The Texas Hospital Association has been selected to participate in a landmark project to dramatically reduce or eliminate central line-associated bloodstream infections (CLABSI) in hospital intensive care units. A central line is a catheter that is placed into a patient’s vein to administer frequent medications or fluids, or to draw blood. The line may stay in place for days or even weeks.

The project is a three-year initiative of the Health Research & Educational Trust (HRET) of the American Hospital Association, in partnership with the Johns Hopkins University Quality and Safety Research Group and the Michigan Health & Hospital Association’s Keystone Center for Patient Safety & Quality (Keystone Center). The project is funded by the Agency for Healthcare Research and Quality, part of U.S. Department of Health & Human Services.

An estimated 250,000 CLABSIs occur in hospitals each year, and as many as 62,000 patients who get these infections die as a result, according to the Centers for Disease Control and Prevention. “On the CUSP: Stop BSI” is a project designed to replicate the success of an earlier project undertaken in Michigan hospitals by the Keystone Center and the Johns Hopkins University, in which the Comprehensive Unit-based Safety Program (CUSP) was implemented in more than 100 intensive care units to successfully reduce or eliminate bloodstream infections.

“Participating in this project will provide hospitals with support to implement a program that has been proven to reduce central-line associated bloodstream infections,” said Dan Stultz, M.D., FACP, FACHE, president and chief executive officer. “We welcome the opportunity to partner with other organizations to spread adoption of this evidence-based program.” THA will invite at least 10 hospitals to participate voluntarily in the project. However, educational programs and best practices will be available to hospitals statewide.

In the coming months, THA will work with member hospitals and partnering organizations to create a new model for spreading innovation and making health care safer for Texas patients and families. “Texas hospitals put patient safety first, and renewed emphasis now is being placed on reducing the number of health care-associated infections,” noted Stultz. “While hospitals have proven processes and protocols in place, ongoing adherence to them – as well as monitoring outcomes – is critical to protecting patients from preventable hospital-acquired infections.”

A major goal of the nationwide program is to reduce the average rate of CLABSI in participating hospitals from the national average of 5 infections per 1,000 catheter days to one infection for every 1,000 catheter days. The project also aims to improve the patient safety culture by 50 percent, as measured by the AHRQ Hospital Survey on Patient Safety Culture. Another goal of the project is to build state-level capacity to encourage adoption of innovative, evidence-based practices to improve quality and safety. The project is convening state-level consortia consisting of state hospital associations, quality improvement organizations, patient safety organizations and other stakeholders.

The Texas Hospital Association is one of 10 groups selected to participate in this national initiative. Groups from California, Colorado, Florida, Massachusetts, Nebraska, North Carolina, Ohio, Pennsylvania and Washington also will participate.

“This project has enormous potential to eliminate bloodstream infections that clinicians used to believe were inevitable,” said John R. Combes, M.D., senior fellow at HRET and principal investigator of the AHRQ-funded project. “We are enthusiastic about working with these state associations and their partners to build an infrastructure that will support the widespread dissemination and adoption of this and other patient safety innovations.”

The project, formally called the “National Implementation of the Comprehensive Unit-Based Safety Program (CUSP) to reduce Central-Line Associated Blood Stream Infections (CLABSI) in the ICU,” began Sept. 30, 2008, and continues through Sept. 29, 2011. Peter J. Pronovost, M.D., Ph.D., of the Johns Hopkins University Quality and Safety Research Group, is the co-principal investigator.

HRET and its partners at the Johns Hopkins University and MHA will work with the above organizations to select at least 10 participating hospitals from each state. In addition, they will develop an educational toolkit and other resources to encourage adoption of the CUSP and specific, evidence-based steps hospitals can take to reduce CLABSI in ICUs.

For more information on the HRET project, visit http://www.hret.org/hret/programs/cusp.html.


Unlike Electroconvulsive Therapy (ECT), NeuroStar TMS Therapy Is Not Associated With Memory Loss

New data presented at the American Psychiatric Association’s annual meeting in San Francisco demonstrated that NeuroStar(R) Transcranial Magnetic Stimulation (TMS) Therapy improved key areas of cognition in patients whose depression improved with NeuroStar treatment. Cognition is defined as the process of thought, and includes memory and the ability to think, concentrate, and make decisions. NeuroStar TMS produced significant improvements on both overall cognitive function and short-term verbal memory. These positive cognitive effects could not be fully accounted for by the improvement in mood alone.

Diminished ability to think, concentrate, and make decisions is a core symptom of depression. This is often further worsened by some common depression treatments, such as some classes of medications. Most notably, electroconvulsive therapy (ECT), while extremely effective, has high rates of cognitive impairment and long-term or even permanent memory loss.

“In this study, NeuroStar TMS Therapy demonstrated no negative effect on cognition, and evidence suggests that it may even improve certain cognitive functions in depressed patients,” said psychiatrist Phil Janicak, M.D., Professor of Psychiatry at Rush University-Chicago and a principal investigator of the trial. “Many patients, by virtue of their depression, already have diminished cognitive functioning. Receiving an effective treatment like TMS, which appears to have no adverse cognitive effects, may benefit millions of people who require alternate treatment options,” Janicak added.

About the Study

Cognitive function was examined in a multi-site, randomized controlled trial of NeuroStar TMS Therapy in patients with pharmacoresistant major depressive disorder (N=155 active TMS, N=146 sham TMS). Specific measures of global cognition (Mini Mental Status Examination), short-term (Buschke Selective Reminding Test) and long-term memory (Autobiographical Memory Interview-Short Form) were obtained prior to first treatment, and at four and six weeks during an acute treatment course of daily TMS. The results showed no significant difference between active TMS and placebo TMS treatment conditions on any of these measures of cognitive function, which indicates that NeuroStar TMS Therapy had no negative effect on cognition.

Additionally, each treatment group was stratified by clinical outcome (HAMD24 responder) at the end of six weeks. Within the TMS group only, there was a statistically significant improvement on the Buschke Selective Reminding Test in the TMS responders compared to TMS non-responders for both short-term recall (P = 0.0116 at four weeks; P = 0.0038 at six weeks) and delayed recall (P = 0.0463 at four weeks; P = 0.0012 at six weeks). This improvement in cognitive function was not seen in placebo-treated patients.

“We believe that the reason for the lack of negative cognitive effects with NeuroStar TMS Therapy is likely due to the focused stimulation of a key brain region, rather than the whole brain effects of both medications and ECT,” said Mark A. Demitrack, MD, Chief Medical Officer for Neuronetics Inc., a psychiatrist, and the study’s lead author. “The fact that NeuroStar caused no negative effects on cognition, and appeared to improve some measures of cognition in some patients, is a testament to the safety of this new non-systemic and non-invasive treatment option.”

NeuroStar TMS Therapy(R) was cleared by the FDA in October 2008 for patients who have not adequately benefited from prior antidepressant medication.* NeuroStar TMS Therapy is a non-systemic (does not circulate in the bloodstream throughout the body) and non-invasive (does not involve surgery) form of neuromodulation. It stimulates nerve cells in an area of the brain that is linked to depression, by delivering highly focused MRI-strength magnetic field pulses. The treatment is typically administered daily for 4-6 weeks. In an open-label clinical trial, which is most like real world clinical practice, approximately 1 in 2 patients experienced significant improvement in symptoms, and 1 in 3 experienced complete symptom resolution. There were no systemic side effects, such as weight gain and sexual dysfunction. The most common adverse events related to treatment were scalp pain or discomfort at the treatment area during active treatments. NeuroStar TMS Therapy may not be effective for all patients with depression.

Availability of NeuroStar TMS Therapy

Treatment with NeuroStar TMS Therapy is now available at over 50 treatment centers in 21 states. For specific information on treatment locations with NeuroStar TMS Therapy, please visit www.NeuroStarTMS.com or call the Neuronetics Customer Service Center at (877) 600-7555.

Neuronetics, Inc. is a privately-held medical device company focused on developing non-invasive therapies for psychiatric and neurological disorders using MRI-strength magnetic field pulses. Based in Malvern, PA, Neuronetics is the leader in the development of TMS Therapy, a non-invasive form of neuromodulation. For more information, please visit www.neuronetics.com.

Depression affects at least 14 million American adults each year. Researchers estimate that by the year 2020, depression will be the second leading cause of disability worldwide. Each year, over 30,000 people in the US commit suicide, 60% of which suffer from depression. The economic burden of depression in 2000 was estimated at $83.1 billion in the US. Women are almost twice as likely as men to suffer from depression. However, some experts feel that depression in men is under-reported. Depression has no racial, ethnic, or socioeconomic boundaries. About two-thirds of those who experience an episode of depression will have at least one other episode in their lives. Despite major advances in treating this debilitating illness, nearly 30% of patients with depression do not benefit from or are intolerant of antidepressant therapy.

* NeuroStar TMS Therapy(R) is indicated for the treatment of Major Depressive Disorder in adult patients who have failed to achieve satisfactory improvement from one prior antidepressant medication at or above the minimal effective dose and duration in the current episode.

Source: Neuronetics, Inc.


LTC Expert Denise Gott Says Health Reform Risks Failure Without Long Term Care Provisions

President Obama, backed by Congressional leaders, has called for affordable, accessible, high-quality health care for all Americans. “But that won’t be enough,” says Denise Gott, “unless it also embraces the long term care needs of millions of longer-living Americans.” Gott is Chairman of the Board of LTC Financial Partners LLC (LTCFP)  one of the nation’s most experienced long term care insurance agencies.

“If President Obama’s three goals — universal coverage, choice, and cost control — are to be met,” Gott says, “provision for long term care must be part of the legislative mix.” Obama’s goals, in his own words, are listed below, followed by Gott’s reasoning.

1. Obama: “All Americans have to have quality, affordable healthcare.”

Gott’s response: “About 46 million Americans, close to 1 in 6, lack health insurance, but many times that number lack long term care insurance. Only about 9 million Americans have it — out of a population of more than 300 million. And among those at greatest risk, 45 and older, more than 9 in 10 go uncovered. Does it make sense to protect ourselves from shorter-term illnesses or injuries, and neglect the longer-lasting ones?”

2. Obama: “Americans have to be able to choose their own doctor and their own plan.”

Gott’s response: “It’s great for people to have options. For example, to stick with their employer’s health plan, or opt for a public alternative (if one is legislated). But when it comes to long term care, choice today is very limited. The majority who lack LTC insurance face a bleak, narrow prospect. They must spend down their assets to pay their bills; to qualify for public assistance through Medicaid, they must in effect become poor; and then they’re forced into an often overcrowded nursing home when they might prefer home care or assisted living.”

3. Obama: “The rising cost of healthcare has to be brought down.”

Gott’s response: “The government estimates that healthcare could consume one fifth of the economy in ten years, up from one sixth today. Clearly that huge drag needs to be moderated. But reflect on this: 77 million Baby Boomers are set to retire, contributing predictable long term care costs of hundreds of billions to trillions over the next two or three decades. Shouldn’t we moderate these costs too?”

Gott’s recommendations to the President and Congress:

  • First, include strong long term care provisions in the legislative package you’re now crafting. LTC is the unseen elephant in the room.
  • Offer substantial new tax incentives to help people afford long term care insurance as a part of their overall health package.
  • Offer substantial new tax incentives to companies that include long term care options in their health benefit plans.
  • For people who can’t afford long term care premiums, modify Medicaid to allow a choice of home care or assisted living in addition to nursing-home care.
  • Avoid creating a new form of public insurance covering long term care. Instead, reform Medicaid to serve the same purpose in an affordable manner.
  • Avoid forcing people to buy long term care insurance. Instead, rely on communication and persuasion. For example, add a tax-deduction checkbox to the Federal income tax return; or create a well-publicized Internet gateway to independent long term care insurance advisors.
  • To control costs, rely heavily on prevention in the long term care arena, just as for shorter-term health needs. A great many adult-onset diseases, ranging from diabetes to Alzheimer’s, may be avoided or minimized through proper diet, exercise, and stress control. Consider incentives for individuals, insurers, and employers who promote good health later and later in life, with shorter periods of down time.

“Now’s the time to make your views known to the White House, your Senators, and Congressional representatives,” says Gott. A simple way to do that is to submit a form or dial a phone number found at — http://www.usa.gov/Contact/Elected.shtml. Gott also encourages citizens to write their favorite TV show to suggest a segment on LTC. “When something gets on Oprah, Good Morning America, The View, or 60 Minutes,” she says, “Washington listens.”

Source: LTC Financial Partners LLC


Minnesota Passes Legislation Allowing Mid-level Oral Health Provider

  • Author: Health Informer
  • Filed under: Health News
  • Date: May 19,2009

History was made on May 13, 2009, as Minnesota became the first state to pass legislation allowing a “mid-level” oral health provider into state statute – enabling students who are educated under the Advanced Dental Hygiene Practitioner (ADHP) model to become licensed to practice. The Minnesota state House and Senate overwhelmingly passed Senate File 2083, a bill establishing the Dental Therapist and Advanced Dental Therapist providers in the state. Minnesota Governor Tim Pawlenty signed the bill into law on May 16.

The new providers will focus their practice on care for underserved populations in the state and will administer educational, preventive, palliative, therapeutic, and restorative services. The bill is supported by the Minnesota Safety Net Coalition, which has taken the lead in advocating for a new provider. Proponents of the OHP, including the Minnesota Dental Hygienists’ Association, have also lent support to the effort. The Minnesota Dental Association is not opposed to the legislation.

The Dental Therapist/Advanced Dental Therapist provider language was the culmination of nearly two years of work spearheaded by Minnesota State Senator Ann Lynch who first brought legislation to establish a new oral health provider forward in 2008. Senator Lynch along with Representative Cy Thao in the House were integral in both supporting legislation for the new providers and forging a compromise among the various stakeholders.

American Dental Hygienists’ Association President Diann Bomkamp, RDH, BSDH noted, “The leadership demonstrated by Senator Lynch, Representative Thao and their colleagues who worked closely on this effort is to be commended. Forging consensus on workforce issues is never easy but Minnesota is a demonstration to others throughout the country that solutions can be developed and implemented.”

As previously mentioned, the legislation paves the way for the first students in the country who are educated under the Advanced Dental Hygiene Practitioner model to become licensed and enter the workforce. Minnesota licensed dental hygienists who have met admission requirements are entering the Masters program offered by Metropolitan State University in St. Paul, Minnesota. These students will obtain the competencies needed to practice as Advanced Dental Therapists in the state.

Interim Dean of Health Sciences of Normandale Community College and Co-Chair of Metropolitan State University Dental Hygiene Program Colleen Brickle, RDH, EdD, noted, “We are proud that our efforts in Minnesota will be part of an access solution and pave the way for meeting the needs of underserved in other states.”

ADHA developed the AHDP provider model beginning in 2004 and finalized ADHP Competencies in 2008. Providers educated under the ADHP model build on their dental hygiene skill set by learning additional clinical skills and will also become competent in skills necessary to navigate the complex health care system, advocate for patients, and effectively manage a clinic or practice. The providers will focus on providing care to underserved patient populations.

President Bomkamp commended the efforts in the state, remarking, “The passage of the legislation in Minnesota is truly historic. The underserved in Minnesota who have long struggled to obtain dental care that is so vital to their overall health will now have a new provider to seek care from and a new way to enter into the health care system.”

For additional information about the effort in Minnesota, please see the following links:

  • History of the midlevel effort
  • Full text of Senate File 2083
  • Metro State/Normandale ADT Program
  • ADHP Competencies
  • University of Minnesota’s School of Dentistry Dental Therapy Program
  • Minnesota Public Radio Story
  • Minnesota Dental Hygienists’ Association

ADHA is the largest national organization representing the professional interests of more than 150,000 dental hygienists across the country. Dental hygienists are preventive oral health professionals, licensed in dental hygiene, who provide educational, clinical and therapeutic services that support total health through the promotion of optimal oral health. For more information about ADHA, dental hygiene or the link between oral health and general health, visit ADHA at http://www.adha.org/.

Source: American Dental Hygienists’ Association


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