After Heart Surgery, House Calls by Physician Assistants Help

TUESDAY, Jan. 26, 2016 (HealthDay News) — Heart surgery patients who receive home visits from physician assistants are less likely to be readmitted to the hospital, a new study finds.

They also have lower overall health care costs, the researchers said.

The study followed nearly 1,200 people after heart surgery. In the week after leaving the hospital, some patients received two home visits from cardiac surgery physician assistants involved in their care, while those in a “control” group received no visits.

Patients who received physician assistant visits on the second and fifth day after leaving the hospital were 41 percent less likely than those in the control group to be readmitted to the hospital within 30 days — 10 percent versus 17 percent, the study found.

House calls to 540 patients cost $23,500, but saved $977,500 in hospital readmission costs, researchers said. That means $39 was saved for every $1 spent, according to the study.

The findings were scheduled for presentation Tuesday at the annual meeting of the Society of Thoracic Surgeons in Phoenix.

“Adult cardiac surgery has one of the highest readmission rates for all hospitalized patients,” study leader Dr. John Nabagiez, of Staten Island University Hospital in New York City, said in a society news release.

“The physician assistants who made the house calls in our study were fully trained cardiac surgery PAs who were actively involved in the preoperative, intra-operative, and postoperative care of our patients,” he explained.

“Unlike standard visiting nurses, our PAs knew each patient personally and understood all of the pertinent issues of the patient’s medical history. They also knew the patient’s individual postoperative course prior to discharge, so they entered the patient’s home already knowing the concerns, if any, of the surgeon and the patient,” Nabagiez added.

But for this strategy to succeed, it’s essential for patients to comply with all prescribed medications and physical rehabilitation after heart surgery, he said.

Noting that complications can arise in the first week after surgery, Nabagiez said these initial home visits can help diagnose problems earlier, which can keep patients out of the emergency department.

“We found that making these two visits is cost effective and keeps patients on the road to recovery, while also reducing hospital readmissions,” Nabagiez said.

Research presented at meetings is usually considered preliminary until published in a peer-reviewed medical journal.

More information

The U.S. National Heart, Lung, and Blood Institute has more about heart surgery.

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Parents Often Ill-Informed About Food-Allergy Emergencies

TUESDAY, Jan. 26, 2016 (HealthDay News) — Many parents of children with food allergies say doctors did not discuss emergency care for their youngsters, a new study finds.

It’s crucial that parents have a written emergency plan for home and school, the study authors said.

“This is potentially lifesaving information,” study author Dr. Ruchi Gupta, an associate professor in pediatrics at Northwestern University Feinberg School of Medicine in Chicago, said in a university news release.

“Physicians need to make sure patients understand when and how to use epinephrine and that they have an emergency action plan,” she added.

Gupta’s team surveyed 859 Chicago-area parents of children with food allergies. Less than 70 percent said their child’s allergist explained when to use epinephrine, and less than 40 percent said their child’s pediatrician did so, the study found.

Even fewer parents said they were shown how to use an epinephrine auto-injector or received a written emergency plan from their child’s allergist or pediatrician, according to the study published recently in the Journal of Allergy and Clinical Immunology: In Practice.

The auto-injector is used to treat life-threatening allergic reactions. And a written emergency plan describes common symptoms of a food allergy reaction and what to do, depending on whether a child has mild or severe symptoms, the study authors explained in the news release.

“These points need to be hammered home by the physician at every visit,” Gupta said.

“Physicians have to make sure the parents can repeat back the directions,” she added. “Parents may not be digesting all the information given to them in a short period of time.”

Food allergies affect 8 percent of American children, according to the news release. Peanut allergy is the most common, followed by milk, egg and tree nut allergies. About half of children with a food allergy have suffered a severe allergic reaction.

“There is a gap in the communication between doctors and parents in management of their children’s food allergies that we need to fix,” Gupta concluded.

More information

The American Academy of Family Physicians has more about food allergies.

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Cancer’s Financial Burden Tied to Poorer Survival, Study Finds

By Steven Reinberg
HealthDay Reporter

TUESDAY, Jan. 26, 2016 (HealthDay News) — The staggering cost of cancer care forces many patients to file for bankruptcy, and that financial stress may play a role in cutting their lives short, new research suggests.

In fact, patients suffering from colon, prostate or thyroid cancers who went broke had almost 80 percent higher odds of dying during the study period compared with similar patients who remained financially sound, the researchers said.

“Bankruptcy, for reasons that we don’t know, is a serious threat to survival for cancer patients,” said lead researcher Dr. Scott Ramsey, from the Fred Hutchinson Cancer Research Center in Seattle.

While the study found a link between financial strain and cancer death, the research wasn’t designed to prove a definitive cause-and-effect relationship between these factors.

Still, medical costs are one of the most common reasons why people go bankrupt, Ramsey said. “We think that what happens is that when people are diagnosed, they had to leave their job, use up all their savings, go into debt and at some point the debt was overwhelming,” he explained.

When patients go bankrupt, they may stop getting care or stop their treatment early, or they don’t go for recommended treatment, he said. The link between bankruptcy and dying “is probably a failure to get necessary care,” Ramsey said.

In addition, the stress of bankruptcy on top of cancer may also play a role, he suggested.

Patients with financial pressures should ask their doctor to consider cost of treatment options, Ramsey said. “Many of the treatments that are recommended equally can vary 10 or 100 times in price,” he said. “Choosing a therapy that’s less expensive might be better because the patient may be able to complete it.”

For example, there are five recommended treatments for stomach cancer. “The least expensive treatment costs $800, the most expensive treatment costs $57,000,” he said.

In addition, patients can forgo some suggested treatments that are expensive but not vital, such as high-cost scans and drugs used to treat certain side effects of chemotherapy, Ramsey said.

Even insured patients need to take costs into account, he added. These patients may face high out-of-pocket costs and co-pays.

“We have to figure ways of keeping people out of severe financial distress,” he said. Doctors need to ask patients about their finances and “be aggressive in trying to help them manage their finances, and get them to financial services earlier rather than later so they don’t end up in this extreme situation,” Ramsey explained.

The new report was published in the Jan. 25 online edition of the Journal of Clinical Oncology.

For the study, the researchers collected data on more than 230,000 cancer patients listed in the Western Washington Surveillance, Epidemiology and End Results program cancer registry. The investigators linked these data with federal bankruptcy records for the region.

Between 1995 and 2009, more than 4,700 patients filed for bankruptcy. These patients were more likely to be younger, female, non-white and to have received treatment for cancer, the findings showed.

Jason Zheng, a senior epidemiologist at the American Cancer Society, said, “We know that cancer patients are more likely to file bankruptcy, compared with other patients.”

These patients are more likely to skip medications, which can “lead to bad results and higher mortality,” he said. “We need to identify patients at financial risk before they file for bankruptcy,” Zheng suggested.

Dr. Steffie Woolhandler, a spokeswoman for Physicians for a National Health Program, said, “It’s shocking that we have a society that would bankrupt people when they have cancer and put them in a situation where they can’t get the medical care they need to stay alive.”

She said that people whose medical debt drives them to bankruptcy may also have trouble affording food and utilities, as well as medical care. “We need to make medical care completely free,” said Woolhandler, a professor in the School of Public Health at Hunter College in New York City.

Changes within the Affordable Care Act (sometimes called “Obamacare”) reduce the number of uninsured Americans, she said. But high co-pays and out-of-pocket costs, along with uncovered procedures, can cost cancer patients hundreds of thousands of dollars, she explained.

“Skimpy coverage leaves many cancer patients at risk for bankruptcy, which puts them at risk for early death,” Woolhandler said. “Unfortunately, Obamacare did not improve the problem of underinsurance.”

More information

For more on the cost of cancer care, visit the American Society of Clinical Oncology.

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Cancer’s Financial Burden Tied to Poorer Survival, Study Finds

By Steven Reinberg
HealthDay Reporter

TUESDAY, Jan. 26, 2016 (HealthDay News) — The staggering cost of cancer care forces many patients to file for bankruptcy, and that financial stress may play a role in cutting their lives short, new research suggests.

In fact, patients suffering from colon, prostate or thyroid cancers who went broke had almost 80 percent higher odds of dying during the study period compared with similar patients who remained financially sound, the researchers said.

“Bankruptcy, for reasons that we don’t know, is a serious threat to survival for cancer patients,” said lead researcher Dr. Scott Ramsey, from the Fred Hutchinson Cancer Research Center in Seattle.

While the study found a link between financial strain and cancer death, the research wasn’t designed to prove a definitive cause-and-effect relationship between these factors.

Still, medical costs are one of the most common reasons why people go bankrupt, Ramsey said. “We think that what happens is that when people are diagnosed, they had to leave their job, use up all their savings, go into debt and at some point the debt was overwhelming,” he explained.

When patients go bankrupt, they may stop getting care or stop their treatment early, or they don’t go for recommended treatment, he said. The link between bankruptcy and dying “is probably a failure to get necessary care,” Ramsey said.

In addition, the stress of bankruptcy on top of cancer may also play a role, he suggested.

Patients with financial pressures should ask their doctor to consider cost of treatment options, Ramsey said. “Many of the treatments that are recommended equally can vary 10 or 100 times in price,” he said. “Choosing a therapy that’s less expensive might be better because the patient may be able to complete it.”

For example, there are five recommended treatments for stomach cancer. “The least expensive treatment costs $800, the most expensive treatment costs $57,000,” he said.

In addition, patients can forgo some suggested treatments that are expensive but not vital, such as high-cost scans and drugs used to treat certain side effects of chemotherapy, Ramsey said.

Even insured patients need to take costs into account, he added. These patients may face high out-of-pocket costs and co-pays.

“We have to figure ways of keeping people out of severe financial distress,” he said. Doctors need to ask patients about their finances and “be aggressive in trying to help them manage their finances, and get them to financial services earlier rather than later so they don’t end up in this extreme situation,” Ramsey explained.

The new report was published in the Jan. 25 online edition of the Journal of Clinical Oncology.

For the study, the researchers collected data on more than 230,000 cancer patients listed in the Western Washington Surveillance, Epidemiology and End Results program cancer registry. The investigators linked these data with federal bankruptcy records for the region.

Between 1995 and 2009, more than 4,700 patients filed for bankruptcy. These patients were more likely to be younger, female, non-white and to have received treatment for cancer, the findings showed.

Jason Zheng, a senior epidemiologist at the American Cancer Society, said, “We know that cancer patients are more likely to file bankruptcy, compared with other patients.”

These patients are more likely to skip medications, which can “lead to bad results and higher mortality,” he said. “We need to identify patients at financial risk before they file for bankruptcy,” Zheng suggested.

Dr. Steffie Woolhandler, a spokeswoman for Physicians for a National Health Program, said, “It’s shocking that we have a society that would bankrupt people when they have cancer and put them in a situation where they can’t get the medical care they need to stay alive.”

She said that people whose medical debt drives them to bankruptcy may also have trouble affording food and utilities, as well as medical care. “We need to make medical care completely free,” said Woolhandler, a professor in the School of Public Health at Hunter College in New York City.

Changes within the Affordable Care Act (sometimes called “Obamacare”) reduce the number of uninsured Americans, she said. But high co-pays and out-of-pocket costs, along with uncovered procedures, can cost cancer patients hundreds of thousands of dollars, she explained.

“Skimpy coverage leaves many cancer patients at risk for bankruptcy, which puts them at risk for early death,” Woolhandler said. “Unfortunately, Obamacare did not improve the problem of underinsurance.”

More information

For more on the cost of cancer care, visit the American Society of Clinical Oncology.

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Teens Who ‘Vape’ May Be More Likely to Try Smoking, Too

TUESDAY, Jan. 26, 2016 (HealthDay News) — Teens who use e-cigarettes may be more likely to switch to real cigarettes within a year, a new study suggests.

In fact, the researchers found that teens who used e-cigarettes, also known as “vaping,” when the study began were about three times more likely to have started smoking a year later than students who had never vaped.

“This suggests that e-cigarette use among adolescents is not without behavioral costs,” wrote Dr. Thomas Wills, from the Prevention and Control Program at the University of Hawaii Cancer Center, in Honolulu. “These findings should be considered for policy discussions about the availability of e-cigarettes to adolescents.”

Restricting young people’s access to e-cigarettes could have health benefits, the researchers suggested.

While this study found an association between e-cigarette use and starting to smoke tobacco cigarettes, it wasn’t designed to prove a cause-and-effect link between those behaviors.

The findings were published online Jan. 25 in the journal Tobacco Control.

For the study, researchers surveyed more than 2,300 high school freshmen and sophomores in Hawaii about their vaping and smoking habits in 2013. They repeated the teen surveys one year later. The teens were an average of 15 years old.

The teens reported how often they used e-cigarettes and cigarettes. They were also asked about their home life, including their parents’ level of education and their tendency to be rebellious.

Overall, 31 percent of the teens used e-cigarettes at the time of the first survey. One year later, 38 percent had tried vaping. In 2014, 21 percent of the teens had smoked at least one cigarette up from about 15 percent in 2013, the study revealed.

Nearly all the teens surveyed in 2013 had heard of e-cigarettes. More than two-thirds of these students viewed vaping as healthier than smoking. Of nonusers of either product in 2013, one in 10 tried vaping by 2014 and 2 percent tried smoking cigarettes. Fewer than 4 percent had tried both, according to the survey.

The researchers also found that any use of e-cigarettes in 2013 was linked to trying smoking one through four times by 2014.

The study also showed that e-cigarettes didn’t help those who smoked when the study began to reduce their habit.

The teens who moved on to cigarettes or smoked and vaped by 2014 were generally older, white or Native Hawaiian and exhibited more rebelliousness. On the other hand, those with more family support and education were less likely to transition from e-cigarettes to smoking.

More information

The U.S. Food and Drug Administration provides more information on e-cigarettes.

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Blood Donors Needed After East Coast Storm: Red Cross

TUESDAY, Jan. 26, 2016 (HealthDay News) — Jonas, the massive snowstorm that hammered the East Coast, has led to a shortage of blood products and there is an emergency need for both blood and platelet donors, the American Red Cross said Tuesday.

“The impact of this weekend’s winter storm continues to affect multiple states along the East Coast, and more blood drives will likely be canceled. Right now, blood products are being distributed to hospitals as quickly as donations come in,” the Red Cross said in a news release.

Since Jan. 1, severe winter weather has led to the cancellation of more than 300 blood drives in 20 states, resulting in about 9,500 fewer donations to an already low winter supply, the Red Cross noted.

Blood products can be transported where and when they are most needed, so donors in areas unaffected by the winter storm are encouraged to make blood and platelet donations, the Red Cross said. Donors in areas affected by the storm should donate only when travel is considered safe.

To make an appointment to donate blood or platelets, call 1-800-733-2767, download the Blood Donor App or go to the Red Cross website. At check-in, a blood donor card or driver’s license and two other pieces of identification are required.

To be eligible to donate, people have to be age 17 or older (16-year-olds can donate with parental consent in some states), weigh at least 110 pounds, and be in generally good health. Donors age 18 and younger also have to meet certain height and weight requirements.

The Red Cross needs about 14,000 blood and platelet donations a day to meet the needs of patients at about 2,600 hospitals and transfusion centers across the country. The donated blood and platelets benefit a wide range of patients, including accident and burn victims, those having heart surgery and organ transplants, and those being treated for leukemia, cancer or sickle cell disease, the agency said.

More information

You can learn more about donating blood at the American Red Cross.

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Smoking Lowers Breast Cancer Survival, Study Finds

By Kathleen Doheny
HealthDay Reporter

TUESDAY, Jan. 26, 2016 (HealthDay News) — Women diagnosed with breast cancer who continue to smoke cigarettes are less likely to survive than those who never smoked or those who quit, new research finds.

The study suggests that it’s never too late to quit smoking to help boost cancer survival.

“Women who quit smoking at the time of their diagnosis do better, they have better outcomes than women who continue to smoke after the diagnosis,” noted study leader Michael Passarelli, a cancer epidemiologist at the University of California, San Francisco.

The smokers also had a higher risk of dying from respiratory cancers or heart disease and strokes, the research team found.

The study was published online Jan. 25 in the Journal of Clinical Oncology.

The researchers looked at the data from more than 20,000 women. The women were between the ages of 20 and 79, and nearly all were white. All had been diagnosed with breast cancer between 1988 and 2008.

Six years after the diagnosis, the researchers contacted more than 4,500 of the women, asking about their smoking status. During the follow-up of about 12 years, almost 6,800 women died, including about 2,900 deaths due to breast cancer, the findings showed.

Active smokers who were smoking a year before the diagnosis were 25 percent more likely than never smokers to die from breast cancer. They were also more likely to die from respiratory cancer, respiratory disease or from cardiovascular disease, according to the report.

The researchers compared the 10 percent of women who kept smoking after diagnosis to the never smokers, and found they were 72 percent more likely to die of breast cancer.

Next, the investigators compared those who quit smoking after being diagnosed with those who continued to smoke. Those who quit were 33 percent less likely to die of breast cancer during the follow-up period, although the researchers said the difference was not statistically significant.

Women who quit smoking after their breast cancer diagnosis were 60 percent less likely than those who kept smoking to die of respiratory cancer, the research showed.

At the study start, 20 percent of the women were current smokers. That went down to 10 percent at the six-year follow-up, according to the report.

Other studies have looked at the risk of death from cancer in smokers, but surveying the patients six years later, as this team did, is not commonly done, Passarelli said.

“Oncologists should be very aggressive about getting their patients to stop smoking,” Passarelli said. Exactly why smoking lowers survival odds wasn’t looked at in the new study, but he said that smokers may have more treatment-related complications, among other factors. Smoking could also affect the tumor growth, he suggested.

The results are not surprising, said Dr. Veronica Jones, who reviewed the findings. However, Jones, a clinical assistant professor of surgical oncology at City of Hope Cancer Center in Duarte, Calif., said that the extent of the excess risk of cancer death for those who smoked is sobering.

“Smoking causes damage to cells,” Jones said. “If you have a cell that’s already predisposed to becoming a cancer cell and it gets more DNA damage, it is more likely to become a cancer cell.”

Surgeons routinely tell patients to stop smoking, she said. “Before any surgery at all, we counsel patients to stop smoking,” Jones explained. “It decreases the blood supply to the tissues, and if you don’t have a good blood supply to the tissues, your tissues won’t heal.”

More information

To learn more about the harms of smoking and benefits of quitting, visit the U.S. National Cancer Institute.

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Move of the Week: Jumping Jack Reach

Ready to mix up your ab routine? The Jumping Jack Reach is a challenging (and fun!) move that uses a stability ball to really work your core. Health’s contributing fitness editor Kristin McGee demonstrates how to bounce your way to a sculpted stomach, and boost your energy level in the process.

RELATED: 4 Exercises to Lose Your Gut and Boost Your Butt

Here’s how to do it: Start by sitting with your feet together. As you bounce on the ball, hop your feet apart, then together, then apart again. Stand and reach your right hand over your head to the left.  Sit down, hop your feet together and repeat the sequence on the other side. Complete four reps on each side.

Trainer tip: When you stand, use the hand that isn’t reaching overhead to keep the ball steady behind you.

 

 

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Zika Virus Could Be Spread Through Sex, Cases Suggest

Photo: Getty Images

A small amount of evidence suggests the Zika virus, which has been linked to paralysis and brain damage in infants, could be transmitted by sex.

Despite only two such known cases being described in medical literature, some experts feel that federal authorities should inform all travelers, not just pregnant women, of the potential dangers, reports the New York Times.

The first case occurred when scientists found high levels of the Zika virus in the semen of an unidentified 44-year-old man from French Polynesia.

The second episode occurred in 2008 in Colorado, where a specialist in insect-borne diseases, Brian D. Foy, fell ill with symptoms typical of several mosquito-borne illnesses after a trip to Senegal. A few days following his return, his wife showed similar symptoms to him and their blood samples later tested positive for the Zika virus. Neither passed the disease to their kids or close family, so the couple realized it could have been sexually transmitted.

Foy later wrote about his experience in 2011 and has been trying to get funds to research the phenomenon.

Officials from Centers for Disease Control and Prevention (CDC), according to the Times, say evidence is insufficient to warrant a warning to all travelers as the two instances suggest a “theoretical risk” of sexual transmission.

This article originally appeared on Time.com.

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Some College Kids Spend a Fifth of Class Time on Digital Devices

By Alan Mozes
HealthDay Reporter

TUESDAY, Jan. 26, 2016 (HealthDay News) — College students spend one-fifth of their time in class using digital devices — such as smartphones — for non-educational purposes, new research reveals.

The main culprit is texting. Almost nine out of 10 reported that texting was their main digital diversion while in class. About three-quarters said they emailed or checked the time on their devices. Seventy percent reported checking in on social media (for example, Facebook), while 40 percent surfed the web. One in 10 spent time in class playing games on their devices.

“Most of us love technology,” said study author Barney McCoy, an associate professor in the College of Journalism and Mass Communications at the University of Nebraska-Lincoln. “And we want it to benefit us. But technology also affords a view that can be distracting.

“So the question now is, how do we balance this out?” he added. “How can we take in all the constructive dynamic benefits that this technology enables us to have, and then also be disciplined enough to recognize that there is a time and place to put it aside, and pay attention and stay focused?”

McCoy and his colleagues reported their findings in the January issue of the Journal of Media Education.

The researchers polled 675 students attending colleges and universities across 26 states during 2015. They polled undergraduate and graduate students majoring in mass communications, marketing, business, law, education and agriculture. About one-third were male and two-thirds were female. They ranged in age from 18 to 22.

Many (41 percent) said non-class-related digital use ate up between 1 percent and 10 percent of class time. One in five students said their digital devices consumed between 11 and 20 percent of class time, the survey found.

Most students — between 80 and 90 percent — acknowledged that such behavior might distract from studying. More than one-quarter said it threatened to diminish academic performance.

Yet, a majority argued against penalties for non-academic use in class, the survey found. Nearly one in three students said the practice had no negative impact on their studies.

Nearly three-quarters said their instructors already had some form of restrictive digital policy in place, but more than one-quarter said they should be able to use their devices at will. About one in 10 said they wouldn’t be able to stop even if they wanted to, the survey found.

Compared with a 2013 survey, the new poll shows a slight uptick in the regularity with which students are using their devices in class. For example, while just 30 percent said they checked their device a minimum of 10 times a day back in 2013, that figure rose to 33 percent by 2015, the study authors said.

In 2013, about 8 percent of students said they never used their devices for non-educational purposes in class. By 2015, that figure dropped to just 3 percent, according to the researchers.

Scott Campbell, an associate professor of communication studies at the University of Michigan, Ann Arbor, expressed little surprise at the findings.

“Young people turn to digital media as an immediate way to relieve boredom and, sadly, the classroom is one of the environments in which they most commonly experience boredom,” he said. “Also, young people feel naked when they are cut off from their peer networks.

“Expectations for being accessible to others, and for having access to digital content, are very high these days. We may not always be thinking about it consciously, but it’s there underneath the surface. The need to stay connected,” Campbell added.

As a result, he said, many people are “glued to their mobile and portable devices without even being fully aware of it. This helps explain why people use their digital media in problematic ways, such as during class or while driving, when they know it’s harmful,” he pointed out.

Still, Campbell cautioned that the study relied on self-reported recollection of digital use, which is not always reliable. And, the ultimate impact on academic performance is not entirely clear.

“I have seen studies that show lower grades as a result of digital distraction, and other studies where there is no significant effect on grades,” he said. The bottom-line will likely depend on a number of overlapping factors, such as the size and nature of the class, individual student differences, and exactly how the technology is used, he suggested.

More information

Read about how some teachers are using smartphones as tools from the National Education Association.

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