After my daughter’s death, I work to prevent future deaths

By Martha Deed
KevinMD.com
Originally published March 17, 2013

Here are som excerpts:

Another disturbed and disturbing night. It doesn’t happen often three years later. Now – when it does happen – I generally know why.

I am preparing to make a presentation of a sentinel event from my daughter’s final illness to a group of medical professionals and patient advocates. Last night, I was working on key points. What issues seem most important for hospital staffs to address after these years of reflection?

I am convinced – have understood for some time – that the fundamental issue is not that my daughter is dead or even how she died. The basic issue is, “Can we learn anything to prevent future deaths?”
The conference presentation makes use of the past to inform the future. I am co-presenting with a chief medical officer of a hospital system in another state.

Recently, he asked me how I am able to do this – stare into the disaster, sort it out, convey a message of hope. He asks, “What separates people like me who work toward improving safe and competent care from people who cannot move beyond paralyzing grief and anger?”

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My obligation as a parent and as a social scientist engaged in patient advocacy is to do what I can to help health care providers in their work. As a layperson, I can’t do much to improve patient outcomes; I have neither the education, nor the position to change anything within a hospital or medical office.

The entire blog entry is here.

Thanks to Ed Zuckerman for this information.

New Israeli law banning underweight models goes into effect, aims to prevent eating disorders

The Associated Press
Originally published January 11, 2013

When Margaux Stelman began modeling a few months ago, she always had her sister Aline in mind.

Aline was an ex-model who died three years ago after a long battle with anorexia, a common affliction of models trying to look thinner and thinner — and girls trying to look like them.

Now, thanks to a new Israeli law that prohibits the employment of underweight fashion models, Stelman says she feels protected from the traditional pressures of an industry notorious for encouraging extremes in thinness. The law sets weight minimums with the aim of discouraging anorexia and bulimia, eating disorders that affect mostly young women, who go on extreme diets and are unable to eat normally.

"This disease is something that's very close to me," the 21-year-old university student from Belgium said at a recent photo shoot, the country's first since the law took effect last week. "Doing the exact opposite, showing girls that (they) can be healthy and be a model anyway, it's really something I want to show."

The Israeli law, passed by parliament last year, is the first of its kind. The United States and England have guidelines, but their fashion industry is self-regulated. Other governments have taken steps to prevent "size zero" medical problems but have shied away from legislation.

Israel, like other countries, is obsessed by models. International supermodel Bar Refaeli is considered a national hero. Refaeli, an Israeli who has graced the cover of the Sports Illustrated swimsuit edition, among others, is not unnaturally thin.

The entire story is here.

Building a Space for Calm

By ROGER S. ULRICH
The New York Times
Published: January 11, 2013

Here are some excerprts:

Efforts to reduce violence in psychiatric hospitals have focused on identifying potentially aggressive patients through clinical histories and improving staff training and care procedures. But these approaches, while worthy, are clearly not enough. While definitive numbers are hard to come by, the incidence of violence in care facilities appears to be going up.

Research suggests, however, that there’s an effective solution that has largely been overlooked: designing hospital spaces that can reduce human aggression — to calm emotionally troubled patients through architecture.

Currently, questions about design at psychiatric care facilities are viewed through the prism of security. How many guard and isolation rooms are needed? Where should we put locked doors and alarms? But architecture can — and should — play a much larger role in patient safety and care.

One prominent goal of facility design, for example, should be to reduce stress, which often leads to aggression.

For patients, the stress of mental illness itself can be intensified by the trauma of being confined for weeks in a locked ward. A care facility that’s also noisy, lacks privacy and hinders communication between staff and patients is sure to increase that trauma. Likewise, architectural designs that minimize noise and crowding, enhance patients’ coping and sense of control, and offer calming distractions can reduce trauma.

Thanks to decades of study on the design of apartments, prisons, cardiac intensive care units and offices, environmental psychologists now have a clear understanding of the architectural features that can achieve the latter — and few of these elements, if incorporated into a hospital design from the outset, significantly raise the cost of construction.

Providing day rooms and other shared spaces with movable seating, for example, gives patients the ability to control their personal space and interactions with others. Sound-absorbing surfaces reduce noise (and stress), as do designs that offer more natural light.
Some features, like single-patient bedrooms with private toilets, do increase the building cost — but that is arguably offset by the reduced trauma for patients and hospital workers. Violence, after all, isn’t just a danger to well-being, its effects — from medical care to lawsuits — are frequently expensive, too.

The entire story is here.

Thanks to Gary Schoener for this story.

U.S. could save $2 trillion on health costs - study

By David Morgan
Reuters
Originally published January 10, 2012


The United States could save $2 trillion in healthcare spending over the next decade, if the U.S. government used its influence in the public and private sectors to nudge soaring costs into line with economic growth, a study released on Thursday said.

Compiled by the nonpartisan Commonwealth Fund, the study recommends holding the $2.8 trillion U.S. healthcare system to an annual spending target by having Medicare, Medicaid, other government programs and private insurers encourage providers to accelerate adoption of more cost-effective care.

Such a plan would require new legislation from a bitterly divided U.S. Congress, where Republicans would likely oppose new government controls, despite claims by the study's authors that families, employers and government budgets would receive long-sought relief from their growing financial healthcare burdens if the changes were enacted.

But Commonwealth Fund President Dr. David Blumenthal, a former healthcare adviser to President Barack Obama, said the approach could find bipartisan support in upcoming deficit talks as an alternative to cutting so-called entitlement programs including Medicare, the popular healthcare program for the elderly and disabled.

"In comparison with what some of those proposals advocate, we think that some of what we're proposing will look like an escape valve," Blumenthal told reporters in a conference call.

The United States has the world's most expensive healthcare system, which government forecasters say will cost more than $9,200 this year for every man, woman and child. Spending growth has slowed in recent years, but costs continue to outpace inflation and restrain overall economic growth.

The entire article is here.

Report Urges ‘Cultural Shift’ as Hockey Coaches Defy Concussion Specialists

By JEFF Z. KLEIN
The New York Times
Originally Published: November 30, 2012

Despite several years of intensive research, coverage and discussion about the dangers of concussions, the idea of playing through head injuries is so deeply rooted in hockey culture that two university teams kept concussed players on the ice even though they were taking part in a major concussion study.

The study, which was published Friday in a series of articles in the journal Neurosurgical Focus, was conducted during the 2011-12 hockey season by researchers from the University of Western Ontario, the University of Montreal, Harvard and other institutions.

“This culture is entrenched at all levels of hockey, from peewee to university,” said Dr. Paul S. Echlin, a concussion specialist and researcher in Burlington, Ontario, and the lead author of the study. “Concussion is a significant public health issue that requires a generational shift. As with smoking or seat belts, it doesn’t just happen overnight — it takes a massive effort and collective movement.”

The study is believed to be among the most comprehensive analyses of concussions in hockey, which has a rate of head trauma approaching that of football. Researchers followed two Canadian university teams — a men’s team and a women’s team — and scanned every player’s brain before and after the season. Players who sustained head injuries also received scans at three intervals after the injuries, with researchers using advanced magnetic resonance imaging techniques.

The entire article is here.

Online Patient Access to Records May Boost Visits

By John Gever, Senior Editor
MedPage Today
Published: November 20, 2012


Patients with access to their physicians' electronic health record systems had more office visits, hospital admissions, and emergency room encounters than those without such access, researchers said.

Participants in a Kaiser Permanente program giving them access to their electronic records, including a secure email system for communicating with clinicians, showed significant increases in nearly all measures of healthcare utilization, relative to the period before they joined the program, Ted E. Palen, MD, PhD, MSPH, of Kaiser Permanente Colorado in Denver, and colleagues reported in the Nov. 20 issue of the Journal of the American Medical Association.

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In an accompanying editorial, two researchers at Brigham and Women's Hospital in Boston noted that the study findings stood in contrast to Kaiser investigations in other regions, which had found reductions in utilization associated with so-called patient portals to electronic health records.

The entire story is here.

MaleSurvivor Conference Examines Sexual Abuse in Sports

By Eric V. Copage
The New York Times
Originally published November 18, 2012

Here are some excerpts:

A dour procession of stories about sexual misconduct by coaches toward their male charges has come to light in recent months. Jerry Sandusky, a former assistant football coach at Penn State, was sentenced in October to 30 to 60 years in prison on 45 counts of child molesting. Sugar Ray Leonard wrote in his autobiography last year that he was sexually molested by an Olympic boxing coach. The N.H.L. players Theo Fleury and Sheldon Kennedy were sexually abused as teenagers by their hockey coach Graham James.
      

The prevalence of sexual abuse among all boys 17 and under has been variously estimated to be as low as 5 percent and as high as 16 percent. For some of the millions of children who participate in sports nationwide, and their parents, sexual assault in a sports context has its own dynamic.

      

“Sports is a place where parents send their boys to learn skills, to learn how to be teammates and how to work together — to make boys stronger and healthier,” said Dr. Howard Fradkin, author of “Joining Forces,” a book about how men can heal from sexual abuse. “It’s the place where we send our boys to grow up. The betrayal that occurs when abuse occurs in sports is damaging because it destroys the whole intent of what they started out to do.”

 

The entire story is here.

Maine West High School Sued For Student Hazing, Sodomy 'Sanctioned By Coaches'

The Huffington Post
Originally published November 20, 2012

The family of a Illinois high school freshman is suing the Maine Township High School District 207, claiming that Maine West High School officials sanctioned hazing of the unnamed teen as part of a years-long ritual at the school.

The unidentified mother appeared at a news conference Monday wearing a baseball cap and sunglasses alongside attorney Antonio Romanucci.

"I thought my son would be safe at school," she said, according to WLS-TV. "You think when you drop off your son, it's a safe place to be. But I feel like the coaches should have kept him safe on the soccer field, and they didn't do that."

The mother adds that the acts -- and the school's failure to respond -- breaks Illinois state anti-bullying laws.

The lawsuit claims that the 14-year-old and at least two other boys were sexually assaulted during soccer practice in September -- during school hours and condoned by coaches. The complaint alleges that teammates shoved the three boys to the ground and beat them. The older players then held them down, pulled down their pants and underwear and sodomized them.



The entire story is here.

A Regular Checkup Is Good for the Mind as Well as the Body

By Ann Carrns
The New York Times
Originally published November 13, 2012

EVERYONE is familiar with the concept of a periodic medical checkup — some sort of scheduled doctor’s visit to check your blood pressure, weight and other physical benchmarks.

The notion of a regular mental health checkup is less established, perhaps because of the historical stigma about mental illness. But taking periodic stock of your emotional well-being can help identify warning signs of common ailments like depression or anxiety. Such illnesses are highly treatable, especially when they are identified in their early stages, before they get so severe that they precipitate some sort of personal — and perhaps financial — crisis.
      

“Absolutely, people should have a mental health checkup,” said Jeffrey Borenstein, editor in chief of Psychiatric News, published by the American Psychiatric Association. “It’s just as important as having a physical checkup.”

 

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Over all, however, 15 percent of employers in the United States do not offer mental health coverage to employees, according to the Society for Human Resource Management. Such benefits may become more widely available in 2014, when many provisions of the Affordable Care Act take effect. Mental health benefits will be part of the “essential package” that must be offered by many insurance plans, including the new state-sponsored insurance exchanges.

 

The entire article is here.

25 Tips to Prevent Data Breaches

By Sharon D. Nelson & John W. Simek
The Wisconsin Lawyer

Volume 85, No. 11, November 2012

Another day, another data breach. Data breaches have proliferated with amazing speed. Here is the roundup of some of the largest victims in 2011 alone: Tricare, Nemours, Epsilon, WordPress, Sony, HB Gary, TripAdvisor, Citigroup, NASA, Lockheed Martin, and RSA Security. Some mighty big names on that list.

Don't be lulled into thinking that law firms (large and small) aren't suffering data breaches just because they don't have millions of clients affected. On Nov. 1, 2009, the FBI issued an advisory, warning law firms that they were specifically being targeted by hackers. Rob Lee, an information security specialist who investigates data breaches for the security company Mandiant, estimated that 10 percent of his time in 2010 was spent investigating law firm data breaches.

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Top Practical Security Tips

1. Have a strong password – at least 12 characters. No matter how strong an eight-character password is, it can now be cracked in about two hours. A strong 12-character password takes roughly 17 years to crack. Much easier to hack someone else. Use a passphrase so you can remember the password: "Love ABATECHSHOW 2013!" is a perfect example.

2. Don't use the same password everywhere. If they crack you once, they've got you in other places, too.

3. Change your passwords regularly. This will foil anyone who has gotten your password.

The entire story is here.

Thanks to Ken Pope for this article.

Overtreatment as Myth

New York Times Letter to the Editor
Originally published September 3, 2012

To the Editor:

Re “Overtreatment Is Taking a Harmful Toll” (Well, Aug. 28): Undertreatment could be a much bigger problem than overtreatment. Studies by the RAND Institute, published in The New England Journal of Medicine, have found significant underuse of preventive testing and treatment for cervical, breast and colorectal cancer, as well as for H.I.V., heart disease and diabetes. RAND concluded that, on average, Americans receive only 55 percent of recommended preventive care and that underuse of such care was a bigger problem than overuse.

Alan Mertz

Washington

The writer is president, American Clinical Laboratory Association.

♦

To the Editor:

The overwhelming medical care in this country is actually appropriate. By emphasizing the bad experiences of a few, this article may end up suggesting to people that they should not trust their doctors.

Defensive medicine is sometimes practiced for fear of malpractice suits, but this should not be confused with the honest effort of the overwhelming majority of physicians to give their patients the best care possible.

Barry E. Rosenbloom, M.D.

Beverly Hills, Calif.

Two Healthcare Data Breaches Show Importance Of Encryption

Patient data from Howard University Hospital and California Department of Child Support Services wasn't fully encrypted, and one security expert wants to know why.

By Neil Versel
InformationWeek
Originally published April 5, 2012

The theft of a laptop containing more than 34,000 unencrypted records from Howard University Hospital in Washington, D.C., and the loss of backup tapes containing records of 800,000 people enrolled in California Department of Child Support Services programs are just the latest in a string of healthcare data breaches that could have and should have been prevented, a data protection expert contends.

Last week, Howard University Hospital disclosed that it had notified 34,503 patients that a personal laptop of a former contractor was stolen in January from that individual's car. The laptop, according to the hospital, was password-protected, but the actual data was not encrypted.

That is disturbing to Mark Bower, data protection expert and VP at Voltage Security, based in Cupertino, Calif. "Why was their contractor allowed to use their own laptop, connect to the network, and download this data?" Bower wondered. "Why was that information not encrypted on the back end?"

The entire story is here.

Russians alarmed by rash of teenage suicides

By Mansur Mirovalev

Associated Press

Originally published 2/10/12

MOSCOW (AP) — A rash of teenage suicides in Russia has set off alarm bells and experts are urging the government to take immediate action.

Russia has the world's third-highest rate of suicide among teenagers aged 15-to-19, with about 1,500 taking their own lives every year, according to a recent UNICEF report. The rate is higher only in the neighboring former Soviet republics of Belarus and Kazakhstan.

In recent years, there have been 19-to-20 annual suicides per 100,000 teenagers in Russia — three times the world average, Boris Polozhy of the respected Serbsky psychiatric center in Moscow said Friday.

"Until the highest authorities see suicide as a problem, our joint efforts will be unlikely to yield any results," he said.

In the southwestern Siberian region of Tuva, the rate reaches a staggering 120 suicides per 100,000 teenagers, while the nearby region of Buryatiya has an average rage of 77 per 100,000. Both regions are impoverished and have high crime and alcoholism rates.

Two 14-year-old girls in the Moscow suburb of Lobnya killed themselves this week by jumping off the roof of a 14-story building while holding hands. They had skipped classes for two weeks and were terrified of what their parents would do to them once they found out, Russian media quoted their friends as saying.

The entire story is here.

Preventing a Data Breach and Protecting Health Records

Preventing a Data Breach and Protecting Health Records
Found in the public domain.

Report Finds Most Errors at Hospitals Go Unreported

By ROBERT PEAR

New York Times - Health

Published: January 6, 2012

Hospital employees recognize and report only one out of seven errors, accidents and other events that harm Medicare patients while they are hospitalized, federal investigators say in a new report.

Yet even after hospitals investigate preventable injuries and infections that have been reported, they rarely change their practices to prevent repetition of the “adverse events,” according to the study, from Daniel R. Levinson, inspector general of the Department of Health and Human Services.

In the report, being issued on Friday, Mr. Levinson notes that as a condition of being paid under Medicare, hospitals are to “track medical errors and adverse patient events, analyze their causes” and improve care.

Nearly all hospitals have some type of system for employees to inform hospital managers of adverse events, defined as significant harm experienced by patients as a result of medical care.

“Despite the existence of incident reporting systems,” Mr. Levinson said, “hospital staff did not report most events that harmed Medicare beneficiaries.” Indeed, he said, some of the most serious problems, including some that caused patients to die, were not reported.

Adverse events include medication errors, severe bedsores, infections that patients acquire in hospitals, delirium resulting from overuse of painkillers and excessive bleeding linked to improper use of blood thinners.

The rest of the story is here.

Importing Research Based Anti-Bullying Program

University of Kansas

An interdisciplinary team of researchers at the University of Kansas plan to bring a highly successful anti-bullying effort, the KiVa program, to American schools. Starting as early as the 2012-13 school year, a pilot program could kick off in selected classrooms in Lawrence, Kan. If shown to be successful there, soon afterward the model could expand nationally.

KiVa, implemented in Finland in 2007, has impressed researchers with its proven reduction in bullying incidents. According to one recent study, KiVa "halved the risk of bullying others and of being victimized in one school year."

"Any time you see an intervention reported in the literature, if they work, they barely work," said Todd Little, KU professor of psychology and director of the Center for Research Methods and Data Analysis. "This is one of the first interventions we're seeing with effects that are impressive and pervasive. We here at KU are going to be the sole source for testing KiVa in the U.S."

The program takes a holistic approach to the bullying problem, including a rigorous classroom curriculum, videos, posters, a computer game and role-play exercises that are designed to make schools inhospitable to bullying. When bullying episodes do occur within the school, a small team of trained employees addresses the incident individually with the victim and bully or bullies to ensure bullying is ultimately stopped.

"The KiVa program targets the peer environment, trying to create an ecology where bullying is no longer tolerated," said Anne Williford, assistant professor of social welfare at KU. "Instead of targeting only a bully and victim for intervention, it targets the whole class, including kids who are uninvolved in bullying behavior. KiVa fosters skills to help students take actions, either large or small, to shift the peer ecology toward one that does not support bullying."

The researchers said the program works because it recognizes that bullies sometimes may earn higher social status from their behavior.

"People have traditionally framed bullying as social incompetence, thinking that bullies have low self-esteem or impulse problems," said Patricia Hawley, KU associate professor of developmental psychology. "But recent research shows that bullying perpetrators can be socially competent and can win esteem from their peers."

By changing perceptions of peers who are neither bullies nor victims, the program undercuts a social environment that supports bullying.

"It changes the rewards structure," Hawley said. "At the end of the day, the goals of the bully are like yours and mine — they want friendship and status. They have human goals, not pathological ones. With KiVa, bystanders are set up to win by intervening, and their status can go up. As a bystander, I can achieve goals of friendship and status by standing up to a bully."

In Lawrence schools, the KU researchers hope to compare instances of bullying and victimization in both intervention and control groups to establish the strength of the KiVa program in a U.S. setting.

School district officials welcomed the opportunity.

"We're pleased to have the opportunity to collaborate with Dr. Williford and KU's School of Social Welfare on the KiVa anti-bullying project," said Kim Bodensteiner, Lawrence USD 497's chief academic officer. "Given our experiences using other bullying prevention programs, Lawrence Public Schools' teachers and staff can provide valuable feedback to researchers during the development of KiVa program materials. We look forward to the possibility of participating in a future pilot study."

Results from the pilot program are to be measured by KU's Center for Research Methods and Data Analysis.

Social Environment and Suicide

Suicide awareness and prevention is a significant concern among psychologists.  Having a strong knowledge base about suicide risk factors will help psychologists function at their highest levels.  In a previous blog post, a military study highlighted unit cohesion as a factor in decreasing suicidal ideation. Here is an abstract from the journal Pediatrics that indicates how the social environment plays a role in teenage suicide rates.

The Social Environment and Suicide Attempts in Lesbian, Gay, and Bisexual Youth

OBJECTIVE: To determine whether the social environment surrounding lesbian, gay, and bisexual youth may contribute to their higher rates of suicide attempts, controlling for individual-level risk factors.

METHODS: A total of 31 852 11th grade students (1413 [4.4%] lesbian, gay, and bisexual individuals) in Oregon completed the Oregon Healthy Teens survey in 2006–2008. We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students.

RESULTS: Lesbian, gay, and bisexual youth were significantly more likely to attempt suicide in the previous 12 months, compared with heterosexuals (21.5% vs 4.2%). Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96–0.99]).

CONCLUSIONS: This study documents an association between an objective measure of the social environment and suicide attempts among lesbian, gay, and bisexual youth. The social environment appears to confer risk for suicide attempts over and above individual-level risk factors. These results have important implications for the development of policies and interventions to reduce sexual orientation–related disparities in suicide attempts.

Hopefully, this research will shed light on the importance of environmental influences and risk factors relating to suicide.  Prevention programs, suicide awareness among professionals, and competent suicide assessments are keys to decreasing the silent epidemic of teen suicide, especially with GLBT youth.