Tag: Hospitals

Molecule in blood linked to cognitive decline in old age.

A new study has found a molecule that could serve as a biomarker to identify those at greater risk of developing dementia in later life. It could also help scientists develop preventive treatments.

seniors doing a jigsaw puzzle

A recent study suggests a molecule within the blood could be an early tell-tale sign of cognitive decline.

Dementia is a debilitating condition that involves the progressive decline of memory, communication, and thinking.

Globally, the number of people with this condition has more than doubled, rising from 20.2 million in 1990 to 43.8 million in 2016.

The most common form of dementia is Alzheimer’s disease, which accounts for 60-70% of all cases. As populations age, the prevalence of Alzheimer’s and other forms of dementia is expected to continue rising.

Currently, once symptoms occur, they cannot be reversed. With this in mind, researchers are exploring ways to diagnose the condition years or even decades before it develops, and find drugs to prevent its progress.

One promising biomarker of Alzheimer’s is a molecule that circulates in the blood, known as asymmetric dimethylarginine (ADMA).

By inhibiting an enzyme called nitric oxide synthase, ADMA reduces the amount of nitric oxide synthesized by the endothelial cells that line blood vessels.

The role of nitric oxide is to dilate blood vessels, increasing blood flow. When levels are abnormally low, it restricts blood flow to tissues, starving them of oxygen and triggering inflammation.

The importance of childhood intelligence

Low levels of nitric oxide are linked to the development of atherosclerosis, cardiovascular disease, and Alzheimer’s. A few small studies have also found a link between high concentrations of ADMA and cognitive decline in older people.

However, none of these studies have adjusted for the effect of low intelligence in childhood, which accounts for up to 50% of cognitive decline in old age.

Now, researchers at the University of Aberdeen and the University of Oxford in the United Kingdom, and Flinders University in Melbourne, Australia, have found a breakthrough.

They analyzed data from 63-year-olds, who had all taken the same mental ability test at Scottish schools in 1947 when they were 11 years of age.

Two decades ago, the 1936 Aberdeen Birth Cohort was established by medical researchers to follow this unique set of people.

Between 2000 and 2004, 93 of them took part in a research project to study cognitive aging and health. Blood samples were taken in 2000, and the participants underwent a series of cognitive tests at regular intervals over the next 4 years.

After adjusting for their childhood intelligence test scores, the authors of the new study found a link between raised ADMA concentrations in their blood and a decline in cognitive performance four years later.

Source : https://www.medicalnewstoday.com/articles/molecule-in-blood-linked-to-cognitive-decline-in-old-age

CDC Expands List of Those with Higher COVID-19 Risks: What to Know

  • The Centers for Disease Control and Prevention has added new underlying conditions to its list of conditions that can lead to more serious COVID-19 cases.
  • Among the conditions added are diabetes and pregnancy.
  • The agency also has amended its guidelines on aging, now saying people are more vulnerable to serious cases as they get older instead of just people over the age of 65.

The Centers for Disease Control and Prevention (CDC) has updated its listTrusted Source of underlying conditions that may lead to more severe outcomes from a COVID-19 diagnosis.

The agency is warning that people with type 2 diabetes, kidney disease, whole organ transplants, and women who are pregnant could experience more severe outcomes if they contract COVID-19.

The updated guidelines also remove 65 as the age when more severe outcomes may occur. Instead, it is suggesting as people age, the chance of severe outcomes increases.

What does this mean to the public?

By removing a set age cut off, the updated guidelines give notice to people with underlying conditions of all ages that they are more likely to end up in an intensive care unit (ICU) if they contract the virus.

The guidelines do not suggest that people with these underlying conditions are more susceptible to developing COVID-19.

What should the public do?

Experts say the key is to stay in the know and practice safe habits such as masking, physical distancing, and, when needed, isolation.

A close look at the new conditions

Here’s a look at some of the underlying conditions added to the CDC list.

Pregnancy

“Pregnancy is a situation with all kinds of hormonal changes in the mix,” said Dr. Alan Fishman, medical director for Obstetrix Medical Group in San Jose, California, and board certified in obstetrics and gynecology and maternal-fetal medicine. “Pregnancy is a stress on a healthy woman’s body.”

That’s why, he said, a pregnant woman who contracts COVID-19 may face more severe outcomes.

“It appears that pregnant women [who contract COVID-19] are 5.5 times more likely to be hospitalized than a non-pregnant woman,” Fishman told Healthline. “That’s pretty significant.”

“There is zero evidence that women who are pregnant are more likely to get COVID-19,” he added.

But the risks mean his office is carefully counseling those considering pregnancy.

“I counsel them to think about this information and how it sits with them,” he said. “They have to remember that it is not a good idea to skip a medical appointment or space them out more.”

While some pregnancy appointments can be done virtually, many must be done in person.

So what should a pregnant woman do?

“Common sense still holds,” Fishman said.

Wear a mask, wash your hands, keep a physical distance, and isolate when needed is still the key, along with not missing any medical appointments.

“Clearly these types of modifications are going to be with us for a long time,” he said.

Diabetes

There’s been some confusion around COVID-19 in the diabetes community.

First, there’s no evidence yet that people with diabetes are more likely to contract the novel coronavirus.

“The CDC has not come out and said that type 1 or type 2 diabetes makes you more susceptible [to COVID-19],” said Dr. Joshua Miller, the medical director of diabetes care for Stony Brook Medicine and an assistant professor of endocrinology and metabolism at the facility’s New York Campus, told Healthline.

However, there is research that concludes people with diabetes can develop more serious cases of COVID-19.

“What we are absolutely seeing are that people who carry a comorbidity struggle more when they contract this,” Miller told Healthline.

Figuring out what is going on with those with diabetes who contract COVID-19 is a challenge for healthcare providers.

“It’s challenging looking at the numbers and statistics because the way in which we [track diabetes] in the medical world is a challenge,” Miller said.

Even in medical reports, he said, type 1 can be mixed up with type 2.

Miller is working with the National Institutes of Health (NIH) to gather and assess data around COVID-19 patients with diabetes. But he points out that mixed information makes it harder to rely on the data.

Right now, the CDC has listed people with type 2 diabetes as being “at increased risk” of more severe outcomes if they contract COVID-19, and people with type 1 diabetes as “might be at an increased risk.”

Miller, who has had type 1 diabetes for 21 years, knows one thing for sure.

“When [a person with diabetes] is in the hospital for this, their insulin needs go way up,” he said.

Even those with type 2 diabetes who take medication may need injected insulin during treatment, he added.

His advice for those with any kind of diabetes?

“The big lesson we are learning here is simply this,” he said. “The healthier our patients are, the better they do with COVID-19. Focus in earnest more than ever on your health. Across the board, the best outcomes come from this.”

“While the area you live in has confirmed community spread, your risk is higher than not,” he added. “Stay at home if you can. And always, wear the mask, wash your hands, keep that distance. Be smart, be safe.”

The aging population

The CDC has moved away from a specific age cutoff for heightened concern to a more general statement on aging.

The CDC now says, “People in their 50s are at higher risk for severe illness than people in their 40s. Similarly, people in their 60s or 70s are, in general, at higher risk for severe illness than people in their 50s. The greatest risk for severe illness from COVID-19 is among those aged 85 or older.

That, say aging experts, is an important change.

“I have to give credit to the CDC for really clarifying that,” Dr. Ronald Caplan, author of “The Care of the Older Person” and “Long Life Strategy,” told Healthline. “Prior to this we were saying 65 and beyond, like the Cinderella phenomenon. At midnight (in this case 65 years of age) your coach just turns into a pumpkin? This is not the way medicine and real life works.”

Caplan says that when you consider that 60 percent of Americans have some kind of underlying health condition, that 40 percent of adults are obese, and that many aging Americans have heart health issues, it just makes sense that as a person ages, a COVID-19 battle gets more challenging.

What should older people do?

“The more you know, the safer you can make yourself and the less anxious you will be,” Caplan said. “We are all getting more familiar with this. We can see [the disease] attacks major organ systems, so knowing how to treat any [comorbidities] you have now will help you later.”

His best tips for older adults?

“Older people should not neglect seeing their healthcare providers, now more than ever,” Caplan said. “And get your vaccinations [for] flu and whatever else you need.”

The older population should also be careful about self-isolating when there is community spread, but they should do so with support.

“Suicide among older people is a non-talked about thing, but it is a thing,” Caplan said. “You lose a spouse, a friend or friends and all of a sudden you are alone, and then this virus comes along. It can be overwhelming.”

He suggests for those who must isolate making a small trusted bubble of friends or family who visit and check on you.

He also repeats the suggestions to wear masks, maintain distancing, and wash hands.

“All those common sense measures that the CDC is giving us all go back to when I was a kid, before vaccinations,” Caplan said. “This is what we did. And now, the answer is we need an effective vaccination. We’re going to have to wait for that, though, and do the right thing in the meantime.”

What’s next

Expect additions, subtractions, and other changes to this list as the pandemic continues, experts say.

“It’s a fascinating virus,” Dr. Mary Dale Peterson, MSHCA, FACHE, FASA, president of the American Society of Anesthesiologists, told Healthline. “It has a propensity to attack organs, but we are still very much learning as we go along.”

Some of what medical professionals are seeing makes historic sense, she added, such as people with obesity having more difficulty recovering and pregnancy taxing the heart and lungs.

As one who sees the impact of comorbidity on COVID-19 recovery first hand, Peterson has suggestions.

“The way I look at it is this: We all have our own set of risk factors,” she said. “So look at what are in your spheres of control.”

“I can make sure I take care of my chronic disease. I can eat a good diet. I can get up and actually not be a couch potato as tempting as it is to be one right now,” she explained.

“Physical activity is actually a treatment we use in the hospital on COVID-19 patients,” she added. “Double down on your healthy habits. It will only help.”

sourcelink:https://www.healthline.com/health-news/cdc-expands-list-of-those-with-higher-covid19-risks#Whats-next

E-health is increasingly attracting the investor community

The economic meltdown caused by the COVID-19 pandemic has forced many startups to shut businesses and lay off people left, right and centre. But in a seemingly different universe, health tech start-ups are witnessing an upswing in business transactions. DocsApp is one such company. It has attained an average of 60 per cent increase in online consultations across various departments and is expecting higher returns in the coming days. In May, the company raised a series B funding of $9.5 million (Rs 72.5 cr) from Bessemer Venture Partners India, Fusian Capital, Rebright Partners and Milliways Fund LLC, and recently had a merger with MediBuddy. Moreover, during COVID-19, DocsApp has partnered with PhonePe, Shemaroo Entertainment, Lokal Hypermarket, Seniority and many others to provide a free consultation. Satish Kannan, Co-Founder and CEO, MediBuddy DocsApp seems greatly encouraged by his company’s progress.

How has your business faring during these COVID times?

Although there were supply chain issues initially with regards to the delivery of medicine and in terms of collection of lab test samples, etc., we have always maintained a strong vendor connection to help deal with such challenging times.

We have seen an increase in people opting for online doctor consultations, with an average of 60 per cent increase in consultations across various departments. At this point, MediBuddy DocsApp caters to the healthcare needs of three crore Indians, attending to the needs of over 25,000 Indians daily across the length and breadth of the country.

How have you kept your employee motivated in these times? Any workforce crunching done so far?

Considering the current situation, where everyone, from CEOs to managers are working from home, our team members have adapted themselves to these challenging times really well. Pets and kids walking by and waving at the camera help us in embracing our human side in these desperate times, coupled with an obsession to help more and more individuals with online consultations, medicine delivery and lab tests that are critical; especially now more than ever.

You seem to have had a number of collaborations in the recent past, how will these strategic partnerships boost your business, especially in this economic downtime?

MediBuddy DocsApp’s vision is to provide high-quality healthcare to all. In the fight against this pandemic, it is extremely important to be able to connect with medical experts and get credible information. At MediBuddy DocsApp, we are focusing our efforts on raising awareness and ensuring the availability of trusted medical advice to help control the spread of the disease and panic.

We have also extended our medical assistance to MyGate, CRED, Zee Digital, PhonePe, Shemaroo Entertainment, Lokal, Seniority etc., and will be working with more partners to reach out to communities, increase awareness and provide only doctor consultation support to their customers.

Moving forward, in times to come, what are the changes that DocsApp will incorporate for better customer services and business viability?

At MediBuddy DocsApp, we worry about customers, their experience and needs. We will continue to focus on the customer. With a customer-first attitude, we will improve our range and quality of service to ensure a great experience for the user.

With a partner network of over 90,000 doctors, 7,000 hospitals, 3,000 diagnostic centres and 2,500 pharmacies covering over 95 per cent of all pin codes, MediBuddy DocsApp will continue to focus on enabling healthcare services like online specialist doctor consultations, lab tests, preventive health checks, delivery of medicines, etc. to customers across India. Our focus is to provide best-in-class, end to-end-services in digital healthcare.

How will you strategically utilise the funds you have recently raised?

We will utilise the funding in further strengthening our doctor base, patient reach and develop our product to move a step closer to its mission of providing high-quality healthcare to billions.

Do you personally feel, this could be a good time to invest in healthcare? What would be the investment scenario in the coming future?

Yes, with tailwinds supporting the industry and e-health becoming the new normal, there is a lot of interest in the investor community. However, at the end of the day, business, health and growth of right metrics will only help onboard investors.

For now, we are well capitalised, our plan is to make it grow and ensure access to high-quality healthcare to all.

What are the new business opportunities that you think can bring a complete transformation to  the healthcare sector here on?

People always resist change. COVID has been a tailwind situation. Like demonetisation was to digital payments, COVID is making an adaption of online health exponentially faster. More people will be open to talking to a doctor online. Entry to healthcare for an individual will start with teleconsultation and then move to physical consultation, labs and others, as required.

How will the coming times encourage or discourage the start-up community within healthcare?

Times are changing rapidly, and we should change accordingly. Start-ups who adapt to it and take decisions/actions faster will grow faster and survive.

sourcelink:https://www.expresshealthcare.in/interviews/e-health-is-increasingly-attracting-the-investor-community/422013/

Nearly All Hospitals Use Locum Tenens Physicians, Demand for Specialists Up: Survey

The use of temporary physicians, known as “locum tenens,” to fill staffing shortages continues to be a very widespread practice, according to a new survey from Staff Care, a leading national physician staffing firm and a company of AMN Healthcare. And a growing percentage of locum tenens physicians are specialists due to acute shortages.

Staff Care’s 2020 Survey of Temporary Physician Staffing Trends indicates that 85% of hospitals, medical groups, and other healthcare facilities used locum tenens doctors in the previous 12 months, primarily to maintain services until permanent physicians are found and to fill gaps caused by turnover.

“Virtually every hospital in the United States now uses locum tenens doctors,” said Jeff Decker, president of Staff Care. “They have emerged as a key part of the medical workforce in an era of physician shortages and evolving delivery models.”

According to Decker, locum tenens physicians are filling openings that last from a few days to over a year while healthcare facilities seek difficult-to-find primary care physicians and specialists. They also can be used to fill-in when healthcare facilities experience turnover on their medical staffs, an increasing problem due in part to the growing employment of physicians by hospitals and other healthcare facilities.

As the employed physician model replaces physician practice ownership, physicians have more latitude to change jobs, according to Decker, creating more temporary openings and hence more demand for locum tenens physicians. Employed physicians commonly enjoy a month of vacation and continuing education time off each year, which also creates demand for locum tenens doctors, Decker said.

Specialists in rising demand as “temps”

Primary-care physicians, including family physicians, general internists, and pediatricians, are the most in-demand type of locum tenens doctors, according to the survey. Thirty percent of healthcare facility managers surveyed indicated they used locum tenens primary care doctors in 2019, higher than any other type of physician. However, this is down from 44% in 2016, the last time Staff Care conducted the survey.

By contrast, the use of locum tenens specialists has accelerated. For example, 21% of healthcare facilities managers reported using locum tenens surgeons in 2019, up from 11% in 2016; 17% reported using locum tenens internal medicine subspecialists, up from 9%; and 22% reported using locum tenens anesthesiologists, up from 11%.

The need for specialists is being driven by an aging population and by an aging physician workforce, with many specialists entering retirement age. In its April 2019 report, the Association of American Colleges projected a shortage of up to 122,000 physicians by 2032, including up to 55,000 primary care doctors but an even larger shortage of up to 67,000 specialists.

“Older patients need specialists to care for ailing organs and body systems,” Decker said, “and we simply don’t have enough specialists to go around.”

52,000 locum tenens doctors

Each year it conducts the survey, Staff Care estimates the number of physicians who work as locum tenens based on the number of doctors the company places annually and its knowledge of the locum tenens staffing industry. Staff Care estimates that approximately 52,000 physicians worked as locum tenens in 2019, or about 6% of the active physician workforce.

“Locum tenens is an increasingly popular practice style among physicians, because it allows them to focus on what they like to do best, which is treat patients, while minimizing the administrative duties they like least,” Decker said.

sourcelink:https://www.amnhealthcare.com/nearly-all-hospitals-use-locum-tenens-physicians-survey/

What sort of staying power does telehealth really have?

This past week, Centers for Medicare and Medicaid Services Administrator Seema Verma said she “can’t imagine going back” to making beneficiaries return to in-person visits after the agency’s relaxation of telehealth regulations in response to the coronavirus pandemic.

Verma’s comments came as industry leaders pushed for two-dozen federal regulatory waivers surrounding telehealth to become permanent, and other new studies have shown notable patient appreciation for what it could mean for their healthcare experience.

All this hope for telehealth’s staying power, given the current momentum behind it, raises the question: What will telehealth look like in the long term for both providers and patients?

“I think it’s difficult to predict right now,” said Heather Alleva, attorney at Buchanan Ingersoll and Rooney.

Alleva, who focuses on the federal regulation of healthcare providers, payer enrollment and HIPAA compliance, told Healthcare IT News that it’s still too soon to tell how patients will react to loosening coronavirus restrictions.

“Some states are still in particular phases,” she said. “I’ve seen a downtick in the number of appointments being made in telehealth. Some people are going back to their in-person appointments.”

The coronavirus, she said, has acted as “kind of an unexpected experiment.” 

“Providers got to dip their toe in telehealth provision in a way they wouldn’t have had to without major financial considerations in the past,” she said. “It’s not easy for businesses to just try something new.”

Though the relaxation of regulatory hurdles by CMS and the Office for Civil Rights around HIPAA has allowed providers to begin implementing telehealth en masse, new challenges have become evident. 

“It’s reinvigorated an argument around broadband access,” she said. “It’s great that OCR is waiving HIPAA requirements, but if your patient doesn’t have access to high-speed Internet, so you can’t actually connect in that way, you’re not going to be able to utilize the telehealth.” 

Other experts have pointed to the need for medical interpreters and the gap in patient access to devices as additional barriers presented by the rise in telehealth. 

Whether telehealth is as widely available in the future, Alleva said, depends on the degree to which payers are willing to pay for it – which may not be a given. Verma, for example, hinted that the government may not continue paying at the same rate for virtual visits as for in-person care.

“I think [payers] will choose to continue covering things in the mental health space,” Alleva predicted, especially considering the high rates of anxiety and depression around the country during the pandemic. She pointed to so-called sensitive medical topics – such as sexually transmitted infections, erectile dysfunction and hair loss – as good candidates for telemedicine coverage, as well as dermatology and ophthalmology. 

“I’m not so optimistic about prescriptions, especially in the opioid space,” she said. In-person requirements for controlled substance prescriptions “were put in place as a protection.” And, she noted, referring to the ongoing opioid crisis, “we’re still in an epidemic, even in a pandemic.”

When it comes to lasting regulatory changes, “licensure is the biggest one,” said Alleva. During the epidemic, many states created ways for out-of-state providers to get medical licenses in that state; the American Telemedicine Association is pushing for regional compacts along those lines.

Another perhaps lesser-appreciated consideration is law around corporate practice of medication. 

“It’s very arcane, but the concept is a corporation isn’t licensed to practice medicine – it can get complicated in the different states,” said Alleva.

“If you have some type of national provider,” she explained, “you don’t just have the hurdle of making sure physicians are licensed in all 50 states. You also have to make sure the provider is complying with corporate practice of medicine restrictions in different states.” 

This is an issue in states such as Pennsylvania, for example. Though its border with New Jersey is only a ten-minute drive away from Philadelphia, “some states don’t recognize other states’ professional entities.”

Like other experts, Alleva hypothesized that telemedicine will be a “supplement to care: an additional tool.”

Before COVID-19, telemedicine was “underutilized,” she said. “And telehealth during the pandemic was a replacement for all care.”

But without in-person care, “kids are going under-vaccinated; people aren’t getting their cancer screenings,” Alleva explained.

“You can’t get all your care from a cell phone,” she said.

sourcelink:https://www.healthcareitnews.com/news/what-sort-staying-power-does-telehealth-really-have