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September 26, 2016   Download print version

UPMC Starts Curavi Health to help nursing-home patients via telemedicine

200 million Americans have ‘Erin Brockovich’ carcinogen in their tap water

Disease-related malnutrition costs U.S. $15.5 billion annually

Possible new treatment for Alzheimer's disease

Some Zika 'firsts' as disease spreads across Caribbean

Leading cause of injury, death in older Americans is on the rise

Vocera Integration with prescriptive analytics reduces patient falls

Clorox Healthcare introduces the next generation of bleach


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September 2016

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by Sandra Beauclair, BSN, RN, CNOR

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UPMC Starts Curavi Health to help nursing-home patients via telemedicine

As a geriatrician who has cared for patients in nursing homes across western Pennsylvania, Steven Handler, M.D., Ph.D., has seen first-hand how some are transferred unnecessarily in the middle of the night to hospital emergency rooms. That’s because nursing staff couldn’t get the right medical advice at the right time.

“Transfers to the emergency room, which frequently result in admission to the hospital, are highly disruptive to older adults and sometimes harmful to their health,” said Dr. Handler. “What’s more, these avoidable hospitalizations are costing Medicare, private insurers and taxpayers billions of dollars every year.”

Handler’s experience prompted the creation of Curavi Health, a new UPMC Enterprises-backed company that is bringing its comprehensive telemedicine solution and physician care to the nursing home bedside, where patients and staff need it most. “We’ve spent three years developing and refining the equipment, software, training and support to help nursing homes significantly reduce potentially avoidable hospitalizations. That means better care and higher satisfaction for patients and staff,” said Dr. Handler, now Curavi’s chief medical and innovation officer and associate professor of geriatric medicine and director for geriatric telemedicine programs at the University of Pittsburgh.

Although Curavi Health is new to the market, its deep expertise with nursing homes and telemedicine stems from work done by Dr. Handler and his team over the last several years, starting with 17 non-UPMC nursing homes under a Centers for Medicare and Medicaid Services (CMS) Innovation Grant. Those efforts to reduce potentially avoidable hospitalizations for conditions like urinary tract infections and pneumonia were then expanded to include UPMC’s owned skilled nursing facilities.

That combined experience resulted in training more than 1,000 nurses and healthcare professionals in telemedicine, 212 real-time video  consults and avoidance of 108 unnecessary transfers of patients to hospitals over the last two years.

According to recent data released by CMS, of the $14.3 billion spent by Medicare in 2011 on inpatient admissions from nursing homes, an estimated $8 billion was spent unnecessarily. In Pennsylvania alone, those potentially avoidable hospitalizations total 27,000 annually from about 700 nursing homes, at a cost of $220 million. 

Curavi’s telemedicine solution aims to change that by allowing nursing home staff to access UPMC geriatricians at night and on weekends so that they can identify acute changes in a patient’s condition and intervene in a timely way.

The CuraviCart equipment allows physicians to remotely interact with patients and nursing home staff through a pan/tilt/zoom camera, Bluetooth stethoscope, digital otoscope, document scanner and 12-lead EKG system. The proprietary CuraviCare software, which facilitates interaction between the remote physician and the patient, is designed for simple operation by nursing home staff and tailored to their workflow. 

Curavi expects to soon offer a “bring your own provider” solution that will allow nursing homes to use their own attending physicians and nurse practitioners for on-demand telemedicine consults. That means Curavi can expand quickly across the country without the need to license physicians across state lines.

Visit UPMS for the story.


200 million Americans have ‘Erin Brockovich’ carcinogen in their tap water

For more than a year, federal, state and local officials have struggled to properly respond to the crisis in Flint, MI, where lead contamination of the city’s drinking water has threatened the health of 8,000 children and forced residents to use bottled water to drink and bathe.  Even now, Democrats and Republicans on Capitol Hill are fighting over whether to include $100 million to assist that beleaguered community as part of a major year-end spending bill.

Lead contamination of municipal water systems, sadly, is a relatively widespread problem in this country and would require massive resources at the federal and local level to adequately address the problem. CNBC reported recently that data it obtained from the Environmental Protection Agency (EPA) shows that 41 states have reported higher-than-acceptable levels of lead in drinking water during the past three years.

Now comes a troubling report from the Environmental Working Group (EWG), an activist research organization, that chromium-6, a carcinogenic chemical compound, has contaminated water supplies for more than 200 million Americans in all 50 states. The tests conducted by utilities across the country and supervised by the EPA found chromium-6 in almost 90 percent of the water systems sampled.

The study found that levels of chromium-6 are at or exceed 0.03 parts per billion in three-quarters of the samples that were tested between 2013 and 2015. Roughly seven million people received or consumed tap water with levels of the compound higher than the 10-parts-per-billion legal limit set by California - the only state that currently imposes a maximum contaminant level.

Arizona, California and Oklahoma had the highest average statewide levels, according to the report. Phoenix by far had the highest average level among major cities while Houston and St. Louis also registered comparatively high levels. Hexavalent chromium or chromium-6 is a chemical compound commonly used in industry for a number of purposes, including electroplating and manufacturing stainless steel and textiles.

Chromium-6 is also used as a coolant in power plant towers and is found in the ash of coal burned by utilities. While scientists may differ on the degree of public health risks that it poses, research has shown that exposure to small quantities of chromium-6 in drinking water can produce cancer in humans and animals.

The National Institute for Occupational Safety and Health (NIOSH) considers all chromium compounds to be “occupational carcinogens” that are closely connected with lung, nasal and sinus cancer, according to a government website.

The chemical industry has long opposed tough regulation of chromium-6, arguing that additional research was needed. The EPA has never set a specific limit on chromium-6 in drinking water, although the environmental agency has established a drinking water standard of 100 parts per billion for all forms of chromium, which is a natural occurring element.

Environmental activists say a national standard for chromium-6 in drinking water is long overdue.

Visit the Fiscal Times for the article.


Disease-related malnutrition costs U.S. $15.5 billion annually

The United States could save at least $15.5 billion in annual healthcare spending if malnutrition caused by chronic diseases is better addressed, according to a study.

The study, conducted by Abbott Laboratories' nutrition division and the University of Illinois, noted one in three patients who arrive at a U.S.-hospital suffer from malnutrition. A further one-third become malnourished during their stay.

Disease-associated malnutrition (DAM), which is linked with longer hospital stays, higher rates of readmission and increased mortality, is considered an invisible affliction as it occurs in both obese and underweight individuals.

It disproportionately affects the elderly, who have vulnerable immune systems and are commonly afflicted with chronic diseases. While individuals over 65 represent only 14 percent of the American population, they accounted for nearly a third, or $4.3 billion, of DAM costs, according to the study.

An aging population and rising medical costs are expected to lift healthcare spending by an average 5.8 percent annually over the next decade, the U.S. federal government estimated in July.

Malnourished patients cost 20 percent more to treat on average, said lead author Dr Scott Goates, a health economist at Abbott's nutrition division, which accounted for about 34 percent of the company's $20.41 billion in 2015 net sales.

The study used publicly available data to calculate the increase in expenditure due to malnourishment associated with eight common chronic diseases, including stroke, depression, dementia and colorectal cancer.

It did not factor in patients' socio-economic status. Companies, including Abbott, Nestle SA and Danone SA, sell products that help in recovery following illness, injury or surgery. These products are particularly useful for patients having trouble swallowing or digesting.

Visit Reuters for the report.


Possible new treatment for Alzheimer's disease

Despite the promise of immune therapy for Alzheimer-type dementias, several approaches have failed. Now, industry-funded investigators report results on a newly developed, experimental monoclonal antibody, aducanumab.

In animal studies, aducanumab passed through the blood–brain barrier, attached to both soluble and insoluble amyloid, and decreased brain amyloid accumulations. In a human phase-1b double-blind, placebo-controlled, safety study, 165 participants with prodromal or mild Alzheimer disease intravenously received various aducanumab doses (1, 3, 6, or 10 mg/kg-1) or placebo, administered monthly for o1 year.

Dropouts occurred in 25% of the placebo group and 23% to 38% of the aducanumab subgroups (dropout rates increased at higher doses). On positron emission tomography (PET), most aducanumab doses were associated with decreasing amyloid in a dose- and time-dependent fashion.

These decreases were similar for prodromal and mild disease and for those with or without the APOE4 risk allele. In exploratory cognitive testing, disease progression slowed at some aducanumab doses. Cerebral vasogenic edema, seen on PET, occurred in 3% to 41% of aducanumab recipients (highest at upper doses) and resolved within 4 to 12 weeks.

Visit NEJM for the study.


Some Zika 'firsts' as disease spreads across Caribbean

The World Health Organization's (WHO's) weekly Zika update included a series of Zika "firsts" in several countries, including the first Zika-related birth defects reported in Guatemala. Also, the CDC released new Zika numbers for the United States, while human trials of a vaccine are set to begin in Brazil.

According to the WHO's weekly Zika situation report, the two-island nation of St. Kitts and Nevis is now experiencing Zika transmission, bringing the number of countries or territories with Zika virus to 73.

The number of cases of Zika-related microcephaly also increased this week, as Guatemala reported 17 suspected cases of congenital birth disorders. These are the first such cases reported in the Central American country. Brazil reported 23 more cases of microcephaly, bringing that country's total to 1,911.

More cases of microcephaly were also reported in Martinique and the United States, bringing the total number of Zika-related microcephaly cases to 2,047 in 21 countries. Microcephaly, a severe congenital malformation of the brain, is one of the most serious outcomes of Zika infection.

Ecuador reported its first cases of suspected Zika-related Guillain-Barre syndrome (GBS), bringing the number of countries with reported GBS to 19. The WHO noted that "neurological complications have been linked only to post-2007 strains of the 'Asian' lineage" Zika virus, but it warned that as new information about different strains of the virus emerges, there could be cases linked to the African strain of the virus, or to strains in Southeast Asia.

The Centers for Disease Control and Prevention (CDC) also released its updated Zika numbers which includes all cases in the United States and its territories. The CDC reported two more babies born with Zika-related birth defects, bringing that number to 20. The number of pregnancy losses stayed at 5. There are 749 reported cases of Zika in pregnant women in the US states (18 more than last week), and 1,348 in US territories (192 more than last week) as of Sep 15.

The number of travel-related Zika infections in the Unites States is now at 3,314, with 182 more cases reported. In US territories, the number of local infections increased by 2,077 to 17,629, most in Puerto Rico.

Two Zika DNA-based vaccines developed by the National Institutes of Health (NIH) proved to be effective in protecting monkeys from the disease after two doses, the NIH said today in a press release. The vaccine uses circular DNA to replicate the shape of the Zika virus.

One of the vaccines is already being testing by human volunteers in three study centers in the United States. If the phase 1 trials are successful, a phase 2 trial in Zika-endemic countries will begin in early 2017.

Visit CIDRAP for the report.


Leading cause of injury, death in older Americans is on the rise

Older Americans need to go for regular eye exams, get rid of their throw rugs, and retire their high heels. These are just some of the pieces of advice experts on aging and government health officials are doling out in tandem with a new report that shows falls are the number one cause of fatal and nonfatal injuries among adults over 65.

In 2014, older Americans fell 29 million times, leading to seven million injuries, according to the report out today in the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

About 2.8 million cases were treated in emergency departments, and approximately 800,000 seniors went on to be hospitalized for fall-related issues.

More than 27,000 falls led to death. 

And the problem is growing as more Americans age into the 65-and-over category.

The CDC said individuals, families and healthcare providers can take steps to defy the trend.

Dr. Gisele Wolf-Klein, M.D., director of geriatric education at Northwell Health in Great Neck, New NY, told CBS News one concern is that seniors who have experienced a fall alone at home don’t tell anyone. When that happens, prevention efforts don’t begin and they’re at risk for additional – and possibly more serious – tumbles that lead to broken bones and brain injuries.

When someone does fall and hurt themselves, especially if they’re put in the hospital or have to have surgery, they’re often never the same, Wolf-Klein said. 

Falls also lead to higher healthcare costs, CDC experts said in the report. Fall injuries in 2014 amounted to an estimated $31 billion in annual Medicare spending.

A CDC initiative called STEADI – Stopping Elderly Accidents, Deaths, and Injuries – is aimed at reducing the risk of falls and offers guidance for doctors, patients and families. It includes information on how to screen a person’s fall risk, online resources to help train healthcare providers to deal with the issue, and informational brochures for patients and caregivers.

Part of the challenge is overcoming the stigma associated with the problem. 

Visit CBS News for the story.


Vocera Integration with prescriptive analytics reduces patient falls

Vocera Communications, Inc. announced that long-time customer MedStar Montgomery Medical Center has improved patient care with the launch of a fall prevention program. The new initiative combines prescriptive analytics using the hospital’s clinical data with the Vocera Communication System.

The software platform enables real-time alerts and notifications, secure texting, hands-free communication, and integration with more than 75 clinical systems including electronic health records, nurse call and bed management solutions. The program is supported by analytics MD’s prescriptive analytics solution.

With a continuous focus on patient safety and satisfaction, MedStar implemented analytics MD’s prescriptive analytics solution in 2016, gaining real-time, actionable insight into its patient population. The analytics MD platform looks at both historical and transactional data to proactively notify MedStar team members about fall risks.

Now MedStar has a real-time fall alert system that notifies care teams about high-risk patients. These alerts are sent directly to assigned nurses via their Vocera Communication Badge. Because the badges are wearable, staff members’ hands are free to quickly help patients at the bedside while also calling for co-workers’ assistance if needed.

Visit Vocera for the release.


Clorox Healthcare introduces the next generation of bleach

Bleach has played an important role in public health for more than a century. Announced at the Association for the Healthcare Environment (AHE) EXCHANGE 2016 annual conference, Clorox Healthcare is proud to release it’s healthcare disinfection with the introduction of Clorox Healthcare Fuzion Cleaner Disinfectant.

Fuzion is the next generation of bleach and the first product of its kind to combine trusted bleach efficacy against tough-to-kill pathogens with the aesthetics required for broad use throughout healthcare facilities. Fuzion is Environmental Protection Agency (EPA) registered to kill Clostridium difficile (C. difficile) spores in two minutes, the fastest kill time available, and 35 other pathogens in one minute.

Clorox Healthcare Fuzion Cleaner Disinfectant’s innovative features include:

·         Proven Efficacy: The formula is EPA-registered to kill drug-resistant threats such as C. difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecalis (VRE) and carbapenem-resistant Klebsiella pneumoniae (CR-KP) as well as other bacteria, viruses and fungi in two minutes or less.

·         Excellent Aesthetics and Surface Compatibility: Fuzion is a pH-neutral, highly-efficacious form of bleach that won’t cause damage to common surfaces. It can be safely used on stainless steel, chrome, countertops, sinks, mattress covers, glazed tiles – even finished wood, clear plastics and glass. The low residue formula leaves surfaces looking clean, not cloudy, and has a low odor profile with any mild bleach odor dissipating in minutes.

·         Design for Enhanced User Experience: Fuzion was designed with environmental services professionals (EVS) in mind. The product features an ergonomic bottle shape and innovative trigger spray designed to deliver the appropriate concentration of active ingredient every time the trigger is pulled.

This approach makes Fuzion tough on pathogens, yet easy on surfaces and practical for everyday use across a wide variety of healthcare surfaces and settings. These features, combined with the ease of use of a one-step cleaner and disinfectant represent the next generation of disinfectants and an entirely new user experience designed for efficacy and satisfaction.

Visit Clorox for more information.