Tag Archives: Healthcare

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Study: Only 1.5% of those at high risk of opioid overdose receive a prescription for naloxone

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The vast majority of people who are at high risk of opioid overdose are not prescribed the naloxone they may one day need to save their lives, according to the results of a new study published in JAMA. In fact, the researchers found that only about 1.5% of high-risk patients receive such a prescription, despite multiple opportunities.

Sarah Follman and associates from the University of Chicago performed a retrospective study in which they analyzed data from the Truven Health MarketScan Research Database. The researchers reviewed information on subjects who had ICD-10 codes associated with opioid use, misuse, dependence, and overdose from Oct. 1, 2015, through Dec. 31, 2016.

The team identified 138,108 high-risk individuals as having interacted with the healthcare system nearly 1.2 million times. The interactions included 88,618 hospitalizations, 229,680 emergency department (ED) visits, 568,448 family practice visits, and 298,058 internal medicine visits.

Despite the high number of interaction with medical professionals, clinicians prescribed naloxone to only 2,135 of the 138,108 high-risk individuals during the study period.

At an odds ratio (OR) of 2.32, patients previously diagnosed with both opioid misuse/dependence and overdose were more likely to receive naloxone than were those who had only a history of dependence. Furthermore, those with a history of only overdose alone without a history of misuse were less likely to receive a prescription for naloxone, as were patients with a history of only misuse without overdose.

In their discussion, the authors of the study called this “surprising,” noting “prior overdose is the strongest predictor of subsequent overdose and overdose death.”

The researchers found that other factors could significantly reduce a patient’s odds of receiving a naloxone prescription. These factors included being from the West (OR 0.85) or Midwest (OR 0.62), or being 30 to 44 years of age (OR 0.72).

Factors that increased the odds of receiving a naloxone prescription included medication-assisted therapy (OR 1.68), visiting a detoxification facility (OR 1.51), receiving other treatment for substance use disorder (OR 1.16), or receiving outpatient care from a pain specialist (OR 1.57), psychologist (OR 1.49), or surgeon (OR 1.19).

The researchers suggest that health care visits are missed opportunities for providing naloxone. Nearly one-third of the cohort had at least one hospital admission, yet the provision of naloxone was only associated with having three or more hospitalizations during the study period. Similarly, slightly more than half had at least one ED visit during the period, yet only those with three or more ED visits were likely to receive the drug.

The authors of the study acknowledged that the results might underestimate the distribution and use of naloxone, as patients may get the lifesaving drug through private programs that do not bill insurance companies. The findings may not reflect patients covered by Medicaid or some Medicare plans, and the uninsured.

The researchers concluded by saying that most patients at high risk of opioid overdose do not receive a prescription to naloxone through direct prescribing. “Clinicians can address this gap by regularly prescribing naloxone to eligible patients. To address barriers to prescribing, hospital systems and medical schools can support clinicians by improving education on screening and treating substance use disorders, clarifying legal concerns, and developing policies and protocols to guide implementation of increased prescribing. Health care systems can also create or strengthen processes to encourage naloxone prescribing.”

Recommendations for Naloxone Prescriptions from Health and Human Services

The Health and Human Services suggests prescribing naloxone for patients who:

  • Are receiving opioids at a dosage of 50 morphine milligram equivalents (MME) or more daily.
  • Have respiratory conditions such as obstructive sleep apnea or chronic obstructive pulmonary disease (COPD).
  • Have been prescribed benzodiazepines.
  • Have a non-opioid substance use disorder, has reported excessive alcohol use, or have a mental health disorder.
  • Use heroin, illicit synthetic opioids.
  • Misuse prescription opioids.
  • Use other illicit drugs, including methamphetamine and cocaine, which may be contaminated with fentanyl or other illicit synthetic opioids.
  • Are currently undergoing treatment for opioid use disorder, including medication-assisted treatment.
  • Have a history of opioid misuse and a recent release from incarceration or another controlled setting that has reduced his or her tolerance to opioids.

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Patriarchy and healthcare: A dying zeitgeist

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Like so many cultural and societal institutions in the United States and around the world, medicine and healthcare have been built upon the foundations of patriarchy and male dominance. In many aspects of our lives, this paradigm is shifting for the better, and that same change is also underway in the healthcare sphere.

The Reign of the Male Doctor

Since time immemorial, men have dominated medicine. Not many decades ago, female nurses were considered the handmaidens of doctors, labeled as “pink collar” nonprofessionals whose vocation was to support physicians in their apparently more valuable work.

Nurses were historically viewed as subservient laborers who followed orders and carried no sense of personal or professional agency; in that same vein, female physicians were less numerous and not readily recognized for their contributions by their male peers.

Earlier this year, the Kaiser Family Foundation reported that of the 1,005,295 professionally active physicians in the United States, 644,683 are male and 359,409 are female. AthenaHealth published research in 2018 showing that the lower the age bracket, the more dominant women are becoming in medicine:

“From January to June 2017, AthenaHealth surveyed 18,000 physicians at 3,500 practices on its network, and determined that more than 60 percent of physicians under the age of 35 are female, while just under 40 percent are male. In the next-highest age bracket (35 to 44 years of age), women are the dominant gender as well just slightly coming in at 51.5 percent. As each age bracket gets older, the percentage of female physicians drops, with 82.4 percent of physicians over the age of 65 being male.”

“The trend shows no signs of slowing down: In 2017, the number of women enrolling in U.S. medical schools exceeded the number of men for the first time, according to data from the Association of American Medical Colleges.”

“As women become a major force within the medical community, healthcare executives and administrators, many of whom are men, are tasked with creating an environment that prioritizes retaining and supporting female physicians in order to maintain a robust workforce.”

We can also see that the rise in popularity, acceptance, and influence of nurse practitioners is ruffling some feathers in some corners of the medical establishment, perhaps even more so since the majority of those advanced practice nurses are more likely to be female.

Gender-Specific Double Standards

When it comes to double standards in healthcare and medicine, AthenaHealth’s research drew other conclusions, as well:

One of the best ways to make the needs of female physicians heard is to place them in executive roles. ‘Female physicians are still underrepresented and underutilized in positions of power, especially at the most senior levels,’ says Deborah Shlian, M.D., a medical management consultant in Florida. ‘We need to eliminate those double standards that penalize women for traits and behaviors that are rewarded in men, like assertiveness, daring, risk-taking, and bravery. Yes, we need to ‘lean in,’ but we also need to push back.”

“Those double standards are visible to many female physicians. ‘We have robust data that demonstrates that women are rated more poorly in medical school and residency, and that gaps in their evaluations actually grow through their training,’ says Poorman, who cites a 2010 study that found men are more likely to be seen as ‘quick learners’ than comparable women.”

The grip of patriarchy on medical training and practice has been slipping in recent years, and as we can see from the data cited above, demographic changes are indeed afoot as some previously disturbing trends are slowly reversed.

Millennials on the Ascendancy

The millennial generation is the first to come of age at a historical moment when the population as a whole is waking up to disparities related to gender identity, race, sexual orientation, socioeconomics, and other crucial factors.

With #MeToo and other social movements fueling further awareness and activism, changes are afoot in many societies around the world.

Simultaneously, emerging millennial leaders such as Rep. Alexandria Ocasio-Cortez are assuming positions of power and influence, infiltrating historically male-dominated institutions and turning them on their heads. These entrenched institutions are being forced to reconcile their past with the current reality as women and young people — especially young women of color — subvert dominant paradigms and call past practices and norms into question.

The (Medical) Future is Female

Taking into consideration the demographic and societal trends at play, the feminine future of healthcare and medicine appears to be assured. And with young women being encouraged to pursue STEM (science, technology, engineering, and mathematics) education in larger and larger numbers, the pipeline of female talent is being further primed with eager candidates.

Meanwhile, the aforementioned young congresswoman and role models such as Michelle Obama, Oprah Winfrey, and others are further empowering women of all ages to realize their worth and assert themselves in the workplace and the wider public arena.

With the sands of gender and power shifting within the zeitgeist of healthcare, we can all look forward to a continued evolution towards a more equal balance of power making itself known. And the further influence of women and feminine viewpoints will likely bring increasing humanity, sensitivity, and awareness of widespread disparities and inequality to a healthcare space in dire need of positive change and feminization.

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Newly approved device to help increase access to suitable lungs for transplant

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On April 26, the U.S. Food and Drug Administration (FDA) approved a new device that may increase access to more lungs for transplant. The new Xvivo Perfusion System (XPS) with Steen Solution Perfusate is a type of ex vivo lung perfusion (EVLP) therapy, which can temporarily ventilate and pump preservation solution through lungs.

The process can increase the percentage of lung transplants by allowing transplant teams to identify better quality lung grafts that would have been otherwise rejected for transplantation in the past.

The EVLP device allows transplant teams to pump preservation solutions through the lungs outside of the body. This allows the team to perform a careful assessment of lung function and determine whether the lungs are viable for transplant.

The FDA originally granted the Xvivo Perfusion System in 2014 under a humanitarian device exemption (HDE), which limited use of the device to a maximum of 8,000 patients per year. Approval removes this yearly restriction, which allows for a greater number of lungs to be available for transplant. FDA approval could also increase the number of patients benefiting from this technology.

Lung transplantation is the only known lifesaving treatment for end-stage lung disease, but many patients do not survive long enough to receive a viable organ. Surgeons performed approximately 2,530 lung transplants in 2018, according to the U.S. Department of Health and Human Services.

The number of lung transplants is significantly lower than the number of other organ transplants, such as kidney and liver transplants at 21,167 and 8,250, respectively.

The FDA notes that only about 15% of lungs from deceased donors are suitable for transplantation, largely because large number of donor organs have questionable physiological function. A number of factors, such as lung injury, poor lung function and not enough time to find suitable donor-recipient matches can reduce lung function and decrease the number of available organs.

“Sadly, too many patients on transplant lists die waiting for suitable lungs. Providing patients with access to safe medical devices that have the potential to be lifesaving remains a top FDA priority, and we support the development of innovative technologies that can increase the donor organ pool for transplant patients in need of suitable lungs,” said Benjamin Fisher, Ph.D., in the statement issued by the FDA. Fisher serves as Director of the Division of Reproductive, Gastro-renal and Urological Devices at the FDA’s Center for Devices and Radiological Health.

About the Xvivo Perfusion System

The Xvivo Perfusion System allows transplantation teams to ventilate, oxygenate and perfuse lungs at a standard normal body temperature for up to five hours. This gives surgeons enough time to assess suitability and even allows them to transplant some lungs initially determined to be unsuitable.

The device features a perfusion cart with electrical and mechanical components that ventilate, oxygenate and pump lung preservation solution through the lungs.

Prior to granting approval, investigators from the FDA evaluated data from a study in which researchers allocated 332 sets of donor lungs into three groups. Lungs immediately deemed suitable for transplant served as the control group; these lungs were provided to 116 recipients after standard preservation.

The second group included lungs initially deemed unsuitable for transplant, but determined to be suitable after perfusion with the Xvivo Perfusion System; these lungs were transplanted into 110 recipients. Lungs in the third group were still not suitable after perfusion with XPS, and therefore not implanted into patients.

At 94% for recipients in the control group and 86.4% for the lung perfusion patients, the difference in one-year survival rates between the two groups was clinically insignificant. The most common adverse events associated with the Xvivo Perfusion System include acute rejection, infections, bronchial complications, and respiratory failure.

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Pew report: Provider demand for accurate patient matching is high

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The Pew Charitable Trusts is concerned with the ability to accurately match patients to their health records. According to healthcare providers surveyed, match rates are “far below the desired level for effective data exchange,” said researchers at Pew, which collaborated with eHealth Collaborative on the report.

Patient matching is the comparing of data from different health IT systems to verify if data sources match and belong to the same patient. Matching data completes the patient’s health history and medical care record. If data matches, that patient’s records are combined to eliminate duplication and confusion.

Patient matching makes it possible to integrate data from different providers and health IT systems, including electronic health records and personal health records. Mismatched records can lead to care delays, patients receiving inappropriate care, or being prescribed the wrong medicine.

Mismatched patient records also can raise healthcare costs.

The two organizations interviewed doctors at 18 hospitals, doctors’ offices and health IT exchanges. The current state of patient matching provides ample opportunity for improvement, these caregivers said.

Matching patients to their healthcare records is an ongoing problem. Current match rates between organizations are as low as 50%, the Office of the National Coordinator (ONC) reports.

Pew found that many companies measure only duplicate records within their systems, not how often outside records can be linked with records providers already have in-house.

“Many companies also were not able to pinpoint their match rates because they simply don’t know the universe of the records that should be related, and don’t know how many records should have been linked but weren’t,” Healthcare Dive reported about the study.

Data issues are compounded in urban healthcare systems as they are more likely to share records because their patients get care at multiple locations.

Pew said that techniques to improve matching vary by scope, method and price. Some suggestions include creating unique patient identifiers; patient verification of records via smartphone; standardizing demographic data; and enacting referential matching.

Pew also found that many healthcare players automate matching and employ four to five employees full-time to manage mismatched records.

HHS released two rules in mid-February to further interoperability. If finalized, by 2020, insurers participating in any CMS-run plans must be able to grant patients electronic access to their health data free of charge.

The industry would be incentivized to adopt standardized ways of communicating with each other, and the Office of the Inspector General would fine actors found to be blocking information up to $1 million per violation.

In a response to ONC interoperability rules, the College of Healthcare Information Management Executives (CHIME), representing healthcare CIOs, recommended adding patient matching to the certification requirements that health IT vendors must meet. “At a minimum, vendors should be required to attest to their matching rate; make it a violation under data blocking not to share a patient matching rate,” the organization said.

CHIME submitted the comments in collaboration with affiliate organizations the Association for Executives in Healthcare Information Technology (AEHIT) and the Association for Executives in Healthcare Information Applications (AEHIA), which together represent 4,000 health IT professionals.

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Mefloquine: A personal perspective

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I began to worry about having taken mefloquine hydrochloride (aka Lariam) about four years ago when I was listening to an NPR podcast of a show called the “Dinner Party Download.” During the podcast, the actress Aubrey Plaza said that she taken Lariam during a two-month-long trip to Ghana.

She said, “I had really bad hallucinogenic, neuro-psychological side effects from this drug.” She described having panic attacks, paranoia, and a hallucination that it was raining, when it wasn’t. She said that she had to be hospitalized until the symptoms abated.

If you’ve deployed to Iraq or Afghanistan, especially in the early days of Operation Iraqi Freedom and Operation Enduring Freedom, you were probably prescribed mefloquine. For those of you who are unfamiliar with the drug, it is an anti-malarial with some odd and obvious side effects.

The drug, a white pill, was to be ingested every Monday morning for the duration of the deployment, followed by a two-week-long daily dose of primaquine.

I experienced two side effects. First, often, shortly after taking mefloquine, I would feel an unexplained feeling of anger, which might last all day, or a few hours. The second side effect included intense and vivid dreams that would occur on Monday nights. These dreams felt like reality, which could be enjoyable if it was a nice dream. However, oftentimes, they were just bizarre.

My OEF deployment was not my first time to be ordered to take a pill for my “own good.” During Operation Desert Shield, we were given Pyridostigmine Bromide (PB) pills as a pre-treatment for nerve agent exposure. Shortly before redeploying to Fort Campbell, one of our medics told us that they had been ordered to scrub our medical records of any mention of PB pills, and he recommended that we save our blister packs, in case we needed to prove that we’d taken them.

Flash forward 12 years, and sure enough, my prescription for mefloquine was nowhere to be found in my medical file. I did save the blister packs, though. They’re sitting in a box right next to my PB pills.

In the early weeks of my OEF deployment, I wasn’t sure if I should follow orders and take the mefloquine. I based my decision to take them on three things. First, I didn’t think that the PBs had caused any permanent damage. Second, I remembered the unnecessary uproar over mandatory anthrax vaccinations given in the late 1990s.

Finally, while participating in Operation Warrior Sweep, a mortar platoon leader, and a PFC mortarman were afflicted with symptoms of malaria. From my point of view, it looked like they were suffering from the worst hangover imaginable. The platoon leader had been an SF medic (18D) prior to getting his commission. He said that he was more afraid of the mefloquine than of malaria. That should have been a red flag, but I didn’t heed it.

Prior to 1946, the primary treatment for malaria was quinine, taken in powder form and mixed into a liquid, or in the form of tonic water. In fact, the cocktail known as the gin and tonic was invented by British soldiers serving in India, as a more palatable way to ingest the bitter tasting quinine.

In 1946, the drug primaquine was developed and is considered an essential medicine by the World Health Organization. People with the sickle cell trait should not take primaquine.

According to the National Institutes of health, mefloquine was developed at the Walter Reed Army Institute of Research in 1975. Clinical studies of the drug were conducted on inmates in prisons in Illinois and Maryland.

Also according to NIH, patients taking mefloquine began reporting “neuropsychiatric adverse effects” as early as the mid-1990s.

Between the years 2001 and 2003, the World Health Organization performed three clinical studies which confirmed that mefloquine had “potential for causing psychological illness.” Furthermore, the studies reported “an excess of neuropsychiatric adverse effects in the mefloquine arm.”

In November 2018, the Veterans Administration posted a Public Health Announcement that acknowledged that, “Recent scientific literature has suggested side effects (of mefloquine) including mood changes, bad or vivid dreams, agitation, suicidal thoughts, and suicidal behavior.”

In the announcement, the VA reminded interested parties that the agency considers disability claims by veterans who believe their health may have been affected by taking mefloquine.

Earlier this year, the VA established a committee to study the long-term effects of mefloquine toxicity.

It’s good that the VA is taking steps toward, hopefully, a treatment for mefloquine toxicity. However, I’m sure that most vets would rather have not been compelled to take the drug in the first place.

For me, the lesson learned was; if an 18D tells you not to take a pill, then don’t take the pill.

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5 surprising ways to decrease risk in your operating rooms

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Operating room safety is a major, ongoing priority for your medical facility — and you no doubt practice scrupulous technique when it comes to monitoring procedures and equipment.

Research shows, though, that employing unexpected personnel strategies can also be a highly effective way to cut risks and improve surgical outcomes in both the long and short term. Try these science-driven tips to improve your OR environments:

Schedule two surgeons for spine surgeries.

A study from the Group Health Research Institute found that this simple double-staffing technique can reduce major complications.

What’s more: two doctors can split tasks to reduce fatigue and mistakes and check each other’s work. Patients may also feel doubly reassured from a psychological standpoint when they know two doctors are there to facilitate an easy and safe procedure.

Pay attention to posture.

University of Buffalo researchers report that when surgeons stand in awkward positions for long periods of time, it can lead to shoulder, neck and back pain, impairing their ability to do their next job.

Implement mandatory seminars that teach surgeons the importance of changing positions periodically as they work and offer stretching/yoga/posture instruction programs they can use to feel more comfortable. Also, encourage your OR teams to helpfully spot each other, remind each other to change positions, and take short breaks whenever possible during surgery. This can go a long way to reduce strain as well.

Take the emotional strain out of surgical training.

An intriguing study from the University of Houston found that when medical students are taught early to think of surgery as a “hobby,” it removes the stress that leads to the fight-or-flight response as they train. From this, they learn skills such as microsurgical cutting much more efficiently.

This is not to say you should encourage your teachers to treat surgery as a frivolous skill in any way — what can work is to simply move training to a relaxed setting, like a classroom, as opposed to an actual OR-simulated environment.

Letting medical students know that mastering their general studies first and effectively will make surgical training less scary is a very helpful strategy.

Pick a positive playlist.

Encourage a good mood in your ORs by piping in amusing and relevant music. A study from U.K. researchers found that great songs to accomplish this with are “Stayin’ Alive” by the Bee Gees, “Smooth Operator” by Sade, and “Comfortably Numb” by Pink Floyd.

Positive personnel do their best work in high-pressure situations. A great additional option, of course, is to keep your surgical teams happy by allowing them to take turns bringing in their own playlists, encouraging them to choose uplifting music for everyone to listen to together.

Check in with your staff.

Ask your OR teams on a regular basis what they need to do their best work…then provide it! Keep up a running dialogue to meet that need, and you’ll always be on top of any problems or concerns that can contribute to increased risk.

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HHS finalizes rule requiring drug prices in TV ads

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Frustrated viewers of nearly every television program barraged by advertisements of drug commercials that feature all the medicine’s benefits, the litany of potential side effects, etc. — but who receive no pricing information — are getting a little reprieve.

Those ads will soon change slightly, according to the Trump administration, which has finalized a rule that will require pharmaceutical companies to disclose the price of their products in television advertising as soon as summer 2019.

Pharmaceutical companies and drugmakers have stood in opposition of this rule from taking effect, but HHS says efforts by these companies — such as directing patients to websites for pricing information — is not enough to make a significant difference in pricing transparency.

The Department of Health and Human Services (HHS) is going so far as to say that since the drug companies benefit so much from selling directly to consumers via the TV, they should disclose costs via the same channels. Thus, like cars and other direct-to-consumer goods being sold and priced on television, pharmaceuticals should be no different.

Billions are spent each year by drugmakers marketing their wares directly to the public, most of which comes in the form of the 30- or 60-second television spots. “We’re telling drug companies today that you’ve got to level with people what your drugs cost,” HHS Secretary Alex Azar said on a call with reporters. “Patients have a right to know and, if you’re ashamed of your drug prices, change your drug prices.”

According to the HHS announcement of the program, the rule will require direct-to-consumer television advertisements for “prescription drug and biological products covered by Medicare or Medicaid to include the list price — the Wholesale Acquisition Cost — if that price is equal to or greater than $35 for a month’s supply or the usual course of therapy, with the prices updated quarterly.”

Meanwhile, the 10 most commonly advertised drugs have list prices ranging from $488 to $16,938 per month or usual course of therapy. “Patients deserve to know what a drug costs as they discuss their options with their doctor,” HHS said in its statement.

Also, per HHS, 7% of Americans have high-deductible health insurance plans, under which they often pay the list price of a drug until they have spent through their deductible. All seniors on Medicare Part D have co-insurance for certain types of drugs, which means their out-of-pocket expenses are calculated as a share of list price. List prices are also what patients pay if a drug is not on their insurance formulary.

All of this to say that Americans, who are on the hook for a good bit of the out-of-pocket expenses required by their plans, likely want to know roughly how much they will have to spend on their drugs, and now can via the TV ads.

The final rule, part of the “American Patients First” blueprint, will go into effect 60 days after it is published in the Federal Register.

The rule allows drug companies to provide additional information about expected costs for insured patients and other helpful information, if they choose.

One disclaimer is that if a manufacturer simply includes price information in a direct-to-consumer advertisement as required, that information in the advertisement will not require review by the FDA Office of Prescription Drug Promotion (OPDP).

“OPDP does not review price information in prescription drug advertisements and does not intend to do so in the future, unless the price information explicitly or implicitly incorporates safety or efficacy information about the drug, or makes express or implied claims about the safety or efficacy of the drug,” the statement said.

Drugmakers would be required to include text in their television ads that states the list price for either a 30-day supply or a typical course of treatment for the product being marketed. The statement would also note that costs may differ if a consumer has health insurance that covers drugs.

“We are concerned that the administration’s rule requiring list prices in direct-to-consumer television advertising could be confusing for patients and may discourage them from seeking needed medical care,” said Stephen Ubl, president of the drug lobby PhRMA, in a statement.

How HHS ensures compliance is to be determined. The agency plans to publish a list of companies that are in violation of the requirement and expects competitors would sue citing false and misleading advertising under the Lanham Act.

The U.S. and New Zealand are the only countries that allow for direct-to-consumer pharmaceutical adverting that includes product claims.

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You can do these things in your sleep

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You never go to bed early because you’re trying to get stuff accomplished, right? Rethink that strategy.

Science is proving that your brain is surprisingly good at multitasking while you sleep — and your body functions at a surprisingly energetic level, too. Here are just a few of the surprising things you can do in your sleep — your mental and physical health will thank you!

Prep for that presentation.

Trying to memorize data for a big work project? Take a 20-minute nap in a hammock or rocking chair or recliner.

A study from the University of Geneva found that sleeping while your body gently rocks or sways activates the memory consolidation channels within your brain, sharpening your ability to recall facts quickly and efficiently. Rocking also helps you fall asleep faster and stay asleep, too.

Learn a new language.

University of Bern researchers found that during the phase of sleep known as slow wave, new vocabulary is efficiently cemented in your memory due to specific brain cells repairing themselves from your busy day.

Play a recording on your phone of those French phrases you’re trying to learn for that upcoming vacation to Paris while you snooze, and when you wake up, you’ll know them.

Heal that wound.

European researchers report that during sleep, your immune cells attach themselves to “targets” in your system — like the cold virus or the infection you might have gotten from a cut.

Sleep super-powers your immune cells to kill what’s making you sick. Give these immune cells a boost by making sure you get at least seven hours of uninterrupted ZZZZs.

Stop those aches and pains.

Research published by the Society for Neuroscience found that just one night of decreased sleep can adversely activate the brain’s perception of pain. If you get 7-8 hours of shuteye, though, you may experience less pain the next day — so sleep can help you get control of those aches and pains you deal with from hunching over your computer and phone as you work.

Enjoy a better outlook.

Good sleep can help cement a positive attitude once you wake up the next morning. When your brain is rested, you feel clearer about the possibilities and potential of what you can achieve. So, turn in early, and wake up tomorrow ready to meet those goals and more!

Here are five additional strategies for good sleep hygiene to help you get the highest quality rest, according to the American Sleep Association:

  • Go to bed and get up at the same time each day.
  • Don’t nap, which can throw off the amount of sleep you get later.
  • Avoid caffeine after noon each day.
  • Exercise before 2 p.m. each day; it will help you sleep through the night.
  • Put your alarm clock or phone in a place you can’t see it when you go to bed to avoid checking the time constantly.

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Why understanding the time pyramid is critical for healthcare administrators

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Everything that falls under the auspices of healthcare administration is complex. From budgets to billing and policy to care management, healthcare administrators at any level must understand, manage, and optimize complicated systems.

As such, the actions of one healthcare administrator can impact a significant number of departments, teams and employees. Because of this, it is critical for administrators to become familiar with and embrace the time pyramid.

Dorks unite!

Jake Knapp and John Zeratsky are tech industry veterans that took the lessons they learned optimizing systems while maintaining constant connectivity and condensed them into a practical guide to creating time for what matters, called “Make Time.” An essential theme of the book — combatting constant busyness and distractions — is something most healthcare administrators face regularly.

The first step in trying to solve for busyness and distractions is to get clear on the myriad things that take the focus away from critical work.

Unfortunately, even trying to do so might be overwhelming. In some cases, it may be difficult to discern what is truly important from what is not; in other situations, it could be there are simply too many distractions to allow any time to figure it all out.

Pyramid or pond?

This is where the time pyramid comes in. In a recent article, “Making Time at Work,” Zeratsky described the impact of leadership decisions on teams and, subsequently, staff decisions as an upside-down pyramid. At the point, leaders are small but their decisions impact the next layer of management, whose decisions impact the next level of employees, with the impact expanding at each layer.

By pairing this visual with an understanding of the things that keep us busy and distracted, we can begin to see how exponentially any lack of focus can create ripples that continue to grow and expand throughout the organization.

Because of the nature of the role of healthcare administrators, it is then critically important that all leaders in this field prioritize effectively.

No time to make time

The problem is, again, because of the nature of the job, healthcare administrators rarely have any time to focus on time. Yet doing so is essential to their success.

So, how do they begin? The key is to start small.

First, admit that your decisions can have a significant and wide-ranging impact on systems and people. Second, understand that your day is a constant battle against an even more wide-ranging number of things trying to keep your attention regardless of whether they deserve it.

Third, note that few of the things vying for your attention actually deserve it. And fourth, figure out what is important, must have your focus and is something truly only you can do.

Getting to and through that last step requires commitment. But once you have made it, the rest is all about practicing the word no. At that point, one of the best things to do is focus again on the upside-down pyramid.

When facing distraction, remember that anything that keeps you off track impacts the rest of the employees down the line. As leaders, it is our responsibility to ensure our employees have the chance to excel and the ability to be productivity.

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6 ways your hospital can reduce patient anxiety

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In a hospital, you’re always trying to improve patient experience — but you might be overlooking the most crucial area that needs fixing. Anxiety is a well-established issue at varying levels for many patients facing a procedure, extensive treatment, or just waiting for test results. However, many physicians don’t see the importance of systematically addressing it.

It’s important to do so, though. When you take the time to find ways to reduce your patients’ nerves and trepidations, customer satisfaction can skyrocket. Plus, reassurance is humane — which is the point of practicing medicine in the first place.

Implement these scientifically proven strategies to provide more calm and ensure better feedback for your organization:

Add customer reps to your radiology department.

Research from Children’s Hospital Medical Center in Cincinnati found that adding representatives to a computerized radiology reading room ensures that physicians get results as quickly as possible.

This means patients can actually remain in the waiting room after testing, then see their doctors directly to get their results. This eliminates days of anxious waiting on the patient’s side.

Be consistent in terms of face time.

A recent Johns Hopkins study found that good management of physician scheduling allows them to spend a consistent amount of time with each outpatient they see.

This is important, because if a patient feels shortchanged when their doctor appears to be rushing through an appointment, they may not ask all the questions they have about their health. As a result, the patient will walk out of that appointment feeling anxious about what they don’t know.

Make sure your hospital clinics run efficiently, so unexpected delays don’t happen.

Make sure “essential touch” is handled with empathy.

Many patients don’t like the kind of “functional intimacy” that’s required during an exam, according to researchers at the University of Chicago’s Booth School of Business.

Your physicians, nurses, medical assistants and PCAs can reduce the anxiety of these patients by smiling and explaining exactly when and why they are using touch before they do it. This will give patients a sense of understanding and control.

Address the needs of “frequent flyers.”

Research presented by Henry Ford Hospital shows that ER “frequent flyers” — patients who use the emergency department at least 10 times a year as their primary source of health care — test the patience of between 59-77% of emergency room doctors, leading to less empathy for these patients. In turn, that can cause patient anxiety to heighten.

Identify and work to find these patients PCPs so they feel more consistently informed and cared for. Then, your ER docs will have the time to deal with actual emergencies.

Watch out for patient stereotyping.

A study from the University of Southern California found that patients who feel judged by physicians regarding their weight, age, race, gender, or social class become more distrustful, less satisfied, and less likely to seek preventative care.

All of this, obviously, can ramp up their health anxiety as a whole. Establish a no-tolerance policy for any stereotyping of patients for your personnel, and enforce it scrupulously.

Ask questions.

Add queries to your patient satisfaction surveys regarding health anxiety. For example, you can ask, “Did you feel anxious prior to your appointment about your health?” “Did you tell your doctor you felt anxious?” “How did he or she address your anxiety?”

This is an excellent way to get a snapshot of how well your patients’ needs are being met. Use their feedback to help with your physicians communicate better and ease your patients’ worries — better outcomes will soon arise!

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