Antidepressant use increases hip fracture risk among elderly

from: Medical New Today .com

Antidepressant use nearly doubles the risk of hip fracture among community-dwelling persons with Alzheimer’s disease, according to a new study from the University of Eastern Finland. The increased risk was highest at the beginning of antidepressant use and remained elevated even 4 years later. The findings were published in the International Journal of Geriatric Psychiatry.

For each person with Alzheimer’s disease, two controls without the disease were matched by age and sex. Antidepressant use was associated with two times higher risk of hip fracture among controls. However, the relative number of hip fractures was higher among persons with Alzheimer’s disease compared to controls.

The increased risk was associated with all of the most frequently used antidepressant groups, which were selective serotonin reuptake inhibitors (SSRI drugs), mirtazapine and selective noradrenaline reuptake inhibitors (SNRI drugs). The association between antidepressant use and the increased risk of hip fracture persisted even after adjusting the results for use of other medication increasing the risk of fall, osteoporosis, socioeconomic status, history of psychiatric diseases, and chronic diseases increasing the risk of fall or fracture.

Antidepressants are used not only for the treatment of depression, but also for the treatment of chronic pain and behavioral and psychological symptoms of dementia, including insomnia, anxiety and agitation. If antidepressant use is necessary, researchers recommend that the medication and its necessity be monitored regularly. In addition, other risk factors for falling should be carefully considered during the antidepressant treatment.

The study was based on the register-based MEDALZ cohort comprising data on all community-dwelling persons diagnosed with Alzheimer’s disease in Finland between 2005-2011, and their matched controls. The study population included 50,491 persons with and 100,982 persons without the disease. The follow-up was 4 years from the date of Alzheimer’s disease diagnosis or a corresponding date for controls. The mean age of the study population was 80 years.

Rapid-Inflation Intermittent Pneumatic Compression for Prevention of Deep Venous Thrombosis

Eisele R, Kinzl L, Koelsch T:J Bone Joint Surg Am. 89:1050-6, 2007

Over 1800 consecutive inpatients were enrolled in this randomized prospective clinical study. A total of 902 patients were managed with chemoprophylaxis alone and 901 patients received chemoprophylaxis augmented with [VenaFlow] intermittent pneumatic compression (IPC). All patients were Dopplered for evidence of symptomatic and nonsymptomatic deep vein thrombosis (DVT) at discharge. In the chemoprophylaxis-only group, fifteen patients (1.7%) were diagnosed with a DVT; three thromboses were symptomatic. In the IPC group, four patients (0.4%) were diagnosed with DVT; one thrombosis was symptomatic. The difference was significant. In addition, patients who wore the IPC device more than six hours per day had no deep vein thromboses. The results demonstrate that the multimodal approach of using a rapid inflation intermittent pneumatic compression device as an adjunct to low-molecular-weight heparin is significantly more effective in preventing DVTs than using low-molecular-weight heparin alone.

Studies have shown that carefully controlled exercise is safe for patients with lymphedema.

INFORMATION FROM THE NATIONAL CANCER INSTITUTE

Exercise does not increase the chance that lymphedema will develop in patients who are at risk for lymphedema. In the past, these patients were advised to avoid exercising the affected limb. Studies have now shown that slow, carefully controlled exercise is safe and may even help keep lymphedema from developing. Studies have also shown that, in breast-cancer survivors, upper-body exercise does not increase the risk that lymphedema will develop. Some studies with breast cancer survivors show that upper-body exercise is safe in women who have lymphedema or who are at risk for lymphedema. Weight-lifting that is slowly increased may keep lymphedema from getting worse. Exercise should start at a very low level, increase slowly over time, and be overseen by the lymphedema therapist. If exercise is stopped for a week or longer, it should be started again at a low level and increased slowly. If symptoms (such as swelling or heaviness in the limb) change or increase for a week or longer, talk with the lymphedema therapist. It is likely that exercising at a low level and slowly increasing it again over time is better for the affected limb than stopping the exercise completely.

AMA Blasts Medicare Part B Drug Price Plan

Votes to ask CMS to withdraw proposal

by Joyce Frieden
News Editor, MedPage Today

 

CHICAGO — A proposal by the Centers for Medicare & Medicaid Services (CMS) to change the way Medicare pays for drugs under the Part B program would hurt physician practices, the American Medical Association said at its annual meeting here.
“This is a patient care issue and an access issue,” said Heather Smith, MD, an ob/gyn in Bronx, N.Y., who spoke on behalf of the American Congress of Obstetricians and Gynecologists. “This will impact care of our patients, especially those with ovarian cancer.”

The AMA House of Delegates passed a resolution Wednesday asking that CMS withdraw its proposal and, if that doesn’t happen, that the AMA lobby Congress block the proposal’s implementation. The proposal, if put into place, “would significantly undermine the ability of physician practices to meet the significant administrative and financial burdens associated with the rapidly evolving healthcare environment,” according to the resolution.
The CMS plan would replace the current Medicare reimbursement — the average sales price of the drug plus a 6% add-on fee to cover costs — with a rate of the average sales price plus 2.5%, plus a flat fee of $16.80 per drug per day. The flat fee would be adjusted at the beginning of each year.

For full story go to: http://www.medpagetoday.com/MeetingCoverage/AMA/58630

A Respiratory Protection Program: Why you need it and what it entails

By Richard Best
Every year, between 1 and 3 million serious infections occur in nursing homes, skilled nursing
facilities and assisted living organizations. That number stands to grow with baby boomers
quickly aging and needing additional care. As more patients enter long-term care settings, it’s
critical to make sure infection control is a top priority in these organizations in order to keep both
patients and staff safe and healthy. Long-term care patients often have compromised immune
systems due to their age and comorbid conditions, making them less able to fight infection. As
such, elderly patients frequently contract diseases that younger or healthier individuals might not.
For example, a young, healthy person with latent tuberculosis infection (LTBI) probably will not
progress to active TB disease. However, an elderly patient who has previously acquired LTBI is
much more susceptible for active TB disease to develop. Because of patients’ increased
vulnerability, it can be very difficult to control infections in long-term care settings if an
organization does not immediately and consistently employ the proper precautions. One way to
minimize the spread of infection is to have a comprehensive respiratory protection program in
place. The Occupational Safety and Health Administration (OSHA) requires organizations to
develop such a program to protect staff if they are exposed to airborne pathogens, such as
tuberculosis, influenza, chicken pox and so on. In addition to shielding staff, a well-executed
program can also ensure that patients are not infected, preserving their safety as well as their
health. Despite the OSHA requirements, long-term care organizations often don’t realize they
need a respiratory protection program, believing the risks of encountering a virulent airborne
illness are low. However, due to the vulnerability of this particular patient population, the
chances that a facility will at some point see a patient with a fast-spreading respiratory disease,
such as active TB disease, are increased. Even if the organization transfers that individual to an
acute care facility, it should still have a program in place to protect staff for the time period the
patient is awaiting transfer. Also, there are some cases where a novel influenza virus, such as
2009’s H1N1 outbreak, would warrant the activation of a respiratory protection program.

Elements in a Comprehensive Effort
As long-term care facilities begin to plan their respiratory protection programs, they should keep
in mind several essential components to remain compliant, effectively mitigate risk and protect
patients and staff:

Qualified administrator
This individual should be intimately familiar with OSHA regulations and understand the
potential infectious hazards an organization may face. He or she should also be aware of the
necessary personal protective equipment (PPE) that will adequately safeguard staff. Typically
this is an N-95 respirator-a device that prevents the spread of target sized particulate matter 95%
of the time.

A written plan
Underpinning a dynamic program is a detailed document that describes how the organization
shields staff from respiratory hazards and complies with OSHA regulations. This document
should describe any PPE needed, as well as the required environmental controls, such as proper
ventilation. To assist organizations in crafting a written plan, OSHA provides in-depth resources
that outline necessary components. In particular, the agency’s small entity respiratory program
compliance guide is quite helpful, including a sample plan for reference.

A workplace analysis
To ensure a respiratory protection program mitigates the correct hazards, long-term care
organizations should conduct a workplace analysis to see what risks are, or may be, present.
Organizations should take this assessment seriously as it is the only way to guarantee the
selection of optimal respirators and PPE. The program administrator may want to consult
external resources when conducting this assessment, such as CDC modules about specific
airborne diseases.

Tyco fire protection recalls Simplex fire alarm control panels due to failure to activate.

According to an article in the February, 2015 issue of PULSE from the Florida Health Care
Association, Tyco has initiated this recall. Providers outside Florida who may not have seen this
notice should contact Tyco if their control panel is a Tyco model.

Polygel DVTCare System Can Improve Patient Compliance and Lessen Risk of DVT

Lower extremity deep venous thrombosis remains an issue for patients who are at high risk after surgeries or traumatic events. Sequential pneumatic compression devices are very useful in lessening the risk of DVT and blood clots. But these devices have limitations as many must be plugged in and are quite cumbersome when trying to move around operating rooms, hospital beds, and emergency rooms.

In the early 2000s, the American Venous Forum conducted a study showing how portable pneumatic compression devices helped improve compliance and, in time, would lessen the chances of DVT. As we enter into 2012, the latest in portable DVT care is the Polygel Ca5 DVTCare System. At the size of a book and one pound to carry in the over-the-shoulder case, the system is easy to use. Plus the battery works for 15 hours for single-leg therapy and 8 hours for dual-leg therapy.

So now when patients need to get out of bed, get transferred from the OR or ER to their hospital room, patient compliance can improve. The patient can wear it as he or she is getting radiographic studies, physical therapy, or other procedures. Compliance goes up, the device is easier to function in different settings, and the chances of DVT and blood clots goes down. As the study showed with a portable device, “…to be effective, they (devices) must be in use continuously; there is no effect that lasts beyond the time they are applied and functioning on the legs.”

Health care professionals will also have peace of mind that the functionality is the same as plug-in devices. The Polygel Ca5 DVTCare System has two segmented cuffs, wraps around the legs, and compresses veins to promote blood flow. The cuffs are comfortable and can be hand washed as needed.

As the previous American Venous Forum study showed, some medical professionals are concerned about the risk of bleeding in the early stages after an injury. Portable pneumatic compression devices can last for a long time and give everyone peace of mind that they are taking a proactive approach. And after a daylong worth of use, it can be plugged in and still used. Within 3.5 hours it is completely recharged again.

For the hospital setting, these devices can offer far more compliance than standard compression devices and thus are becoming more commonplace for doctors to prescribe. Portable devices can also be prescribed by the doctor for the home setting, as the system is made to be on the go.

To learn more about a Polygel Ca5 DVTCare System, pneumatic compression device, or Lymphedema boots, visit http://www.vascularprn.com/ or call 800.886.4331.

Nursing Home Mistakes Can Be Corrected With Early Intervention

Nursing home mistakes can hurt residents and a facility’s ability to be reimbursed by Medicare. And if nursing home abuse is discovered, it can void insurance coverage and often lead to a handful of lawsuits. Many nursing home workers put a lot of effort into their work and care for the livelihood of their residents. But it takes only one or a few mistakes to be in violation of the patient standard of care.

Patient abuse is the most severe violation, and can involve workers stealing from residents, withholding food, or other physical and emotional types of abuse. Pressure ulcers and wounds are the next most common mistake. Nursing home workers should document and take photos of any ulcers on admissions. This can help to have a baseline reference of how the patient came into the facility and what steps the nursing home staff can take to heal these conditions.

It can never be said enough that bandages must be checked. A recent lawsuit awarded $650,000 to a woman whose bandages were not checked for 11 days and once the site was checked, it was crawling with maggots. Medical professionals cannot ignore internal controls and patient complaints. The New England Journal of Medicine reports that 16 percent of nursing home residents deal with decubitis ulcers. Innovative products such as the Skin IQ™ Microclimate Manager can dramatically cut down the risk of developing decubitis ulcers. The Skin IQ is an electrically powered mattress coverlet that pulls moisture away from a patient’s skin and lowers the skin temperature to make them more comfortable. It costs about $6 a day versus a Low Air Loss mattress that is around $30 a day. For nursing home residents that are more immobile, this type of technology can be critical to lessening ulcers and the risk of patient liability.

Most pressure ulcers and wrongful death lawsuits stem from malnutrition and dehydration. Medical professionals at the nursing home must monitor each patient’s nutrition and watch out for weight loss. Also, patients must be monitored for issues regarding deep vein thrombosis and venous stasis ulcers. Compression therapy machines are affordable to rent and can help residents from having more severe issues. All these concerns should be addressed in each patient’s care plan; otherwise, lack of documentation can cause a nursing home to be liable for an injury or death.

Risk of falling is another area that nursing homes can improve on. Nursing homes must have initiatives to help residents stay mobile and have assistive devices as needed. Equally as important is the risk of residents wandering or escaping a facility. Insufficient staffing or ignoring internal procedures is no excuse for having a patient’s life in jeopardy. Nursing homes should take extra care in doing employee background checks to make sure they have the right staff on board and ensure that the ratio of residents to workers will help ensure the standard of care is upheld.

To learn more about the Skin IQ, and Vascular PRN’s other products such as Sequential Compression Devices, SCD boots, or Lymphedema boots, visit http://www.vascularprn.com/ or call 800.886.4331.

Innovative Mattress Product Helps Nursing Homes Create Big Savings

Nursing home budget cuts create a harsh atmosphere for administrators who must find innovative ways to cut costs and recover from extensive nursing home deficits. In part, this is happening due to Medicaid services being provided by care providers in the home setting. With Medicaid cuts of around three percent and Medicare cuts a little over 11 percent, nursing homes are scrambling to cut costs or face closing.

With these cuts, nursing homes are getting creative about ways to cut costs. This can be difficult given that nursing homes often take care of post-hospital patients. Patient advocates say that nursing homes could save money just by taking better care of patients as an estimated 14 percent of patients in their post-op care must go back to the hospital. Patient infections, falls that cause broken bones and other injuries, and medication mishaps could have been prevented. These incidents also are a part of “never events” that Medicare will not reimburse a facility for.

Taking on losses like this can equal a nursing home’s demise. As many facilities do a sufficient job of helping their short and long-term residents, a nursing home administrator must look at ways to cut costs in other departments or increase revenue. Ways to strengthen revenue include marketing to new and different groups for nursing home services, and responding to patient referrals quicker. Many nursing homes have already frozen wages, cut staff, and halted facility upgrades.

From here, they must find savings by looking at medical supplies that could do more for the nursing home at a lesser cost. From tissues and briefs to wound care and lotions, and even bigger items such as beds and medical equipment, every single item is being analyzed. For facilities that already have a pressure redistribution mattress, they can stop using a Low Air Loss (LAL) mattress, which typically costs $30 a day, and use the new Skin IQ™ coverlet for about $6 a day.

The Skin IQ coverlet does more to prevent skin breakdown and pressure ulcers than a LAL mattress. This new mattress cover wicks moisture away from the patient, minimizes odors, and helps prevent infections. For a nursing home that might rent 75 LAL beds per month, for example, for high risk patients, switching to a Skin IQ coverlet could save $54,000 in 30 days. The product is easy to clean and can be used for individuals up to 500 pounds.

To learn more about the Skin IQ, and Vascular PRN’s other products such as Sequential Compression Devices, SCD boots, or Lymphedema boots visit http://www.vascularprn.com/ or call 800.886.4331. Vascular PRNSM helps healthcare professionals nationwide with product sales and rentals to help maintain a patient’s skin integrity and lessen decubitus ulcers.

To learn more about a Sequential Compression Device, SCD boots, or Lymphedema boots, visit http://www.vascularprn.com/ or call 800.886.4331.

Best Recommendations for Long-Term Care Residents to Take After an Orthopedic Surgery

After orthopedic surgery, it is highly recommended to use sequential compression devices until a patient is back to walking around more frequently. Especially in nursing home settings, this can be important for residents who have just returned from the hospital or an outpatient surgery center and need some time to heal.

Compression therapy can help prevent deep vein thrombosis and blood clots. Surgery already increases the chances of a blood clot as blood vessels are injured during a procedure. As a patient heals from getting a knee or hip replaced, for example, being immobile for long periods of time also elevates a person’s risk. Your orthopedic doctor will recommend a course of post-op treatment that can include the short term use of blood thinners and compression therapy.

The National Blood Clot Alliance reminds individuals and their loved ones to be on the lookout for signs of any unusual pain, skin color and temperature, or swelling that is beyond what your doctor has noted during recovery. Also, a rapid heartbeat, difficulty breathing, or bloody mucus can signal an imminent blood clot.

Nursing home medical professionals are responsible for communicating with the resident’s doctor about any irregularities and should be utilizing compression therapy unless there are contraindications for specific individuals. Of equal importance is making sure that a resident does not start to get bedsores. Immobility and other factors can make a person prone to developing bedsores that turn into more serious pressure ulcers. Aggressive measures should be taken to prevent this from happening, including helping patients turn every couple of hours as they rest in the bed or use a wheelchair.

Some residents are more prone to moisture problems as a result of excessive perspiration that can be caused by their medical condition or the medications they are taking. Pressure ulcers can arise when the skin develops excess moisture as more friction occurs against clothing, sheets and the mattress cover. Incontinence is similar as it can make the skin moister and cause infections. Many long-term care facilities already have pressure redistribution mattresses on hand for decubitus ulcer prevention. When a Skin IQ™ Microclimate Manager can be used on top of the mattress, a resident can benefit by the latest in skin integrity technology. The facility also benefits by obtaining the same results as with a Low Air Loss bed, but at a fraction of the cost.

The Skin IQ™ is a reasonably priced solution for nursing homes to use to prevent skin ulcers, minimize odors, lower temperature at the contact points and reduce friction. It is a good solution for residents of almost any size, even up to 500 pounds.

Vascular PRNSM assists long-term care centers and nursing home professionals with compression therapy products and the Skin IQ coverlet to prevent decubitus ulcers. They rent, sell and ship products to health care centers throughout the United States, and can send by overnight delivery. They carry high-quality brands that are built for even the most rigorous medical demands.

To learn more about a Sequential Compression Device, SCD boots, or Lymphedema boots, visit http://www.vascularprn.com/ or call 800.886.4331.