Articles Posted in Clinical guidelines

alztest-300x79It isn’t just the testing for the novel coronavirus that has already anxious Americans upset these days. Controversies also are swirling around existing and developing ways for experts to screen older patients for cognitive decline, namely  dementia and its most familiar form,  Alzheimer’s disease.

Alzheimer’s disease, which accounts for 60%-80% of dementia cases, is the sixth leading cause of death in the United States overall and the fifth leading cause of death for those age 65 and older, researchers say. Medical scientists have engaged in furious efforts for a while now to determine the condition’s causes and to create treatments for it — a response that is sorely lacking now.

But the New York Times reported that experts believe they are nearing a better way to screen and diagnose the illness using the blood rather than current “expensive methods like PET scans of the brain and spinal taps for cerebrospinal fluid.” As reporter Pam Belluck wrote:

covidgovhogan-150x150Imagine in an alternate world in which it is not the poor and ravenous Oliver Twist who implores the world for more porridge, please. Instead, think of the “poor me” cries coming from Bumble the Beadle or Mr. Limbkins, two nefarious guys who exploit kids at the venal workhouse to which Oliver is consigned.

Welcome to the Dickensian drama that continues to envelop nursing homes and other long-term care facilities savaged by the Covid-19 pandemic. It may be a harsh view, but what to make about the persistent bleating by the profit-hungry owners and operators of care homes about the cost of safeguarding and testing the institutions’ vulnerable residents and health workers?

Maryland officials, struggling themselves with “the worst economic crisis since the Great Depression” and confronting the prospect of state agency budget cuts of up to 20%, have told nursing homes they soon must shoulder the costs of weekly coronavirus tests for their staff, the Washington Post reported.

dcvafacility-300x185Veterans Affairs officials are taking yet more fire over medical services provided at the sprawling agency’s facilities:

vaccination-300x199As the novel coronavirus infections and deaths keep skyrocketing, Americans more and more have been forced into tough risk analyses, and frankly, too often thinking like gamblers. They are, for example, looking a lot at the much-promoted possibility of a Covid-19 vaccine in desperate poker ways — “betting on the come” and playing “river, river …”

Experts are asking just how savvy this health care approach is, putting in high stakes in the hopes the deck is dealt just so, or believing in a cliff’s edge rescue when the last cards on the table are flopped over to reveal a winner? Is it reality check time? And is there is a Plan B?

Vaccine makers around the world are racing to produce a viable response to Covid-19. U.S. infections have skyrocketed past 4 million and the disease is heading toward killing 150,000 Americans. Politicians and public health officials continue to speak optimistically about “Operation Warp Speed” and other campaigns globally to develop a vaccine that experts say will play a vital role in blunting Covid-19’s sickening and lethal spree through humanity.

CMS-300x105Five months after national media sounded alarms about  a novel coronavirus savaging a Washington state long-term care center, federal regulators have begun to roust themselves with more vigor to safeguard hundreds of thousands of elderly, sick, and injured residents of nursing homes and other similar facilities.

The Centers for Medicare and Medicaid Services — which is supposed to be the country’s top long-term care watchdog — is barking lots now about its regulatory activity, including promises to send owners and operators billions of dollars more in aid, ordering staffers in areas of great virus risk to undergo weekly Covid-19 tests,  shipping equipment for them to do so, and ramping up inspections.

Owners and operators have offered guarded praise and thanks to the agency. But skeptics say it is yet more of the Trump Administration’s baleful pandemic response — too little and too late.

bookingpicretamays-150x150She was a 46-year-old Army veteran hired by the Louis A. Johnson Medical Center in 2015 with no certification or license to care for patients. Reta Mays worked in the middle of the night, tending to elderly, onetime service personnel, sitting bedside and monitoring their vitals, including their blood sugar levels. Mays went room to room, largely unnoticed for three years on Ward 3A.

But as unexplained deaths mounted on the surgical unit between 2017 and 2018, the bespectacled mother of three — who had served in the Army National Guard and had deployed to Iraq and Kuwait — shifted from being a nurse’s aide to becoming a murder suspect.

She now has confirmed in court that she injected multiple doses of insulin in at least seven patients in the rural Veterans Affairs hospital a few hours away from the nation’s capital, causing the frail victims’ blood glucose levels to plunge in fatal fashion.

cmschiefSeemaVerma-150x150With the calendar pages flying off to the fall presidential elections, why isn’t today an excellent time for President Trump to thank Seema Verma for her service and send her packing as head of the Centers for Medicare and Medicaid Services (CMS) in the Department of Health and Human Services?

Two news organizations — Vox and Politico — have posted detailed and disturbing takedowns of CMS and its oversight failures that have helped to worsen the terrible Covid-19 toll in the nation’s nursing homes and other long-term care facilities.

CMS, for example, halted nursing home inspections as the pandemic broke out — with disastrous consequences, as the Washington Post explains in a separate report. The agency earlier had also acceded to industry bleating about tough regulation, with Verma and her agency relaxing fines on owners and operators for detected problems and easing training requirements for under paid, over worked, and already ill-trained caregivers. The training standards have gotten so lax that a reporter, in 40 minutes of online effort, became certified temporarily to be a 24/7 caregiving aide.

faucipic-150x150To paraphrase the White House press secretary, science denialism is not getting in the way of the rampaging Covid-19 pandemic.

Eighteen states have hit “red zone” status where infections, hospitalizations, and deaths have soared to such dire levels (more than 100 new cases per 100,000 people per week) that a study held in private by the Trump Administration recommends officials impose tough public health measures.

The country now has, at least twice, shattered daily coronavirus case counts, reporting 70,000 new Covid-19 diagnoses. The country, as the New York Times reported, also has “set a record with 75,600 new cases [in one day], the 11th time in the past month that the daily record had been broken.”

cancerlungscreen-300x217Tens of millions of Americans who have not kicked the harmful smoking habit or who have only recently done so may want to keep a watch on the work of a blue-chip advisory group as its medical scientists consider how much lung-cancer screening best benefits tobacco users.

The panel is seeking expert comment on its proposal for a greater number of older smokers and recent quitters to undergo low-dose computed tomography. That is a diagnostic procedure that combines X-rays and computers to give doctors a better look at patients’ lungs with multiple views and cross-sectional images.

The U.S. Protective Screening Task Force — which advises the federal government on preventive care and issues recommendations that can affect patient costs and insurer coverage for procedures — says more patients should have tomography than the panel recommended in 2014 when it last considered evidence on it.

covidSEvetcenter-300x200To paraphrase the late, great writer and activist Maya Angelou, nursing homes and other long-term care facilities are showing the public in the middle of this pandemic just truly what they are.

It is hard to believe, still, the shabby way they are treating the aged, sick, and injured. Just consider this sampling of recent news reports:

“Care” facilities — including centers dealing with veterans — have been too willing to subject residents to risky medical experimentation to fight the novel coronavirus, including what appear to be  inappropriate treatments with a much-promoted anti-malarial drug. This echoes a situation involving nursing home residents in Galveston, Texas,  and their facility’s dosing them with hydroxychlorquine without their loved ones’ knowledge and iffy circumstances about their individual capacity to consent to receiving the drug. As the Washington Post reported of a Philadelphia area veterans’ facility (shown in federal photo above):

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