Need a last-minute gift idea? Make one of these bread recipes. When you put love into cooking, that's way more meaningful (and delicious) than buying a traditional gift
Thursday, April 30, 2020
What Really Goes Down During Your Menstrual Cycle
Whether or not youu2019re trying to get pregnant, knowing when an egg is present is a u201cgood to know.u201d Hereu2019s the rundown on all four stages of menstruation and what symptoms you can expect during each
Can You Actually Increase Your Height
Here are a few factors that may help you maximize your height before puberty, and how to appear taller after you're done growing
Losing Your Lady Locks? Try These 14 Hair Loss Treatment
Genetics or an underlying condition could be the root of female hair loss. Here are 14 treatments and remedies that may help your thinning hair
Letu2019s Play 21 Questions... About Our Future After COVID-1
You could sit and wait it out. Or you could sit and wonder about how things need to change
Nipple Orgasms: What Are They and How Do I Get One
Stimulating the nipples can give you an orgasm because it's an erogenous zone. Hereu2019s everything you need to know about nipple orgasms
Chafing: The Complete Guide to Avoid the Dreaded Bur
Chafing is a red, painful, and sometimes bumpy rash that can affect many areas of the body. If you do any friction-creating activity, you could be prone to chafing. Here's how to treat and prevent chafing
This Familyu2019s u201cQuarantine Olympicsu201d Is Exactly What You Need to Survive Pandemic Boredo
Every night at 10 p.m., we tune in and our spirits are lifted a little higher
Bogged Down By Negative News? Ground Yourself with a Gratitude Journa
Research shows practicing regular gratitude can help us feel more optimistic about life, improve our sleep, might support immune function, and helps us appreciate the present. The best part is, itu2019s easy to start. All you need is pen and paper
Donu2019t Call It a Diet: 10 Gold Star Plan
These are the 10 best diets for for almost every weight loss and health goal. What makes them the best? They're sustainable, they're not super restrictive, and they put health and feeling good first
14 Portable Breakfasts You Can Make in a Muffin Ti
Muffin tins are perfect for prepping bite-size breakfasts, whether youu2019re keto, gluten-free, paleo, or vegetarian. Consider them essential when youu2019re running out the door every weekday morning, or just donu2019t feel like cooking
Rural areas are the new hotspots around the country; Norton trying therapies; plasma's helped several critically ill patients
- Big cities and major urban areas have seen the greatest number of coronavirus deaths, but a new Kaiser Family Foundation analysis finds the growth rate is now higher in rural areas. The report includes an interactive map that shows the per-capita number of coronavirus cases and deaths across metropolitan and non-metro counties.
- The KFF analysis found that in the two-weeks ending April 27, non-metro counties saw a 125% increase in coronavirus cases (from 51 to 115 per 100,000 people) and a 169% increase in deaths (from 1.6 to 4.4 deaths per 100,000). Metro counties saw a 68% increase in cases (from 195 to 328 per 100,000) and a 113% increase in deaths (from 8 to 17 deaths per 100,000).
- Norton Healthcare specialists are researching experimental therapies to treat patients with covid-19, including medications to kill the virus or prevent it from growing; to help stop the body's immune response that results in increased damage to otherwise healthy organs; and to improve immunity; and research that looks at the benefits of "convalescent plasma" in treating covid-19 patients, according to a hospital news release.
- The release says 21 critically ill Norton patients have received convalescent plasma, which comes from a fully recovered covid-19 patient, and researchers say they are seeing "very encouraging results," with six patients having recovered and gone home. Click here to learn more about how to donate blood plasma.
- The Medicaid and CHIP Payment and Access Commission, a non-partisan group that analyzes policy and data makes recommendation, wrote Health and Human Services Secretary Alex Azar reiterating concern that the federal relief funds from the Coronavirus Aid Relief and Economic Security (CARES) Act are not providing sufficient help to health-care providers who serve Medicaid beneficiaries, and that this may do permanent damage to the nation's health care safety net. Click here to see the letter.
- Housing authorities in more than 100 Kentucky communities will get about $12.6 million from the CARES Act, according to Senate Majority Leader Mitch McConnell. His news release, which includes the list of recipients, says the money "will be used to support prevention and preparation services for their residents, for responding to the coronavirus pandemic in public housing, and supporting the health and safety of assisted individuals and families."
- State Budget Director John Hicks predicts that General Fund revenue for the fiscal year ending June 30 will fall $319 million to $496 million short of estimates. Joe Sonka reports for the Louisville Courier Journal, "Revenues are then expected to fall another 10.5% to 17.2% in the first two quarters of the 2021 fiscal year, with the report containing two revenue projection scenarios based on the timing of the peak of covid-19 cases and the relaxation of the governor's social-distancing orders."
- Rosedale Green nursing home in Covington is a covid-19 hotspot. Julia Fair of the Cincinnati Enquirer reports in detail on what health departments and St. Elizabeth Healthcare are doing to reduce coronavirus infections, including a plan to separate residents based on exposure and symptoms, increased testing, additional clinical supports, more personal protective equipment and doing a deep clean. As of Wednesday, the facility had reported 54 residents and 22 staff who had tested positive, and 14 resident deaths.
- A long list of African American faith and civil-rights leaders in Kentucky joined a statement issued by such leaders around the nation "encouraging communities to stay at home in states where stay at home orders are being lifted until there is evidence that it is safe." African Americans have been disproportionately affected by covid-19; their death rate from it in Kentucky is about double their share of population in the state.
- The Kentucky Distillers’ Association and the Kentucky Chamber of Commerce are partnering to help business make sure they have enough hand sanitizer needed to protect Kentuckians as businesses, a chamber news release says. Click here if you are a Kentucky business in need of hand sanitizer, to find out where to get it.
- A Versailles-area winery is "putting the words of the man who told them to partially shut down to good use," John McGary reports for The Woodford Sun. Wildside Winery's first varietal is named Six Feet Petite, and bears Gov. Andy Beshear’s familiar admonition “Y’all can’t be doing that” under an illustration of male and female silhouettes separated by a two-way arrow. Co-owner Elisha Holt told McGary that most buyers get two bottles, one to save for storytelling in the future. "Six Feet Petite came out of the barrel last week, and Monday Holt said they’d already sold a third of it," McGary writes.
- The University of Kentucky's international Chinese partners have donated 15,000 pieces of personal protective equipment to the university, says a UK news release.
COVID-19 and the LGBTQ+ community: Rising to unique challenges
As the COVID-19 pandemic continues, new challenges arise each day for people across the world. Some of these challenges particularly affect the LGBTQ+ community. This unique time calls for LGBTQ+-specific resources and new ways to connect and cope.
Minority stress in the LGBTQ+ community
Unrelated to COVID-19, this community faces minority stress based on anti-LGBTQ+ stigma that is harmful for their health and well-being (see key articles here and here). Those among us who are also racial/ethnic minorities, people with disabilities, immigrants, and people with low income may experience compounded minority stress at the intersections of these identities. For example, a person who is Black and bisexual may experience minority stress differently from someone who is White and gay, even though both of these people are LGBTQ+. LGBTQ+ Asian Americans may be experiencing even greater minority stress, due to increased discrimination against Asian Americans because the first COVID-19 outbreak was in China.
Research has shown that minority stress harms the mental and physical health of LGBTQ+ people (see here and here). It contributes to higher risk for a number of health problems, including anxiety and depression, which may worsen due to the stress of COVID-19.
New forms of stress for the LGBTQ+ community during the COVID-19 pandemic
Loss of work and income. Compared with non-LGBTQ+ people, LGBTQ+ people are more likely to have lower income and to have jobs that do not allow for working from home, such as retail stores and the service industry. Therefore, LGBTQ+ people may be more likely to experience food or housing insecurity during this time.
School closures. School closures may be especially challenging for the LGBTQ+ community. Many LGBTQ+ youth and young adults have experienced rejection from their family of origin. With schools closed and colleges and universities now online, LGBTQ+ youth and young adults with unsupportive families may now be home with those families full-time, or must find another place to live if they have been kicked out. Some LGBTQ+ youth and young adults who were “out” as LGBTQ+ at school and with peers, but not with their family, may now have to choose whether to hide their identities while they are at home.
Reduced access to care. During the COVID-19 pandemic, many forms of care that are considered nonessential have been delayed, with unique effects on the LGBTQ+ community. Transgender and nonbinary people may have trouble accessing gender-affirming care because hormones and surgeries may be considered nonessential. However, research suggests that access to gender-affirming care, such as hormonal treatments and surgery, is essential to the health and well-being of transgender and nonbinary individuals.
For LGBTQ+ people who are building families, access to fertility clinics is essential. However, many clinics are now delaying fertility treatments, which also delays family building for LGBTQ+ families.
Worries about seeking care for COVID-19 symptoms. Many LGBTQ+ people have had negative experiences with healthcare in the past, especially transgender and nonbinary people who have experienced discrimination related to their gender identity or gender expression. Thus, some LGBTQ+ people may need encouragement to seek care if they have COVID-19 symptoms, such as fever, cough, and fatigue.
Reduced access to legal protections. Even during this COVID-19 crisis, laws that restrict rights for the LGBTQ+ community continue to be proposed. In addition, LGBTQ+ people may be unable to access existing legal protections because of COVID-19-related closures. LGBTQ+ people with housing insecurity may be unable to access legal help to contest evictions because many lawyers are not currently taking new clients. LGBTQ+ families may lose access to critical legal protections related to co-parent adoption while family courts are closed. At a time when so many have become sick from COVID-19, ensuring the legal rights of a nongestational parent in a same-sex couple if the gestational parent becomes ill is more important than ever.
Coping with stress and loss of support
Some research finds that LGBTQ+ people are more likely to use stress-relief strategies that may be harmful, such as using tobacco or vaping and other substance use. So it’s possible that LGBTQ+ people may increase their use of unhealthy substances to cope with the stress of daily life during a pandemic.
As freedom of movement is restricted to curb the spread of COVID-19 through physical (“social”) distancing, many helpful coping strategies, such as meeting friends and spending time gathering in the community, are not an option. LGBTQ+ people who already feel isolated due to family rejection or the stigma of being LGBTQ+ may feel even more isolated with physical distancing and other restrictions on freedom of movement.
Helpful resources for the LGBTQ+ community
Many LGBTQ+ people have developed robust online communities of “chosen family” who continue to provide support and affirmation — resources which you may find helpful. Additionally, some organizations may be able to help you find local resources.
If you’re seeking support and mental health resources:
- Family Acceptance Project Support for LGBTQ+ youth and their families
- Gender Spectrum Resources for challenging times, including online support groups for transgender and nonbinary youth and their families
- LGBTQ+ mental health and substance use information and resources from the Substance Use and Mental Health Services Administration (SAMHSA)
- LGBT National Help Center Support and resources for LGBTQ+ people of all ages, including hotlines, online chat, and connections to local resources
- SAGE LGBT Elder Hotline (877-360-5428) Support for LGBTQ+ seniors
- The Neighborhood: A Virtual Hub for LGBTQ+ Families from Family Equality Online: events and support groups for LGBTQ+ prospective and current parents
- The Trevor Project (866-488-7386) Support for LGBTQ+ young people, including a confidential hotline, online chat, and text messaging
- Trans Lifeline (877-565-8860) Peer-to-peer support for the transgender community
If you’re experiencing financial insecurity:
- Mutual aid and emergency funds for LGBTQ+ individuals, compiled by the National Center for Transgender Equality
- Rapid response and emergency funds for LGBTQ+ individuals and organizations, compiled by Funders for LGBTQ Issues
If you’re struggling with access to health care or legal protections:
- Resources for LGBTQ patients GLMA Health Professionals Advancing LGBTQ Equality
- LGBTQ+ legal rights and resources GLAD Legal Advocates and Defenders
- Transgender rights and resources the Transgender Legal Defense & Education Fund
For more information on coronavirus and COVID-19, see the Harvard Health Publishing Coronavirus Resource Center and podcasts.
The post COVID-19 and the LGBTQ+ community: Rising to unique challenges appeared first on Harvard Health Blog.
Weight loss can help head off lasting damage caused by fatty liver
Non-alcoholic fatty liver disease is the most common cause of liver disease in the United States, and is estimated to affect up to a quarter of adults in the world. It is defined by excess fat accumulating in the liver and usually occurs in people with obesity, high blood sugars (diabetes), abnormal cholesterol or triglyceride levels, or high blood pressure. These disorders often run together and as a group are called metabolic syndrome. The “non-alcoholic” part of “non-alcoholic fatty liver disease” is important to distinguish it from alcohol-related liver disease, which can also cause excess liver fat.
How fat can damage the liver
In some people, the excess fat sits in the liver but may not cause any liver damage. However, in about one in 20 people, excess liver fat triggers chronic liver inflammation. This condition is called non-alcoholic steatohepatitis or NASH (“steato-“ means relating to fat and “hepatitis” means liver inflammation).
As with other liver disease, such as viral hepatitis or alcohol-related liver disease, chronic inflammation can cause ongoing damage, which leads to liver scarring known as fibrosis. Severe fibrosis is called cirrhosis regardless of the cause. People with cirrhosis are at risk for liver failure and liver cancer, and may need liver transplantation.
Diagnosing fatty liver
The key to preventing complications of NASH is to catch it early and treat it before the liver has sustained significant damage. Early diagnosis is tricky; usually people have no symptoms from their liver disease. If you have been diagnosed with any of the components of metabolic syndrome, you should talk to your doctor about your risk of having NASH.
The most accurate way to diagnose NASH is by liver biopsy. But blood tests and imaging tests can be used to determine who might be at low risk for NASH to avoid unnecessary liver biopsies. A useful, noninvasive test for some people is liver elastography, a special kind of ultrasound that estimates how much scarring there is in the liver. Elastography can help sort out who might benefit from further testing by liver biopsy. Regardless of whether NASH is present, exercising and eating a healthy diet can go a long way in treating metabolic syndrome and preventing complications down the road.
Weight loss is key to preventing complications of fatty liver
For people who are overweight or have obesity, the best treatment for NASH is weight loss. A landmark study showed that losing 10% of one’s body weight can reduce liver fat, resolve inflammation, and potentially improve scarring. More recently, in a meta-analysis published in JAMA Internal Medicine, researchers combined data from 22 studies that randomized patients to a weight loss intervention or a control arm (no or lower-intensity weight-loss intervention), to take a more thorough look at the effect of weight loss on non-alcoholic fatty liver disease.
That meta-analysis and other studies confirmed that weight loss by behavioral programs, medications, or weight-loss surgery can successfully treat NASH. Diet and exercise are the first line of treatment. At least 150 minutes of heart-pumping activity is recommended. While it’s not clear which diet is best, those that emphasize vegetables and whole foods, such as the Mediterranean diet, are good options. Regardless of the exact plan, lifestyle changes should be sustainable, and it’s usually best to lose weight slowly over time.
If sufficient weight loss is not attainable with these steps, weight loss surgery, such as gastric sleeve or gastric bypass, can be considered. There are currently no FDA-approved medications specifically for NASH, but medications that promote weight loss may be helpful. For certain people without diabetes, vitamin E can help treat NASH. For those with diabetes, certain medications that improve blood sugar, such as the thiazolidinedione drug pioglitazone (Actos) and the incretin mimetic drug liraglutide (Saxenda), may also have beneficial effects on the liver. Any decisions regarding medications for NASH, including the use of vitamin E, should be made in consultation with your doctor.
Individuals with NASH must also protect the liver from any other causes of liver inflammation. This means abstaining from alcohol and making sure you are vaccinated against the hepatitis A and hepatitis B viruses. Finally, anyone with NASH should also identify and treat individual components of metabolic syndrome they may have, in order to reduce the risk of heart disease and strokes.
Awareness of fatty liver may help head off problems down the road
Non-alcoholic liver disease is becoming more prevalent as obesity becomes more common. It is also underdiagnosed, since it usually causes no symptoms. But increased awareness can lead to early diagnosis and prevention of serious problems down the road. Fortunately, active research is ongoing to define how to best identify people who are at risk and to develop new medications to treat NASH.
The post Weight loss can help head off lasting damage caused by fatty liver appeared first on Harvard Health Blog.
Wednesday, April 29, 2020
The COVID-19 research news rollercoaster is running again: STAT News + Gilead’s remdesivir
This morning, STAT News reported:
A government-run study of Gilead’s remdesivir, perhaps the most closely watched experimental drug to treat the novel coronavirus, showed that the medicine is effective against Covid-19, the disease caused by the virus.
Gilead made the announcement in a statement Wednesday, stating: “We understand that the trial has met its primary endpoint.” The company said that the National Institute of Allergy and Infectious Diseases, which is conducting the study, will provide data at an upcoming briefing.
The finding — although difficult to fully characterize without any data for the study — would represent the first treatment shown to improve outcomes in patients infected with the virus that put the global economy in a standstill and killed at least 218,000 people worldwide.
I’ve been staying on the sidelines this morning, watching the Tweets pile up on this. I often choose to chime in when I think I might contribute something that no one else will. The wisdom of the crowds may have this one covered. Some email and social media reactions follow.
One of the nation’s leading public health journalists wrote to me:
I know that STAT’s business model is implicitly pro-pharma but even given that, this story is a press release.
In other words, that leading journalist didn’t view this as journalism but as PR – public relations.
A former Boston hospital CEO, Paul Levy, retweeted what STAT story co-author Adam Feuerstein had tweeted. Philadelphia Inquirer journalist Tom Avril chimed in.
STAT’s Helen Branswell, another of the nation’s leading public health journalists, tweeted:
Data to follow, apparently from NIAID. Unusual way to release critical results; can’t kick tires.
The New York Times, in a Gina Kolata quickie, published a story, “Gilead claims ‘positive data’ to come from NIH trial of remdesivir.” The sub-headline was: Neither the company nor the institutes discussed the data. Previous results for the potential coronavirus treatment have been inconclusive.
Journalism professor Michael Balter tweeted, in response:
It might be good to go public with this when data are available, not when it is good PR for the company.
This kind of tweet doesn’t help, but it’s what you get in the cacophony of rushing research results into public consumption:
Ok, I don’t get the deal with Remdesivir.
First they tell us it’s awesome. Then they tell us it doesn’t work at all. Today it’s awesome again.
What the HELL is going on?
— Bill Mitchell (@mitchellvii) April 29, 2020
So what has happened before 10 a.m. Central time today is that there has been considerable criticism of a government health agency’s PR, of a drug company’s PR, and of a leading news organizations’s coverage of same. It would be helpful for news consumers if we could break this cycle.
This post may be updated later today and/or in days to come.
Addenda:
Today, The Lancet published a paper, Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. (Complete paper is behind a paywall.) Excerpt: “In this study of adult patients admitted to hospital for severe COVID-19, remdesivir was not associated with statistically significant clinical benefits.”
Later today, Bloomberg and many other news organizations reported:
The U.S. government’s top infectious-disease expert said that early results of a closely watched clinical trial offered “quite good news” regarding a potential Covid-19 therapy made by the biotechnology company Gilead Sciences Inc.
Anthony Fauci, the head of National Institute of Allergy and Infectious Diseases, which is conducting the study, said at a White House meeting … that the trial showed a significant positive effect in treating the virus.
…
Last week, the market swooned after apparently discouraging results from a Chinese trial that was halted early after researchers struggled to enroll patients were accidentally posted on a World Health Organization web page. Data confirming those more downbeat results were published in the U.K. medical journal The Lancet on Wednesday. Fauci said at the White House Wednesday that that trial was “not an adequate study.”
Some in the financial world seem to be suggesting a double standard with Dr. Fauci touting his own agency’s unpublished study (NIAID) as “quite good news” while criticizing the Chinese paper in The Lancet. Just one example: Stocks Soar On Fauci-Touted Remdesivir Study Despite Marginal Survival Benefit, Snubs Lancet Findings.
It’s a randomized, double-blind, placebo-controlled, multi-center published study, with all data available, in The Lancet. Versus a US federal health agency study, the results of which have not yet been published in peer-reviewed literature, but which were touted by the head of that agency in a White House meeting.
Quick summary: Breathe. Go slowly in jumping to any conclusions. Caveat lector.
Study shows drug can reduce length and severity of covid-19 cases, but difference in the death rate is statistically insignificant
- A preliminary study of the drug remdesivir shows that it can speed recovery from covid-19 and lessen its severity. "What it has proven is that drug can block this virus," said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which is doing the study. Dr. Sanjay Gupta said on CNN, "It's the best news in terms of a therapeutic that I think we've heard in some time." However, it made no statistical difference in the death rate.
- The Wall Street Journal reports on the race for a coronavirus vaccine, reporting that Pfizer Inc. will begin testing of its experimental vaccine in the U.S. as early next week.
- Kentucky nursing homes struggle to purchase personal protective equipment, such as masks and gloves, Deborah Yetter reports in detail for the Louisville Courier Journal., which published the story April 22 and in its print edition April 27. Signature HealthCare, which operates 41 nursing homes in the state, said its PPE costs have risen 200%.
- Ben Tobin reports for the Louisville Courier Journal that the Tyson Foods plant in Robards will temporarily shut down, after 71 employees at the Henderson County plant tested positive for the coronavirus.
- Dan Horn reports for the Cincinnati Enquirer that recent studies show that Kentucky and Ohio and "not even close" to the amount of virus testing to safely reopen the economy.
- The left-leaning Kentucky Center for Economic Policy has released a detailed report titled, "Lessons from the Great Recession: Kentucky and Other States Need More Federal Relief." Jason Bailey says the lessons are: Federal aid to states works, and should be robust and last until full recovery; without such aid, state budget cuts drag the economy further; now, such cuts can hinder the responses of Medicaid, public health, mental health, first responders and more.
- The University of Texas Health Science Center has created a covid-19 dashboard with state and global data. A news release says the site not only provides information on the number of cases and deaths, but also shows processed data instead of raw numbers.
- New provisional death statistics from the Centers for Disease Control and Prevention shows that total deaths are likely higher than the reported statistics capture, The New York Times reports.
- Costco Wholesale announced that it will require customers to wear masks as of Monday, and admit only one member per card. In other states, it is allowing two members per card; it did not explain the difference. It said stores would have a special hour, 9-10 a.m., for members over 60 and those with disabilities.
- The Washington Post reports that scientists know ways to help stop viruses from spreading on airplanes, but too late for this pandemic: "It is a problem of biology, physics and pure proximity, with airflow, dirty surfaces and close contact with other travelers all at play."
- CNBC reports that JetBlue will require passengers to wear masks; American Airlines and Delta Air Lines will require employees to wear masks and will provide them for passengers; and United Air Lines requires masks for its flight attendants, as does Jet Blue and Frontier Airlines.
Harvard Health AdWatch: An arthritis ad in 4 parts
Perhaps you’ve grown as weary as I have of repeated arthritis ads. They appear in frequent rotation on television, online, and in magazines, promoting Enbrel, Humira, Otezla, Xeljanz, and others.
If you’ve actually read or listened to these ads, you might have felt perplexed at certain points. Here’s a quick rundown on what they’re saying — and not saying — in one of those ads.
“The clock is ticking”
Part 1: A teakettle whistles on the stove and a disembodied voice speaks as this ad for Humira opens. “This is your wakeup call. If you have moderate to severe rheumatoid arthritis, month after month the clock is ticking on irreversible joint damage. Ongoing pain and stiffness are signs of joint erosion.” Three people are shown starting their day in pain: one rubs his knee and grimaces, another has a sore shoulder, and the third, sore hands. Their suffering is clear, and you hear ticking in the background as a digital clock clicks forward one minute.
Part 2: “Humira can help stop the clock.” A garage door opens and out comes the man with the achy knee, now smiling and comfortably walking out into the sunshine as the music swells. “Prescribed for 15 years, Humira targets and blocks a source of inflammation that contributes to joint pain and irreversible damage.”
Part 3: The long list of side effects is voiced while happy scenes and beautiful music distract you: an adorable dog hikes with its once-achy-kneed owner; a young mother drops off her kids with a beaming grandma who previously was wringing her sore hands. “Humira can lower your ability to fight infection. Serious and fatal infections including tuberculosis and cancers, including lymphoma, have happened, as have blood, liver, and nervous system problems, serious allergic reactions, and new or worsening heart failure. Tell your doctor if you’ve been to areas where certain fungal infections are common, and if you’ve had tuberculosis, hepatitis B, are prone to infections, or have flulike symptoms or sores. Don’t start Humira if you have an infection.”
Part 4: The big finish is short and to the point: “Help stop the clock on irreversible joint damage. Talk to your rheumatologist.”
What did the ad get right?
Let’s start with several accurate points:
- The prolonged morning stiffness depicted at the start is a typical symptom of rheumatoid arthritis (RA). It’s so characteristic that it helps doctors make the diagnosis.
- Humira is a brand name of adalimumab, a treatment for rheumatoid arthritis and related conditions. It’s often highly effective and has a good safety profile, despite the long disclaimer about side effects.
- The drug targets inflammation. It does this by blocking tumor necrosis factor (TNF), a substance directly involved in rheumatoid arthritis inflammation. Anti-TNF drugs were first approved by the FDA for rheumatoid arthritis more than 20 years ago. They have revolutionized treatment for this disease.
- An active lifestyle is a reality for many people with rheumatoid arthritis who begin effective treatment soon after symptoms begin. The potential for improvement is often underestimated, perhaps because it wasn’t long ago that doctors had few effective options to treat rheumatoid arthritis. Fortunately, that has changed.
Now, about the rest of the ad
- Ongoing pain and stiffness are not specific signs of joint erosion. They are symptoms of joint inflammation, which may, over time, lead to erosions. However, not everyone with RA experiences joint erosions, and it generally takes many weeks or months for erosions to develop. Showing a clock with minutes ticking by implies more urgency than is accurate.
- The word “irreversible” is stated three times in this 60-second ad. While it’s true that joint damage related to RA generally does not heal, some people have minimal or no damage, especially when taking effective treatment. The implication that permanent joint damage is inevitable seems overly dramatic to me, and perhaps alarmist.
- The FDA requires that long disclaimer. While it lists the most important risks and side effects of the drug, some of its equivocal language is chosen carefully: “Serious and fatal infections… and cancers… have happened.” Were these problems caused by adalimumab? Or were they unrelated? Or do they just not know? Generally, the safety profile of anti-TNF drugs is considered good. The most recent studies suggest that there is no significant increased risk of cancer, except for skin cancers.
- I would bet that the average person seeing this ad has no idea if they’ve been in places where “certain fungal infections are common” — or what that even means! In fact, it refers to certain infections that can become silent in the body, but re-activate in people taking adalimumab. This includes histoplasmosis (Midwest of the US), Coccidioides (southwestern US), and blastomycosis (Ohio and Mississippi River Valleys and the Great Lakes).
What’s left unsaid?
The ad never mentions some important information about adalimumab:
- It’s expensive. While insurance may cover most or all of the cost, the price of adalimumab can run about $40,000/year.
- It’s given by injection under the skin (a bit like insulin injections for people with diabetes), usually every two weeks.
- Humira is only approved — and likely to work — for a few arthritic conditions, including RA. It’s not for osteoarthritis, the most common type of arthritis, an age-related, degenerative joint disease.
- Four other medications work in a similar way, with similar effectiveness and similar cost, side effects, and risks. Additionally, a host of other medications unrelated to TNF inhibition are also just as effective.
The bottom line
As drug ads go, those for arthritis in general and adalimumab in particular are not the worst I’ve seen. But they can be misleading, perplexing, and incomplete. Of course, the main purpose of these ads is to sell drugs, not to provide a complete and balanced review of treatment options for RA. You’ll need to ask your doctor for that.
Follow me on Twitter @RobShmerling
The post Harvard Health AdWatch: An arthritis ad in 4 parts appeared first on Harvard Health Blog.
Tuesday, April 28, 2020
Looking past the pandemic: Could building on our willingness to change translate to healthier lives?
If the COVID-19 pandemic has taught us anything, it’s that people have the capacity to change entrenched behaviors when the stakes are high enough. Who among us declared that 2020 would be the year for us to perfect the practice of physical distancing? Although we were clueless about pandemic practices a mere three months ago, we’ve adopted this new habit to avoid getting or spreading the virus. But what about other unhealthy behaviors that have the potential to shorten life spans across the US? On January 1, 2020, some of us made New Year’s resolutions aimed at improving our health: to eat less, lose weight, exercise more, drink less alcohol, stop using tobacco, get more sleep, start meditating regularly, schedule that colonoscopy, and so on. Might there be hope for gaining traction with one or more of these healthy behaviors, too?
Moving from clueless to changing behavior
Health psychologists and addiction medicine professionals like me use a standard model of behavioral change to understand how people move from a mindset of cluelessness to one of action. Predictably, we pass through the following six stages of change:
- Precontemplation (“Life is short — there’s nothing I need to change.”)
- Contemplation (“I suppose I should consider making a change.”)
- Preparation (“The time to make this change is very close. Here’s my plan.”)
- Action (“I’ve done it. I hope I can keep it up.”)
- Maintenance (“I can make this work for as long as I need to; I’ll keep on keeping on.”)
- Moderation or Termination (“I’ll rely upon my common sense and sound medical advice to decide whether to maintain or let up when the time is right.”)
The empty streets of New York and many other major US cities bear witness to the fact that with regard to social distancing, large numbers of Americans have moved rapidly from precontemplation to maintenance. Because we have embraced this dramatic change and the mortality curve is being flattened in some parts of the US, the actual death toll from COVID-19 is likely to be a fraction of what it would have been if we had stayed put, mired in precontemplation or contemplation.
The pandemic is not the only danger to our health and lives
But wait a second. Don’t lifestyle blights like obesity, hypertension, addiction, and violence exact a far greater human toll from us than COVID-19? And aren’t these biopsychosocial maladies correlated with low socioeconomic status? And aren’t COVID-19 fatalities particularly high in disadvantaged people who suffer from one or more chronic illnesses?
A quick look at US death rates and life expectancy on a state-by-state basis suggests, sadly, that the answer to all three questions is yes. The impact of “lifestyle health” and socioeconomic status on life expectancy is very high: residents of Marin County, California can expect to live a dozen or more years longer than residents of Harlan County, Kentucky!
What enables us to change our social behaviors so rapidly to combat a viral adversary, while, relatively speaking, we are losing the war against lifestyle and socioeconomic enemies like obesity, addiction, and violence? Perhaps this has to do with the fact that when it comes to the latter, the famous words of Walt Kelly’s Pogo apply: “We have met the enemy, and he is us.”
Human nature is complex. Compared with seemingly intractable lifestyle afflictions, which may be determined or amplified by socioeconomic factors, a coronavirus represents a more tractable adversary. It’s possible that the scientific, medical, and technological expertise of our hyperconnected global brain trust might ably defeat it. But individually as well as collectively, we seem to be less proficient when it comes to taking on and defeating the lifestyle enemies that “are us.” We stay mired in precontemplation and contemplation until it is too late. Why do so many smokers opt to quit only after a diagnosis of lung cancer? Why is it that some alcoholics do not stop drinking until the onset of jaundice caused by end-stage alcoholic liver disease? How many more shrines shall we erect to the victims of senseless violence directed to the self or others, pledging now to wake up and make a difference?
Just as our society has rallied to take on a wily viral adversary like COVID-19, starting right now it is just as important for us to focus attention on addressing, curing, and — better yet — preventing lifestyle afflictions like obesity, addiction, and violence. We can start small during this time of sheltering in place, by combating couch-potato tendencies with daily exercise, avoiding the temptation to get buzzed, and keeping the Healthy Eating Plate in mind as we wrestle with the temptation to manage stress by consuming unhealthy comfort food.
Together — as individuals, families, communities, and a society — we should resolve to take action to promote health. Our successes battling this viral pandemic should inspire us to combat every serious adversary that threatens our well-being, not merely those that pose a sudden, immediate, and frightening threat.
The post Looking past the pandemic: Could building on our willingness to change translate to healthier lives? appeared first on Harvard Health Blog.
Covid-19 update: Attorney General Cameron says Beshear's order banning interstate travel by Kentuckians is unconstitutional
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| Beshear and Cameron at the latter's appointment |
Cameron filed a motion in a lawsuit that was started by a woman in Campbell County, which borders Ohio, against Beshear and Cameron. The woman has dropped out of the case, but two other plaintiffs remain; now Cameron wants to join them.
His attorneys wrote in the motion that “his interests coincide with those of the existing plaintiffs” and “The governor’s travel ban impermissibly violates the fundamental right of every Kentucky citizen to interstate travel. This being the attorney general’s position, he should be realigned as a plaintiff.”
Morgan Eads of the Lexington Herald Leader notes that "After the lawsuit was filed, Beshear said in a press conference, "I’m not worried about it, and we will win it.'" Beshear, a Democrat who was attorney general when elected governor, appointed Cameron, a Republican who was elected the same day but took office almost a month later, to fill his unexpired term.
In other covid-19 news Tuesday:
- Doctors say older adults with covid-19 have some unusual symptoms, "complicating efforts to ensure they get timely and appropriate treatment, according to physicians," Kaiser Health News reports. "Seniors may seem 'off' — not acting like themselves ― early on after being infected by the coronavirus. They may sleep more than usual or stop eating. They may seem unusually apathetic or confused, losing orientation to their surroundings. They may become dizzy and fall. Sometimes, seniors stop speaking or simply collapse."
More sexual partners, more cancer?
Two headlines caught my eye recently:
The relationship between chronic diseases and number of sexual partners: an exploratory analysis
and
Study warns more sex might mean higher likelihood for cancer
It may be hard to believe, but both of these refer to same medical research. I’m not sure which one I like better. The first one is the actual title of the research, which provides no information about its findings. The second one is a newspaper headline. It cuts right to the chase about the study’s main findings. While it’s much more specific — and alarming — it is also misleading.
Is there a link between the number of sexual partners and cancer?
The study investigating this possibility was published BMJ Sexual & Reproductive Health. It enrolled about 2,500 men and 3,200 women who were 50 or older (average age 64). Each person was surveyed about the total number of sexual partners they’d had over the course of their lives. This information was compared with a number of medical conditions they’d developed, including cancer, heart disease, and stroke.
The study demonstrated that
- Men who reported 10 or more sexual partners in their life were nearly 70% more likely to have developed cancer when compared with those reporting 0 or 1 lifetime sexual partners.
- For women, the findings were even more dramatic: women who reported 10 or more sexual partners in their life were nearly 91% more likely to have developed cancer when compared with those reporting 0 or 1 lifetime sexual partners.
Men were more likely than women to report having at least 10 partners (22% of men vs. 8% of women) while women were more likely to have fewer partners (41% of women and 28.5% of men reporting having had 0 to 1 partners).
It’s worth noting this study was performed in England with health information initially collected in the late 1990s. The results could have been different if researchers had assessed risk of a different population or at a different point in time. In addition, self-reporting was relied upon to assess sexual behavior, and it’s possible the reported number of sexual partners and other health behaviors were not accurate.
Does this mean having sex leads to cancer?
The answer is almost surely no.
That’s because this type of study cannot assess whether sex causes cancer. It can only determine whether there is a correlation between the two. Also, we already know of ways that sexual behavior can indirectly affect cancer risk without actually causing cancer, especially through sexually transmitted infections. Some of the strongest connections are for:
- human papilloma virus (HPV), which increases the risk of cancers of the cervix, mouth, penis, and anus
- human immunodeficiency virus (HIV) infection, which increases the risk of cancers such as Kaposi’s sarcoma and lymphoma
- hepatitis B and hepatitis C infection, which have been linked to liver cancer
- gonorrhea, which increases the risk of prostate cancer (particularly among African American men).
In addition, people with more sexual partners tended to smoke more and drink more alcohol. These factors could, themselves, increase the risk of cancer. So, certain factors — in these cases, infections, smoking, and drinking — could have an impact on cancer risk, rather than having sex or the number of sexual partners.
While future research could find previously unidentified risks in having a higher number of sexual partners, we already know enough to explain the connection.
The bottom line
While it may be tempting to conclude from this new research that limiting the number of sexual partners you have will lower your risk of cancer, I think that would be a misinterpretation of the data. The better take-home message would be to take precautions to avoid sexually transmitted diseases and pursue other proven strategies to lower your cancer risk, including stopping smoking and limiting alcohol.
The post More sexual partners, more cancer? appeared first on Harvard Health Blog.
New radiation therapies keep advanced prostate cancer in check
Treatments for prostate cancer are always evolving, and now research is pointing to new ways of treating a cancer that has just begun to spread, or metastasize, after initial surgery or radiation. Doctors usually give hormonal therapies in these cases to block testosterone, which is a hormone that makes the cancer grow faster. But newer evidence shows that treating the metastatic tumors directly with radiation can produce better results.
In March, researchers published the latest study that supports this approach. Based at Johns Hopkins University School of Medicine in Baltimore, the team used a method for delivering powerful beams of high-dose radiation to very small cancers in the body. This approach is called stereotactic ablative radiotherapy (SABR), and it can spare healthy tissues with remarkable precision. Doctors map out where to pinpoint the radiation in advance by putting patients into a computed tomography (CT) scanner that takes x-rays of the body from many different angles.
During their study, the Johns Hopkins team recruited 54 men with three or fewer metastatic tumors. All the men had already undergone initial treatment for cancer while it was still in the prostate, and some had also been treated with hormonal therapy, though not within six months of being enrolled for the research. The men were 68 years old on average, and they were each randomly assigned to one of two groups: A third of the men were placed in an observation (control) group, meaning they received no additional treatment until the study was over. The rest were given SABR at a rate of one to five treatments per tumor over a period of about a week.
Then the men were followed for six months and monitored for changes such as PSA increases, tumor growth, worsening symptoms, or how many men wound up on hormonal therapy.
What the results showed
Results showed that the SABR-treated men fared better in all respects. Overall, 19% of those who got the targeted radiation had their cancers progress, compared to 61% of men in the control group. Taken together, the findings support a view that all detectable lesions should be removed, if feasible, to maximize the odds “of a cancer cure,” according to the authors of an editorial accompanying the published paper.
What makes SABR effective for treating early-stage metastases? Scientists are trying to find out. The investigators behind this study speculated that irradiating visible traces of cancer might block signals that feed the growth of even smaller tumors that are still too small to see. It’s also possible that radiation induces a sort of vaccinating effect, which prompts the immune system to attack other tumor cells.
Meanwhile, SABR could soon benefit from an ability to flag even smaller tumors for treatment. A new type of imaging scan called PMSA-targeted positron emissions tomography (PET) was tested in the study, and it found very small tumors that CT scanning had missed.
Dr. Marc Garnick, Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org, says the whole concept of treating metastatic prostate cancer “is undergoing re-evaluation.” He added, “The findings in this case need to be supported with a larger study. However, this research provides more evidence that for patients with less extensive metastasis, SABR treatments can significantly delay systemic therapies such as chemotherapy or hormonal treatment.”
The post New radiation therapies keep advanced prostate cancer in check appeared first on Harvard Health Blog.
Monday, April 27, 2020
7 tips for going outside safely with your children during the COVID-19 pandemic
During the COVID-19 pandemic, getting outside can be a great idea for both the physical and mental health of you and your family. But as with everything else these days, going outside needs to be done safely. Here are my top seven tips for what you need to think about as you put on your shoes and head outdoors.
- Be careful about what you touch as you go outside or return home. For those who live in single-family homes this isn’t a big deal, but if you live in a shared building, you need to be careful about things like elevator buttons and doorknobs that others touch. Make a game of it so your kids don’t touch — pretend that surfaces (including walls) are hot — and wear gloves, or bring a paper towel or tissue so you can hit those buttons and touch doorknobs.
- Bring hand sanitizer so that you can wash hands while you are out, if needed.
- Choose the best outdoor space. Your own yard is best, but that isn’t an option for everyone. Ideally, you should go somewhere where you won’t encounter lots of other people. This has become a problem as lots of people head outdoors!
- Keep up the physical distancing while you are outdoors. The chances of you catching something from someone as they pass you is quite small, but it’s best to give the widest berth you can.
- Only go outdoors with the people you live with. It’s tempting to join another family for a walk, but it’s hard to keep six feet between you — and children may have a particularly hard time with this. Speaking of things that children have a hard time with…
- Don’t touch stuff. So, no playing on playground equipment, sitting on benches, sharing balls, or touching signposts or mailboxes or anything else. You just don’t know who has touched it or when. Having the hand sanitizer helps when children and others forget.
- Bring masks along. Hopefully they will stay in your backpack with your water bottles and snacks, but if keeping physical distance between you and others becomes difficult at any point, you can whip them out and put them on. According to the American Academy of Pediatrics, children under 2 shouldn’t wear masks for safety reasons, but everyone else should have a mask — or some other face covering — on hand just in case.
It sounds like a lot, but it’s not — and it’s completely worth doing so that you can all get out of the house, get some exercise, have some fun, and feel a bit more normal.
The post 7 tips for going outside safely with your children during the COVID-19 pandemic appeared first on Harvard Health Blog.
Caring for your lungs, including avoiding tobacco smoke and e-cig aerosol, can help protect you from coronavirus, professors write
By Ellen Hahn and Chizimuzo T.C. Okoli
Professor & director, and associate professor, BREATHE, University of Kentucky
The novel coronavirus attacks our airways, making it difficult to breathe. It is particularly important to take special care of our lungs during the pandemic and beyond. Caring for our lungs can help us better avoid and fight this infection.
Most Kentuckians have heeded the pleas by our governor to practice social distancing, wash our hands, disinfect surfaces, and ‘stay healthy at home.’ All these activities help prevent the spread of the coronavirus. What else can we do to prevent getting and spreading this dangerous illness?
We stay ‘lung healthy’ at home by avoiding breathing tobacco smoke and aerosol, such as from vaping products, in and around our homes and cars.
Tobacco smoke and aerosol contain tiny particles that get trapped in the lungs, hurting our ability to fight off infection. Exposure to these particles happens in two ways: breathing in sidestream and mainstream smoke or aerosol.
Staying healthy at home is the best way to prevent getting or spreading the new coronavirus. Let’s stay ‘lung healthy’ at home by avoiding tobacco smoke and aerosol for ourselves and those we love. Caring for our lungs is especially crucial now as our airways and lungs are directly impacted by what we breathe. Since tobacco smoke and aerosol impair our ability to fight infection, what better way to prevent getting or spreading the virus by staying ‘lung healthy’ at home?
Professor & director, and associate professor, BREATHE, University of Kentucky
The novel coronavirus attacks our airways, making it difficult to breathe. It is particularly important to take special care of our lungs during the pandemic and beyond. Caring for our lungs can help us better avoid and fight this infection.
Most Kentuckians have heeded the pleas by our governor to practice social distancing, wash our hands, disinfect surfaces, and ‘stay healthy at home.’ All these activities help prevent the spread of the coronavirus. What else can we do to prevent getting and spreading this dangerous illness?
We stay ‘lung healthy’ at home by avoiding breathing tobacco smoke and aerosol, such as from vaping products, in and around our homes and cars.
Tobacco smoke and aerosol contain tiny particles that get trapped in the lungs, hurting our ability to fight off infection. Exposure to these particles happens in two ways: breathing in sidestream and mainstream smoke or aerosol.
The smoke that is released from lighting or puffing on a tobacco or vaping product is called sidestream smoke or aerosol. Mainstream smoke or aerosol is what a user inhales and then exhales into the air around them. It is possible that the virus can attach to the smoke or aerosol particles when breathing in and exhaling into the surrounding air, spreading the virus. It is really important to avoid breathing both sidestream and mainstream smoke and aerosol to stay ‘lung healthy at home’ and fight off infection.
If someone in your home smokes, uses electronic cigarettes, or vapes, there are ways to avoid exposing them and others to tobacco smoke or aerosol:
If someone in your home smokes, uses electronic cigarettes, or vapes, there are ways to avoid exposing them and others to tobacco smoke or aerosol:
- Keep the air clean in your home by smoking or vaping at least 20 feet away from entryways, windows, and vents.
- Avoid using tobacco and vaping in the car; the smoke and aerosol can be very concentrated in this small space, even with the windows open.
- Consider that older adults, young children and those who already have breathing problems like asthma or emphysema are at greatest risk for breathing problems from smoke and aerosol exposure.
We have noticed during this crisis that many Kentuckians including tobacco users want to keep their lungs healthy. There is no better time than now! Check out free help from www.smokefree.gov where you can sign up to receive text messages to quit. Call the free telephone call line: 1-800-QUIT-NOW (1-800-784-8669). There is a free mobile phone program to stop vaping: text DITCHJUUL to 88709.
Staying healthy at home is the best way to prevent getting or spreading the new coronavirus. Let’s stay ‘lung healthy’ at home by avoiding tobacco smoke and aerosol for ourselves and those we love. Caring for our lungs is especially crucial now as our airways and lungs are directly impacted by what we breathe. Since tobacco smoke and aerosol impair our ability to fight infection, what better way to prevent getting or spreading the virus by staying ‘lung healthy’ at home?
With kids at home, now's a good time to get them to quit using electronic cigarettes; state has programs designed for teenagers
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| A message from "This is Quitting" |
Kentucky offers two free programs specifically targeted to teens:
"This is Quitting" is for people 13 to 24 and provides coaching by text message.
Signs that a teenager may be using e-cigarettes include: increased secrecy, unwillingness to stay at home, desire for spicy or salty foods, disappearing money, increased thirst, increased irritability or mood changes.
46 rural hospitals in Ky. to share $3.88 million from CARES Act
Forty-six rural hospitals in Kentucky will share almost $3.9 million from the Coronavirus Aid, Relief, and Economic Security (CARES) Act, according to Senate Majority Leader Mitch McConnell.
The Center of Excellence in Rural Health, part of the University of Kentucky, will distribute $3,878,582 from the U.S. Department of Health and Human Services’ Health Resources and Services Administration.
“I’ll continue working to help provide resources and supplies to these healthcare heroes on the front lines,” McConnell said in a release, which said "The CARES Act funding allows hospitals maximum flexibility in how they respond to covid-19 within their communities, including for testing and laboratory services as well as the purchase of personal protective equipment to minimize covid-19 exposure."
The money “comes at a crucial time in assisting our rural hospitals and the communities they serve in providing access to care and helping in the fight to defeat the COVID-19 pandemic,” said Dr. Fran Feltner, director of the Center of Excellence in Rural Health.
Ernie Scott, director of the Kentucky Office for Rural Health, said in the release, “The covid-19 pandemic has caused a widespread disruption to our health system. While preparing for and fighting the coronavirus, our hospitals have had to discontinue outpatient care and elective procedures. As a result of that lost revenue, many hospitals have been faced with the reality of having to temporarily furlough staff. Through it all, though, these hospitals have remained open all day, every day. And, their staff has continued to place the medical needs of community members above all else.”
KORH will oversee the administration of federal funds to these rural hospitals:
1. AdventHealth Manchester
2. ARH Our Lady of the Way Hospital in Martin
3. Barbourville ARH Hospital
4. Bluegrass Community Hospital in Versailles
5. Bourbon Community Hospital in Paris
6. Breckinridge Memorial Hospital in Hardinsburg
7. Caldwell Medical Center in Princeton
8. Carroll County Memorial Hospital in Carrollton
9. Casey County Hospital in Liberty
10. Crittenden Health Systems in Marion
11. Cumberland County Hospital in Burkesville
12. Ephraim McDowell Fort Logan Hospital in Stanford
13. Ephraim McDowell James B. Haggin Hospital in Harrodsburg
14. Flaget Memorial Hospital in Bardstown
15. Fleming County Hospital in Flemingsburg
16. Harrison Memorial Hospital in Cynthiana
17. Jane Todd Crawford Hospital in Greensburg
18. Kentucky River Medical Center in Jackson
19. Livingston Hospital & Healthcare Services in Salem
20. Logan Memorial Hospital in Russellville
21. Marshall County Hospital in Benton
22. Mary Breckinridge ARH Hospital in Hyden
23. McDowell ARH Hospital
24. Mercy Health-Marcum & Wallace Memorial Hospital in Irvine
25. Methodist Health in Morganfield
26. Middlesboro ARH Hospital
27. Monroe County Medical Center in Tompkinsville
28. Morgan County ARH Hospital in West Liberty
29. Ohio County Healthcare in Hartford
30. Owensboro Health Muhlenberg Community Hospital in Greenville
31. Paul B. Hall Regional Medical in Paintsville
32. Pineville Community Health Center
33. Rockcastle Regional Hospital and Respiratory Care Center in Mt. Vernon
34. Russell County Hospital in Russell Springs
35. St. Elizabeth Grant in Williamstown
36. Saint Joseph Berea
37. Saint Joseph Mount Sterling
38. The Medical Center at Albany
39. The Medical Center at Caverna
40. The Medical Center at Franklin
41. The Medical Center at Scottsville
42. Three Rivers Medical Center in Louisa
43. T.J. Health Columbia
44. Trigg County Hospital in Cadiz
45. Twin Lakes Regional Medical Center in Leitchfield
46. Wayne County Hospital in Monticello
The money “comes at a crucial time in assisting our rural hospitals and the communities they serve in providing access to care and helping in the fight to defeat the COVID-19 pandemic,” said Dr. Fran Feltner, director of the Center of Excellence in Rural Health.
Ernie Scott, director of the Kentucky Office for Rural Health, said in the release, “The covid-19 pandemic has caused a widespread disruption to our health system. While preparing for and fighting the coronavirus, our hospitals have had to discontinue outpatient care and elective procedures. As a result of that lost revenue, many hospitals have been faced with the reality of having to temporarily furlough staff. Through it all, though, these hospitals have remained open all day, every day. And, their staff has continued to place the medical needs of community members above all else.”
KORH will oversee the administration of federal funds to these rural hospitals:
1. AdventHealth Manchester
2. ARH Our Lady of the Way Hospital in Martin
3. Barbourville ARH Hospital
4. Bluegrass Community Hospital in Versailles
5. Bourbon Community Hospital in Paris
6. Breckinridge Memorial Hospital in Hardinsburg
7. Caldwell Medical Center in Princeton
8. Carroll County Memorial Hospital in Carrollton
9. Casey County Hospital in Liberty
10. Crittenden Health Systems in Marion
11. Cumberland County Hospital in Burkesville
12. Ephraim McDowell Fort Logan Hospital in Stanford
13. Ephraim McDowell James B. Haggin Hospital in Harrodsburg
14. Flaget Memorial Hospital in Bardstown
15. Fleming County Hospital in Flemingsburg
16. Harrison Memorial Hospital in Cynthiana
17. Jane Todd Crawford Hospital in Greensburg
18. Kentucky River Medical Center in Jackson
19. Livingston Hospital & Healthcare Services in Salem
20. Logan Memorial Hospital in Russellville
21. Marshall County Hospital in Benton
22. Mary Breckinridge ARH Hospital in Hyden
23. McDowell ARH Hospital
24. Mercy Health-Marcum & Wallace Memorial Hospital in Irvine
25. Methodist Health in Morganfield
26. Middlesboro ARH Hospital
27. Monroe County Medical Center in Tompkinsville
28. Morgan County ARH Hospital in West Liberty
29. Ohio County Healthcare in Hartford
30. Owensboro Health Muhlenberg Community Hospital in Greenville
31. Paul B. Hall Regional Medical in Paintsville
32. Pineville Community Health Center
33. Rockcastle Regional Hospital and Respiratory Care Center in Mt. Vernon
34. Russell County Hospital in Russell Springs
35. St. Elizabeth Grant in Williamstown
36. Saint Joseph Berea
37. Saint Joseph Mount Sterling
38. The Medical Center at Albany
39. The Medical Center at Caverna
40. The Medical Center at Franklin
41. The Medical Center at Scottsville
42. Three Rivers Medical Center in Louisa
43. T.J. Health Columbia
44. Trigg County Hospital in Cadiz
45. Twin Lakes Regional Medical Center in Leitchfield
46. Wayne County Hospital in Monticello
Is angioplasty plus stenting or coronary artery bypass surgery better for treating left main coronary artery disease?
One of the most dangerous places to have a coronary blockage is in the left main coronary artery. Why is a blockage there so precarious?
To answer that, let’s start with some basic cardiac anatomy. The two major coronary arteries — the blood vessels that supply blood to the heart — are the left and right coronary arteries. The left main coronary artery (LMCA) is the very first portion of the left coronary artery. It provides oxygenated blood to most of the left ventricle, which is the main pumping chamber of the heart.
Any amount of blockage in the LMCA, such as from plaque buildup or a clot, is referred to as “LMCA disease.” However, treatment is only needed when there is a blockage of 50% or more. At that level, there is an increased risk of death, a major heart attack, or a life-threatening arrhythmia (irregular heartbeat). That’s why it needs to be treated quickly after a blockage is detected.
But what exactly is the best treatment of LMCA disease? This is the source of a lot of recent and ongoing controversy.
Treatment options for LMCA disease
Currently, there are three options for treating LMCA disease:
- Coronary artery bypass grafting, also known as bypass surgery or CABG, in which a blood vessel taken from a person’s leg, arm, or chest is moved and used to reroute blood around a clogged coronary artery.
- Percutaneous coronary intervention, also known as angioplasty and stenting. In this procedure, a catheter with a deflated balloon and stent (a wire mesh device) at the tip is threaded into the heart through a blood vessel in the leg or wrist. The balloon inflates along with the stent, clearing the blockage. The stent is left in place to prop open the blood vessel.
- Medical (drug) therapy.
Medical therapy is used in combination with both bypass surgery and stenting to help improve long-term outcomes. However, medical therapy alone has been shown to have worse outcomes in managing LMCA disease.
When comparing bypass surgery and stenting, there are some pros and cons to each. Stenting is much less invasive than bypass surgery, and has a significantly quicker recovery time. However, studies have shown that patients who have very complex LMCA disease (based on specific anatomic features) have better results with bypass surgery in the long term. But when there is less anatomic complexity, there is some uncertainty regarding which treatment is better.
Recent studies: More data, but no clear answers
Two recent clinical studies (NOBLE and EXCEL) compared bypass surgery and stenting in the low and intermediate anatomic complexity groups, and found two different results.
Let’s start off with the NOBLE study, which compared stenting to bypass surgery with regard to the combination of death, heart attack, need for repeat stenting or bypass surgery, and stroke after five years in patients with LMCA disease. It found that stenting was worse than bypass surgery for this combination of outcomes. However, the difference was mainly due to stenting patients having a higher rate of heart attacks and needing repeat stenting or bypass surgery. There was no difference in death or stroke between the two groups.
The EXCEL study also compared patients who underwent stenting with those who underwent bypass surgery for LMCA disease, but looked at the combination of death, stroke, and heart attack after five years; unlike NOBLE, the main endpoint of this study did not include the need for repeat stenting or bypass surgery. This study found no difference between the two treatments for the main endpoint. The stenting group had a slightly higher rate of death, but it wasn’t due to cardiac causes. (There were slightly more patients in the stenting group who died from infection and cancer, which was felt to be unrelated to the procedure.) Similar to NOBLE, EXCEL also found that patients undergoing stenting had higher rates of needing bypass surgery or repeat stenting. There was no difference in stroke rates.
A recent meta-analysis (a study that pools together and analyzes many studies) found that bypass surgery and stenting were equal in terms of death, heart attacks, and stroke for the low- and intermediate-complexity groups. However, patients undergoing stenting required slightly more repeat stenting or bypass surgery afterwards.
Final takeaway
Ultimately, what are patients with LMCA disease to do? Based on the data, patients who have anatomically complex LMCA disease should undergo bypass surgery, if possible. In patients with low or intermediate anatomic complexity, shared decision-making between patients, cardiologists, and heart surgeons is required to determine the best treatment option for each individual patient.
Some patients may be too frail or may have medical conditions that prevent them from undergoing bypass surgery. Other patients may not want the longer recovery process associated with bypass surgery, and those patients could be considered for stenting. Otherwise, bypass surgery would be a very good option.
Follow me on Twitter @DrDarshanDoshi
The post Is angioplasty plus stenting or coronary artery bypass surgery better for treating left main coronary artery disease? appeared first on Harvard Health Blog.
Covid-19 update: Eight people from various interests to discuss reopening Ky. economy on KET's 'Kentucky Tonight' at 8 p.m. ET
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| Renee Shaw |
The overwhelming question for Kentucky and the rest of the nation, when to reopen the economy, will be the topic of "Kentucky Tonight" on KET at 8 p.m. Host Renee Shaw will have these guests:
- Steven Stack, commissioner, state Department for Public Health
- Ashli Watts, president and CEO, Kentucky Chamber of Commerce
- Jon Klein, vice dean, University of Louisville medical school
- Ben Chandler, president/CEO, Foundation for a Healthy Kentucky
- Tod Griffin, president, Kentucky Retail Federation
- Stacy Roof, president/CEO, Kentucky Restaurant Association
- Mae Suramek, owner of Noodle Nirvana, a Berea restaurant
- Allison Adams, president, Kentucky Health Departments Association and public health director, Buffalo Trace District Health Department
Sunday, April 26, 2020
46% of Ky. covid-19 deaths in long-term-care facilities, higher than other states; protective gear, testing and staffing are concerns
By Melissa Patrick
Kentucky Health News
With 46 percent of Kentucky's covid-19 deaths occurring in long-term care facilities, up from 32% just a week ago, nursing homes continue to be a tinderbox for the coronavirus. That has prompted state officials to ramp up testing and to create a Long-Term Care Task Force charged with finding ways to slow down the spread of the virus inside these facilities.
Gov. Andy Beshear said the state has increased testing for the virus in these facilities, and more resources than ever are available for them to fight it, but he cautioned that as he begins to reopen the state's economy, it will be even more important to protect some of Kentucky's most vulnerable people.
"As we make these new decisions, as we try to ease restrictions, we've got to make sure that we don't increase the exposure," he said at his Sunday briefing. " Listen, this is what has happened in these facilities when we've had everything shut down . . . So, we've got to be really careful when we start expanding our opportunities that we're not allowing additional access to these facilities."
As of Sunday, Kentucky reported that 610 long-term-care residents and 280 employees in 60 facilities had tested positive for the virus. Ninety-five residents and one employee have died of covid-19. Statewide, there have been 4,074 confirmed cases and 208 deaths.
In several of Kentucky's surrounding states, long-term-care facilities account for a smaller share of covid-19 deaths, the Kaiser Family Foundation reports: Tennessee had 37 deaths, or 22% of its total; Illinois had 284, or 18%; and Virginia had 78, or 22%. West Virginia, Missouri, Indiana and Ohio are not among the 23 states that have reported their long-term-care deaths yet.
The overall rate among those states is 27%. LTCs accounted for over half of covid-19 deaths in six states: Delaware, Massachusetts, Oregon, Pennsylvania, Colorado and Utah. The Centers for Medicare and Medicaid Services told all nursing homes April 19 to report cases to the Centers for Disease Control and Prevention, but the data is not yet available.
Kentucky's higher rate could partly result from differences in how states define a covid-19 death. In Kentucky, any person who dies having tested positive is counted, regardless of any other condition.
The dangers are very real for residents of nursing homes, personal-care homes, family-care homes and assisted-living facilities, given their group living conditions and their many underlying health conditions.
The challenges for protecting them include finding ways to isolate, in buildings that often have few single rooms, those who have been infected; and ways to protect staff who care for this most vulnerable population – especially when basic supplies, like gowns, masks, and gloves, otherwise known as personal protective equipment – is so scarce.
"Staffing, PPE and testing are the common themes of everybody who is really concerned about what do we do next if this goes south on us," said Keith Knapp, the state official and former long-term-care administrator who acts as convener of the task force.
One task-force member is Sherry Culp, executive director of the Nursing Home Ombudsman Agency of the Bluegrass in Lexington. She said there are about 315 Kentucky nursing homes, with about 28,000 residents, and about 206 personal-care and family-care homes, with about 7,400 residents.
Personal protective equipment
PPE is needed to not only protect vulnerable residents, but to also protect staff, and nursing homes were running short of these supplies long before the pandemic hit, said Betty Shiels, director of Kentucky Emergency Preparedness for Aging and Long Term Care, a public-private coalition.
“They were running short on PPE because they were using so much of it up because they were being hard hit by the flu," she said.
In an interview, Dr. Muhammad Babar, a geriatrician and independent physician who is on the task force, called the PPE shortages in these facilities "big" and spoke to some of the challenges around procuring it.
"That really limited our facilities, which are still struggling with PPE," he said. "The cost has increased tremendously, and as we all know our states are competing with each other."
Babar is regional hub medical director for Signature HealthCare, which has 42 nursing homes in Kentucky, more than any other operator; the medical director of four of them in Louisville, an assistant clinical professor at the University of Louisville, and the founder of Doctors for Healthy Communities Inc. and Muslim Americans for Compassion.
Beshear speaks almost daily about the challenges of procuring enough PPE for health-care providers in the state, and often pleads for donations, which can be made at any of the 16 state police posts, or can be arranged by calling 1-833-GIVE-PPE or going to givePPE.ky.gov.
Adding to the challenge, the federal government requires the state to make daily reports of its PPE stock in order to be eligible to make a request for additional PPE, and that requires daily reporting from all of the state's health-care providers, including long-term-care facilities.
Shiels, who is also on the task force, said the facilities have been doing everything they can to follow the CDC guidelines, but took second priority to hospitals for PPE supplies from the strategic national stockpile, which is now depleted.
Since then, she said, PPE has been "trickling in" and nursing facilities are doing the best they can with what they have available. “I'd say there is varying available supply of PPE for nursing homes right now," she said.
Culp encouraged facilities to keep reaching out to public health for PPE because "this is an evolving situation."
Betsy Johnson, president of the Kentucky Association of Health Care Facilities, the long-term-care industry's trade group, said her association's main focus has been to secure PPE and testing for its members and residents. “It's not been easy,” she said, “and I wouldn't say we've had a great deal of success.”
Testing
Testing capacity is finally picking up in Kentucky, but Johnson said it is still "iffy" and "I do know that we were not prioritized for testing, either." She said the association's stance is that testing needs to be a priority in these facilities.
"In order to protect our residents, we have to prioritize testing for skilled nursing facilities – all residents, all staff, all the time – to ensure that we know what is going on in that building," she said. "You can be asymptomatic and still be shedding the virus."
Acting Health Secretary Eric Friedlander said last week that the health cabinet has been testing all residents of some facilities, starting with those that need the most help, and that is working with all facilities that have a positive case.
Beshear said Sunday that nursing homes are classified by red, yellow and green categories, based on several factors, and the state is the red group first.
He said for a nursing home to qualify for testing by the state, it must "be working with our Department of Public Health, it's got to collaborate on its established process on how it deals with potential infection and its response, and it's got to comply with a facility plan we put out there of best practices."
He added, "I don't want to sugar-coat it, the coronavirus is deadly in these settings. It's why we cut all visitors at a time when people maybe didn't understand why we were doing it, and so this is a setting where it is a matter of life and death, and we are doing the best we can in a very difficult circumstance with a virus that comes for those that are already vulnerable."
Health officials have called for "sentinel surveillance," which involves rigorous, frequent testing to find hidden carriers of the virus, isolate them limit its spread.
Staffing
Staffing has been an issue for nursing homes for decades. They have successfully lobbied against laws or regulations to require certain staffing levels. Johnson said her members have trouble finding and keeping staff because unemployment rates have been low and they have a non-competitive wage scale because of low payments form Medicaid, the program that pays the bill for most residents.
“I think this covid-19 pandemic has allowed us to really highlight the fact that our skilled nursing facilities simply need more support," she said. "We need support from our policymakers in government. We need support from our communities. We need support from the media."
Culp noted that while the federal CMS agency normally keeps a tally of staffing at these facilities, it has removed this requirement during the pandemic. "That really concerns me, that when this is all over, we will not have a good picture of how the short staffing may have played into this," she said.
The state has several measures to help facilities with staffing issues, including the Medical Reserve Corps, which can be used to improve emergency response capabilities and the creation of a rapid response team of providers who can be deployed as needed. Knapp said the state is also working on a "strike force" of health-care professionals to help facilities deal with crises.
An advertisement in the The Messenger newspaper in Madisonville shows that the state is paying registered nurses $65 an hour, licensed practical nurses $50 an hour, and certified nursing assistants $32.50 an hour to work in the state's traveling covid-19 crisis team for long-term care facilities.
The state has temporarily waived certain training requirements for nursing aides, who provide most of the hands-on care for residents, to allow for temporary covid-19 personal-care attendants. These new hires would not be allowed to provide care for residents in covid-19 isolation areas.
The state has also partnered with Norton Healthcare to set up a 24-hour hotline staffed by health-care professionals to help long-term-care facilities manage complex infection-control issues and see if they need more support.
"Mostly they need to know that someone is out there willing to help, willing to support," Friedlander said last week. "And we've found that on many calls, that is what is most needed."
Many who work with nursing-home employees are quick to point out their dedication to their jobs. "There are a lot of dedicated people who are working in long-term care," Culp said.
"They are good people," Babar said. "They represent our society. They do their best every day in this broken healthcare system. They are doing a good job."
Johnson said, "This group of people are the most dedicated. They are just hard workers who really want to do the right thing, with very little support."
Visitation restrictions will remain in place
As restrictions are eased elsewhere in the coming months, Beshear has said, “Visitation is going to be extremely, extremely restricted” at long-term-care facilities, a decision that both Babar and Johnson support.
“I think we still need to make the sacrifices of not visiting our loved ones in the facilities, we need to protect them from the outside world and that visitation should be the last thing allowed,” Babar said.
He praised Inspector General Adam Mather's decision to restrict visitation in long-term-care facilities, saying it saved lives.
"We were one of the very first states to stop visitation in our facilities, because of his leadership," Babar said. "He has done a marvelous job because of the base of his knowledge."
Prior to becoming inspector general, Mather was regional operations vice president for Signature, and some criticized his appointment because of his ties to the industry.
Johnson, whose mother is in a nursing home, said, "I haven’t seen Mom since the beginning of March, but I fully support that decision by both the federal and state government. We have to keep these elders safe. It is hard; it's been hard on my family, but hopefully we'll get through this and we'll keep our elders safe at the same time.”
Culp said most of her calls right now are about the visitation restrictions and a need to know if their loved ones facility has been infected with the coronavirus.
The state recently started posting a daily update on Kentucky facilities that have coronavirus cases, listing the number of residents and staff testing positive and the number of covid-19 deaths. It is at https://chfs.ky.gov/agencies/dph/covid19/LTCupdate.pdf.
Infection Control
Shiels, who does emergency preparedness training for nursing homes, said they are fully prepared to control infections, because that's what they do everyday. She said the challenge with covid-19 is that it is so contagious and PPE is in short supply. "Everybody has been doing the very best they can under extreme circumstances," she said.
Inspectors have stopped routine visits to nursing homes during the pandemic, with a short list of reasons for investigation, including serious allegations and targeted infection control.
The Long-term Care Task Force's guidance is posted on the state's covid-19 website, kycovid19.ky.gov. It recommends that residents be screened for fever and respiratory symptoms at least daily, including daily use of blood-oxygen meters, since "long-term care residents with confirmed covid-19 infections may be less likely to show signs of fever and respiratory signs, and symptoms may be subtle." Research has shown many people infected with the virus have low oxygen levels without recognizing it or any other symptoms.
"There are a lot of moving parts to this," said Knapp, a newcomer to state government. Speaking later about the efforts of the health cabinet, he said, "This Team Kentucky thing, it's more than a slogan, it permeates the place."
Kentucky Health News
With 46 percent of Kentucky's covid-19 deaths occurring in long-term care facilities, up from 32% just a week ago, nursing homes continue to be a tinderbox for the coronavirus. That has prompted state officials to ramp up testing and to create a Long-Term Care Task Force charged with finding ways to slow down the spread of the virus inside these facilities.
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| Photo from The News Courier, Athens, Ala. |
"As we make these new decisions, as we try to ease restrictions, we've got to make sure that we don't increase the exposure," he said at his Sunday briefing. " Listen, this is what has happened in these facilities when we've had everything shut down . . . So, we've got to be really careful when we start expanding our opportunities that we're not allowing additional access to these facilities."
As of Sunday, Kentucky reported that 610 long-term-care residents and 280 employees in 60 facilities had tested positive for the virus. Ninety-five residents and one employee have died of covid-19. Statewide, there have been 4,074 confirmed cases and 208 deaths.
In several of Kentucky's surrounding states, long-term-care facilities account for a smaller share of covid-19 deaths, the Kaiser Family Foundation reports: Tennessee had 37 deaths, or 22% of its total; Illinois had 284, or 18%; and Virginia had 78, or 22%. West Virginia, Missouri, Indiana and Ohio are not among the 23 states that have reported their long-term-care deaths yet.
The overall rate among those states is 27%. LTCs accounted for over half of covid-19 deaths in six states: Delaware, Massachusetts, Oregon, Pennsylvania, Colorado and Utah. The Centers for Medicare and Medicaid Services told all nursing homes April 19 to report cases to the Centers for Disease Control and Prevention, but the data is not yet available.
Kentucky's higher rate could partly result from differences in how states define a covid-19 death. In Kentucky, any person who dies having tested positive is counted, regardless of any other condition.
The dangers are very real for residents of nursing homes, personal-care homes, family-care homes and assisted-living facilities, given their group living conditions and their many underlying health conditions.
The challenges for protecting them include finding ways to isolate, in buildings that often have few single rooms, those who have been infected; and ways to protect staff who care for this most vulnerable population – especially when basic supplies, like gowns, masks, and gloves, otherwise known as personal protective equipment – is so scarce.
"Staffing, PPE and testing are the common themes of everybody who is really concerned about what do we do next if this goes south on us," said Keith Knapp, the state official and former long-term-care administrator who acts as convener of the task force.
One task-force member is Sherry Culp, executive director of the Nursing Home Ombudsman Agency of the Bluegrass in Lexington. She said there are about 315 Kentucky nursing homes, with about 28,000 residents, and about 206 personal-care and family-care homes, with about 7,400 residents.
Personal protective equipment
PPE is needed to not only protect vulnerable residents, but to also protect staff, and nursing homes were running short of these supplies long before the pandemic hit, said Betty Shiels, director of Kentucky Emergency Preparedness for Aging and Long Term Care, a public-private coalition.
“They were running short on PPE because they were using so much of it up because they were being hard hit by the flu," she said.
 |
| Dr. Muhammad Babar donating PPE from the Association of Physicians of Pakistani descent in North America (from governor's briefing) |
"That really limited our facilities, which are still struggling with PPE," he said. "The cost has increased tremendously, and as we all know our states are competing with each other."
Babar is regional hub medical director for Signature HealthCare, which has 42 nursing homes in Kentucky, more than any other operator; the medical director of four of them in Louisville, an assistant clinical professor at the University of Louisville, and the founder of Doctors for Healthy Communities Inc. and Muslim Americans for Compassion.
Beshear speaks almost daily about the challenges of procuring enough PPE for health-care providers in the state, and often pleads for donations, which can be made at any of the 16 state police posts, or can be arranged by calling 1-833-GIVE-PPE or going to givePPE.ky.gov.
Adding to the challenge, the federal government requires the state to make daily reports of its PPE stock in order to be eligible to make a request for additional PPE, and that requires daily reporting from all of the state's health-care providers, including long-term-care facilities.
Shiels, who is also on the task force, said the facilities have been doing everything they can to follow the CDC guidelines, but took second priority to hospitals for PPE supplies from the strategic national stockpile, which is now depleted.
Since then, she said, PPE has been "trickling in" and nursing facilities are doing the best they can with what they have available. “I'd say there is varying available supply of PPE for nursing homes right now," she said.
Culp encouraged facilities to keep reaching out to public health for PPE because "this is an evolving situation."
Betsy Johnson, president of the Kentucky Association of Health Care Facilities, the long-term-care industry's trade group, said her association's main focus has been to secure PPE and testing for its members and residents. “It's not been easy,” she said, “and I wouldn't say we've had a great deal of success.”
Testing
Testing capacity is finally picking up in Kentucky, but Johnson said it is still "iffy" and "I do know that we were not prioritized for testing, either." She said the association's stance is that testing needs to be a priority in these facilities.
"In order to protect our residents, we have to prioritize testing for skilled nursing facilities – all residents, all staff, all the time – to ensure that we know what is going on in that building," she said. "You can be asymptomatic and still be shedding the virus."
Acting Health Secretary Eric Friedlander said last week that the health cabinet has been testing all residents of some facilities, starting with those that need the most help, and that is working with all facilities that have a positive case.
Beshear said Sunday that nursing homes are classified by red, yellow and green categories, based on several factors, and the state is the red group first.
He said for a nursing home to qualify for testing by the state, it must "be working with our Department of Public Health, it's got to collaborate on its established process on how it deals with potential infection and its response, and it's got to comply with a facility plan we put out there of best practices."
He added, "I don't want to sugar-coat it, the coronavirus is deadly in these settings. It's why we cut all visitors at a time when people maybe didn't understand why we were doing it, and so this is a setting where it is a matter of life and death, and we are doing the best we can in a very difficult circumstance with a virus that comes for those that are already vulnerable."
Health officials have called for "sentinel surveillance," which involves rigorous, frequent testing to find hidden carriers of the virus, isolate them limit its spread.
Staffing
Staffing has been an issue for nursing homes for decades. They have successfully lobbied against laws or regulations to require certain staffing levels. Johnson said her members have trouble finding and keeping staff because unemployment rates have been low and they have a non-competitive wage scale because of low payments form Medicaid, the program that pays the bill for most residents.
“I think this covid-19 pandemic has allowed us to really highlight the fact that our skilled nursing facilities simply need more support," she said. "We need support from our policymakers in government. We need support from our communities. We need support from the media."
Culp noted that while the federal CMS agency normally keeps a tally of staffing at these facilities, it has removed this requirement during the pandemic. "That really concerns me, that when this is all over, we will not have a good picture of how the short staffing may have played into this," she said.
The state has several measures to help facilities with staffing issues, including the Medical Reserve Corps, which can be used to improve emergency response capabilities and the creation of a rapid response team of providers who can be deployed as needed. Knapp said the state is also working on a "strike force" of health-care professionals to help facilities deal with crises.
An advertisement in the The Messenger newspaper in Madisonville shows that the state is paying registered nurses $65 an hour, licensed practical nurses $50 an hour, and certified nursing assistants $32.50 an hour to work in the state's traveling covid-19 crisis team for long-term care facilities.
The state has temporarily waived certain training requirements for nursing aides, who provide most of the hands-on care for residents, to allow for temporary covid-19 personal-care attendants. These new hires would not be allowed to provide care for residents in covid-19 isolation areas.
The state has also partnered with Norton Healthcare to set up a 24-hour hotline staffed by health-care professionals to help long-term-care facilities manage complex infection-control issues and see if they need more support.
"Mostly they need to know that someone is out there willing to help, willing to support," Friedlander said last week. "And we've found that on many calls, that is what is most needed."
Many who work with nursing-home employees are quick to point out their dedication to their jobs. "There are a lot of dedicated people who are working in long-term care," Culp said.
"They are good people," Babar said. "They represent our society. They do their best every day in this broken healthcare system. They are doing a good job."
Johnson said, "This group of people are the most dedicated. They are just hard workers who really want to do the right thing, with very little support."
Visitation restrictions will remain in place
As restrictions are eased elsewhere in the coming months, Beshear has said, “Visitation is going to be extremely, extremely restricted” at long-term-care facilities, a decision that both Babar and Johnson support.
“I think we still need to make the sacrifices of not visiting our loved ones in the facilities, we need to protect them from the outside world and that visitation should be the last thing allowed,” Babar said.
He praised Inspector General Adam Mather's decision to restrict visitation in long-term-care facilities, saying it saved lives.
"We were one of the very first states to stop visitation in our facilities, because of his leadership," Babar said. "He has done a marvelous job because of the base of his knowledge."
Prior to becoming inspector general, Mather was regional operations vice president for Signature, and some criticized his appointment because of his ties to the industry.
Johnson, whose mother is in a nursing home, said, "I haven’t seen Mom since the beginning of March, but I fully support that decision by both the federal and state government. We have to keep these elders safe. It is hard; it's been hard on my family, but hopefully we'll get through this and we'll keep our elders safe at the same time.”
Culp said most of her calls right now are about the visitation restrictions and a need to know if their loved ones facility has been infected with the coronavirus.
The state recently started posting a daily update on Kentucky facilities that have coronavirus cases, listing the number of residents and staff testing positive and the number of covid-19 deaths. It is at https://chfs.ky.gov/agencies/dph/covid19/LTCupdate.pdf.
Infection Control
Shiels, who does emergency preparedness training for nursing homes, said they are fully prepared to control infections, because that's what they do everyday. She said the challenge with covid-19 is that it is so contagious and PPE is in short supply. "Everybody has been doing the very best they can under extreme circumstances," she said.
Inspectors have stopped routine visits to nursing homes during the pandemic, with a short list of reasons for investigation, including serious allegations and targeted infection control.
The Long-term Care Task Force's guidance is posted on the state's covid-19 website, kycovid19.ky.gov. It recommends that residents be screened for fever and respiratory symptoms at least daily, including daily use of blood-oxygen meters, since "long-term care residents with confirmed covid-19 infections may be less likely to show signs of fever and respiratory signs, and symptoms may be subtle." Research has shown many people infected with the virus have low oxygen levels without recognizing it or any other symptoms.
"There are a lot of moving parts to this," said Knapp, a newcomer to state government. Speaking later about the efforts of the health cabinet, he said, "This Team Kentucky thing, it's more than a slogan, it permeates the place."
