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May 2012
‘Kidney Attack’ As Serious as Heart Attack, Warns UPMC Critical Care Expert
Kidney complications during hospitalization are as frequent and as dangerous to patients as heart attacks, and the medical community must implement recently developed guidelines to better detect and respond to the problem, said a critical care expert at UPMC and the University of Pittsburgh School of Medicine today in the online version of the Journal of the American Medical Association.
Acute kidney injury (AKI) is not well understood by doctors, and is even more unfamiliar to the public, wrote John A. Kellum, M.D., professor and vice chair for research, Department of Critical Care Medicine, Pitt School of Medicine; Rinaldo Bellomo, M.D., of Austin Hospital and Melbourne University, Australia; and Claudio Ronco, M.D., Ospedale San Bortolo, Vicenza, ltaly.
“Research shows that as many as 60 percent of patients in the intensive care unit will develop kidney problems, which can lead to long-term, life-threatening complications,” Dr. Kellum said. “Doctors, patients and families should perhaps view the dangers of and the need to avoid a ‘kidney attack’ with the same sense of urgency that heart attack provokes.”
Until recently, there were no recommendations about when to start treatments, such as a medication change, correcting fluid overload, or dialysis, in response to abnormal kidney function, he said. But in March, an international panel of experts co-chaired by Dr. Kellum established clinical practice guidelines to end the confusion.
At UPMC, an effort will launch this month in which an alert will appear in the electronic medical record when certain lab tests of kidney function are abnormal. It will cue the medical staff to seek advice about appropriate therapeutic strategies from nephrologists or, in the case of severe illness, critical care specialists.
“That’s a simple way of making sure that the patient gets assessed early by clinicians who have the most experience in managing AKI,” Dr. Kellum said. “UPMC already includes a sign of kidney attack – very low urine output – as a trigger for its rapid-response team. The idea is to address kidney attacks just as we do with cardiac arrest and other scenarios in which a patient becomes dangerously ill very quickly.”
And, as detection and public awareness of AKI improves, there could be more support for research into the problem, said the authors, who noted also that estimates indicate that in 2012, 3 million people worldwide could die of AKI, which currently has no definitive treatment.
HEALTH DEPT. OFFERS TIPS ON HOW TO PREVENT AND RESPOND TO DRUG OVERDOSES
The Allegheny County Health Department is reporting that drug overdoses have become a serious public health problem and the leading cause of injury death in Allegheny County and across the United States.
Drug overdose deaths have tripled nationwide since 1990 and in the past ten years have tripled among Allegheny County residents 24 years of age and younger.
The Health Department’s Child Death Review Team examined 23 drug overdose deaths countywide between 2008 and 2011 affecting youths 15 to 21 years of age and found that every death involved at least one type of opioid. Opioids include heroin as well as pain medications such as Vicodin, OxyContin and Morphine. Nationwide, opioid pain relievers are involved in about 74% of drug overdose deaths.
Other findings about the 23 local deaths include: more than 50% of the youths lived with their parents; 43% used other substances in addition to opioids, mainly cocaine or depressants such as benzodiazepines or tranquilizers; 40% had a history of drug treatment, 17% mental health treatment, 13% involvement with child protective services, 9% with juvenile probation; 9% had been prescribed opioid pain medication by a physician.
To combat the growing number of drug overdose deaths, it is necessary to expand drug prevention and treatment efforts to include education on immediate life-saving tools. Toward that end, the Health Department is working with Prevention Point Pittsburgh to offer information, advice and training on how to prevent drug overdoses and respond to them with life-saving assistance.
Overdose prevention and response materials geared to adolescents and their families are available on the Health Department’s web site at www.achd.net. The materials give prevention tips, list overdose symptoms and explain what to do when an overdose happens.
The best way to prevent overdose is to use opioids only as prescribed by a physician and follow dosing instructions carefully. The risk of overdose is increased when opioids are taken with other drugs or alcohol. It is important to know what type of opioid you are taking and how strong it is. If you have taken opioids regularly and then stop for a while, starting again puts you at increased risk due to changes in tolerance.
Overdose deaths can be prevented by knowing these symptoms and knowing what to do if you see them in someone who takes opioids: not breathing or breathing slowly; blue or gray lips, fingertips and skin; and unresponsive to shaking and calling their name.
If you think someone has overdosed, try to wake them, shake them and call their name. If they are not breathing, call 911 and breathe for them via rescue breathing until help arrives or they start breathing on their own. If it’s available and you know how to use it, give them the opioid overdose medication naloxone (Narcan).
Rescue breathing or breathing for someone else is done in this manner: tilt their head back; remove anything in their mouth; pinch their nose shut; take a deep breath and breathe into their mouth, two breaths to start and then one breath every four seconds.
Naloxone (Narcan) is a very safe, effective medication used by paramedics and hospitals to reverse opioid overdose. It is increasingly available by prescription to individuals who use opioids. Some physicians prescribe naloxone when opioids are prescribed for pain to decrease the risk of overdose.
Prevention Point Pittsburgh offers naloxone by prescription at no charge to individuals who use opioids, after they complete 20-minute training on overdose prevention and response, which includes instruction on how to perform rescue breathing and how to administer naloxone.
Monongahela Valley Hospital Is a Safe Haven for Newborns
Females who are experiencing unexpected or unwanted pregnancies can turn to Monongahela Valley Hospital as a Safe Haven for their babies. Under the Newborn Protection Act of 2003, any parent may leave a newborn baby in the care of the hospital without being criminally liable as long as the baby is no older than 28 days and is not harmed.
“Sometimes young women want to care for their unborn babies, but once the child arrives the responsibility is overwhelming and they find themselves in crisis situations and do not know where to turn,” said Brenda L. Walther, M.D., the hospital’s chief of Emergency Medicine. “MVH is here to protect those babies and to give them the care that they need and deserve.”
As a Safe Haven, MVH will accept the baby without asking any questions. Parents will not be asked for any personal information and their identities will remain anonymous. At the hospital, the baby will be examined by a doctor in the Emergency Department (ED) who will provide any necessary medical care. The local children and youth agency will take custody of the baby and find the infant a loving home.
Monongahela Valley Hospital displays a sign at the entrance to its Emergency Department indicating that the hospital is a Safe Haven. Babies may be brought to the ED or given to the guard at the front of the hospital 24/7.
For more information about Safe Haven of Pennsylvania, visit www.secretsafe.org.
Monongahela Valley Hospital’s SmokeStoppers® helps kick the habit
Are you smoking, rubbing snuff or using chew and want to give up the habit for good?
Monongahela Valley Hospital offers classes once each week in May to help tobacco users quit for good with its You CAN Quit SmokeStoppers® Smoking Cessation Program at the Healthy Directions walk-in clinic at the Finleyville Giant Eagle.
Presented as a community outreach program by MVH, SmokeStoppers is a straight-forward, no nonsense, quit-smoking program offered at 6 p.m. May 7, 14, 23 and 28.
The You CAN Quit classes cost a total of $20, which includes class instruction and a cessation kit. To encourage success, MVH will give a complete refund to those who attend all four sessions. For registration or more information, call 724-258-1321.
Smoking behavior is a very complex physiological and psychological phenomenon. Therefore, smoking cessation requires a diverse and nonjudgmental approach that considers individual’s differences.
This program features all the elements necessary to help tobacco users change their behaviors and stop smoking for good. The program offers strategies for conquering smoking in one’s thoughts, feelings and actions.
The sessions at the Healthy Directions at Giant Eagle emphasize common sense regulation of the two most difficult obstacles for persons who quit smoking — stress management and the fear of gaining weight.
According to Donna Hatalowich, Nurse/Health Educator and moderator of the program, former smokers who have participated in the program said that quitting smoking was one of the best things they have ever done for their health.
“They feel a greater sense of control, have more stamina and an easier time breathing when walking or exercising,” she said. “They have fewer colds and flu and have the peace of mind knowing they have greatly reduced their risk of coronary heart disease and cancer.”
In addition to offering strategies and plans for conquering the smoking habit, the SmokeStoppers classes also offer group support.
“The classes contain all the elements to help individuals help themselves,” Ms. Hatalowich said. “Most smokers do not want to smoke, have thought about quitting smoking or have previously tried to quit. They are waiting for the ‘right time.’ They needn’t wait any longer.”
Family Hospice and Palliative Care Ranked #1 Hospice Provider in Pennsylvania
An independent review of hospice providers in Western Pennsylvania and across the Commonwealth ranks Pittsburgh-based Family Hospice and Palliative Care as the leading hospice provider in Pennsylvania, based on Medicare hospice claims data statewide.
The report, called Hospice Market Atlas, was complied and published by the Summit Business Group. It shows that 2,323 patients received care from Family Hospice in calendar year 2010, the most recent for which data is available. This number reflects the fact that Family Hospice cared for more Medicare hospice patients than any other hospice provider in Pennsylvania.
“We know that patients, families and health care providers have a choice – and more of them are choosing Family Hospice than any other provider,” said Rafael Sciullo, President and CEO of Family Hospice. “We are grateful that a growing number of families and professionals have recognized our CompassionateCare philosophy and treatment provided by our staff across all disciplines, each and every day.”
The data also shows that Family Hospice provided care for more Medicare hospice patients in Allegheny and Mercer counties than any other provider in 2010. When palliative home care services are factored in, along with patients covered by Medicaid, private insurance, and those who qualified under federal poverty guidelines to receive uncompensated care, Family Hospice admitted a total of 3,462 patients in 2010 and 3,572 in 2011. Patients are cared for at home, in skilled nursing facilities, long-term care settings, hospitals and Family Hospice’s inpatient units in Mt. Lebanon and Lawrenceville.
April 2012
The Washington Hospital Partners With Cura Hospitality
To Introduce Exceptional Locally Sourced Dining Experience
The Washington Hospital, a progressive community-based hospital dedicated to providing the highest quality care to patients in southwestern Pennsylvania, has partnered with Cura Hospitality, a leading specialist in healthcare and acute care dining, to provide a fresh and local dining experience with an emphasis on enhancing patient satisfaction.
Cura will enhance current patient services with its signature Completely Satisfied guest services model, which has achieved peer-leading patient satisfaction results. Through Completely Satisfied, Washington Hospital patients have their dining orders taken in person by a dining assistant who focuses on each patient’s specific health and dietary needs as well as their personal preferences. The Cura team will meet regularly with The Washington Hospital staff to design food choices that will help speed the healing process for post-operative and post-injury patients. Cura also assists in identifying nutritionally at-risk patients and recommends proactive plans to help keep them nourished.
Cura was one of the first healthcare food providers in the U.S. to eliminate trans fatty acids from its menu. Cura has also made substantial commitments to promoting healthier lifestyles with Healthier Tomorrow which identifies healthier choices in the café and promotes wellness initiatives including preventative health screening services, health education and nutrition workshops for patients and members of the community.
Food is prepared by executive chefs from scratch using local agriculture sourced through FarmSource™, a sustainable sourcing program. Through FarmSource™, Cura and its parent, Eat’n Park Hospitality Group, purchases $23 million in local foods from farmers and producers of food we support within a 125-mile radius, which greatly reduces the distance food travels from harvest to table.
For those who choose, or are too busy to eat in the café, an extensive selection of On-the-Go items, made daily, will be the solution they have sought, including entrée salads, sandwiches, snacks, parfaits and desserts. Most appropriate to healthcare, our outstanding “Healthy Interruption Points” will showcase colorful, appropriately sized, healthier choice snacks like homemade granola bars, yogurt raisins, trail mixes, and local fresh produce and fruit snack options to promote choices that are both tasty and good for you.
The Washington Hospital and Cura will also partner to make complete renovation
improvements to the retail café to elevate flow of service, ease of use and more seating options to become a welcoming spot for all. “We look forward to improving the dining options for our patients, staff and visitors, while creating a wonderful environment for our guests to eat in every day,” said Ward.
Open Your Heart Off ers Volunteer Opportunities Across Allegheny County
Open Your Heart to a Senior is celebrating National Volunteer Month this April by opening their
doors to volunteers.Open Your Heart to a Senior is committed to helping senior citizens live safely and independently in their own homes throughout Allegheny County. Volunteers can help by providing transportation to medical appointments and grocery shopping, telephone reassurance calls, friendly home visits, yard work and simple home repairs.
• Shopper – Two to four times monthly; one to two hours per trip
• Driver - One to two hours per trip
• Weekly or Biweekly Friendly Visitor – One to two hours per visit
• Telephone Caller - Thirty minutes per week per care receiver
• Safety for Seniors - Five hours on a Saturday for training and safety checks
• Handyperson and Yardwork
• Snow Shoveler
• Mail Assistant - Two to four hours monthly
• Office Help - Three hours weekly
Safety for Senior Days also will be held April 28 from 11 a.m. to 4 p.m. After an hourlong training session, volunteers will pair up to visit two senior citizens’ homes and evaluate each home for common fall and fire hazards. Registration is required for all trainings.
• May 30 - 6:30 p.m. - North Hills Community Outreach at 1975 Ferguson Road in Allison ParkFor more information, on volunteering, visit www.openyourhearttoasenior.org, call 412-307-0071 or
toll-free at 866-467-0888 or email at seniors@nhco.org.
Highmark value-based benefit designs incent employees to get engaged in health care
Highmark Inc. recently introduced to its group customers a comprehensive package of value-based benefit designs, which are more commonly known across the industry as health insurance plan designs that offer incentives and rewards for employees to become more engaged in their health care.
"Value-based benefit designs are a broad spectrum of tools that are used like 'carrots' and 'sticks' to push and pull members towards appropriate care," said Steven Nelson, senior vice president of health services strategy, product and marketing at Highmark. "Rewards, like cash and gift cards, and incentives, like lower cost-sharing through benefit designs, have proved to be important tools to encourage employees to better understand and more effectively utilize health care."
More than a dozen businesses across Highmark's service area are currently implementing value-based benefit designs with their workforce.
Holy Family Institute, a children and family services nonprofit based in Pittsburgh, introduced a value-based benefit design to incent its employees with chronic conditions, including asthma, depression, diabetes, high cholesterol and hypertension, to get the medical care needed to treat and control these conditions. Holy Family employees who sign up for the value-based design and agree to work with a health coach on their condition pay no deductible on the medical services eligible to treat these conditions.
Mon Valley Hospital receives $145,860 grant to reduce hospital readmissions
The Highmark Foundation announced a two-year $145,860 grant to Monongahela Valley Hospital to support the Assisting Care Transitions Program. The program will ensure safety, accuracy and completeness during transitions of care following discharge in order to decrease hospital readmissions and emergency room visits for chronic obstructive pulmonary disease and congestive heart failure patients.
On a national level, patients who are discharged from hospitals with a clear understanding of their after-care hospital instructions, including how to take medications, are 30 percent less likely to be readmitted or revisit the emergency room than patients who lack this information.
Based on patient volume statistics, Monongahela Valley Hospital estimates that readmission reductions will result in annual savings of $170,000.
“The grant will allow a clinical pharmacist to visit with each patient and his or her caregivers prior to discharge,” said Monongahela Valley Hospital Senior Vice President Donna Ramusivich. “The clinical pharmacist will provide education related to prescribed medications and act as a bridge between attending physicians and their patients.”
Concordia Acquires Two New Locations
Concordia Lutheran Ministries of Pittsburgh recently acquired two facilities: Pristine Pines of Franklin Park and Pristine Pines of Wexford. Concordia’s Board of Directors approved the purchase to further enhance opportunities for Concordia’s mission and future.
The facility in Franklin Park, now called Concordia of Franklin Park, is a licensed personal care home on Georgetowne Drive, near the intersection of Routes 79 and 910. It is licensed for 100 beds through the Pennsylvania Department of Public Welfare. The facility in Wexford, now called Concordia of Wexford, is also a licensed personal care facility. Located on Brown Road, it is licensed for 56 beds.
Concordia President and CEO Keith Frndak said, “We are pleased to add these new facilities to our continuum of care and look forward to serving our new family of residents.”
Family Hospice’s New Inpatient Unit Accepting Patients
The Center for Compassionate Care Canterbury, Family Hospice and Palliative Care’s new inpatient unit, began accepting patients on Monday Feb. 27. Located on the campus of Canterbury Place, a UPMC Senior Community in Lawrenceville, the inpatient unit has a full Family Hospice staff and operates under Family Hospice’s license. The Center for Compassionate Care Canterbury has 14 private patient rooms, a gathering room, kitchen and dining area for families, and picturesque views of the City of Pittsburgh. Unit Manager Megan King, RN (pictured lower left) and her staff provide CompassionateCare for patients and their loved ones alike. For information, call 1-800-513-2148.
OHIO STATE STUDIES ADHD DRUG, PARENT TRAINING FOR AUTISM
Researchers at The Ohio State University are conducting a study to determine which is more effective for helping children on the autism spectrum: training parents or taking medication.
Researchers at Ohio State’s Nisonger Center are studying whether a particular non-stimulant typically used to treat children with attention deficit hyperactivity disorder can help children with autism. At the same time, researchers are also analyzing the benefits of a training intervention for parents of children with autism to help curb attention problems, hyperactivity and noncompliance.
During the study, some patients will receive a drug known as atomoxetine, while others will receive a placebo. And some parents will be taught intervention techniques by a professional to better control their children’s symptoms of autism, while others will not receive the additional parent training, said principal investigator Michael Aman, director of research at the Nisonger Center at the Ohio State University Wexner Medical Center.
As for the role of the parent, Aman says therapists will teach parents behavior techniques to help them better manage behavioral issues in children. There are subtle clues that parents can be taught to recognize and help prevent problems before they start, according to Aman. In addition, certain reward techniques have proven effective in clinical settings.
“We’re trying to have the greatest possible impact on children with autism,” says Aman, a professor of psychology and psychiatry who focuses on pharmacological and behavioral studies for children. “Obviously it gives us an opportunity to look at each technique in isolation, but more importantly, it enables us to look at the combination of the two treatments to see if there is a bonus.”
Atomoxetine is already approved for use in children with ADHD, but this marks the first large-scale study using this drug in children on the autism spectrum, Aman said.
“We think there is a better chance that this drug will work for children when stimulants have failed, because it actually works on a different neuro-chemical,” Aman says. “So, the chance of seeing a breakthrough on a child who has yet to respond to the stimulants is much greater.”
“By combining the pill and the parental involvement, we’re hoping that we’ll see an effect which is greater than with the use of either treatment alone,” Aman says.
The study is open to boys and girls ages 5 to 14 who are in good health and have been diagnosed with autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), or Asperger’s disorder.
After the first 10 weeks, study participants may continue in the treatment program based on how they responded during the first phase of the study. This includes the opportunity to receive the real medicine if they received the placebo earlier.
The study is currently taking place at the Nisonger Center at Ohio State University, in conjunction with the University of Pittsburgh and the University of Rochester in New York.
For more information about the study, go to http://nisonger.osu.edu/study_participation and click on “CHARTS Website” or call 614-688-8214.
Heritage Valley Expands Services in Moon Township
Heritage Valley Health System has expanded health care services in the western Allegheny County neighborhoods by opening a Heritage Valley ConvenientCare location in Moon Township at 935 Thorn Run Road. ConvenientCare is a walk-in clinic, open 7 days a week with extended hours providing treatment for minor illness and injuries by a staff of Certified Registered Nurse Practitioners. The ConvenientCare in Heritage Valley Moon Township will complement other services at the Thorn Run location including diagnostic imaging and lab draw services, Signature Rehab outpatient rehabilitation services, an office location for the Heritage Valley Heart & Vascular Center (Philip D. Nicol, M.D.), and the Heritage Valley Medical Group offices of Fouad Bassilios, M.D. and Cherrington Medical Associates (Eileen Neely, M.D. and Stephen Osmanski, M.D.).
MEDICAL STUDIES: New High Definition Fiber Tracking Reveals Damage Caused by Traumatic Brain Injury, Pitt Team Reports
A powerful new imaging technique called High Definition Fiber Tracking (HDFT) will allow doctors to clearly see for the first time neural connections broken by traumatic brain injury (TBI) and other disorders, much like X-rays show a fractured bone, according to researchers from the University of Pittsburgh in a report published online today in the Journal of Neurosurgery.
“There are about 1.7 million cases of TBI in the country each year, and all too often conventional scans show no injury or show improvement over time even though the patient continues to struggle,” said co-senior author and UPMC neurosurgeon David O. Okonkwo, M.D., Ph.D., associate professor, Department of Neurological Surgery, Pitt School of Medicine. “Until now, we have had no objective way of identifying how the injury damaged the patient’s brain tissue, predicting how the patient would fare, or planning rehabilitation to maximize the recovery.”
“We have been wowed by the detailed, meaningful images we can get with this technology,” Dr. Okonkwo said. “HDFT has the potential to be a game-changer in the way we handle TBI and other brain disorders.”
MEDICAL STUDIES: UPMC Researchers Find Early Indicators May Predict Recovery Time from Sports Concussions
The unpredictable nature of concussions is one of the most frustrating factors to the millions of sufferers each year, but early neurological indicators and symptoms can predict a protracted healing time in certain cases, according to specialists at UPMC and the University of Pittsburgh School of Medicine.
“It’s a highly variable injury with a variety of outcomes,” said Michael “Micky” Collins, Ph.D., director of the UPMC Sports Medicine Concussion Program and co-investigator of the Pitt/UPMC study published in the February issue of Neurosurgery. “We see some patients who take a day or two to recover, and some who take a year or longer to recover. If clinicians had a way of determining within two days of injury who’s going to take a month or longer to recover, that’s a very important piece of information to have. It’s a game-changer.”
The study, one of the first to examine concussion prognoses, showed that specific neurocognitive “cut-off” scores derived from ImPACT™ (Immediate Post-concussion Assessment and Cognitive Testing) improved clinicians’ ability to predict which sports-related concussions could take longer — as much as five times longer — to rehabilitate than others. They found, in as many as 85 percent of the cases, the scores could warn athletes, parents, coaches, schools, teams and health professionals when a concussion is likely to take on average a month to heal.
Such an objective prognosis could help clinicians to better prepare a treatment plan, arrange academic accommodations for students and set tangible expectations for return to play and school, Dr. Collins said.
“We’ve established statistical ‘cut-offs’ that indicate people who take a month or longer to recover,” Dr. Collins said. “Eighty percent of concussed people recover inside of three weeks. This prognostic information allows us to develop a risk profile of athletes who don’t recover well from this injury.
Other study authors include Brian Lau, B.S., from the Pitt School of Medicine, and Mark Lovell, Ph.D., the Concussion Program’s founding director who retired from UPMC last summer.
Seniors Find Increased Value with UPMC for Life Medicare Advantage Plans
UPMC for Life, the Medicare Advantage program of UPMC Health Plan, is a growing choice for health-conscious Medicare consumers. Results of the latest Open Enrollment Period available from Centers for Medicare and Medicaid Services (CMS) note that UPMC for Life saw a growth rate of 13.6 percent in 2011, more than four percentage points above the national growth rate for such plans.
“The reasons behind the increases are many, but one stands out,” said Eugene Scanzera, Vice President of Medicare for UPMC Health Plan. “When Medicare members are shopping they are thinking of higher value.
“When it comes to value, there are four variables they have to consider – total costs that include premium cost and cost sharing, benefits, quality and service. And, for all four variables, our product is a great value.”
UPMC Health Plan’s reputation for quality, superior customer service and its concierge-level of additional service are the factors that drive growth as well as help maintain high retention rates for Medicare Advantage members.
UPMC for Life’s total membership as of January 1, 2012, is 92,617, an increase of 11,072 members from January 1, 2011. CMS, the federal agency that administers Medicare, announced that the national rate of growth for Medicare Advantage was 9.4 percent. In 2011, there were 11.7 million Medicare Advantage members, and it rose to 12.8 million in 2012.
Over the past four years, UPMC for Life has grown from 64,676, to 92,617 members. The rates of increase were 11.7 percent in 2010, 12.8 percent in 2011 and 13.6 percent in 2012.
Nationally, UPMC ranks 15th of more than 160 plans in terms of enrollment and is the third largest Medicare Advantage plan in Pennsylvania. In Allegheny County, UPMC for Life membership increased 11.2 percent to 30,564.
UPMC for Life has consistently ranked among the best plans in the nation in terms of quality measures such as effectiveness of care, member satisfaction, and plan operation according to the National Committee for Quality Assurance (NCQA).
UPMC for Life saw the biggest rise for its Preferred Provider Organization, or PPO. UPMC for Life offers a high-deductible PPO plan, a PPO plan with drug coverage and a PPO available to workers through their employer group. UPMC for Life also offers three Health Maintenance Organization (HMO) plans.
“Western Pennsylvania is a very competitive landscape for Medicare,” said Scanzera. “For us to have high growth, it means changing the market share and we have done that. It’s clear we’re getting more than just our `fair share’ of growth.”
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