Planning Is Prevention: More Planning Means Less Stress — and a Big Boost in Happiness - - TIME Healthland

A recent survey by Harvard professor Robert Epstein found that 25% of our happiness hinges on how well we're able to manage stress. The next logical question is, of course, how best can we reduce our stress?

Epstein's study, which he presented last month at the Western Psychological Association meeting in Los Angeles, was intended to help answer that question. It involved 3,000 participants in the U.S. and 29 other countries, who responded to an online questionnaire. Participants' stress-management skills were gauged by asking them to rate their level of agreement with 28 items, such as "I frequently use breathing techniques to help me relax." The volunteers were also asked about how happy they were and how successful they were in their personal and professional lives.

The stress management technique that worked best, according to the survey: planning. In other words, "fighting stress before it even starts, planning things rather than letting them happen," says Epstein. "That means planning your day, your year and your life so that stress is minimized."

Epstein points to his friend, the late Harvard behaviorist B.F. Skinner, as a master organizer. (To the rest of us, Skinner is probably better known for his highly influential research on the effects of reinforcement on behavior.) "Skinner was amazing at managing stress. He was quite a planner. Not only did he plan his day every day, but he had a 10-year planner," says Epstein.

Epstein's survey was also able to track stress management with participants' overall levels of happiness. "The association was very strong," says Epstein, "suggesting that nearly 25% of our happiness is related to our ability to manage stress." (Incidentally, he remembers his former colleague Skinner as having been a genuinely happy person.)

But the bad news is that, in general, people are really bad at managing stress. "The mean score on our test was 55%. In a course, that would lead to a failing grade: F," says Epstein.

You don't have to be scientist to know that excess stress can lead to a host of ill effects, psychologically and physically — including early death. According to the New England Centenarian Study carried out by Boston University School of Medicine researchers in 2010, longevity is 20%-30% determined by genes and 70%-80% attributable to the environment. And a major characteristic consistent among people who lived to 100, the study found, was the ability to manage stress. "Stress kills," says Epstein. "Stress is not only daunting, it's also an important factor responsible for the acceleration of the biological clock."

"The most important way to manage stress is to prevent it from ever occurring," by planning, says Epstein. Of course, for some people, the idea of making checklists and calendars, organizing and planning ahead sounds, well, stressful. So Epstein suggests a few other stress-management techniques that might work better for you:

Relax. O.K., if you could do that, you wouldn't have any stress to begin with. But you can learn to decompress. Epstein found that study participants who had received stress-management training — even just a yoga class — had higher happiness scores than people who hadn't. The more hours of training, the higher their scores.

Getting relaxed can be as easy as deep breathing, meditating or practicing muscle relaxation. "It's important to practice one or more of these techniques every day, before stress ever hits," says Epstein. "That's a way of 'immunizing' yourself against stress, so that it doesn't hurt you so much when it occurs."

One simple breathing technique: the cleansing breath, which consists of inhaling deeply, holding for a slow count of five and exhaling slowly.

Tummy Breathing. When you're stressed, you breathe with your chest, so Epstein recommends learning to breath with your gut. Place one hand on your chest and another on your stomach and try to keep your chest still as you breathe more with your tummy. "Abdominal breathing relaxes muscles throughout the body and lowers stress levels," says Epstein.

Double Blow. Another easy breathing technique. All you have to do is exhale fully, breathe in fully and then blow out forcefully — this helps fight the tendency to take shallow fast breaths when you're stressed. "This gets rid of the air trapped in the lower lungs and refreshes the respiratory system," says Epstein, noting that shallow breathing circulates carbon dioxide and other toxins through the bloodstream.

Epstein says he taught his daughter the double blow when she was just 3 years old. Now 5, when she gets upset, he says he tells her, "Do your blowing." Epstein says it works every time: "She'll do this huge 'Pfff' and try to blow my head off and then she'll start laughing. She'll go from borderline getting upset to absolute cheerful."

In a previous study, Epstein found that parents' stress management was the second most powerful predictor, after love and affection, in outcomes of parenting. "The tragedy is that we don't teach these things to children," says Epstein.

Reframing. Last but not least, Epstein says people can reduce stress by reframing, which means thinking about things in a neutral or positive way, instead of negatively. "We don't have much control over the events around us, but we have almost total control over how we interpret them," Epstein says.

Often, we make assumptions or blow things out of proportion, only to realize later that we were wrong. So, for instance, if your boss passes you in the hall looking surly without saying hello, don't immediately jump to the conclusion that you're about to get laid off. Rather, ask yourself whether he might have just received some bad news or was simply being absent-minded.

Tuning In to Patients' Cries for Help -

Tom Kerr of Pittsburgh will never forget the long-distance call from his elderly mother, who was in a hospital in the Cleveland area with a broken leg.

She phoned her son, more than 100 miles away, because no one in the hospital was answering her call button.

Mr. Kerr quickly called the hospital operator, tracked down the floor nurse and asked for someone to check on his mother.

"She had to call me long distance, and then I had to call the hospital long distance," he recalled recently. "I complained to the hospital about the lack of a response to her call button and received an apology. There was obviously no defense."

Whether it's a request for ice water, help getting to the bathroom or a plea for pain relief, an unanswered call light leaves hospital patients feeling helpless and frustrated. And for nurses, often the first responders to these calls, the situation is frustrating too: Short staffing and a heavy workload often make it impossible to respond as quickly as they would like.

Now some hospitals around the country are starting programs to deal with the problem.

Presbyterian Healthcare Services, which operates three hospitals inAlbuquerque, began focusing on improving the efficiency of its call light system after hearing complaints from focus groups of nurses and patients.

The company discovered that requests could be handled far more efficiently if call-button calls were sent to a central operator.

That operator can summon support workers via text message to take care of simple requests, like pillows or help with the television remote, freeing nurses to deal with bigger problems like pain relief or tangled IV lines. The hospitals now use the system in 13 units with a total of 400 beds, with plans to expand it further.

"We've really fundamentally changed the way we interact with our patients around their needs," said Lauren Cates, the hospitals' chief operating officer. "If you press a call light you have no idea if anyone is listening. Now we interact with the patient much more quickly."

In national patient satisfaction surveys, Presbyterian has moved from the 40th percentile in call response promptness to the 75th percentile. And the company says it has seen a 92 percent reduction in patient complaints about lack of communication.

Moreover, of the 1,400 patient calls the system receives each day, about 10 percent are mistakes, caused by rolling over on the button or mistaking it for the television remote.

"Think about how much wasted time, with 140 errors a day, for our nurses who had to drop what they were doing and respond," Ms. Cates said. "It's made a real difference in the productivity of our staff."

In one case, a patient gasping for air hit the call button, which the operator answered in a matter of seconds. When the operator heard the patient's distress, she alerted an emergency response team, which rushed to the bed and performed CPR, saving the patient's life.

At Montefiore Medical Center in the Bronx, a program called No Passing Zone trains all hospital workers — maintenance people, secretaries, volunteers, security officers and, yes, doctors — to stop what they are doing, if possible, and look in on a patient when they see the call light illuminated.

"The call bell is the patient's lifeline," said Jeanne DeMarzo, clinical director of nursing. "We need to act quickly and promptly to respond to the patient's concern."

As the Albuquerque system found, many call-light requests can be handled by nonmedical staff. When the patient has a medical need, the responder immediately tracks down a qualified employee to take care of it.

In addition, under a "rounding" program, a nurse, administrator or hospital aide must stop by each patient's room once an hour, regardless of whether the call light is on. "Rounding proactively to address patient needs helps avoid use of the call bell," said Joanne Ritter-Teitel, vice president and chief nurse executive.

Even doctors sometimes answer patient calls. "Bedpans are certainly one of the things I would happily reach for if a patient needed one," said Dr. William Southern, chief of hospital medicine at Montefiore. "Call bells are something that me and my entire staff think it's important to answer. It's extraordinarily important to patients and their families."

For patients, changes like these can't come soon enough.

Walter Rhett, 59, of Charleston, S.C., spent time in the hospital last year for thoracic surgery and needed assistance going to the bathroom after being given laxatives. The cord to the call button device was tangled in the various tubes connected to hospital machines. After ringing for the nurse he waited and waited, but no one arrived. Finally, unable to wait any longer, he soiled his bed and rang the nurse again to be cleaned up. That time, the nurse showed up quickly, he said.

When Liz Farrar, 30, of Austin, Tex., was trying to breast-feed her day-old son last year, she called the nurse repeatedly for help.

Gestational diabetes during pregnancy had put the baby at risk, and when she did not get immediate help with breast-feeding and, later, a bottle, the baby's blood sugar dropped and he wound up in the neonatal intensive care unit for five days.

"After the first night, every nurse and doctor were very helpful," said Ms. Farrar, whose son has fully recovered. "But it makes my temperature rise just thinking about the first night.

"Bottom line, never leave anyone in the hospital overnight by themselves immediately after a procedure or birth, even if they tell you it's O.K."

Doctors Soften Their Stance on Obama’s Health Overhaul -

With Republicans in complete control of Maine's state government for the first time since 1962, State Senator Lois A. Snowe-Mello offered a bill in February to limit doctors' liability that she was sure the powerful doctors' lobby would cheer. Instead, it asked her to shelve the measure.

"It was like a slap in the face," said Ms. Snowe-Mello, who describes herself as a conservative Republican. "The doctors in this state are increasingly going left."

Doctors were once overwhelmingly male and usually owned their own practices. They generally favored lower taxes and regularly fought lawyers to restrict patient lawsuits. Ronald Reagan came to national political prominence in part by railing against "socialized medicine" on doctors' behalf.

But doctors are changing. They are abandoning their own practices and taking salaried jobs in hospitals, particularly in the North, but increasingly in the South as well. Half of all younger doctors are women, and that share is likely to grow.

There are no national surveys that track doctors' political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors' advocates in those and other states.

That change could have a profound effect on the nation's health care debate. Indeed, after opposing almost every major health overhaul proposal for nearly a century, the American Medical Association supported President Obama's legislation last year because the new law would provide health insurance to the vast majority of the nation's uninsured, improve competition and choice in insurance, and promote prevention and wellness, the group said.

Because so many doctors are no longer in business for themselves, many of the issues that were once priorities for doctors' groups, like insurance reimbursement, have been displaced by public health and safety concerns, including mandatory seat belt use and chemicals in baby products.

Even the issue of liability, while still important to the A.M.A. and many of its state affiliates, is losing some of its unifying power because malpractice insurance is generally provided when doctors join hospital staffs.

"It was a comfortable fit 30 years ago representing physicians and being an active Republican," said Gordon H. Smith, executive vice president of the Maine Medical Association. "The fit is considerably less comfortable today."

Mr. Smith, 59, should know. The child of a prominent Republican family, he canvassed for Barry Goldwater in 1964, led the state's Youth for Nixon and College Republicans chapters, served on the Republican National Committee and proudly called himself a Reagan Republican — one reason he got the job in 1979 representing the state's doctors' group.

But doctors in Maine have abandoned the ownership of practices en masse, and their politics and points of view have shifted dramatically. The Maine doctors' group once opposed health insurance mandates because they increase costs to employers, but it now supports them, despite Republican opposition, because they help patients.

Three years ago, Mr. Smith found himself leading an effort to preserve a beverage tax — a position anathema to his old allies at the Maine State Chamber of Commerce and the Republican Party but supported by doctors because it paid for a health program. The doctors lost by a wide margin, and the tax was overturned.

Mr. Smith still goes to the State Capitol wearing gray suits, black wingtips and a gold name badge, but he increasingly finds himself among allies far more casually dressed, including the liberalMaine People's Alliance and labor groups. And while he still greets old Republican friends — he is a lobbyist, after all — he spends much of his time strategizing with Democrats.

Representative Sharon Anglin Treat, a powerful Democrat who was first elected in 1990, said that she and Mr. Smith were once bitter foes. "But Gordon's become like a consumer activist," she said with a big smile. "I've seen him more times in the last few years than I can count."

Dr. Nancy Cummings, a 51-year-old orthopedic surgeon in Farmington, is the kind of doctor who has changed Mr. Smith's life. She trained at Harvard, but after her first son was born she began rethinking 18-hour workdays. "My husband used to drive my son to the hospital so that I could nurse him," she said. "I decided that I really wanted to be a good surgeon, but also wanted to raise healthy, well-adjusted kids I would actually see."

So she went to work for a hospital, sees health care as a universal right and believes profit-making businesses should have no role in either insuring people or providing their care. She said she was involved with the Maine Medical Association, for the most part, to increase patients' access to care.

Dr. Lee Thibodeau, 59, a neurosurgeon from Portland, still calls himself a conservative but says he has changed, too. He used to pay nearly $85,000 a year for malpractice insurance and was among the most politically active doctors in the state on the issue of liability. Then, in 2006, he sold his practice, took a job with a local health care system, stopped paying the insurance premiums and ended his advocacy on the issue.

"It's not my priority anymore," Dr. Thibodeau said. "I think Gordon and I are now fighting for all of the same things, and that's to optimize the patient experience."

Many of Mr. Smith's counterparts in other states told similar stories of change.

"When I came here, it was an old boys' club of conservative Republicans," said Joanne K. Bryson, the executive director of the Oregon Medical Association since 2004.

Now her group lobbies for public health issues that it long ignored, like insurance coverage for people with disabilities.

Even in Texas, where three-quarters of doctors said last year that they opposed the new health law, doctors who did not have their own practices were twice as likely as those who owned a practice to support the overhaul, as were female doctors.

Dr. Cecil B. Wilson, the president of the A.M.A., said that changes in doctors' practice-ownership status do not necessarily lead to changes in their politics. And some leaders of state medical associations predicted that the changes would be fleeting.

Dr. Kevin S. Flanigan, a former president of the Maine Medical Association, described himself as "very conservative" and said he was fighting to bring the group "back to where I think it belongs." Dr. Flanigan was recently forced to close his own practice, and he now works for a company with hundreds of urgent-care centers. He said that in his experience, conservatives prefer owning their own businesses.

"People who are conservative by nature are not going to go into the profession," he said, "because medicine is not about running your own shop anymore."

Falling seniors: A preventable problem, a ‘huge health burden’ - The Globe and Mail

Fractured hips, pneumonia and significantly reduced mobility are among the most deadly health risks faced by seniors.

But for many, these threats are not an inevitable part of aging. They are caused by falls, an entirely preventable problem that leads to a vast array of serious injuries and the onset of debilitating illnesses that rob seniors of their independence, mobility, and in many cases, their lives.

"It's just a huge health burden," said Vicky Scott, clinical associate professor at the University of British Columbia and senior adviser on fall and injury prevention for the B. C. government. "[Falls are] that trigger event that seems to really spiral [the health of seniors] downward."

In Canada, the issue of seniors falling isn't unrecognized. Leading Canadian researchers have helped bring attention to the problem, and now many parts of the country have fall prevention programs for homes, hospitals, residential-care facilities and other centres.

But experts say the implementation, enforcement and scope of these programs are often lacking and there is not enough pressure on health-care facilities or home-care programs to prioritize fall-prevention strategies.

At the same time, such programs don't account for the fact that thousands of seniors living independently aren't aware of the risks they face and never have a discussion about it with their physician.

These glaring gaps lead to countless injuries, unnecessary deaths and a major strain on the health-care system – and a growing number of experts in the field say things need to change.

"It's common, it's preventable and the prevention for this will protect from other diseases as well," said Karim Kahn, leader of fracture prevention at the Centre for Hip Health and Mobility, a Vancouver-based research institute focused on arthritis and hip-related fractures.

Studies show that one in three people 65 and older, and perhaps more, will fall at least once a year.

Not all falls lead to serious injury. But falls cause more than 90 per cent of all hip fractures in seniors. One in five seniors who fractures a hip will die within a year of the break.

More ...

How it feels to have a stroke - TEDtalks - Neuroanatomist Jill Bolte Taylor

Jill Bolte Taylor - Wikipedia, the free encyclopedia

Jill Bolte Taylor (born 1959 in Louisville, Kentucky) is a neuroanatomist who specializes in the postmortem investigation of the human brain. She is affiliated with theIndiana University School of Medicine and is the national spokesperson for the Harvard Brain Tissue Resource Center. Her own personal experience with a massive stroke, experienced in 1996 at age 37, and her subsequent eight-year recovery, has informed her work as a scientist and speaker. For this work, in May 2008 she was named to Time Magazine's list of the 100 most influential people in the world.[1] "My Stroke of Insight" received the top "Books for a Better Life" Book Award in the Science category from the New York City Chapter of the National Multiple Sclerosis Society on February 23, 2009 in New York City.[2]

[edit]Stroke of Insight

On December 10, 1996, Taylor woke up to discover that she was experiencing a stroke. The cause proved to be bleeding from an abnormal congenital connection between an artery and a vein in her brain, an arteriovenous malformation (AVM). Three weeks later, on December 27, 1996, she underwent major brain surgery atMassachusetts General Hospital (MGH) to remove a golf ball-sized clot that was placing pressure on the language centers in the left hemisphere of her brain.
Taylor's February 2008 TED Conference talk[3] about her memory of the stroke[4] became an Internet sensation, resulting in widespread attention and interest around the world.[5]


Following her experience with stroke, Taylor wrote the best-selling book My Stroke of Insight: A Brain Scientist's Personal Journey,[6] about her recovery from the stroke and the insights she has gained into the workings of her brain. Subsequently, Taylor appeared on the Oprah Winfrey Show on October 21, 2008.[7] In her later commencement address at Duke University on May 10, 2009, Oprah Winfrey quoted Taylor's assertion that, "You are responsible for the energy that you bring" in encouraging the students to assume this same responsibility in their future lives.[8] Taylor was the first guest featured on Oprah's Soul Series[9] webcast on and Satellite radio show.

News from The Associated Press

A growing shortage of medications for a host of illnesses - from cancer to cystic fibrosis to cardiac arrest - has hospitals scrambling for substitutes to avoid patient harm, and sometimes even delaying treatment.

"It's just a matter of time now before we call for a drug that we need to save a patient's life and we find out there isn't any," says Dr. Eric Lavonas of the American College of Emergency Physicians.

The problem of scarce supplies or even completely unavailable medications isn't a new one but it's getting markedly worse. The number listed in short supply has tripled over the past five years, to a record 211 medications last year. While some of those have been resolved, another 89 drug shortages have occurred in the first three months of this year, according to the University of Utah's Drug Information Service. It tracks shortages for the American Society of Health-System Pharmacists.

The vast majority involve injectable medications used mostly by medical centers - in emergency rooms, ICUs and cancer wards. Particular shortages can last for weeks or for many months, and there aren't always good alternatives. Nor is it just a U.S. problem, as other countries report some of the same supply disruptions.

It's frightening for families.

At Miami Children's Hospital, doctors had to postpone for a month the last round of chemotherapy for 14-year-old Caroline Pallidine, because of a months-long nationwide shortage of cytarabine, a drug considered key to curing a type of leukemia.

"There's always a fear, if she's going so long without chemo, is there a chance this cancer's going to come back?" says her mother, Marta Pallidine, who says she'll be nervous until Caroline finishes her final treatments scheduled for this week.

"In this day and age, we really shouldn't be having this kind of problem and putting our children's lives at risk," she adds.

There are lots of causes, from recalls of contaminated vials, to trouble importing raw ingredients, to spikes in demand, to factories that temporarily shut down for quality upgrades.

Some experts pointedly note that pricier brand-name drugs seldom are in short supply. The Food and Drug Administration agrees that the overarching problem is that fewer and fewer manufacturers produce these older, cheaper generic drugs, especially the harder-to-make injectable ones. So if one company has trouble - or decides to quit making a particular drug - there are few others able to ramp up their own production to fill the gap, says Valerie Jensen, who heads FDA's shortage office.

The shortage that's made the most headlines is a sedative used on death row. But on the health-care front, shortages are wide-ranging, including:

-Thiotepa, used with bone marrow transplants.

-A whole list of electrolytes, injectable nutrients crucial for certain premature infants and tube-feeding of the critically ill.

-Norepinephrine injections for septic shock.

-A cystic fibrosis drug named acetylcysteine.

-Injections used in the ER for certain types of cardiac arrest.

-Certain versions of pills for ADHD, attention deficit hyperactivity disorder.

-Some leuprolide hormone injections used in fertility treatment.

No one is tracking patient harm. But last fall, the nonprofit Institute for Safe Medication Practices said it had two reports of people who died from the wrong dose of a substitute painkiller during a morphine shortage.

"Every pharmacist in every hospital across the country is working to make sure those things don't happen, but shortages create the perfect storm for a medication error to happen," says University of Utah pharmacist Erin Fox, who oversees the shortage-tracking program.

What can be done?

The FDA has taken an unusual step, asking some foreign companies to temporarily ship to the U.S. their own versions of some scarce drugs that aren't normally sold here. That eased shortages of propofol, a key anesthesia drug, and the transplant drug thiotepa.

Affected companies say they're working hard to eliminate backlogs. For instance, Hospira Inc., the largest maker of those injectable drugs, says it is increasing production capacity and working with FDA "to address shortage situations as quickly as possible and to help prevent recurrence."

But the Generic Pharmaceutical Association says some shortages are beyond industry control, such as FDA inspections or stockpiling that can exacerbate a shortage.

"Drug shortages of any kind are a complex problem that require broad-based solutions from all stakeholders," adds the Pharmaceutical Research and Manufacturers of America, a fellow trade group.

Lawmakers are getting involved. Sen. Herb Kohl, D-Wis., is urging the Federal Trade Commission to consider if any pending drug-company mergers would create or exacerbate shortages.

Also, pending legislation would require manufacturers to give FDA advance notice of problems such as manufacturing delays that might trigger a shortage. The FDA cannot force a company to make a drug, but was able to prevent 38 close calls from turning into shortages last year by speeding approval of manufacturing changes or urging competing companies to get ready to meet a shortfall.

"No patient's life should have to be at risk when there is a drug somewhere" that could be used, says Sen. Amy Klobuchar, D-Minn., who introduced the bill.

iPad EMR Apps | A Guide to Electronic Medical Records - Software Advice Articles

Apple's iPad is making rounds in healthcare. Its ergonomic design, long battery life, and beautiful user interface (UI) gives other tablets a run for their money. Several reports indicate that the iPad is growing in popularity among physicians. As a result, more and more electronic medical record (EMR) vendors are releasing iPad-specific versions of their EMRs. Some offer native iPad EMRs; others offer web-browser access through the iPad. However, there is no perfect iPad EMR solution. Each type of deployment has it benefits and drawbacks. In this guide we review the three main iPad EMR options:

  • Web-based EMRs. These systems are used through a web browser, and can therefore be accessed using the iPad's Safari browser. They are great for many reasons.
  • Remote access EMRs. Most client/server, on-premise EMRs can be accessed from a remote system, including iPads, through utilities like Citrix. This isn't ideal, but it works.
  • Native iPad EMRs. These are probably what you want most – a slick app developed just for the iPad – but the options are very limited so far. You might have to wait.

More ...

Squandering Medicare’s Money -

MEDICARE has suddenly taken center stage in American politics, with Democrats now trying to score an advantage from the unpopularity of the Republican plan to overhaul the government health insurance program. Apart from the politics, though, Medicare's financing challenges are worsening: this month, Medicare's trustees projected that the insurance program would become insolvent by 2024, five years earlier than previously estimated.

Much has been said about the growing gap between the program's spending and revenues — a gap that will widen as baby boomers retire — but little attention has been focused on a problem staring us in the face: Medicare spends a fortune each year on procedures that have no proven benefit and should not be covered. Examples abound:

• Medicare pays for routine screening colonoscopies in patients over 75 even though the United States Preventive Services Task Force, an independent panel of experts financed by the Department of Health and Human Services, advises against them (and against any colonoscopies for patients over 85), because it takes at least eight years to realize any benefits from the procedure. Moreover, colonoscopies carry risks of serious complications (like perforations) and often lead to further unnecessary procedures (like biopsies). In 2009, Medicare paid doctors more than $100 million for nearly 550,000 screening colonoscopies; around 40 percent were for patients over 75.

• The task force recommends against screening for prostate cancer in men 75 and older, and screening for cervical cancer in women 65 and older who have had a previous normal Pap smear, but Medicare spent more than $50 million in 2008 on such screenings, as well as additional money on unnecessary procedures that often follow.

• Two recent randomized trials found that patients receiving two popular procedures for vertebral fractures, kyphoplasty and vertebroplasty, experienced no more relief than those receiving a sham procedure. Besides being ineffective, these procedures carry considerable risks. Nevertheless, Medicare pays for 100,000 of these procedures a year, at a cost of around $1 billion.

• Multiple clinical trials have shown that cardiac stents are no more effective than drugs or lifestyle changes in preventing heart attacks or death. Although some studies have shown that stents provide short-term relief of chest pain, up to 30 percent of patients receiving stents have no chest pain to begin with, and thus derive no more benefit from this invasive procedure than from equally effective and far less expensive medicines. Risks associated with stent implantation, meanwhile, include exposure to radiation and to dyes that can damage the kidneys, and in rare cases, death from the stent itself. Yet one study estimated that Medicare spends $1.6 billion on drug-coated stents (the most common type of cardiac stents) annually.

• A recent study found that one-fifth of all implantable cardiac defibrillators were placed in patients who, according to clinical guidelines, will not benefit from them. But Medicare pays for them anyway, at a cost of $50,000 to $100,000 per device implantation.

The full extent of Medicare payments for procedures with no known benefit needs to be quantified. But the estimates are substantial. The chief actuary for Medicare estimates that 15 percent to 30 percent of health care expenditures are wasteful. Medicare spending exceeded $500 billion in 2010, suggesting that $75 billion to $150 billion could be cut without reducing needed services.

Why does Medicare spend so much for procedures and devices on patients who get no benefit and incur risks from them?

One reason is that Medicare's reimbursement procedures are not sophisticated enough to track the appropriateness of the care provided. Medicare delegates its claims administration to private local contractors based on how quickly and cheaply they can process claims.

These contractors have few incentives to audit the taxpayer dollars they are paying out, and even if they wanted to, they would need information often not available on the claim form. For example, a claims administrator, processing a claim for a screening colonoscopy, does not know when the patient's last colonoscopy was, or whether there was a new clinical reason for repeating it. While this information is available, finding it would require extra steps, and there are no incentives to do so.

Moreover, denying payment after a procedure is performed invites the wrath of both patient and physician. Medicare and private insurers are also keen to avoid situations that could be viewed as telling doctors how to practice medicine — even if such advice is in the patient's best interest. The political sensitivity of limiting services based on age, for example, was illustrated by the uproar over the Preventive Services Task Force's findingtwo years ago that women in their 40s do not benefit from routine mammography.

Another factor is the shocking chasm between Medicare coverage and clinical evidence. Our medical culture is such that if the choice is between doing a test and not doing one, it is considered better care to do the test. So while Medicare is obligated to follow the task force's recommendations to cover new preventive services, it has no similar mandate to deny coverage for services for which the task force has found no benefit.

Changing the system would be relatively easy administratively, but would require a firm commitment to determining whether tests and procedures truly benefit patients before performing them. Unfortunately, in a political environment in which doctors providing end-of-life counseling are called death panels, and in which powerful constituencies seek to preserve an ever-increasing array of procedures and device sales, this solution remains hidden in plain view.

Of course, doctors, with the consent of their patients, should be free to provide whatever care they agree is appropriate. But when the procedure arising from that judgment, however well intentioned, is not supported by evidence, the nation's taxpayers should have no obligation to pay for it.

Rita F. Redberg, a cardiologist, is a professor of medicine at the University of California, San Francisco, and the editor of Archives of Internal Medicine.

Sleep-deprived doctor problem needs strategy - Health - CBC News

The problem of drowsy doctors may get worse, a medical journal editorial warns.

Last year, researchers reported higher rates of surgical complications if a surgeon had less than six hours of sleep the night before.

"The problem may only be getting worse," Drs. Noni MacDonald, Paul Hébert, Ken Flegel and Matthew Stanbrook wrote in an editorial in Tuesday's issue of the Canadian Medical Association Journal.

Doctors themselves are part of the problem of sleep deprivation in medicine, a medical journal editorial says. iStock

Medical care is more complex, as patients with life-threatening conditions now survive thanks to medical innovations, drugs and technologies that weren't an option in past decades, the editorial noted.

The greater complexity at both the bedside and in the operating room not only affects surgeons but also doctors who stay up all night assisting at a birth or dealing with a patient in crisis, they said.

"We doctors ourselves are part of this problem," the editorial said. "We need to shift our professional culture. Long periods on call should not be accepted as routine or a source of pride. Instead, we must admit that working while impaired from sleep deprivation is neither normal nor acceptable."

A previous study suggested that sleep deprivation from an overnight call can cause a similar degree of impairment in judgment and motor performance as having a blood alcohol level above 0.05 per cent.

But solving the problem could be costly. A U.S. study in 2009 estimated it would take a 71 per cent increase in the physician workforce and a 174 per cent jump in the number of residents to apply the aviation industry's strategy of restricting work hours to ease fatigue in the medical system.

Some hospitals, departments and practices have used innovative strategies such as:

• Adopting strict policies on going home after call.
• Refraining from booking procedures or clinics the day after call.
• Reorganizing schedules to allow for more coverage by doctors.
• Moving to shift work.

Ultimately, licensing, accreditation, insurance and governments need to establish standards on minimum uninterrupted sleep hours and best practices, they concluded.

Without A Prevention Plan, All Nursing Home & Hospital Patients Remain At Risk For Developing Pressure Ulcers

Pressure ulcers are indeed preventable in the overwhelming majority of circumstances. The key is to identify patients who are at risk quickly after their admission to a medical facility and timely– and effectively implement preventative measures such as regular pressure relief and ensuring patients remain clean and dry.

Medicare has determined that pressure ulcers are indeed preventable and hospitals may no longer seek reimbursement for patients who develop pressure ulcers during a hospitalization.

While Medicare's assignment of pressure ulcers to its list of never events remains an important development for patient safety, the fact remains that pressure ulcers are indeed a significant problem for many patients and result in many families seeking answers regarding medical care and legal options.

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Alternative medicine: Think yourself better | The Economist

ON MAY 29th Edzard Ernst, the world's first professor of complementary medicine, will step down after 18 years in his post at the Peninsula Medical School, in south-west England. Despite his job title (and the initial hopes of some purveyors of non-mainstream treatments), Dr Ernst is no breathless promoter of snake oil. Instead, he and his research group have pioneered the rigorous study of everything from acupuncture and crystal healing to Reiki channelling and herbal remedies.

Alternative medicine is big business. Since it is largely unregulated, reliable statistics are hard to come by. The market in Britain alone, however, is believed to be worth around £210m ($340m), with one in five adults thought to be consumers, and some treatments (particularly homeopathy) available from the National Health Service. Around the world, according to an estimate made in 2008, the industry's value is about $60 billion.

Over the years Dr Ernst and his group have run clinical trials and published over 160 meta-analyses of other studies. (Meta-analysis is a statistical technique for extracting information from lots of small trials that are not, by themselves, statistically reliable.) His findings are stark. According to his "Guide to Complementary and Alternative Medicine", around 95% of the treatments he and his colleagues examined—in fields as diverse as acupuncture, herbal medicine, homeopathy and reflexology—are statistically indistinguishable from placebo treatments. In only 5% of cases was there either a clear benefit above and beyond a placebo (there is, for instance, evidence suggesting that St John's Wort, a herbal remedy, can help with mild depression), or even just a hint that something interesting was happening to suggest that further research might be warranted.

It was, at times, a lonely experience. Money was hard to come by. Practitioners of alternative medicine became increasingly reluctant to co-operate as the negative results piled up (a row in 2005 with an alternative-medicine lobby group founded by Prince Charles did not help), while traditional medical-research bodies saw investigations into things like Ayurvedic healing as a waste of time.

Yet Dr Ernst believes his work helps address a serious public-health problem. He points out that conventional medicines must be shown to be both safe and efficacious before they can be licensed for sale. That is rarely true of alternative treatments, which rely on a mixture of appeals to tradition and to the "natural" wholesomeness of their products to reassure consumers. That explains why, for instance, some homeopaths can market treatments for malaria, despite a lack of evidence to suggest that such treatments work, or why some chiropractors can claim to cure infertility.

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Need Therapy? A Good Man Is Hard to Find -

Between unresolved family conflicts, relationship struggles and his mixed-race identity, James Puckett had enough on his mind in college that he sought professional help. But after bouncing from one therapist to another, he still felt stuck.

"They were all female, and they did give me some comfort," said Mr. Puckett, 30, who works for a domestic-abuse program in Wisconsin. "But I was getting the same rhetoric about changing my behavior without any challenge to see the bigger picture of what was behind these very male coping reactions, like putting your hand through a wall."

He decided to seek out a male therapist instead, and found that there were few of them. "I'm just glad I ended up with the person I did," said Mr. Puckett, who is no longer in therapy, "because for me it made all the difference."

Researchers began tracking the "feminization" of mental health care more than a generation ago, when women started to outnumber men in fields like psychology and counseling. Today the takeover is almost complete.

Men earn only one in five of all master's degrees awarded in psychology, down from half in the 1970s. They account for less than 10 percent of social workers under the age of 34, according to a recent survey. And their numbers have dwindled among professional counselors — to 10 percent of the American Counseling Association's membership today from 30 percent in 1982 — and appear to be declining among marriage and family therapists.

Some college psychology programs cannot even attract male applicants, much less students. And at many therapists' conferences, attendees with salt-and-pepper beards wander the hallways as lonely as peaceniks at a gun fair.

The result, many therapists argue, is that the profession is at risk of losing its appeal for a large group of sufferers — most of them men — who would like to receive therapy but prefer to start with a male therapist.

"There's a way in which a guy grows up that he knows some things that women don't know, and vice versa," said David Moultrup, a psychotherapist in Belmont, Mass. "But that male viewpoint has been so devalued in the course of empowering little girls for the past 40 or 50 years that it is now all but lost in talk therapy. Society needs to have the choice, and the choice is being taken away."

The reasons for the shift are economic as well as cultural, most people in these professions agree. Managed care took a bite out of therapists' incomes in the 1990s. Psychiatry, the most male-dominated corner of therapy, increasingly turned to drug treatments. And as women entered the work force in greater numbers, they proved to be more drawn to the talking cure than men — in giving the treatment as well as in receiving it.

"Usually women get blamed when a profession loses status, but in this case the trend started first, and men just evacuated," said Dorothy Cantor, a former president of American Psychological Association who conducted a landmark study of gender and psychology in 1995. "Women moved up into the field and took their place."

The impact of this gender switch on the value of therapy is negligible, studies suggest. A good therapist is a good therapist, male or female, and a mediocre one is a mediocre one. Shared experience may even be an impediment, in some cases: therapists often caution students against assuming that they have special insight into person's problems just because they have something in common.

Still, perception is all important when it comes to seeking help for the very first time. In a recent study among 266 college men, Ronald F. Levant, a psychologist at the University of Akron, found that a man's willingness to seek therapy was directly related to how strongly he agreed with traditionally male assumptions, like "I can usually handle whatever comes my way." Such a man on the fence about seeking treatment could be discouraged by the prospect of talking to a woman.

"Many men like this believe that only another man can help them, and it doesn't matter whether that's true or not," Dr. Levant said. "What's important is what the client believes."

Both male therapists and men who have been in treatment agree that there are certain topics that — at least initially, all things being equal — are best discussed within gender. Sex is one, they say. And some men are far less ashamed about affairs when speaking to another man.

Aggression is another. Many men grow up in a world of hostile body language and real physical violence that is almost entirely invisible to women. A bar fight that sounds traumatic to a female therapist may be no more than a good night out for a man. Likewise, a stare-down in the sandbox that looks vanishingly trivial from a distance may lie like a poisoned well in the stream of the unconscious.

In some men's groups he used to run, Dr. Levant passed out index cards and had each participant write down the one thing he was most ashamed of, that he was reluctant to admit to himself, much less to anyone else. "I would get things like, 'I backed down from a fight in junior high school,' " he said, "and these were mostly middle-aged, married guys."

In just the past few years, psychologists have identified a number of issues that are, in effect, male versions of the gender-identity issues that so many mothers face in the work force: the self-doubt of being a stay-at-home father, the tension between being a provider and being a father, even male post-partum depression.

"In the same way that there is something very personal about being a mother, something very important to female identity, the experience of fathering is also very powerful," said Aaron Rochlen, a psychologist at the University of Texas, Austin. "And some men, I think, prefer to talk about that — the joy of being a father, the stress, how it's impacting them — with a therapist who's had the same experience," from the same point of view.

If they can find one, that is. "I remember when I started training, I looked around and realized that for the first time in my life, I was an endangered minority," said Ryan McKelley, a psychologist at the University of Wisconsin, La Crosse. "Now I tell my male students, if you're interested in clinical care, you can write your own ticket. You'll be hired immediately."