Whitney Howell

Healthcare. Politics. Family.

When Testing Becomes Overtesting

Published on the May 15, 2015 DiagnosticImaging.com website

By Whitney L.J. Howell

On April 1, Mark Cuban, billionaire entrepreneur, NBA team owner, and actor, took to Twitter, sharing his philosophy on how patients can best be engaged with their health care. In a series of tweets, he advocated – among those who can afford it – for having a quarterly blood test in an effort to establish an individualized health baseline.

Not only would this strategy give patients and their children more knowledge about their health care over time, he said, but it would also allow patients to be more proactive about their medical treatment. No more waiting to get sick – patients could, potentially, identify problems early and ask for intervention.

The wake of those tweets has been filled with mixed responses from the medical community. Within radiology, a specialty constantly concerned with the specter of overtesting, providers are in heated disagreement over whether Cuban’s advice is reckless or revolutionary for health care.

To determine the pros and cons of a quarterly blood-test strategy, Diagnostic Imaging interviewed two industry experts. Saurabh Jha, MD, MS, assistant professor of radiology at the Hospital of the University of Pennsylvania, and Stephen Hunt, MD, PhD, an interventional radiologist and co-director of the Penn Image-Guided Interventions Laboratory shared their thoughts.

To read the debate at its original location: http://www.diagnosticimaging.com/practice-management/when-testing-becomes-overtesting?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=15052015

May 15, 2015 Posted by | Healthcare | , , , , , , | Leave a comment

New Research Points to Feeding Peanuts Early to Avoid Allergy

Published on the May 5, 2015, North Carolina Health News Network website

New findings about peanut allergies is turning the advice pediatricians give to parents of young children on its head. Scientists from North Carolina are in the thick of this new research.

By Whitney L.J. Howell

As a 15-month-old, Brayden Baylor touched his first peanut butter cracker. Within minutes, his face turned red, he broke out in hives and he began rubbing his eyes until they were swollen shut.

It was a classic peanut-allergy reaction. But, because he hadn’t actually eaten the cracker, or the peanut butter on it, his parents didn’t realize what was happening – until a second reaction erupted within hours.

“We had given him a dose of Benadryl, and, at the time, we still didn’t really know what caused the problem. There’s no history of food allergies in either of our families,” said Karrie Baylor, Brayden’s mother and a Charlotte resident. “But when it happened a second time, he was sitting in my lap and suddenly turned red and swollen. That’s when we took him to the emergency room.”

After a blood test, a local allergist diagnosed Brayden with a peanut allergy – a potentially deadly immune response affecting between three million and six million Americans, the majority of whom are children. According to a 2001 Archives of Internal Medicine study on food allergies, peanut allergies rank worst, accounting for more than 50 percent of the 200 annual food allergy-related deaths nationwide.

Peanuts are one of North Carolina’s most significant agricultural products, yielding about 8 percent of the U.S. total annual production. Much of the research on peanut allergy has also been done in N.C. Image courtesy USDA

Peanuts are one of North Carolina’s most significant agricultural products, yielding about 8 percent of the U.S. total annual production. Much of the research on peanut allergy has also been done in N.C. Image courtesy USDA

In fact, the fear of peanut allergy and its potentially fatal outcomes prompted the American Academy of Pediatrics, in 2000, to issue guidelines recommending children consume no peanut protein before age 3. The hope was that delayed exposure would give a child’s immune system time to strengthen and prevent peanut allergies.

But that hasn’t happened. Between 1997 and 2010, peanut-allergy prevalence among American children has skyrocketed 50 percent, according to the Centers for Disease Control and Prevention. And, based on existing data, occurrence within North Carolina mimics the national population.

This meteoric rise has baffled allergy and immunology researchers and sparked many investigations into the body’s response to peanut protein and how it can be calmed. Now there’s a watershed study, funded by the National Institutes of Health, that experts say conclusively proves the existing approach to combating peanut allergies has been wrong.

In short, the AAP guidelines meant to safeguard children like Brayden are actually causing more allergy cases to break out.

“This study is definitive. That’s unusual in this business,” said Herman Mitchell, vice president for Rho, the Chapel Hill-based contract research organization that handled the study’s statistical and data coordination. “We usually see trends, but this is a whopping finding that is very clear. It’s a reason to completely change the recommendations about avoiding peanuts at an early age.”

Problem peanuts?

While peanut-allergy rates are high in the United States and United Kingdom, that’s not the case everywhere. A 2008 Journal of Allergy and Clinical Immunology study revealed British children were 10 times more likely to have a peanut allergy than Israeli children.

Those nation’s health care systems are roughly equivalent, but there’s a significant cultural difference. Israeli families introduce children to peanut products far earlier. A snack called Bamba – a peanut butter-flavored corn puff – is present in 90 percent of Israeli homes and helps transition infants to solid food.

As part of the NIH’s Immune Tolerance Network, Gideon Lack, pediatric allergy professor at King’s College London, launched a study to investigate whether eating peanut-protein products, such as Bamba, early has a protective effect, Mitchell said.

Lack’s five-year study enrolled 600 4-to-11-month-old children who were at risk for developing a peanut allergy.

They either had another existing food allergy, a family history of peanut allergy or eczema. Half of the children were introduced to Bamba, while the other half followed the existing guidelines that prohibit exposure. The children who received Bamba ate it three times a week for five years.

The study ended with a food challenge that escalated the peanut-protein amount participants ate over several hours.

The results, published in a February New England Journal of Medicine issue, showed children who ate Bamba were 81 percent less likely to develop peanut allergy. Among non-consumption participants, 13.7 percent developed a peanut allergy, while only 1.9 percent of the Bamba group did.

According to Wesley Burks, chair of pediatrics at the UNC-Chapel Hill School of Medicine, Lack’s study will change how doctors advise parents about peanuts.

Burks leads a long-standing peanut-allergy study designed to help children with existing peanut allergies, including Brayden, develop a tolerance to peanut protein.

“These studies will change the paradigm with respect to feeding in the first six months of life for kids with allergic diseases. The guidelines for introducing peanut protein will change within the next year,” he said. “That will be the easy part; but medical guidelines take years to be disseminated.”

It will take between five and 10 years, he said, for pediatricians to abandon the current guidelines and begin advising parents based on these new findings.

Testing the idea

While the results of Lack’s study seem to indicate that preventing peanut allergy before it occurs is possible, it’s not yet clear whether that’s the case, Mitchell said. The effect could be desensitization, meaning participants who exhibit no current allergic responses could have reactions to peanut protein later in life.

To answer that question, several Bamba group participants agreed to avoid peanut protein for a year and then complete another food challenge. This new group will also include 40 children who don’t have peanut-allergy risk factors but had a positive allergy skin test. Results of this new study will also help doctors treat children with peanut allergies.

“It would be ideal if we could understand exactly who’s at risk,” he said. “Then pediatricians could measure a child’s risk and could recommend early [peanut-protein] exposure.”

Mitchell advised that parents have their child evaluated by an allergist if any peanut-allergy risk factor exists. An allergist can provide guidance on how to introduce peanut protein into the diet.

Slow buildup

These study results and new guidelines will help prevent peanut allergies in

Karrie and 6-year-old Brayden Baylor share a Reese’s Peanut Butter Cup three years after Brayden started treatment for his peanut allergies. Photo courtesy Karrie Baylor.

Karrie and 6-year-old Brayden Baylor share a Reese’s Peanut Butter Cup three years after Brayden started treatment for his peanut allergies. Photo courtesy Karrie Baylor.

infants and newborns, but it can’t help the children who already live with peanut intolerance.

That’s where Burks’ work comes in. For more than 25 years, he has worked toward treatments that help children – most of whom are over age 2 – develop a peanut-protein tolerance that reduces the severity of allergic reaction. The therapy is considered a success if a child can ingest a peanut or peanut protein without being thrown into a debilitating or potentially fatal immune response.

To date, Burks, who is also physician in chief at North Carolina Children’s Hospital, and his team have developed three treatment forms, all of which culminate with a food challenge similar to Lack’s study. In some cases, participants drip peanut protein-infused liquid under their tongue, while others wear patches impregnated with peanut protein. The most effective strategy though has been mixing peanut-protein powder with other well-tolerated foods, such as applesauce or ice cream.

“When the protein powder is introduced regularly – and in increasing quantities – it can make changes to the immune system,” Burks said.

Based on Rho’s data, Burks said he will begin to enroll and treat younger children in a continued effort to reduce peanut-allergy impact.

In the meantime though, he will continue to treat children Brayden’s age and younger, helping them overcome their peanut allergies. Brayden’s therapy has already been declared a success after three years: He passed his final food challenge without exhibiting any signs of allergic reaction.

His celebratory feast? His first-ever Reese’s Peanut Butter Cup.

To read this story at its original location: http://www.northcarolinahealthnews.org/2015/05/05/new-research-points-to-feeding-peanuts-early-to-avoid-allergy/

May 5, 2015 Posted by | Healthcare, Science | , , , , , , , , , , , , , , , | Leave a comment

Accounting Advice for Radiology Practices

Published on the April 23, 2015, DiagnosticImaging.com website

By Whitney L.J. Howell

Editor’s Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed.

Throughout radiology, there’s no shortage of hand-wringing about slashed reimbursements and shrinking bottom lines. New requirements and regulations on the horizon could further endanger your balance sheet.

But, according to industry experts, proactive, thorough accounting strategies and choices can help keep your group or practice afloat.

“Accounting procedures are important because profit margins are declining every year due to Medicare cuts and strategies that payers are employing,” said David Yousem, MD, neuroradiology director, program development vice chairman, and radiology professor at Johns Hopkins Medical Institution. “Mind your Ps and Qs or else you won’t have a profit margin.”

Studying your expenditures and income might frequently take a back seat to your concerns over patient care and quality, but it isn’t something you can ignore, he said. Knowing how to categorize your financial activities and your business model, as well as taking a close look at your daily activities can make the difference in your practice’s monetary health and growth.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/practice-management/accounting-advice-radiology-practices?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=24042015

April 30, 2015 Posted by | Healthcare | , , , , , , , , , , , , | Leave a comment

The Ethical Radiologist

Published on the March 18, 2015 DiagnosticImaging.com website

Editor’s Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed.

By Whitney L.J. Howell

he bedrock code of being a physician and provider is to first, do no harm. Implied in that statement, industry experts said, is a requirement to always act in an ethical manner. It’s one of the easiest ways to safeguard patient safety and present the best quality care.

In radiology, abiding by the highest level of ethical behavior is a sure-fire way to show your colleagues and the health care community that they can have confidence in your work product.

“If you really care about the patient, really care about your colleagues and community, it will shine through,” said Richard Gunderman, MD, an Indiana-based radiologist who has written and published about radiology ethics. “We have an ethical responsibility to put the best interest of the patient above the hospital or health care system that might happen to employ us.”

The American College of Radiology (ACR) Ethics Committee serves as the industry’s highest ethical authority, and it routinely publishes guidelines and policies to help you navigate ethical situations. But, remembering and monitoring ethics at a more local, day-to-day level is also important.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/ethical-radiologist

March 20, 2015 Posted by | Uncategorized | , , , , , , , , | Leave a comment

Exploring the Waves for New Medical Knowledge

Published on the March, 16, 2015 North Carolina Health News website

Researchers in eastern North Carolina are culling the waters of the coast to find ingredients for new drugs and treatments for disease.

By Whitney L.J. Howell

Think about the ocean, and visions of whales, shellfish and the occasional starfish might pop to mind, not medical therapeutics and advancements in drug delivery. But with new research, the waves that crash on North Carolina’s coast are bringing innovative strategies and tools for improving health.

Together, researchers from the University of North Carolina-Wilmington and East Carolina University’s Brody School of Medicine are investigating how microorganisms found in ocean waters could improve the performance of existing medications, such as drugs for diabetes, cancer and heart disease.

“There’s a new class of compounds based on marine life that can get inside cells and show the cell’s permeability,” said David Brown, an ECU cardiac physiologist and associate physiology professor involved in the partnership.

Brown said UNCW researchers know the ocean side of the equation, whereas his group has studied compounds that can potentially be used to create designer medicines that get into cells and function better.

“Where UNCW’s expertise stops … is where we pick up,” he said.

The partnership, which still awaits final funding approval, formed in response to a call from the University of North Carolina Board of Governors for game-changing research between UNC system institutions that could spawn new approaches to treating disease.

Sharing work & benefits

Any research successes borne from North Carolina’s 300 miles of coastline and estuaries would likely be further supported by the UNCW-based Marine Biotechnology in North Carolina program and the nonprofit Wilmington-based Marine Bio-Technologies Center of Innovation. The Bio-Technologies Center, bolstered by a $2.5 million grant from the N.C. Biotechnology Center, is charged with helping shepherd discoveries into products and processes.

The marine life component of this collaboration comes from the lab work of UNCW Center for Marine Science director Dan Baden, who has studied red tide, the algae bloom known for killing large

UNCW Center for Marine Science director Dan Baden with some of the more than 750 cloned samples from more than 500 microorganisms collected from the waters off North Carolina’s coast. Photo courtesy UNC-Wilmington/Jamie Moncrief

UNCW Center for Marine Science director Dan Baden with some of the more than 750 cloned samples from more than 500 microorganisms collected from the waters off North Carolina’s coast. Photo courtesy UNC-Wilmington/Jamie Moncrief

fish populations by paralyzing their central nervous systems.

Baden’s team identified a microorganism capable of crossing a cell’s outer protective layer – the membrane that acts as a gatekeeper, only letting select substances in and out of cells.

His team dubbed these microorganisms “escortins” because they can escort materials through that natural cellular fence, depositing them at a specific target. Escortin™ is already on the market as a cancer-drug delivery tool. Test results showed it delivers cancer medications to cells within minutes, compared to other drug-delivery systems that can take up to a day to be effective.

Work is underway for additional safety and efficacy trials, as well as clinical trials, to test whether Escortin can be used in other ways, Baden said.

Escortin could be given alongside other drugs, said Baden, who is also a UNCW marine sciences professor.

“If we can bind the escortins to a drug of interest at ECU, then we have the potential

to develop a pairing where our molecules carry medications across the membrane efficiently,” he explained. He called escortin “a molecular carrier that could potentially have ubiquitous importance well past the end of all our careers.”

Delivering a guarantee

At ECU, Brown’s research has focused on mitochondria, the structures in cells that convert food into energy. He calls mitochondria the key to medication success.

Brown has focused on the mitochondria inside heart cells, how they affect heart disease and irregular heartbeats and how they repair other malfunctioning mitochondria. When cells are diseased, he said, mitochondria don’t work well.

Because of the cell’s outer membrane, there hasn’t yet been a definitive way to get drugs to the mitochondria in order for them to heal and return to normal functioning.

“Many times, there’s no guarantee a medicine will get into the cell that can benefit from it,” Brown said. “There’s no way to be absolutely sure [a medicine] gets to the right place.”

Escortins create that guarantee for mitochondria, Baden said, taking medications through the cell’s outer membrane.

North Carolina waters bring healing

That targeted drug delivery could have a significant impact on adults living near both institutions.

According to 2010 data from the North Carolina State Center for Health Statistics, nearly 13 percent of adults in eastern North Carolina – the highest rate in the state – live with Type 2 diabetes. Data from the Eat Smart Move More NC initiative also revealed between 63 and 68 percent of adults in the same area are overweight or obese.

Parts of cells being measured out for testing in the UNCW Center for Marine Science. Investigators use methods that involve physics and biology to learn more about the cells’ function and structure at the molecular level. Photo courtesy UNC-Wilmington/Jamie Moncrief

Parts of cells being measured out for testing in the UNCW Center for Marine Science. Investigators use methods that involve physics and biology to learn more about the cells’ function and structure at the molecular level. Photo courtesy UNC-Wilmington/Jamie Moncrief

“Mitochondria in diabetics aren’t good at burning fuel for many reasons,” ECU’s Brown said. “If we can use the ocean to help design treatments, then there’s huge potential for treating the disproportionately high population of diabetics and people with metabolic illness.”

The escortin-medication relationship could also improve the efficacy of heart medications, Baden said. Being able to deliver heart medications to patients who’ve had a heart attack or stroke in a timely manner can potentially decrease avoidable deaths, an important goal in eastern North Carolina, a region known as the “buckle” of the “stroke belt.”

Economic impact

The state’s 300-mile coastline presents the universities with a wealth of discovery opportunities, said Deb Mosca, the Bio-Technologies Center’s chief executive and a microbial geneticist who studies the genetics of microorganisms.

UNCW researchers are already deeply involved in culling the ocean for plants and animals that could benefit human health. Once they find a new organism with intriguing characteristics, they clone it, eliminating the need to harvest more and potentially disrupt the ocean’s ecosystem.

In doing so, Baden said, investigators are looking for new aspects of genetics and chemistry that haven’t been seen before.

“If you combine ECU’s drugs with our molecules, we’ve created new intellectual property that can extend the life of patents and add new value. It’s a scaffold for us to build upon,” UNCW’s Baden said. “Translational science – applying research in a real-world way – earns money from tax dollars and gives back to the American people.”

The process can also work in reverse, he said. If researchers know there’s a need for a certain type of medication that functions in a particular way, they can work toward finding a marine biotechnology solution to the problem. And that could create greater economic stability in the region by bringing new tools, collaborations and science jobs to eastern North Carolina, fueling further economic development.

UNCW is already on that path with its new translational science building, funded by the U.S. Department of Commerce and National Institute of Standards and Technology. The 69,000-square-foot space is the first of its type in the region, and it brings together, under one roof, researchers from a variety of scientific fields, making professional cooperations even easier.

“It’s a resource for North Carolina biotechnology, the UNC system and the state that goes beyond just the faculty and institutions working together – it includes students,” Baden said. “It’s about coming into a multidisciplinary, collaborative environment and developing relationships through big science, business and working with the right people to combine expertise and experiences to do things that weren’t possible before.“

To read the story at its original location: http://www.northcarolinahealthnews.org/2015/03/16/11680/

March 20, 2015 Posted by | Healthcare, Science | , , , , , , , , , , , | Leave a comment

Catching Emotional and Developmental Problems in Homeless Children

Published on the March 2, 2015, North Carolina Health News website

A new study shows children experiencing homelessness are at more risk of mental health and developmental problems.

By Whitney L.J. Howell

Four-year-old Aiden and his mother came to a Raleigh Salvation Army Women & Children’s Shelter for the 30-day overnight program in October. They had no car and had shuttled between the homes of friends and family in Raleigh and Durham, but Aiden’s mother was determined to find the services her son needed.

Aiden, whose name is changed for his privacy, screamed and cried frequently, couldn’t focus and couldn’t sit still. He had language delays, couldn’t convey his needs and wants and couldn’t interact in age-appropriate ways.

Unfortunately, Aiden isn’t alone. A look inside the state’s homeless shelters quickly reveals a sobering fact – many residents are children. And a substantial number of those kids need mental health services they’re not getting.

Luckily for Aiden, a Community Action Targeting Children who are Homeless (CATCH) case manager got involved, screening his developmental and social-emotional status. Aiden scored extremely low, completed additional testing and was diagnosed with autism. The CATCH case manager referred him to Child Find, an exceptional-needs children’s initiative, where he entered a half-day program.

“The Child Find office works closely with CATCH and understands the barriers unique to homelessness. It was extremely helpful to the mom, as the half-day program lets her seek employment and stable housing,” said Jennifer Tisdale, a Project CATCH coordinator who works with Aiden’s case manager.

“Without CATCH case management, it’s entirely possible this child would’ve never been identified and wouldn’t have received the services and placement in an appropriate setting beneficial to them both,” she said.

According to a new NC State University and Salvation Army-funded study, 25 percent of homeless children – from infants to early-elementary school age – need mental health services to avoid developmental delays.

“In North Carolina, the fastest growing homeless population is families, not individuals. It’s really important to see how this situation impacts them, especially young children,” said Jenna Armstrong, an NCSU doctoral student and study co-author. “We found there’s a significantly higher proportion of homeless children experiencing developmental and social-emotional delays than those who aren’t homeless.”

The situation in North Carolina

Nationally, there are 2.5 million homeless children. According to the 2014 National Center on Family Homelessness report, North Carolina falls in the bottom half, at 29th, in addressing this issue. Statewide, there are more than 55,000 homeless children, making North Carolina one of the 15 worst nationwide.

North Carolina has 650 emergency shelters and nearly 1,900 additional transitional or supportive housing spaces for homeless families. A newly formed interagency group on homelessness also exists. But few existing intervention programs focus on young children.

The NCFH report also revealed that North Carolina’s homeless children fall below national averages in academic performance. Only 22 and 29 percent of fourth-graders meet educational standards in reading and math, respectively. By eighth grade, those numbers decline to 19 and 23 percent.

What are the risks?

The NCSU/CATCH study evaluated 328 children, aged two months to six years, in 11 Wake County homeless shelters. They observed children and conducted 20-minute assessments with their parents. Most homeless children adapt and function well, but researchers found a quarter of the group suffer negative effects.

“Many homeless children have experienced prolonged poverty, exposure to family and neighborhood violence, separation from parents due to child protective-services involvement and inadequate parenting,” said Mary Haskett, an NCSU psychology professor and lead study author. “Residing in shelters adds the stress of living in a chaotic, crowded, often unsafe environment, and access to services is extremely limited for young children who are homeless.”

Based on CATCH-conducted assessments, homeless children have greater communication and language development delays – in fact, existing research shows 60 percent have significant communication delays. In this study, toddlers had particularly low communication development scores.

Learning to read is harder for children who don’t hit milestones on time, Haskett said, placing them at higher academic failure risk.

The team assessed physical development in babies, Armstrong said, by whether infants could sit up unsupported, which happens at about 4 to 7 months, and when they began babbling and talking not long afterwards. Investigators also examined social-emotional development by observing whether older children threw tantrums and how well they handled their emotions. By comparing a child’s behavior to large, national pediatric behavioral studies, the team concluded many homeless children, such as Aiden, fell outside normal behavioral development ranges.

These delays could emerge at any age, Haskett said. Boys appeared to be at greater risk than girls for delayed social-emotional development, based on parental reports. Parents of 28 percent of at-risk boys and 21 percent of at-risk girls expressed concerns about their child’s social-emotional development.

But determining the extent of the difference and why it exists requires more research, she said.

What can be done?

Older school-age children receive some mental health services, Haskett said, through the federal McKinney-Vento Homeless Assistance Act. The law requires that schools have an education liaison to help students enroll in school and coordinate transportation for the student to attend. It also mandates other needed services, such as vocational or technical training, free or reduced school meals and before-and-after-school care.

But services for younger children are rare, she said.

“When these children arrive at a shelter, the priorities are housing and other basic needs of families,” Haskett said. “If children’s developmental and mental health needs are severe and obvious to shelter staff, a referral for appropriate services might be made. But if the delays are subtle, it’s unlikely. Untreated minor delays and mental health concerns tend to simmer and worsen over time.”

That’s why screening children, like Aiden, is vital, she said. Early identification can increase their access to existing beneficial programs, such as Early Head Start, a free child-development program for low-income families. The program teaches parents activities to bolster their children’s learning and offers day care center-based learning programs that help kids meet developmental and social-emotional milestones.

Other programs, such as the Nurse-Family Partnership, Incredible Years and the Triple P-Positive Parents Program, also give at-risk children support for improved growth and future academic performance, she said.

Through the Nurse-Family Partnership, maternal and child health nurses work with at-risk and low-income first-time parents, teaching them healthy habits and skills to support their infant’s early development. Incredible Years focuses on ensuring children’s healthy social and emotional development. Triple-P also strives to teach parents effective coping strategies to shepherd their child’s emotional development.

A Child’s Place, a school for homeless children in Charlotte, exemplifies early-intervention success. Ninety-two percent of the homeless children with whom they work read at grade level, compared to 48 percent nationally.

Having early-intervention service representatives participate in screening homeless children could make early assessments more effective, Haskett said. They could help determine whether a child is eligible for targeted programs.

“But the workforce must have competencies in young children’s mental health and development to serve this group,” she said. “Unfortunately, most communities lack mental health providers who can service children ages birth to 5.”

However, the NCFH recently made policy recommendations for promoting development and mental health functioning in homeless children. The hope, Armstrong said, is that this research will support those recommendations, as well as prompt legislators to advocate for expanding assessment screenings and create more support services.

Too often, Armstrong said, children like Aiden fly below the radar.

“They’re not paid attention to in shelters and they’re not noticeable in the school system,” she said. “We’re lucky to be at the forefront of this problem, to advocate for making these invisible children more visible to policymakers who have the power, through money, to remediate the problem.”

To read the article at its original location: http://www.northcarolinahealthnews.org/2015/03/02/catching-emotional-and-developmental-problem-in-homeless-children/

March 2, 2015 Posted by | Healthcare | , , , , , , , , , , , , , , , , | Leave a comment

Business of Radiology: Marketing

Published on the Feb. 27, 2015, DiagnosticImaging.com website

Editor’s Note: It’s no longer enough for radiologists to be imaging experts. Health care is becoming big business and radiologists need to understand how to navigate the system. Diagnostic Imaging’s Business of Radiology series provides radiologists with the business education they need to succeed. 

By Whitney L.J. Howell

Ask any of your peers, and they’ll likely agree – health care as you’ve known it is changing. The patient population has ballooned under the Affordable Care Act. Larger practices and health systems are gobbling up competitors. And, reimbursement dollars are tighter. It’s never been more important to make yourself stand out from the crowd.

Maybe you’ve had a marketing plan for years. Maybe the concept is new to you. Either way, industry experts said, it’s a crucial – and mandatory part – of maintaining a successful radiology practice.

“Radiologists are continuously marketing themselves, whether they recognize it or not. We are at a critical crossroads in our profession, with health care reform and dramatic changes in the health care industry,” Reginald Munden, MD, DMD, MBA, chair of the Houston Methodist Hospital radiology department, wrote in the February Journal of the American College of Radiology. “Radiologic services are in the crosshairs because of the expenses to patients, hospitals, and third-party payers. Perhaps we have done a poor job of marketing ourselves and our profession.”

That’s why, he said, radiologists must improve their marketing for the specialty to survive and flourish.

To read the remainder of the article at its original location: http://www.diagnosticimaging.com/articles/business-radiology-marketing?GUID=EF943FEE-BD0C-44C7-A1BC-C82F32210979&XGUID=&rememberme=1&ts=27022015

February 27, 2015 Posted by | Healthcare | , , , , , , , , , , , , , | Leave a comment

Latino Newborns May Be at Risk Due to Immigration Law Fears

Published on the North Carolina Health News website in February 2015

Regulations that give local law-enforcement officers the authority to act on federal immigration laws could have a chilling effect on the use of health care services within Hispanic communities.

By Whitney L.J. Howell

The health of North Carolina’s Hispanic newborns could be at risk from an immigration law.

The federal Immigration and Nationality Act – the same law that led to a racial profiling lawsuit against the Alamance County Sheriff’s Office in 2012 – could also be having a negative impact on the health of unborn babies in North Carolina’s Hispanic communities, according to new research from Wake Forest University.

According to researchers from Wake Forest’s School of Medicine, the heightened fear of deportation generated by this and other laws, in addition to Latinos’ lack of understanding of their rights under immigration laws, has played a role in the unwillingness of North Carolina’s pregnant Hispanic women to seek out the medical services they need.

The study reveals these women are less likely than women of other ethnicities to receive timely and sufficient prenatal care.

“Regardless of the status of the mother or father, a child born here is an American citizen under the Constitution, and we would hope that all children born in this country are healthy and can avoid preventable illness,” said Mark Hall, a Wake Forest law professor with expertise in health care law and public policy who participated in the study. “So it’s certainly important that all expectant mothers receive adequate prenatal care.”

Delaying prenatal care

But that’s not what’s happening, Hall said.

Based on a data review and personal interviews conducted in 2012, Hall and his fellow researchers discovered approximately 30 percent of Hispanic women in North Carolina don’t start prenatal care until after the first trimester.

The American Congress of Obstetricians and Gynecologists recommendations suggest the initial visit occur between eight to 10 weeks. In comparison, according to the same study data, only 10 percent of non-Hispanic women delayed receiving care. Additionally, 30 percent of Hispanic women – versus 8 percent of all other women – received less than half of the 14 doctor examinations recommended in ACOG guidelines.

Unfortunately, said Angeline Echevarria, executive director of El Pueblo, a Latino community-advocacy group, North Carolina’s Hispanic residents often forego preventive health care services out of fear associated with their citizenship status.

“We’ve found that when community members feel they’re being singled out or targeted by law enforcement, it puts a damper on their willingness to seek health services that aren’t associated with any type of emergency,” she said. “We see this especially in rural areas where public transportation isn’t really an option. A lack of good mobility options limits their willingness to drive around and take a chance for what they deem as unnecessary care. So they put off preventive services, even though we don’t recommend it.”

Although N.C. Healthy Start reports first-generation Hispanics maintain the state’s lowest infant mortality rate – 3.7 per 1,000 live births – pregnant women in this community still face risks if they don’t receive proper medical services. Inadequate prenatal care has been linked to low birth weight; neural tube defects, such as spina bifida; congenital illnesses, impaired heart and brain development; and increased infant mortality. Newborns who don’t receive proper prenatal care are 40 percent more likely to die within the first month of life, according to the Guttmacher Institute.

It’s also possible, Hall said, that this group’s rate of inadequate prenatal care could create a significant public health issue for North Carolina. Based on 2013 U.S. Census Bureau estimates, there are more than 875,000 Hispanics in North Carolina, nearly 9 percent of the state’s population.

Effects of the law?

Using vital records data from 2012, six focus groups, and 17 in-person interviews, the study analyzed how expectant Hispanic women accessed and used prenatal care services for nine months before and nine to 18 months after the Immigration and Nationality Act went into effect. The researchers reviewed data from seven counties that adopted the law and seven that didn’t.

Under the INA’s section 287(g), U.S. Immigration and Custom Enforcement can effectively deputize state and local agencies, giving them the authority to uphold federal immigration laws during routing law-enforcement activities. The U.S. Department of Justice cited traffic stop data to argue that the Alamance County sheriff’s department was being overly aggressive in targeting Latinos under the aegis of the INA.

In 2012, federal officials terminated the county’s participation in the program. This past year, Terry Johnson, the Alamance County sheriff, was tried in a federal court on charges of discriminatory policing. A judge has yet to rule in the case.

Researchers can’t say definitively whether immigration regulations caused the drop in access of prenatal care services, Hall said, but the data did indicate fewer women sought care after its enactment than before.

In the interviews, pregnant women frequently reported a lack of insurance contributed to their foregoing prenatal care.

Data from the Henry J. Kaiser Family Foundation reported 43 percent of N.C. Hispanics don’t have health insurance. This amount mirrors the Pew Research Center statistic of 43 percent of Hispanic 18-to-64-year-olds nationally who are without health insurance.

For some women, transportation was an issue, Hall said. Many were concerned they would be pulled over en route to the doctor’s office for a routine traffic violation and have their immigration status discovered. This is what happened in Alamance County, where a review of traffic stops showed deputies from the sheriff’s department were more likely to stop Latinos for minor traffic violations, such as riding without a seat belt.

Another group of women in the study feared the doctor would report them to immigration officials.

Greater clarity

To combat these concerns, North Carolina’s public policy and medical leaders must improve communication around patients’ rights and access to care, Hall said. Greater clarity about whether immigration enforcement can even affect medical care – medical providers are neither required nor expected to check immigration status when providing services – could also be helpful.

In addition, he said, knowing there’s no real risk of being reported by the doctor’s office could encourage more women to find some type of reliable transportation to their appointments.

Ultimately, Hall said, improving prenatal care for Hispanic women could have a positive impact on North Carolina’s health overall.

“As a society, we have concern over everyone’s health, particularly those of children. If reluctance or fear affects the willingness to get immunizations, it could impact communicable diseases,” Hall said. “In general, there’s a larger implication. We need to think beyond just enforcing immigration policy to the labor and economic impacts on families, as well as the public health impacts that aren’t fully recognized.”

To read the article at its original location: http://www.northcarolinahealthnews.org/nc-research-news/

February 23, 2015 Posted by | Healthcare | , , , , , , , , , , , , , , | Leave a comment

How To Be The Perfect Radiology Group

Published on the DiagnosticImaging.com website on Feb. 19, 2015

By Whitney L.J. Howell

You have reimbursement woes. You worry about your billing practices. You wonder if you’re doing the right things to demonstrate your value to partner hospitals. The daily stresses can be nearly overwhelming – but, if you were a perfect radiology group, these worries wouldn’t exist.

The perfect radiology group has tweaked its day-to-day activities. Their streamlined coding process ensures proper payment. Their targeted marketing attracts more referring physicians, and personnel tactics secure a seat at the administrative decision-making table. Every day, for the perfect radiology group, operations are smooth.

But, is the perfect radiology group really attainable? Not really, industry experts acknowledge, but it’s possible for you to get close. Later this year, the American College of Radiology (ACR) will release a road map for creating your “optimal” radiology practice or department. In it, according to Mark Bernardy, MD, chair of the ACR Managed Care Committee, you’ll find a list of best practices that were tested at the ground level, and can help you on your way. Consider it an expansion of ACR’s Imaging 3.0.

“Imaging 3.0 has laudable big picture ideas. Everyone nods their head that it sounds good and right. But, then, exactly what is it that you want me to do?” said Bernardy, who is also a practicing Georgia-based radiologist. “There’s a big gap. I thought it would be useful to go through the exercise of writing down what it is we mean when we say, ‘This is what the perfect radiology group looks like.’”

As a compilation of best practices gathered from large medical centers and small private practices nationwide, it will be a living document, open to modification with new, effective ideas, he said.

Read the remainder of the story at its original location: http://www.diagnosticimaging.com/practice-management/how-be-perfect-radiology-group?cid=tophero

February 23, 2015 Posted by | Healthcare | , , , , , , , | Leave a comment

What Can Radiologists Really Do About Unnecessary Imaging?

Published on the Jan. 15, 2015, DiagnosticImaging.com website

By Whitney L.J. Howell

Unnecessary imaging and appropriateness criteria. These two phrases have dominated radiology discussions for the past several years. It’s a complicated topic that has an even more complex, and elusive, answer.

And, according to industry leaders, one of the most critical components to the discussion is the role radiologists play in limiting the number of unnecessary and duplicative imaging studies performed.

“Radiologists get painted as these selfish people who are self-interested and who are going to fight against change,” said Jeremy Bikman, chief executive officer for peer60, a big data survey company that provides analysis based on conversations with on-the-ground professionals. “But, they didn’t create their reimbursement structure. It comes from the Centers for Medicare & Medicaid Services, and radiologists are just doing the best they can.”

That performance includes responding to and meeting referring physicians’ needs and desires, which, frequently, he said, can be wasteful. A recent peer60 report puts the nationwide cost of unnecessary imaging between $7.47 billion and $11.95 billion annually.

To reach the article in its entirety at its original location: http://www.diagnosticimaging.com/practice-management/what-can-radiologists-really-do-about-unnecessary-imaging

January 15, 2015 Posted by | Uncategorized | , , , , , , , , , , , , , , , | Leave a comment


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