Thursday, July 30, 2009
Patients must be more involved in their care and treatment plan

By Dr. Anthony Policastro

Last week I introduced the term evidence based medicine as a key item to changing our health care system. The people that provide information on evidence based medicine have divided the evidence into five categories of recommendations. Level A status means that good scientific evidence suggests that the benefits of the treatment outweigh the risks. For example, we know that there are no proven effective treatments for the common cold. For that reason, trying to find a cure when you get a cold will not work. Level B status means that fair scientific evidence suggests that the benefits outweigh the risks. For example, there is evidence that antihistamines and decongestants might give some temporary relief of symptoms in adults with the common cold. Level C status means that fair scientific evidence suggests benefits but the risks are about as significant as the benefits. At one time we used antihistamines and decongestants for symptom relief in children. However, we found that many patients wound up getting overdosed on the medications. Now they are no longer recommended in children under age 6. They might still be as helpful as they are in adults, however, the risks in the younger age group dictate that they no longer be used. Level D status means that fair scientific evidence suggests that the risks outweigh the benefits. For example, antibiotics do not help the common cold. However, they do have side effects. Patients might have an allergic reaction to them. The use for viral infections like colds will eventually increase resistance of bacteria to them in the community. Level I status means that there is not enough scientific evidence to recommend such a treatment. There are a variety of common cold treatments that fall into this category. They include steam inhalation, Vitamin C, echinacea, zinc, Tylenol and ibuprofen for people who have no fever or muscle aches with their cold. Similar lists of treatments could be created for each medical problem that we treat. Focusing on using treatments that fall into the Level A category would provide several benefits. The first would be that we would eliminate some of the less necessary treatments. The second is decreased overall expenses in the system as we use less medication or other resources. The third is less side effects from the unnecessary treatments. The fourth is less mistakes because things are always done the same way. One of the things that patients need to be asking is what kind of evidence is there to support the treatment that they are receiving. They can go online and do a search. If they type in their illness and "evidence based medicine," the search should give them a list. For example, if you look at the evidence for treating ADHD, you will find a difference in terms of the evidence for the approaches. The various medications used to treat ADHD fall into the Level B category. However, if you look at the non-scientific evidence from people who are trying to sell their books on TV, you would get the impression that it is a Level D. That is not true. I frequently have parents come into my office convinced that what they are hearing elsewhere must be true. In addition, behavior modification falls into a Level D. At present time there is no evidence that it can help ADHD without the patient also being on medication. As a matter of fact, if patients with ADHD are not treated for it with medication, they do not pay attention to the behavior modification. As we move forward, patients need to be more involved in their care. They need to know what the evidence shows. As a nation this is one of the important steps for improving our health care system.

Dr. Concha joins Nanticoke Nanticoke Memorial Hospital welcomes Ronald Concha, MD to its active medical staff. Dr. Concha, specializing in gastroenterology and hepatology, is accepting new patients at his practice located at 701 Middleford Road, Suite 201, Seaford. Dr. Concha is board certified in Internal Medicine and graduated from the Universidad Nacional de San Marcos School of Medicine in Lima, Peru. He completed his Internal Medicine residency at the University of Miami/Jackson Memorial Hospital, Miami, Fla. and his Gastroenterology and Hepatology Fellowship at the State University of New York Downstate Medical Center in Brooklyn. His professional memberships include the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy. To reach his office, call 302-629-5193.

Dr. Cruz joins Nanticoke Nanticoke Memorial Hospital welcomes Janet Cruz, MD to its active medical staff. Dr. Cruz, specializing in nephrology, is accepting new patients at her practice located at 505 W. Market St., Suite 140, Georgetown. Dr. Cruz is board certified in internal medicine and nephrology and graduated from the University of the Philippines, College of Medicine. She completed her internal medicine residency at Johns Hopkins Hospital and Good Samaritan Hospital in Baltimore, Md. and her fellowship in nephrology at Johns Hopkins University/Johns Hopkins Bayview Medical Center. Her professional memberships include American College of Physicians, American Medical Association, American Society of Nephrology, National Kidney Foundation, and Renal Physicians Association. To reach her office, call 302-856-2360.

Health care info sessions Looking for opportunities with a great starting salary in the expanding health care field? Attend a free information session on Monday, Aug. 17 from 6 to 8 p.m. at Delaware Technical & Community College, Owens Campus. Discuss new and existing health career certificate programs at Delaware Tech including certified nursing assistant, polysomnography technician, medical coding and billing, medical transcriptionist, health information coding specialist, and health information clerk. For more information or to sign up for this info session, contact Delaware Tech's Corporate and Community Programs at 302-854-6966.

Nemours receives PEP grant Nemours Health and Prevention Services has been awarded a grant from the U.S. Department of Education to increase physical activity in Delaware schools. The highly competitive Carol M. White Physical Education Program (PEP) awarded grants totaling $26.5 million to public schools and other organizations in 25 states to initiate, expand, and improve physical education programs for students in grades K-12. The Nemours award is for $422,300 for the first year of a three-year grant, beginning with the 2009-10 school year. Nemours plans to promote 150 minutes per week of school-based physical activity for all elementary students in Delaware by providing a combination of materials and equipment, teacher training, and an online statewide resource network. In addition to traditional physical education, there are exemplary programs for promoting classroom-based and after-school physical activity, including CATCH, Take 10!, and Energizers. Nemours will be using grant funds to help expand the use of these programs statewide at the elementary level. The grant furthers a process begun by a partnership between Nemours, the Delaware Department of Education, and the state legislature to create the Physical Education Pilot Program and implement the FitnessGram as a means of assessing student physical fitness.

Occupational Health is moving On Monday, Aug. 17, Nanticoke Memorial Hospital's Occupational Health Services will be moving to a new location at 543 N. Shipley St., Suite F in Seaford. The new location is dedicated to only Occupational Health clients. From treatment for work-related injuries and illnesses, DOT screenings, post incident testing, pre-employment physical examinations, to drug testing, Nanticoke's Occupational Health Services has been operating for over 20 years. For more information, contact Occupational Health Services at 302-629-6875.

Pharmacy Tech information session Enter the rapidly expanding field of health care with the pharmacy technician certificate training program at Delaware Technical & Community College, Owens Campus. Pharmacy technicians help pharmacists package or mix prescriptions, maintain client records, refer clients to the pharmacist for counseling, assist with inventory control and purchasing, as well as payment collection and billing coordination. A free information session about the program will be held on Thursday, Aug. 20 from 6 to 8 p.m. The 189-hour classroom course will be held at Delaware Tech on Monday and Wednesday evenings, 6 to 9 p.m., from Sept. 21 to April 19. A 120-hour externship is also necessary to complete the program. Graduates will receive a certificate of completion and be prepared to take the Pharmacy Technician Certification Board (PTCB) exam to become a nationally certified pharmacy technician. Funding through the Department of Labor and a payment plan through Delaware Tech's Corporate and Community Programs are available for this course. For more information, contact Corporate & Community Programs at 302-854-6966.

Safe Sitter Class offered Nanticoke Memorial Hospital is offering a Safe Sitter class for girls and boys ages 11 to 13. The 2-day course will be held from 9 a.m. to 4 p.m., Aug. 4 & 6. The Safe Sitter program is a medically accurate instructional series that teaches youngsters how to handle emergencies when caring for younger children. The cost is $50. Participants are to bring a bagged lunch. To register your son or daughter or your child's babysitter, call 629-6611, ext. 2540. To register or for more information about Safe Sitter, contact Nanticoke Memorial Hospital at 629-6611, ext. 2540.

Stroke Support group to meet Nanticoke Memorial Hospital's next Stroke Support Group meeting is Thursday, Aug. 20 at 1:30 p.m. at Nanticoke Memorial's 2nd Floor Cancer Care Center Conference Room. The support group is designed for individuals who have survived a stroke as well as their families and caregivers. The two-hour support group meetings will consist of guest speakers and breakaway sessions, in which caregivers and stroke survivors will meet in two groups to discuss concerns, provide support and allow for networking. Refreshments will be provided. Pre-registration is not required for this free support group. For more information, contact Nanticoke Memorial Hospital at 302-629-6611, ext. 8626.

Grant to address underage drug use RAMP UP - DE (Reducing Alcohol, Marijuana, and Prescription Use through Prevention in Delaware), will focus on key problems of underage drinking, marijuana use, and prescription drug misuse across the lifespan. The program is made possible through a Strategic Prevention Framework - State Incentive Grant (SPF-SIG) from the Substance Abuse & Mental Health Services Administration of the U.S. Department of Health & Human Services. Delaware will receive $10,678,000 over the next five years for the project. The 1st State Prevention Coalition, a statewide entity formed with a previous SIG, will expand to become the Delaware Advisory Council (DAC) to direct RAMP UP - DE. Efforts will focus on mobilizing and building community capacity to determine local needs, readiness and means to change with cultural sensitivity integral in all phases. Using local data and community readiness indicators, coalitions will create community-level strategic plans aligned with the statewide strategic plan, but focused on specific community needs and resources. Services will be statewide with universal programs reaching over 50,000 people a year.

DHSS issues infection report In its first report, Delaware Health and Social Services' Division of Public Health issued data for central line associated blood stream infections for Delaware's eight critical care hospitals. An estimated 248,000 bloodstream infections occur in U.S. hospitals each year. A large proportion of these infections are attributed to a central line, which is a tube in the chest that returns blood to the heart. Bloodstream infections are usually serious infections typically causing a prolonged hospital stay, increased cost and risk of death. Delaware's Hospital Infections Disclosure Act of 2007 (Title 16 Chapter 10A) requires hospitals to report healthcare-acquired infections to the Department of Health and Social Services (DHSS) by using the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN). NHSN is an Internet-based surveillance system that collects data from U.S. healthcare facilities. As required by law, the following eight Delaware hospitals were enrolled in the NHSN system in 2008 (Veterans Administration Hospitals are not subject to state law) - AI duPont Hospital for Children, BayHealth Medical Center - Kent General Hospital, BayHealth Medical Center - Milford Memorial Hospital, Beebe Medical Center, Christiana Care Health System - Christiana Hospital, Christiana Care Health System - Wilmington Hospital, Nanticoke Memorial Hospital and Saint Francis Hospital. The eight hospitals collectively reported 32 central line associated blood stream infections (CLABSI) in 2008. In one of the eight hospitals, the CLABSI rate was statistically lower than the NHSN rate; six were not statistically different than the NHSN rate; and one was statistically higher. A second measure was evaluated, called a central line utilization ratio. This measure allows hospitals to determine if the use of central lines in their ICU setting is greater than, less than or equal the NHSN benchmark usage numbers for like units. Two hospitals had central line utilization ratios that were statistically lower than the NHSN rate and six had rates that were statistically higher. The law also requires the Department of Correction to report all cases of healthcare associated infections. No cases were reported.

CHEER hosts free workshop Many adults face the challenge of managing one - and often several - chronic medical conditions, such as high blood pressure, heart disease, arthritis, diabetes, hearing problems and depression. The Chronic Disease Self Management Program (CDSMP), developed at Stanford University, has proven extremely effective at enabling people to take more control of their own health. This program can give adults a sense of control over their lives, improve their day-to-day functioning, and help save on medical bills. This program will begin at the CHEER Community Center on Wednesday, Aug. 5 and it ends Wednesday, Sept. 9. The program consists of 6 - 2 hour workshops which will be held from 1 to 3:30 p.m. Registration is required. For more information and to register, call Cindy Mitchell at 302-856-5187.

Depression Support Group There will be a free bimonthly Depression Support Group meeting in Laurel on the second and fourth Wednesday evenings from 7 to 8:30 p.m. Any person who has signs and symptoms of depression and is under the care of a professional counselor/MD is welcome to attend. To register, call Life Matters Counseling and Consulting at 302-465-6612.