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Study Aim: Invest $$ in Preventing Falls, Save on Ambulance, ER

January 14th, 2014, 6:29 AM
Roberta Marks
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A new clinical trial in Australia has the double-pronged goal of conserving resources by cutting down automatic ambulance transport of elders who’ve had a fall but don’t appear to need an ER visit, and reducing the risks of further falls by sending a physiotherapist to the faller’s home for appropriate follow-up.

Fallers, ambulances, and ER departments have a knotty relationship. Some fallers automatically taken to the ER are found  to have incurred no physical disability from the fall and really didn’t need the visit; while some fallers who refuse the ride…

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New Childhood Obesity Program Goes Into the Home and Onto the Sports Field

January 8th, 2014, 2:00 PM
Roberta Marks
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A full-scale undertaking to reduce the body mass index of overweight and obese children is under way at four research centers in the U.S. One such center, in California, has reported its program in detail, so that’s the one we’ll focus on. The three-year multifaceted program, being rolled out by Stanford, is enrolling 240 boys and girls between the ages of 7 and 11, primarily from low-income Latino communities.

The program has three major components. One is a home-based intervention to alter the environment as well as the type and amount…

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Presurgical Home Exercise Benefits Lung Cancer Patients

December 16th, 2013, 3:11 PM
Roberta Marks
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A small, nonrandomized, feasibility study has found that patients awaiting surgery for lung cancer can increase their exercise tolerance and muscle strength through a short period of home exercise.

The first reaction might be: if you’ve got lung cancer, why worry about your exercise tolerance? But it matters. Previous research has shown that poor conditioning is a predictor of postsurgery complications. So, while the few weeks before surgery may be crowded with medical appointments and other last-minute tasks, there is a beneficial payoff if patients are motivated to stick with the…

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Medicare Coverage of Exercise Rehab for CHF in the Works

December 3rd, 2013, 8:50 AM
Roberta Marks
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The Centers for Medicare and Medicaid Services (CMS) is proposing Medicare coverage of rehabilitative exercise for certain patients with chronic heart failure.

This would be an expansion of the cardiovascular rehab rule, which presently covers patients who have had a heart attack within the last year; those who’ve had bypass surgery, heart valve repair or replacement, or heart or heart-lung transplant; those with stable angina; and patients who’ve undergone coronary angioplasty or stenting.

The agency is basing its decision on the HF-ACTION trial, published in 2009, and certain other clinical studies that…

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Self-Monitoring Diabetics a Little Casual About Target Glucose Levels

November 21st, 2013, 6:00 AM
Roberta Marks
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Some diabetics who monitor themselves at home are unfazed by blood glucose readings that are higher than international guidelines, according to researchers in Scotland who studied 207 patients with non-insulin-treated type 2 diabetes. This may be why some clinical trials have not shown a benefit for self-monitoring, the team observes.

When asked what glucose levels they were happy with, a bit more than half the patients called themselves content with readings between 5 and 7 mmol/l (90 to 126 mg/dl). This fits with joint U.S. and European guidelines, which consider the…

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Home Health Nurses Given Full Discharge Orders; Readmissions Drop

November 14th, 2013, 6:30 AM
Roberta Marks
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In a collaborative pilot program, standardization of hospital discharge orders, which greatly improved communication between hospital providers and a home health agency, has shown promise of reducing readmission of heart failure patients within 30 days of discharge.

Only one of nine heart failure patients enrolled according to the new program was readmitted within 30 days—a man who was eligible (under Government insurance) for care and concomitant telemonitoring by a home health  agency but declined to participate. Whether his remaining in the project would have prevented readmission is unknown.

Although the hospital, one…

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Caregivers Suffer When Ill Family Members Promised Home Death Die Elsewhere

November 6th, 2013, 10:30 AM
Roberta Marks
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Family caregivers (FCGs) who make unconditional promises of a home death to a dying relative and then fail to keep that promise are shattered by grief and guilt, a new study emphasizes. Those negative feelings can persist for years, the report finds.

The study was carried out in Canada, where availability of end-of-life care differs according to the geographical province, and professional care is typically delivered in the hospital or in a free-standing hospice, not the home. But grief at not fulfilling a loved-one’s last wishes is a universal constant, and…

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Smartphone Tracks Bipolar Patients, Looks for Early Signs of Trouble

October 24th, 2013, 8:00 AM
Roberta Marks
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Can daily home self-monitoring with a smartphone ‘catch’ bipolar individuals before they slide into a life-altering depressive or manic episode? That question is being investigated in the ongoing randomized, single-blind MONARCA trial, said to be the first to determine whether electronic monitoring at home can influence the outcome of a mental illness.

In this self-monitoring process, bipolar patients recruited from an affective-disorders clinic used the phone every evening to enter numerical values describing such important prognosticators as that day’s mood, number of hours slept the previous night, activity, irritability, cognitive function,…

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Home-Exercise Regimen Targets the Underserved with HIV/AIDS

October 18th, 2013, 8:00 AM
Roberta Marks
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A pilot clinical trial is examining the feasibility and benefits of a home-based exercise program for those with HIV/AIDS.  The nine-month-long program is designed to boost physical activity and thus reduce the risks of associated disorders. Thanks to advanced antiviral regimens, people with HIV/AIDS are living longer—but they are subject to metabolic side effects of their life-extending drug therapy, and they are at greater risk generally for cardiovascular disorders.

The trial, which employs a variant of an existing exercise program known as Active Choices, is home-based in order to reduce the…

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Telemonitoring of the Oldest Old: No Need to Teach Fancy Tech Skills

October 15th, 2013, 8:29 AM
Roberta Marks
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Computers or smartphones aren’t required for monitoring of the elderly at home, a Swedish research team reports.  All you really need is digital pens.

In a pilot trial of home-care patients with moderate to severe heart failure, patients used the pens and a diary to enter daily medication use, any shortness of breath, and weight. A few patients also tracked blood pressure and oxygen saturation. This allowed the research team to catch any deterioration before it became serious enough to require hospitalization—the most expensive part of heart failure treatment.

The trial was…

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