARP - that would require all direct caregivers in nursing homes to be licensed and meet specific training standards. A Senate committee has already approved the legislation, but a full debate in the Senate still needs to take place.

AARP estimates that the proposed legislation would affect more than 70,000 people, including nursing home workers and in-home caregivers. Caregivers would be required to have a minimum amount of basic training and would be able to specialize in areas such as end-of-life care, mental health, oral care and Alzheimer's disease.

Additional training is believed to increase quality in long-term care settings, and federal reimbursement is increasingly moving toward being quality-based.

To learn more, click here.

Happy Birthday, Dr. Seuss!

Today, March 2, would have marked Dr. Seuss's 108th birthday! Born Theodor Seuss Geisel, Dr. Seuss became the best-selling children's author of all time. His books have transcended time and continue to appeal to readers of all ages. Why not share some of these memorable quotes from his books with your residents today in honor of his birthday? You might also encourage them to tell you their favorite Dr. Seuss book. Since he first started publishing in 1937, odds are good that everyone has read at least one!

Popular Dr. Seuss quotes:

• “You have brains in your head. You have feet in your shoes. You can steer yourself any direction you choose. You're on your own. And you know what you know. And YOU are the one who'll decide where to go.” (From Oh, the Places You'll Go!)
• “Today you are You, that is truer than true. There is no one alive who is Youer than You.” (From Happy Birthday to You!)   
• “A person's a person, no matter how small.” (From Horton Hears a Who!)   
• “Unless someone like you cares a whole awful lot, nothing is going to get better. It's not.” (From The Lorax)     
• “I know, up on top you are seeing great sights, but down here at the bottom we, too, should have rights.” (From Yertle the Turtle and Gertrude McFuzz) 
• “I know it is wet and the sun is not sunny, but we can have lots of good fun that is funny.” (From The Cat in the Hat)
   
  
   

The "Silver Bullet" for Wounds?

It might sound like something out of a sci-fi novel, but silver, a natural antimicrobial, continues to gain popularity as a wound care dressing component.

Silver has been used for centuries for applications ranging from fighting off bacteria to keeping food from going bad. The Phoenicians commonly stored their water, wine and vinegar in silver bottles to keep it from spoiling, and in the early 1900s silver coins were often placed in milk bottles to prolong freshness. Silver’s use in preventing and treating infections actually dates back to World War I, before antibiotics came into use.

Silver is a broad-spectrum agent and is effective against gram-positive and gram-negative organisms as well as fungi and resistant strains of bacteria (such as MRSA and VRE). It has not been found to be toxic or harmful to wounds and can speed up the healing of infected, colonized and chronic wounds through both anti-inflammatory and antimicrobial mechanisms.¹

The FDA has approved a number of different silver-impregnated wound dressings, including hydrogels, hydrofibers, foams, hydrocolloid, gauze and alginates. These dressings can work in four different ways¹:

·       By releasing silver into the wound bed for antimicrobial action

·       By absorbing wound exudates into the dressing, where they are acted upon by the silver

·       By absorbing wound exudates and then releasing silver into the wound bed for antimicrobial activity

·       By releasing silver sulfadizine into the wound

When choosing a silver-impregnated dressing, physicians should consider what action the silver is taking on a particular wound.

Reference

1 Podiatry Today. Silver In Wound Care: What You Should Know. Available at: http://www.podiatrytoday.com/silver-wound-care-what-you-should-know. Accessed Feburary 23, 2012.