04.20.15
by

Google Glass In The ER? Health Care Moves One Step Closer To Star Trek …

Imagine walking into an emergency room with an awful rash and waiting hours to see a doctor until, finally, a physician who doesn’t have specific knowledge of your condition gives you an ointment and a referral to a dermatologist.

That could change if a technological device like Google Glass, which is a wearable computer that is smaller than an ink pen and includes a camera function, could be strapped to an emergency room doctor’s head or to his or her eyeglasses and used to beam a specialist in to see patients at the bedside. Not only would a patient get a more specific initial diagnosis and treatment, but a second visit to a dermatologist might not be necessary.

Researchers did just this for a small sample of people at the emergency room of the Rhode Island Hospital in Providence. They found during the course of the study that 93.5 percent of patients who were seen with a skin problem liked the experience, and 96.8 percent were confident in the accuracy of the video equipment and that their privacy was protected.

“There had been a lot of talk about using Glass in health care, but at the time that we designed the study, no one had actually tried it. No one knew if it would work,” said Megan Ranney, a study author and assistant professor of emergency medicine and policy at Brown University.

ER doctors normally have to page an on-call specialist – in the study, a dermatologist — to talk through the patient’s condition. With that information, the dermatologist makes a judgment call about the treatment, usually without ever seeing the patient. If there’s no dermatologist available, which can frequently be the situation, doctors do what they can but then refer the patient for follow-up dermatological care. Many rural and community hospitals do not have dermatologists on staff and it’s up to the emergency physician to care for the patient.

In the study, researchers instead had the physicians connect via Google Glass, enabling the specialist to see on his or her office iPad or computer what the ER doctor was seeing in person. The ER doctor was able to communicate with the dermatologist, and both physicians could ask questions of the patient in real time.

“You’ve rolled the first and second visit into this one visit. You have the specialist at the bedside, and if you get better, you don’t need to have follow-up,” said Paul Porter, a physician in the emergency department of Rhode Island Hospital and study author. “There’s nothing more frustrating [for the patient than] to be seen, leave with diagnostic uncertainty, and have to go somewhere else. … People don’t want that answer.”

Emergency rooms across the country may already use telemedicine technology for patients with skin or other visible conditions, but many of those machines can cost as much as to $60,000 — not to mention the expense of maintenance and support. Google Glass costs less than $2,000.

In addition, many ERs either don’t have the funds to obtain a telemedicine “cart,” or don’t use it because the size – four to six square feet – can be too large for that setting, said Edward Boyer, a professor of emergency medicine at the University of Massachusetts Medical School in Worcester, Mass.

“The crowding in emergency rooms means we physically do not have enough room to manage the patients they have in them. A dermatology cart is not a little thing, and a lot of ERs don’t have that much spare room to store and wheel around one of those things,” said Boyer, also an author.

The researchers’ next step is to study whether Google Glass or similar headset technology could be used for other ER patients, such as those showing signs of stroke or who may have been exposed to poison.

In the latter instances, poison control center toxicologists are always available, though mainly consulted via the telephone. But these patients commonly have visual symptoms such as seizures, said Peter Chai, a lead author and fellow in medical toxicology at the University of Massachusetts Medical School. And, if a person is severely ill due to poisoning, they are flown via helicopter to the closest major hospital, he added.

“If we could see them virtually, could we save the money of transport, keep them in the community intensive care unit, and give better patient care?” Chai said, noting that even if ERs in smaller or rural settings don’t have access to telemedicine, they may be able to afford this type of device.

The research surveyed 31 people with skin conditions in the Rhode Island Hospital emergency department for six months, and was published as a research letter in JAMA Dermatology April 15. Google Glass is currently not available commercially, but health care providers can get the device through health care technology companies.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

04.19.15
by

CDC Advisory: April 24

Regarding: Outbreak of Recent HIV and HCV Infections among Persons Who Inject Drugs

Summary: The Indiana State Department of Health (ISDH) and the Centers for Disease Control and Prevention (CDC) are investigating a large outbreak of recent human immunodeficiency virus (HIV) infections among persons who inject drugs (PWID). Many of the HIV-infected individuals in this outbreak are co-infected with hepatitis C virus (HCV). The purpose of this HAN Advisory is to alert public health departments and healthcare providers of the possibility of HIV outbreaks among PWID and to provide guidance to assist in the identification and prevention of such outbreaks.

Background: From November 2014 to January 2015, ISDH identified 11 new HIV infections in a rural southeastern county where fewer than 5 infections have been identified annually in the past. As of April 21, 2015, an on-going investigation by ISDH with assistance from CDC has identified 135 persons with newly diagnosed HIV infections in a community of 4,200 people; 84% were also HCV infected. Among 112 persons interviewed thus far, 108 (96%) injected drugs; all reported dissolving and injecting tablets of the prescription-type opioid oxymorphone (OPANA® ER) using shared drug preparation and injection equipment.1

This HIV outbreak was first recognized by a local disease intervention specialist. In late 2014, interviews conducted with three persons newly diagnosed with HIV infections in three separate venues (i.e., an outpatient clinic, a drug rehabilitation program, during a hospitalization) indicated that two of these persons had recently injected drugs and had numerous syringe-sharing and sexual partners. Contact tracing identified eight additional HIV infections leading to the current outbreak investigation, which has demonstrated that HIV had spread recently and rapidly through the local network of PWID. Without an attentive health department, active case finding, and additional testing provided as part of this investigation, this cluster may not have been identified.

Urgent action is needed to prevent further HIV and HCV transmission in this area and to investigate and control any similar outbreaks in other communities.

Injection drug use accounts for an estimated 8%2_ENREF_2 of the approximate 50,000 annual new HIV infections in the United States.3 _ENREF_2 HCV infection is the most common blood-borne infection in the United States and percutaneous exposure via drug-injecting equipment contaminated with HCV-infected blood is the most frequent mode of transmission. Nationally, acute HCV infections have increased 150% from 2010 to 2013,4 and over 70% of long-term PWID may be infected with HCV.5  Abuse of prescription-type opioids is increasing nationally6 and opioid-analgesic poisoning deaths have nearly quadrupled from 1999 through 2011.7  Rates of acute HCV infection are increasing, especially among young nonurban PWID, often in association with abuse of injected prescription-type opioids. These increases have been most substantial in nonurban counties east of the Mississippi River.8

Recommendations for Health Departments

  • Review the most recent sources of data on HIV diagnoses, HCV diagnoses (acute as well as past or present), overdose deaths, admissions for drug treatment, and drug arrests. Attributes of communities at risk for unrecognized clusters of HIV and HCV infection include the following:

o    Recent increases in the:

  • Number of HIV infections attributed to injection drug use,
  • Number of HCV infections, particularly among persons aged < 35 years;

o    High rates of injection drug use and especially prescription-type opioid abuse, drug-related overdose, drug treatment admission, or drug arrests.

  • Ensure complete contact tracing for all new HIV diagnoses and testing of all contacts for HIV and HCV infection.
  • Ensure persons actively injecting drugs or at high-risk of drug injection (e.g., participating in drug substitution programs, receiving substance abuse counseling or treatment, recently or currently incarcerated) have access to integrated prevention services,9 and specifically:

o    Are tested regularly for HIV and HCV infection (consider more frequent testing based on frequency of injection drug usage or sharing of injection equipment);

o    If diagnosed with HIV or HCV infection:

  • Are rapidly linked to care and treatment services;

o    If actively injecting drugs:

  • Have access to medication-assisted therapy (e.g., opioid substitution therapy) as well as other substance abuse services, if not already engaged,
  • Are counseled not to share needles and syringes or drug preparation equipment (e.g., cookers, water, filters),
  • Have access to sterile injection equipment from a reliable source.

o    If not HIV infected but actively injecting drugs:

  • Are referred for consideration of HIV pre-exposure prophylaxis10 and if potentially exposed within the past 72 hours (e.g., shared drug preparation or injection equipment with a known or potentially HIV-infected person) HIV post-exposure prophylaxis11,12
  • Remind venues that may encounter unrecognized infections, such as emergency departments and community-based clinical practices (e.g., family medicine, general medicine, prenatal care) of the importance of routine opt-out HIV testing as well as HCV testing per current recommendations13-15
  • Local health departments should notify their state health department and CDC of any suspected clusters of recent HIV or HCV infection.

Recommendations for Healthcare Providers

  • Ensure all persons diagnosed with HCV infection are tested for HIV infection,16 and that all persons diagnosed with HIV infection are tested for HCV infection.17
  • Ensure persons receiving treatment for HIV and/or HCV infection adhere to prescribed therapy and are engaged in ongoing care.
  • Encourage HIV and HCV testing of syringe-sharing and sexual partners of persons diagnosed with either infection.
  • Report all newly diagnosed HIV and HCV infections to the health department.
  • For all persons with substance abuse problems:

o    Refer them for medication-assisted treatment (e.g., opioid substitution therapy) and counseling services,

o    Use effective treatments (e.g., methadone, buprenorphine), as appropriately indicated.

  • For any persons for whom opioids are under consideration for pain management:

o    Discuss the risks and benefits of all pain treatment options, including ones that do not involve prescription analgesics.

o    Note that long-term opioid therapy is not associated with reduced chronic pain.18

  • Contact the state or local health department to report suspected clusters of recent HIV or HCV infection.

For more information:

 

References

 

  1. Spiller MW, Broz D, Wejnert C, Nerlander L, Paz-Bailey G. HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs – 20 Cities, United States, 2012. MMWR Morb Mortal Wkly Rep. Mar 20 2015;64(10):270-275.
  2. Centers for Disease Control and Prevention. HIV Surveillance Report, 2013; vol. 25.  http://www.cdc.gov/hiv/library/reports/surveillance/, last accessed April 22, 2015.
  3. Prejean J, Song R, Hernandez A, et al. Estimated HIV incidence in the United States, 2006-2009. PLoS ONE. 2011;6(8):e17502.
  4. Hagan H, Des Jarlais DC, Stern R, et al. HCV synthesis project: preliminary analyses of HCV prevalence in relation to age and duration of injection. The International journal on drug policy. Oct 2007;18(5):341-351.
  5. Maxwell JC. The prescription drug epidemic in the United States: a perfect storm. Drug and alcohol review. May 2011;30(3):264-270.
  6. Chen LH HH, Warner M. Drug-poisoning deaths involving opioid analgesics: United States, 1999–2011. NCHS data brief, no 166. Hyattsville, MD: National Center for Health Statistics. 2014.
  7. Suryaprasad AG, White JZ, Xu F, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006-2012. Clin Infect Dis. Nov 15 2014;59(10):1411-1419.
  8. Centers for Disease Control and Prevention. Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: summary guidance from CDC and the U.S. Department of Health and Human Services. MMWR Recomm Rep. Nov 9 2012;61(Rr-5):1-40.
  9. US Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States – 2014 clinical practice guideline. 2014; http://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf.
  10. Centers for Disease Control and Prevention. Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States Recommendations from the U.S. Department of Health and Human Services. 2005; http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm.
  11. Kuhar DT, Henderson DK, Struble KA, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infection control and hospital epidemiology. Sep 2013;34(9):875-892.
  12. Centers for Disease Control and Prevention. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. 2006; http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm. Accessed April 22, 2015.
  13. Centers for Disease Control and Prevention and Association of Public Health Laboratories. Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations.  http://dx.doi.org/10.15620/cdc.23447. Accessed April 22, 2015.
  14. Centers for Disease Control and Prevention. Testing for HCV infection: an update of guidance for clinicians and laboratorians. MMWR Morb Mortal Wkly Rep. May 10 2013;62(18):362-365.
  15. AASLD/IDSA/IAS–USA. HCV testing and linkage to care. Recommendations for testing, managing, and treating hepatitis C.  http://www.hcvguidelines.org/full-report/hcv-testing-and-linkage-care. Accessed April 22, 2015.
  16. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. 2015; http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed April 22, 2015.
  17. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. 2015; http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed April 22, 2015.
  18. Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med. Feb 17 2015;162(4):276-286.

 

The Centers for Disease Control and Prevention (CDC) protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

04.17.15
by

Ask a Travel Nurse: Are companies willing to negotiate Travel Nursing pay?

Share

Ask a Travel Nurse

Ask a Travel Nurse: Are companies willing to negotiate Travel Nursing pay?

Ask a Travel Nurse Question:

When it comes to pay, are most offers for hospital jobs set in stone? Are companies willing to negotiate Travel Nursing pay?

Ask a Travel Nurse Answer:

In Travel Nursing, many assignments simply pay what they pay. While you may have a little wiggle room on your hourly rate, that will likely not change more than a few dollars per hour.    

Most hospitals draft a “blanket agreement” (or contract) when dealing with travel companies. This means that every travel company essentially makes the same compensation for providing the facility with a Travel Nurse. The travel company then puts together a package for the nurse, and then presents that, in a contract that you sign with the travel company. The reason that different companies might have a different hourly rate for the same position is due to allocation.

While one company might provide a higher hourly rate, another might provide better housing or health benefits. No ONE company offers the best housing, the highest hourly rate, AND the cheapest, most comprehensive medical insurance. If there was such a company, it would be the ONLY travel company as EVERYONE would travel with them.

Another factor could be the travel company’s profit margin on the traveler; this is why there could be a little wiggle room on the hourly rate. Yes, travel companies want to make money off of you, no surprise there. But they are also paying a lot of people to make sure that your assignment comes together. If you have been with your company for a few assignments and are a loyal traveler, a company should always do what they can to retain you. This could mean making a lower profit margin on your employment and offering you more in compensation.    

However, every company will have a certain margin that they will not exceed (otherwise, they could actually LOSE money on your contract). The recruiters I use are very good about being up front about this and there have been times where I have asked for more of an hourly rate only to be told that it is just not “doable.” If you feel you should be getting more, or require more than they are offering, then just ask. You are only going to get one of two answers.

If you do require more than a travel company is willing to pay on any given assignment, if you have a good recruiter, they should simply say, “I’m sorry, but on that assignment, I just cannot meet your quote. However, let me know what figure you need and we can look for an assignment that will work for you.”

I hope this helps :-)

David

david@travelnursesbible.com

04.17.15
by

Radamenes the Amazing Nurse Cat

Share

Here’s a great story for animal lovers as well as compassionate types everywhere.

Meet Radamenes the Amazing Nurse Cat.Radamenes Polish Nurse Cat

He was delivered to an animal shelter in Bydgoszcz, Poland suffering from a severe upper respiratory infection and in pretty rough condition. When he arrived the vets who first saw him didn’t have much hope for his recovery and considered putting him down to end his suffering. But, when Radamenes began to purr they recognized his will to survive and began treatment.

Radamenes Polish Nurse CatOnce Radamenes was up and around, feeling healthier and stronger, he began to make friends with other animals at the shelter. The staff said they started to notice that Radamenes was especially warmhearted towards animals who were in immediate recovery from major surgeries and other procedures. He dotes on these animals; visiting to help clean, hug, and cuddle them, and sometimes he even gives them massages!Radamenes Polish Nurse Cat

The vets at the shelter say Radamenes has become their mascot and they joke that he’s a full-time nurse. He certainly does display the compassionate care that nurses are known for.

Radamenes Polish Nurse CatWhether through his own experience with recovery or perhaps on some other level, he seems to understand the importance to recovery and the overall comfort of a loving touch and presence for those who are ill.

Way to pay it forward, Radamenes the amazing nurse cat! You make nurses everywhere proud.

Ram nurse Cat 5Have you ever had an animal help “nurse” you or another of your pets back to health? Share your story in the comments.

Image credits: TNV Meteo

04.17.15
by

There May Still Be Time To Save On Health Law’s Tax Penalties

Even though the April 15 tax filing deadline has passed, you might be eligible for some health law-related changes that may save you money down the road.

–If you owed a penalty for not having health insurance last year and didn’t buy a plan for 2015, you may still be able to sign up for a marketplace plan, even though the open enrollment period ended Feb. 15. Many people who didn’t have insurance and didn’t realize that coverage is required under the law are eligible for a special enrollment period to buy a plan by April 30. If you sign up now, you’ll have coverage and avoid the 2015 penalty, which will be the greater of $325 or 2 percent of your household income.

–If you paid the penalty for not having insurance for some or all of last year and didn’t carefully check to see if you might have qualified for an exemption, it’s not too late. You can still apply for an exemption from the requirement by amending your 2014 tax return. It’s worth looking into since the list of exemptions is a long one. For example, if your 2014 income is below the filing threshold of $10,150 — or $20,300 for a married couple — you don’t owe a penalty for not having coverage. Likewise if insurance would cost more than 8 percent of your income or if you’ve suffered financial hardships like eviction or bankruptcy.

–In February, the Centers for Medicare & Medicaid Services announced that 800,000 tax filers who received a federal subsidy to help pay their insurance premium and used the federal health insurance marketplace received incorrect 1095-A tax forms. These forms reported details about the advance premium tax credit amounts that were paid to insurers based on the consumers’ estimates of income. They were then used to reconcile those payments against how much consumers should have received.

If you filed your taxes based on information that was incorrectly reported by the government on the form, you generally don’t have to file an amended tax return even IF you would owe more tax. But you may want to at least recalculate your return, says Tara Straw, a health policy analyst at the Center on Budget and Policy Priorities.

“You have the option to amend if it helps you,” she says. Unfortunately, the only way to figure that out may be to do the math on the tax form 8962 that you use to reconcile your income.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

04.17.15
by

EEOC Proposal On Wellness Program Earns Business Praise, Consumer Concerns

Business groups praised a proposed new rule from the Equal Employment Opportunity Commission clarifying how employers can construct wellness programs, but consumers advocates said the new policy could harm workers.

The EEOC published the long-awaited rule Thursday.

“This is a big step forward, primarily because the EEOC has defined what it means for a wellness program to be voluntary,” says Steve Wojcik, vice president for public policy at the National Business Group on Health, which represents large employers.

The Americans With Disabilities Act prohibits employers from discriminating against workers based on their health. But they can ask workers for details about their health and conduct medical exams as part of a voluntary wellness program. Before this proposal was unveiled, employers and consumer advocates alike had been uncertain how the commission defined voluntary.

Under the proposed rule, a wellness program is considered voluntary if employees aren’t required to participate, it doesn’t deny or limit health insurance coverage if people don’t participate, and it doesn’t retaliate against or otherwise interfere with employees who don’t participate.

In addition, as employers increasingly link participation in wellness programs to financial incentives, the proposed rule would also allow an incentive of up to 30 percent of the cost of employee-only coverage for workers’ participation in a wellness program or achieving health outcomes.

Consumer advocates say adopting such a standard would diminish employee protections.

“I think most people would say that giving people a choice of answering questions [about their health] or [workers] paying several thousand dollars is not a voluntary choice,” says Jennifer Mathis, director of programs at the Bazelon Center for Mental Health Law. “That makes it coercive.”

Last year, the EEOC made a similar argument when it brought an action against Honeywell International.  The commission claimed that penalties in the company’s wellness program made the program involuntary. Under the company’s program, an employee and spouse could face financial penalties of up to $4,000 in insurance and tobacco surcharges, among other things, for not participating.

A federal district judge refused to issue a temporary restraining order sought by the EEOC that would have prevented the company from imposing its wellness program incentives this year.

“The EEOC’s proposed rules are a positive step toward enabling the implementation of the President’s health care law and the desire of all Americans to lead healthier lives,” Honeywell said in a statement.

In recent years, wellness programs have become a favored tool for employers who are seeking to encourage their employees to stop smoking, lose weight and keep their blood pressure and cholesterol under control. The Affordable Care Act allows companies to offer workers wellness incentives of up to 30 percent of the cost of coverage, or up to 50 percent for activities that aim to help people quit smoking.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.