Whitney Palmer

Healthcare. Politics. Family.

How Do Your Patients Perceive Pain?

Published on the Nov. 9, 2015, Rheumatology Network website

By Whitney L.J. Howell

A significant portion of patients with rheumatoid arthritis don’t feel they have effective communication with their rheumatologists, according to a small qualitative study.
Patient perceptions of pain and fatigue can differ from clinical markers. Knowing this can encourage rheumatologists to take patient responses into account when designing treatment plans.

In a presentation given on Nov. 10 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., Mayo Clinic rheumatologist John M. Davis III, discussed how frequently patients report severe rheumatoid arthritis symptoms that exceed the objective markers their rheumatologists observe.

Results suggest patients experience a disconnect with their doctors, friends and family members that contributes to the psycho-social burden of disease. The findings can help providers recognize patients who feel their concerns aren’t being heard, he said, as well as open the door to more transparent patient-physician discussions.

“The sense is if we engage with patients and are attentive to their unmet needs, in terms of complaints and coping with symptoms,” he said, “we’ll have a better sense of what’s going on with patients.”

Based on patient responses through the Clinical Disease Activity Index, the pain visual analog scale, and the Patient Health Questionnaire-9, patient-physician discordance appears in 33 percent of clinical encounters even though not all patients are dissatisfied with their doctors. Patient-physician concordance is defined by a >25-mm absolute difference in these global assessments of their disease activity during the patient’s most recent rheumatology appointment within the previous four weeks.

Patients who report discordance also report high levels of fatigue, pain and difficulty with activities, he said, even though the number of swollen joints and CRP protein levels don’t indicate the same level of disease activity.

To read the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/how-do-your-patients-perceive-pain

November 9, 2015 Posted by | Healthcare | , , , , | Leave a comment

Physical Therapy in Knee Osteoarthritis Relieves Physical and Financial Pain

Published on the Nov. 9, 2015, Rheumatology Network website

By Whitney L.J. Howell

Individuals with knee osteoarthritis can benefit more from intensive physical therapy paired with subsequent booster sessions than from a shorter period of concentrated physical therapy, according to a recent study.

While this strategy is a deviation from current practices, it has been shown to improve outcomes, as well as lower costs. Longer periods of face-to-face work with a physical therapist could also encourage patients to exercise more, helping them maintain health benefits.

In a presentation given on Nov. 8 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., University of Pittsburg physical therapy assistant professor Allyn Bove, discussed the comparative differences between treating knee osteoarthritis patients with short, concentrated periods of physical therapy or with extended physical therapy services augmented by booster session.

“A lot of physical therapists would like to have regular follow-ups with patients to adjust home exercise programs and talk about best strategies to manage knee osteoarthritis,” she said. “It would be much like having a conversation about chronic disease with a primary physician or scheduling regular dental appointments.”

Three hundred participants completed a two-year study and were divided into four groups: 12 exercise-only visits; 9 exercise-only visits with three boosters, spread over 12 months; 12 exercise-only session, plus manual therapy; and, 9 exercise-only therapy, plus manual therapy, plus three booster sessions.

Based on patient-reported outcomes, Healthcare Utilization Project data, and the Medicare physician fee schedule, physical therapy with booster session produced the greatest effectiveness at the lower cost, Bove said. Exercise, manual therapy and booster session cost the least, and exercise-plus-booster cost $1,061 more with a gain of 0.082 Quality-Adjusted Life Years.

According to study results, she said, it would cost $13,000 in medication costs, follow-up visits, and additional services to achieve the same healthcare benefits seen with physical therapy sessions that include booster sessions spread out over a 12-month period.

To read the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/physical-therapy-knee-osteoarthritis-relieves-physical-and-financial-pain

November 9, 2015 Posted by | Healthcare | , , , , | Leave a comment

Q&A: Writing the Book on Radiology Reports

Published on the Nov. 9, 2015, DiagnosticImaging.com website

By Whitney L.J. Howell

For radiology and radiologists, their most significant work product is the radiology report. It provides guidance to referring physicians and plays an integral role in the design of a patient’s treatment plan. However, providers haven’t had much guidance on how to optimize the reports they produce in recent decades.

To change that and offer more clarity, Curtis Langlotz, MD, PhD, professor of radiology and medicine at Stanford University Medical Center, wrote The Radiology Report: A Guide to Thoughtful Communication for Radiologists and Other Medical Professionals, which was released last week.

Diagnostic Imaging spoke with him about why the book was necessary, the information he provides, and the impact he hopes the publication will make.

What was the impetus behind writing this book?

Considered as a whole, radiology reports are awful. Plenty of data in the literature backs up that claim: there is an appalling rate of clinically significant errors, reports that don’t answer the clinical question, dissatisfied clinicians, unnecessary hedging, and just a general lack of clarity. I wanted to help radiologists get better.

Most of my career has been focused on the radiology report in one way or another, and I found myself often lamenting the sorry state of affairs. One of the biggest problems was the lack of a comprehensive resource for radiologists, which leads to poor training and limited skills.

Then around 2005, it finally dawned on me that nobody else was going to write the book, so I probably should. I started collecting relevant literature, reporting pitfalls, and speech bloopers, and began thinking about how to organize the material. Writing doesn’t come easily to me, and style guides can be pretty dry, but it became a fun challenge to make the material interesting.  That was easier for some parts of the book than for others. I will leave it to the reader to judge whether that worked out.

To read the remainder of the story at its original location: http://www.diagnosticimaging.com/pacs-and-informatics/qa-writing-book-radiology-reports

November 9, 2015 Posted by | Healthcare | , , | Leave a comment

Methotrexate Frequently Prescribed Incorrectly

Published on the Nov. 9, 2015, Rheumatology Network website

By Whitney L.J. Howell

Methotrexate is frequently prescribed incorrectly in the United States, a recent study found. It’s under-dosed, prescribed for inadequate time periods, and is rarely switched to the subcutaneous version before biologic are initiated.

If methotrexate was better appropriated, rheumatoid arthritis could be better controlled and it could produce significant cost savings.

In a presentation given on Nov. 9 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., James O’Dell, M.D., University of Nebraska Medical Center rheumatology division chief, discussed how methotrexate is prescribed to treat rheumatoid arthritis and whether it can be used more effectively.

The study pulled health information from Symphony Health Solutions, including demographic characteristics, switches from oral to subcutaneous methotrexate or a biologic with or without concomitant methotrexate, timing of any changes, dosing at the time of changes. Researchers concentrated on patients who received an ICD-9 diagnosis of 714.0 or 714.30 and initiated methotrexate treatment in 2009, following their outcomes through 2014.

Out of 35,640 individuals, 15,599 (43.8 percent) received continuous oral methotrexate, and 17,528 (49.2 percent) added or switched to a biologic agent. Seven percent switched from oral to subcutaneous methotrexate.

Analysis showed that switching to subcutaneous methotrexate prevents the need for or extends the time to the addition of a biologic. More than 40 percent of rheumatoid arthritis patients who started oral methotrexate switched to or added a biologic within 90 days after a median dose of 15 mg/week.

Of those who switched to subcutaneous methotrexate, 71 percent remained on the same treatment for three years, adding a biologic after 289 days. The average time of progression to a biologic was longer for patients who switched to subcutaneous methotrexate (823 days) than those who switched to oral methotrexate (170 days).

To read the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/methotrexate-frequently-prescribed-incorrectly

November 9, 2015 Posted by | Healthcare | , , , | Leave a comment

Patients with RA Make Good Employees

Published on the Nov. 9, 2015, Rheumatology Network website

By Whitney L.J. Howell

Proper medical treatment can keep people with arthritis in the workforce longer, a large study of individuals with arthritis and those without the condition showed.

Physicians should be aware that a growing number of patients, including those with arthritis, are interested in working beyond traditional retirement age, study authors said. And, there is a clinical need to ensure treatment helps them get back to work.

In a presentation given on Nov. 11 at the 2015 ACR/ARHP Annual Meeting in San Francisco, Calif., Monique A.M. Gignac, M.D., an affiliate scientist with the Toronto Western Research Institute, discussed how individuals living with arthritis have the same desires to remain in the workforce as do their counterparts who don’t have the chronic condition.

“Perhaps we need to provide clinicians with resources, policies, and practices about success stories of how people have managed to sustain in the workplace,” she said. “They can provide education and information to patients looking to continue working.”

According to study results, there were no differences in retirement expectations between individuals with arthritis and those without. Both groups expected to retire from their current jobs at age 64, she said, and 60 percent of them said they plan to return to work full-time or part-time at something else for several more years. In fact, she said, 11 percent of both groups indicated they had no intention of ever retiring.

This concept – retiring from one career to take a job in another field – is called bridged retirement, and it’s becoming more common, Gignac said. Based on results from 631 individuals with arthritis and 538 without it, participants with arthritis reported less fatigue, greater job satisfaction, less productivity loss, and less absenteeism in the second-career jobs than did individuals who never left the workforce.

To read the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/patients-ra-make-good-employees

November 9, 2015 Posted by | Healthcare | , , , | Leave a comment

Lung Scarring Systemic Sclerosis

Published on the Nov. 9, 2015, Rheumatology Network website

By Whitney L.J. Howell

Patients with systemic sclerosis who take cyclophosphamide or mycophenolate mofitil both experience nearly the same decrease in lung scarring, according to a small study.

Neither medication is superior in reducing lung scarring and improving skin tightness. Rheumatologists can now better understand the agents’ safety profiles and know more about how to prescribe them and monitor results to help patients live longer with better lives.

In a presentation given on Nov. 8, at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., University of California-Los Angeles rheumatologist Philip Clements, MD, revealed patients with systemic sclerosis experienced equivalent improvement with interstitial lung disease when taking both cyclophosphamide and mycophenolate mofitil.

“Both medications have now been shown to be effective in slowing down the scarring of the lungs in fibrosis,” Clements said. “Hopefully, this will leave patients with less breathlessness, less new fibrosis, more functionality, and longer lives. That’s what we’d really like to see happen.”

Overall, Clements said, 70 percent of patients achieved improved vital capacity in lung function, and 70 percent with thick skin experienced skin softening and thinning for improved joint function.

All total, 106 participants were divided into two groups: (1) oral cyclophosphamide 2kg/mg/day for a year, followed by a placebo and (2) oral mycophenolate mofitial 2kg/mg/day up to 1,500 mg BID for two years. Baseline characteristics for both groups were the same.

At study’s end, improvements in forced vital capacity were roughly the same. In the transition dyspnea index, there was an increase of 2.24 with cyclophosphamide versus 1.86 with mycophenolate mofitil. With modified Rodnan skin scoring, there was a decline of 6.1 with cyclophosphamide versus 2.9 with mycophenolate mofitil.

Nearly twice as many participants taking cyclophosphamide came off the medication for intolerance versus those taking mycophenolate mofitil.

To read the story at its original location: http://www.rheumatologynetwork.com/acr2015-rn/lung-scarring-systemic-sclerosis

November 9, 2015 Posted by | Healthcare | , , , , | Leave a comment

Partnership between WCU, hospitals could boost health care

Published on the Nov. 9, 2015, Carolina Public Press website

By Whitney L.J. Howell

Expanded, consistent health-care access could be around the corner for Western North Carolina if a formalized partnership between Western Carolina University and Harris Regional Hospital and Swain Community Hospital succeeds.

Announced in mid-October, and known as the Ascent Partnership, the initiative is designed to train additional nurse practitioners and create opportunities to engage the surrounding communities about wellness.

According to Doug Keskula, dean of the WCU College of Health and Human Sciences, the overall goal is to ensure North Carolina’s westernmost countries receive quality health care.

“We want to provide an exceptional educational experience for our students and future health-care professionals,” Keskula said. “We can’t do that without our partners.

“We launched discussions about how to build on our existing partnership to take things to the next level — how to better use the resources and expertise of each partner to improve the health of the community through education, service and research.”

Currently, those communities lack significant health-care services, Keskula said.

Based on Mountain Area Health Education Center data, roughly 20 percent of North Carolinians — nearly 2.2 million people — live in rural counties with limited health-care access. Statewide, 42 counties have physician shortages, meaning they have too few providers to meet patient needs. The shortfall includes all of Western North Carolina’s counties.

To address this need through the Ascent Partnership, Harris Regional and Swain Community Hospitals, which are part of Duke LifePoint Healthcare, will pay the roughly $26,000 cost for three students each to complete WCU’s two-year family nurse practitioner (FNP) program.

One student will receive the award during each of the next three years in return for a commitment to work in an area hospital for a yet-undetermined number of years. The award allows students to graduate debt-free, Keskula said, while having guaranteed employment.

The Ascent Partnership furthers a decades-long relationship, said Steve Heatherly, Harris Regional and Swain Community Hospitals’ chief executive officer. During that time, the WCU-hospital connection has spawned two university-based clinics that provide rehabilitation and primary-care services to area communities, as well as clinical training sites for WCU students.

Currently, Heatherly said, the counties immediately surrounding WCU — Jackson, Swain, Graham, and Macon — need six to eight primary-care practitioners. WCU’s nurse practitioner program graduates could fill those roles.

“If it takes two years to be trained, by four years from now, we will have used this investment and partnership with the university to put three, fully-trained primary-care practitioners to work in our communities,” he said.

“They will be able to reduce that provider shortage by one-third within five years.”

Each nurse practitioner, carrying a full patient load, can treat roughly 1,500-to-2,000 patients a year. After all three award recipients graduate, Heatherly said, they could potentially serve 4,500-to-6,000 people who currently don’t have health-care access, accounting for approximately 10 percent of the communities the partnership serves.

But, securing an appointment with a primary-care provider frequently isn’t the problem, said Melissa McKnight, health education specialist with the Jackson County Department of Public Health. Having extra nurse practitioners available to serve the community will be a benefit, she said, but it’s unlikely to address the real issues that limit access to care.

“When we surveyed our communities, we heard it’s not hard to get an appointment to see a provider,” she said.

“What’s difficult is having the transportation or financial resources to get to the provider.”

Additionally, she said, educating extra practitioners won’t reduce the area’s uninsured population. According to public health department data, in 2013, 29 percent of 18-to-65-year-olds in the area were uninsured — a rate higher than WNC and statewide averages.

At this point, specific methods for measuring the partnership’s success haven’t been identified, but Keskula said a key indicator will be whether the initiative bolsters the number of providers in the health-care workforce.

In the long run, Heatherly said, greater primary-care access could create benefits for patients. He anticipates the Ascent Partnership will lead to Western North Carolinians making fewer trips to the emergency room for primary-care services and more people controlling their diabetes.

Keskula said he hopes the program will prompt better eating habits and less smoking among the surrounding population.

“Most importantly, this is a commitment of two major employers in the area to continually seek ways to collaborate for the benefit of our communities,” Heatherly said.

“We both recognize that individually, we play important roles in maximizing the health and well-being of the communities we serve, and collectively, we can make an impact in a much greater way.”

To read the article at its original location: http://www.carolinapublicpress.org/23639/partnership-between-wcu-hospitals-could-boost-health-care

November 9, 2015 Posted by | Education, Healthcare | , , , , , , , , , | Leave a comment

Tai Chi Leads to 167-Point Drop in Pain in Knee Osteoarthritis

Published on the Nov. 8, 2015, Rheumatology Network website

By Whitney L.J. Howell

For individuals with knee osteoarthritis, practicing classical tai chi on a weekly basis can be as effective in treating associated pain as engaging in weekly physical therapy, according to a small study.

According to the Centers for Disease Control and Prevention, nearly 27 percent of Americans live with knee osteoarthritis, and there’s, currently, no effective treatment for it. Identifying effective strategies to reduce the associated pain can improve quality of life and overall functionality.

In a presentation given on Nov. 8 at the 2015 ACR/ARHP annual meeting in San Francisco, Calif., Tufts Medical Center rheumatologist Chenchen Wang, MD, discussed the comparative effectiveness of classical Yang-style Tai Chi and traditional physical therapy in improving pain and quality of life. Previous research has shown both methods are effective, but this is the first study to compare the two directly.

In total, 204 patients participated in the study, and they were randomized into two groups: (1) 12 weeks of classical Yang-style Tai chi, twice weekly and (2) traditional physical therapy twice weekly for six weeks, followed by six weeks of vigorous at-home physical therapy.

“In addition to decreasing pain, we found tai chi offers benefits against depression and improved self-efficacy and quality of life,” she said. “This study exactly identifies what we found before. We’ve replicated our previous results.”

The primary outcome, Wang said, was a reduction in pain. Based on the WOMAC pain scale, participants practicing tai chi experienced a 167-point drop in pain. Physical therapy patients reported a 143-point pain drop. Although researchers had anticipated tai chi would be the superior pain-reduction strategy, she said, in essence, the results were equivalent. Neither method produced any adverse effects, and both led to reduced medication use.

To see the article at its original location: http://www.rheumatologynetwork.com/acr2015-rn/tai-chi-leads-167-point-drop-pain-knee-osteoarthritis#sthash.QmpCGugq.dpuf

November 9, 2015 Posted by | Healthcare | , | Leave a comment


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