Patti's Blog - Advocate for Elders, People with Disabilities and Their Families

Updates on Amanda Baggs – Surgery is on for Today!

Excerpt from: Not Dead Yet (click for full article)

 

Before I start with the specifics, here’s the short version – due to the overwhelming response of disability activists and allies, things changed for the better in terms of communication and setting an agenda for surgery – placement of a feeding tube that will hopefully prevent the frequent bouts Amanda Baggs has had with aspiration pneumonia.  Amanda might be having surgery as I write this, since one of her posts (not included below) that her surgery was scheduled for late morning or early afternoon.  It’s about 30 minutes after noon right now.

Autistic Writer/Blogger/Activist Amanda Baggs Facing Life-Threatening Discrimination in Vermont Hospital

Excerpt from: Not Dead Yet (click for full article)

 

Amanda Bagg’s name and work should be familiar to a lot of people in the disability community.  A lot of people might remember reading her blog essay “If I am killed” on our old site, where it was reproduced with permission – and will be  put up again in the near future.  Many more will remember seeing her youtube video “In My Language.”

Amanda Baggs is an autistic woman who writes brilliantly, doesn’t use speech as her primary mode of communication and also lives with a variety of conditions, one of which has become quite serious in terms of being life-threatening.  Her friend Laura T, aka “webmuskie” around the internet, wrote us that after the last of several bouts with aspiration pneumonia, Amanda had been admitted to the hospital to treat the effects of the gastroparesis that was at the root of the problem.  The understanding going in was that this would involve the placement of a feeding tube, which would help her increase her food intake and lower the risk of aspiration.

Docs decide on duration of antibiotics in long-term care

Excerpt from: Medical Press (click for full article)

 

Nick Daneman, M.D., of the University of Toronto, and colleagues conducted a retrospective analysis of data obtained from 66,901 adults aged 66 years or older in 630 facilities who received an incident treatment course with a systemic antibiotic while residing in a long-term care facility. According to the researchers, seven days was the most commonly selected antibiotic treatment course (in 21,136 courses [41.0 percent]); however, 23,124 courses (44.9 percent) exceeded seven days. The median (interquartile range) proportion of treatment courses over seven days was 43.5 percent among the 699 physicians who were responsible for 20 or more antibiotic courses, while the proportion of prescriptions beyond the seven-day threshold was higher than expected for 21 percent of physicians. Among the patients of prescribers of short-, average-, and long-duration antibiotic courses, characteristics were found to be similar. Using a mixed logistic model, the researchers confirmed that prescribers were an important determinant of treatment duration (P < 0.001).

Nick Daneman, M.D., of the University of Toronto, and colleagues conducted a retrospective analysis of data obtained from 66,901 adults aged 66 years or older in 630 facilities who received an incident treatment course with a systemic antibiotic while residing in a long-term care facility. According to the researchers, seven days was the most commonly selected antibiotic treatment course (in 21,136 courses [41.0 percent]); however, 23,124 courses (44.9 percent) exceeded seven days. The median (interquartile range) proportion of treatment courses over seven days was 43.5 percent among the 699 physicians who were responsible for 20 or more antibiotic courses, while the proportion of prescriptions beyond the seven-day threshold was higher than expected for 21 percent of physicians. Among the patients of prescribers of short-, average-, and long-duration antibiotic courses, characteristics were found to be similar. Using a mixed logistic model, the researchers confirmed that prescribers were an important determinant of treatment duration (P < 0.001).

Read more at: http://medicalxpress.com/news/2013-03-docs-duration-antibiotics-long-term.html#jCp

Nick Daneman, M.D., of the University of Toronto, and colleagues conducted a retrospective analysis of data obtained from 66,901 adults aged 66 years or older in 630 facilities who received an incident treatment course with a systemic antibiotic while residing in a long-term care facility. According to the researchers, seven days was the most commonly selected antibiotic treatment course (in 21,136 courses [41.0 percent]); however, 23,124 courses (44.9 percent) exceeded seven days. The median (interquartile range) proportion of treatment courses over seven days was 43.5 percent among the 699 physicians who were responsible for 20 or more antibiotic courses, while the proportion of prescriptions beyond the seven-day threshold was higher than expected for 21 percent of physicians. Among the patients of prescribers of short-, average-, and long-duration antibiotic courses, characteristics were found to be similar. Using a mixed logistic model, the researchers confirmed that prescribers were an important determinant of treatment duration (P < 0.001).

Read more at: http://medicalxpress.com/news/2013-03-docs-duration-antibiotics-long-term.html#jCp

Good Article on Inaccessible Doctors' Offices

Excerpt from: Disability Law (click for full article)

 

Almost one-fourth of doctors are unable to accommodate and treat patients who use wheelchairs more than 20 years after the passing of the Americans with Disabilities Act, a study found. 

About 22 percent of 256 doctor’s offices surveyed said they couldn’t assist people in wheelchairs, with most of those saying it was because they weren’t able to safely transfer the patient to an exam table, according to research published today in the Annals of Internal Medicine. Lack of access to the building was a secondary reason, the researchers said. 

The Americans with Disabilities Act, passed by the U.S. Congress in 1990, is aimed at ending discrimination for people with disabilities in everyday activities including access to medical care facilities and the services provided there. Today’s findings are one of the first to show where barriers to medical services remain for wheelchair-bound patients, said Tara Lagu, the study’s lead author.

Doctors Turning Away Patients With Disabilities

Excerpt from: Disability Scoop (click for full article)

 

More than two decades after the Americans with Disabilities Act became law, a new survey indicates that more than 20 percent of doctors’ offices remain inaccessible to those with special needs.

The finding comes from a “secret shopper” style poll of 256 randomly selected medical practices in Boston, Dallas, Houston and Portland, Ore. Researchers called to schedule an appointment for a fictitious patient, indicating that the individual used a wheelchair and was unable to transfer independently from the chair to an exam table.

Under the ADA, doctors are required to provide “full and equal access to their health care services and facilities.” Nonetheless, of the medical and surgical subspecialists phoned, 22 percent indicated that they could not accommodate the patient, researchers reported Tuesday in the Annals of Internal Medicine.

The reasons for turning away the fictitious patient varied, but most doctors cited an inability to transfer the patient from a wheelchair to an exam table. Meanwhile, nine practices indicated that their building was inaccessible.

A Path Forward on Medicare Readmissions

Excerpt from: The New England Journal of Medicine (click for full article)

 

Penalizing hospitals for high readmission rates has been controversial since the idea was introduced, with criticism primarily focused on two main areas. The first point of contention is whether the hospital is the appropriate entity to be held accountable for readmissions, given that the events and circumstances that predict readmissions largely take place outside the hospital's walls. The second set of concerns is focused on the specific attributes of the measure itself. There is overwhelming evidence that two groups of patients are at particularly high risk for readmissions: those who have the most severe illnesses (because of their underlying condition) and those who are socioeconomically disadvantaged1 (probably because they lack access to important resources after discharge, such as social support or primary care). The current measure does not take important measures of severity of illness such as disability and complexity into account, and it opts out of accounting for socioeconomic status altogether, leaving hospitals that disproportionately care for the sickest and poorest patients at particular risk for penalties.

 

 

Weekend Reading: Why A Trip To The ER Costs More Than A College Semester

Excerpt from: Kaiser Health News (click for full article)

 

Every week Ankita Rao selects interesting reading from around the Web (Time Magazine, MedPage Today's KevinMD, The New York Times ,Forbes , and The Atlantic ).

Medical Bills Bankrupt Families of Mentally Ill Children

Excerpt from: ABC News (click for full article)

 

An estimated 11 percent of children in the United States are affected by mental health and addiction disorders with significant costs, according to the study, and mental health disorders are the primary cause of hospital admissions for early teens.

About half of all lifetime cases of mental illness begin by the age of 14, and decades often lapse before these people get treatment, according to research supported by the NIMH. By the time they reach adulthood, their disorders are more severe and not as easy to treat, leading to the development of co-occurring conditions, research finds.

The multi-university study looked at the heath care policy for federal employees, which is comprehensive and generous. "We should all have the kind of insurance that members of Congress have," said Barry.

"Historically, there has been inpatient day and outpatient visit limits for services," she said. "For example, you only get 25 outpatient visits. After that, families pay everything themselves. That was the old way of doing things. Now, if those limits don't exist for medical care, they shouldn't exist for mental health care."

 

Nursing home study finds high rate of community-associated MRSA

Excerpt from: McKnight's (click for full article)

Patti's comment: This is so scary… I had 8 broken bones when I got MRSA at a local Michigan Hospital, and it was miserable! I was in so much pain it was unreal. Be careful out there folks!!

 

Community-associated methicillin-resistant Staphylococcus Aureus (CA-MRSA) was discovered in nearly 91% of nursing homes tested in a recent study.

University of California-Irvine researchers acquired samples from more than 2,200 nursing home residents in Orange County, CA. They detected CA-MRSA in 20 of 22 nursing homes where testing occurred between 2008-2011.

Most infection control measures related to CA-MRSA have been undertaken by hospitals, but this study shows nursing homes should also pursue interventions to prevent the spread of the drug-resistant bacteria, the researchers said.

"We believe these at-risk facilities could benefit from further infection control interventions, such as enhanced environmental cleaning or skin decolonization," said lead researcher Courtney R. Murphy, Ph.D.

Study on hospital admissions

Excerpt from: Supporting People with Intellectual Disabilities (click for full article)

 

There are a number of conditions which can usually be looked after outside hospital. These are called Ambulatory Care Sensitive Conditions. Emergency admissions for these conditions raise the question of how well care outside hospital is being organised. IHAL has produced a report which describes a study of admissions of people with learning disabilities for these conditions. You can view the report here.