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AARON SIRI GIVES TESTIMONY ON THE FLOOR OF ARIZONA STATE SENATE https://thehighwire.com/ark-videos/aaron-siri-gives-testimony-on-the-floor-of-arizona-state-senate/ FDA working in support of pharma - no testing of vaccines with circular "approval."
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by Rose Rohloff The current fulminated issues of "hospital kidnapping", and denying Rights of parents has existed for decades. Now health systems are using Department of Children Family Services (DCFS) to enforce. The following are true, documented cases of families, spanning decades, fighting hospitals for the health of their children. In the Mid 1990s, a child was hospitalized in a Children's Hospital. "We had to fight the school system and the local Children's Hospital over coding of 'diagnosis' and school placement for our son: The only time we had to get a lawyer to fight against injustice. Our doctor said the underlying respiratory problem was allergy based, but the school system refused to place him in an environmentally safe school, with the local school having known poor air quality problems - a teacher was already being treated for recurring respiratory illness in the same classroom our child attended. We won. The doctor we trusted successfully identified our child's diagnosis and helped champion against the hospital. The hospital then sent us to a collection agency for refusal to pay for gross billing error. When I called the collection agency and told them what we had already paid, they said we had overpaid. They told us to ask for an audit of the account and the result was that the hospital refunded us the money. When we requested in writing a copy of the whole medical record, the hospital sent without our name on it, and the postal service opened it. The hospital took a long time to respond to our complaint."
Another family with twins experienced an issue with the same hospital. "One twin was diagnosed with a malignant tumor at the base of her spine at about age three. The hospital did surgery. Everything looked good after that. Then, after recovering, the hospital insisted to do a series of chemo. After much prayer by the parents and our entire community, the parents discerned no, and had to fight the hospital. The parents won and the child grew up cancer free and graduated from high school without any further cancer." In 2022, another case happened in a different state (as this is a national issue with health system conglomerations.) A young mother had a two year old child diagnosed with cancer. The latest lab came back White Blood Cell (WBC) of 2.8 (normal 4.5 to 11.0 × 109/L). The mother refused continued chemo treatment which would further drop her son's count. The child was not in protective isolation to add a layer of protection against being given an infection in the hospital. The hospital administrators called DCFS threatening her, along with her new six month old baby at home. This mother had to fight for proper care against open malpractice (if not manslaughter) of her child, with the hospital holding against the mother's will (medical kidnapping) with blatant coercion, threats and intimidation. With the correct second opinion and having to hire advocates, she was able to stop the care.
within the facility, violating the Right to leave against medical advice (AMA); and above all, hoping they do not die before a court ruling can be made. Health systems have been providing admission forms upon entry in many cases, while people are under duress, to have them sign digitally without the time to review and understand "the fine print", when being handed an iPad or touch screen for the electronic record. Sadly, all persons, parents, family members need to stop and take the time to read the full admission forms, red line out and initial any portions they do not agree with, to exercise their legal Right of informed consent, Right to Try, for avoidance of any and all illegal coercion or undue influence by nurses, social workers, clinicians and administrators.
 by Rose Rohloff
"The use of cardiovascular medications can have a variety of neuropsychiatric consequences." Therefore, the following highlights are good review for anyone prescribed a CV drug, especially for the elderly, those with other conditions such as liver or kidney insufficiency, and/or also being prescribed psychiatric medications. Angiotensin-converting enzyme inhibitors"Bottom line: ACE inhibitors and angiotensin II receptor antagonists are associated with low rates of neuropsychiatrie side effects, though mood symptoms, psychosis, and delirium have been reported." Beta-adrenergic blocking agents or Beta (β)-Blockers"Bottom line: β-Blockers as a class are not clearly associated with depression; there is the most evidence for a propranolol-depression link, but even this relationship is equivocal. In contrast, β-blockers are associated with increased rates of fatigue." Calcium channel blockers (CCBs)"Bottom line: CCBs may be associated with fatigue in some patients, but otherwise cause few neuropsychiatrie symptoms." Diuretics"Bottom line: Diuretics most often cause neuropsychiatrie symptoms indirectly, through electrolyte abnormalities (thiazides) or vitamin deficiencies (loop diuretics). Acetazolamide is associated with fatigue and with delirium in renal failure." Doctors should always monitor electrolyte levels (sodium/Na and potassium/K+) of their patients taking diuretics. Centrally acting agents - Antiadrenergic agent"Bottom line: Clonidine is consistently associated with fatigue and sedation; delirium is infrequently associated with its use. (Clonidine) is also commonly used to reduce symptoms of opiate withdrawal. Bottom line: Methyldopa is clearly associated with fatigue and sedation. In contrast to early studies linking methyldopa with depression, later reviews and studies have found this association to be relatively weak. Other neuropsychiatrie symptoms are uncommon. Bottom line: Reserpine is associated with both sedation and daytime fatigue. Incidence of depression may be elevated among patients taking reserpine. However, other (generally more recent) reports question this association." α-Adrenergic agents"Bottom line: Fatigue is the most common neuropsychiatrie side effect associated with -adrenergic antagonists; other neuropsychiatrie side effects are infrequent." Vasodialtors"Bottom line: Vasodilators are generally associated with low rates of neuropsychiatrie consequences. Hydralazine is a leading cause of drug-induced lupus, but this syndrome affects the central nervous system much less commonly than the idiopathic form of the disorder." Antiarrhythmic medications"Bottom line: Most Class I Antiarrthymic agents have been associated with psychosis and delirium in case reports. The syndrome of cinchonism associated with quinidine may include sensory changes along with delirium, and procainamide is a cause of drug-induced lupus. Bottom line: Class III Amiodarone is associated with thyroid abnormalities in 15% of patients, and untreated thyroid dysregulation can lead to a variety of mood, cognitive, and psychotic symptoms. In contrast, direct neuropsychiatrie effects of amiodarone are uncommon. Bottom line: Digoxin is associated with delirium and other cognitive effects, especially in toxicity. Visual changes and hallucinations may also occur with digoxin use, even at normal serum levels." Conclusion by Author"... numerous cardiovascular medications can have neuropsychiatrie side effects, ranging from mood symptoms to cognitive effects to psychosis, and though a given agent may not consistently cause neuropsychiatrie symptoms in the general population, idiosyncratic reactions are possible." More specific studies are needed for, "clinicians ... to make fully-informed prescribing decisions for their patients." Patients and their families know the cognitive baseline of individuals being prescribed medications, and therefore, should always monitor for any neuropsych impact seen if CV drugs are used, on an individual basis for what is safe per person. Any and all side effects should be know, along with contradictions to other drugs, for all medication being taken. * Dr Huffman is a professor of psychiatry at Harvard Medical School and the director of the Cardiac Psychiatry Research Program in the Massachusetts General Hospital (MGH) Division of Psychiatry and Medicine. He also serves as the associate chief for clinical services in the Department of Psychiatry at MGH.
What should you be aware of regarding Vancomycin?by Rose Rohloff
proliferation of the intestines (often after antibiotic use); and some hospitals are using as the standard protocol for elderly in the emergency room, for asymptomatic pneumonia, and other infections. Clinicians (nurses, doctors, physician assistants, etc.) are supposed to do comprehensive history and physicals (H&Ps) before using any drugs or treatments. And, it is important to know underlying conditions before using Vanco, because it can raise glucose levels, especially in diabetics, and/or cause kidney (renal) insufficiency, especially in elderly. The following use case is regarding an admitted primary care doctor as the patient. "I don't know what the average "lay person" does when they don't have all this information, and without a medical person to look out for them." "This article is exactly why they stopped Vanco when he had his MRSA infection. His kidneys were starting to get compromised, so they immediately stopped it and started him on a different antibiotic, Daptomycin, which worked just as well and had less side effects for his kidneys and diabetes. Thankfully they caught it very early because of the blood tests they were doing to see what was happening. The new antibiotic was infused only once a day as opposed to twice a day Vanco, and there weren't all the extra blood draws to make sure the kidneys and glucose were doing okay. God is really in control and watching out for us, because the medical field doesn't always do that, even with a fellow medical person." Vanco and high glucose/hyperglycemia
Vanco and kidney (renal) failureChanges in vancomycin use in renal failure Stefaan J Vandecasteele 1, An S De Vriese pub in 2010 Abstract A progressive increase in vancomycin resistance with consequent treatment failure has been observed in staphylococci. Therefore, new dosing guidelines advocating much higher vancomycin doses have been issued. Target trough levels of 15-20 microg/ml are proposed. Whether and how these targets can be achieved in patients with chronic kidney disease or those on dialysis are still under evaluation. The higher vancomycin doses to achieve these treatment targets carry a substantial risk for nephrotoxicity. This risk is incremental with higher trough levels and longer duration of vancomycin use. Critically ill patients, patients receiving concomitant nephrotoxic agents, and patients with already compromised renal function are particularly at risk for vancomycin-induced nephrotoxicity. Acute kidney injury during daptomycin versus vancomycin treatment in cardiovascular critically illConclusions: Daptomycin appears to be safer than vancomycin in terms of AKI risk in ICU patients treated for cardiovascular procedure-related infection. Daptomycin could be considered as a first line treatment to prevent AKI in high-risk patients. NIH 2019 by Rose Rohloff On July 12, 1974, the National Research Act (Pub. L. 93-348) was signed into law, there-by creating the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. One of the charges to the Commission was to identify the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects. The 1974 Research Act was created in entirety from the Belmont report, and put into place to prevent the Government, it agencies or representatives, military and private companies, from violating an individual's freedom: by forcing, tricking or coercing persons for research, testing and administration of unknown injections/materials, and experimental procedures. This law was enacted after a century long track record of precedence including, and not limited to, the following:
Demonstrated lack of Respect for Persons and their protections in violation of 1974 law. 1- Autonomous agents, individuals capable of deliberation about personal goals and of acting under the direction of such deliberation. The Government and companies have to give weight to autonomous persons' considered opinions and choices, and cannot obstruct their actions and judgments, nor deny individual freedom to act on considered judgments, and cannot withhold information necessary to make a considered judgment. Necessary information includes - but not limited to - all medical opinions by established, industry experts, health status, the necessary assessments, labs, with close monitoring of physical lab and test follow ups of each and every autonomous persons as part of clinical research and testing, along with full documentation of testing, efficacy, use of chimera for research and testing, any and all conceivable side effects, and interactions of conditions.
 2- persons with diminished autonomy are entitled to added protections. Violators to the law have been marketing to the most vulnerable, including the immature and the incapacitated who were in need of extra, added protections, even to the point of excluding them from any injections or procedures which may harm them; violating added safety precautions for children, elderly, or those with diminished capacity. Informed consent - must include full disclosure of ALL contents to be injected, any and ALL possible side effects (which can be several pages long), how those persons are individually to be closely monitored, safety guidelines, and above all the right to say no before or at any time, and full reporting of all individuals regarding their safety monitoring/labs/assessments, and any and all side effects. By promoting COVID shots all still under clinical trial/research, and coercing with careers/jobs, inability to travel, etc. in order to take the shots, this law is being violated through: lack of informed consent, lack of protections of autonomous persons, and/or illegally acting as IRSB board members marketing to those not autonomous and capable of self-determination, with higher standards of protection to be invoked, and assuming the role for their safety. The maxim "do no harm" has long been a fundamental principle of medical ethics. Claude Bernard extended it to the realm of research, saying that one should not injure one person regardless of the benefits that might come to others. An agreement to participate in research constitutes a valid consent only if voluntarily given. This element of informed consent requires conditions free of coercion and undue influence. Undue influence also includes offers of an excessive, unwarranted, inappropriate or improper reward or other overture in order to obtain compliance. Also, inducements that would ordinarily be acceptable may become undue influences if the subject is especially vulnerable as in the case of targeting children, persons with limited capacity, and elderly with elements of mental defect, or instilling fear. Short term morbidity and mortality cases from the shots are well reported and known, such as death, myocarditis along with spontaneous cardiac arrest with no warning, debilitating neurological conditions, etc. And, there is no means yet to determine mid and long term effects because Phase I trials have not been competed, let alone Phase II and III - which is vital information in order to determine informed consent. Injustice has been performed with companies and government representatives, by involving vulnerable subjects, including the young, those unable to fully comprehend with all necessary information, and scaring parents with compromised capacity for free consent. In addition to lack of individual, tightly scheduled, continual monitoring and follow ups, autopsies of all persons involved in this trial participation should be conducted for reporting by the pharmaceuticals companies for any and all persons who received the shots, as well as labs determining efficacy and detriments (as examples, antigen creation, D-dimer, Pulse Cardiac and Troponin Tests) for all those who were coerced or unduly influenced to participate in research. This law was created to protect people from government abuse through experimentation. The government cannot arbitrarily dismiss components, create resolutions or stipulations to supersede the law, as to invalidate its protection of individuals from them, including, but not limited to Health and Human Services (HHS) Center for Disease Control (CDC), Food and Drug Administration (FDA), National Institute for Health (NIH), etc. and pharmaceutical companies, etc. Persons have been illegally acting as members of, or bypassing, IRSB safety review and monitoring of each and every person receiving injections, with open undue influence and coercion, to participate in Covid injections. Coercion has been especially directed to the diminished autonomous, children and elderly, through TV ads, library recordings, verbal encouragement, schools or other public venues acting as government agents, and/or clinical researcher recruiting participants, and/or illegally as untrained IRSB member who is not following up to ensure safety of the people they recruited, coerced or used undue influence. Overall lack of informed consent has become too often common practice across the healthcare industry, including people being given consent forms hours or minutes prior to surgery; no alternative treatments or lifestyle-nutrition changes prior to medications begin prescribed, and undue influence to intubate or perform surgery on patients in lieu of alternative treatments. by Rose Rohloff An India folklore, regarding lack of awareness, demonstrates the current myopic view of various specialists, who look at isolated symptoms without comprehensive assessments, resulting in poor or lack of diagnosing of real issues to address in patients. The industry push to eliminate primary care, teaching people they don’t need a primary doctor, or using primary care doctors as simple pass-through without diagnosing, handing off to multiple other doctors, has resulted in the loss of care coordination, overdosing multiple medications with contraindications/side effects, with increased conditions because multiple doctors only look at their individual view. The following version of the blind men and the elephant story is from Peacecorp.gov, and is analogous to the existing healthcare system of specialists. Long ago, old blind men were curious about the many stories they heard about elephants. The men were led to one for each person to independently touch the animal.
All body systems impact each other, designed to function as a whole, for a well orchestrated, compensatory mechanism. By only looking at individual symptoms of isolated systems, patient’s underlying conditions are not addressed for health, and can often be fulminated and/or obscured by medications. And, the reason primary care doctors are imperative for knowing the whole patient, knowing how to diagnose and treat many conditions. Primary doctors should only pass their patients to specialists for complicated, complex conditions, while always following their patient and maintaining all coordination with any other doctors. by Rose Rohloff Calm intelligence, professionalism, logic and sense. Nine (9) doctors interviewed https://www.bitchute.com/video/2JPy7qZiXvNr/ regarding Covid, Hydroxychloroquine (HCQ) and masks. 
With perpetual reporting of the COVID-19 virus, there has been a lot of panic reaction from the public, fostered by the media, as well as from local clinical staff. These reactions have brought existing issues in the healthcare system to the forefront, that we can address go forward, especially for discernment to champion better quality of care. The following two use case examples happened last week, which demonstrate panic reactions from clinicians, the need for good primary care, and the need to address care standards, especially in crisis, with sense at the delivery level. An immune suppressed mother has three children, one being a 10 yr. old daughter who woke with a 102 temperature and a sore throat. The mother is not reactionary, having good instinct regarding when her children are fighting off bugs, building up their immune systems. She phoned the pediatrician to ask for testing if it is strep or a virus. The pediatrician stated they only test for COVID-19 if someone is hospitalized, and they would not do a strep test, “Don’t bring your child in”, and then the pediatrician went on a rant about social distancing, “This virus will not end …” (with no reported cases in the area) etc. and simply ordered Amoxicillin.
I don't want to give my daughter an antibiotic if she doesn't need it, and especially if it is a virus, let alone the Corona virus." Removing all emotion from the situation with her, we discussed getting zinc in EZC Pak from the CVS a mile away, that she could pick up via their drive through, along with foods high in Vitamin A to boost her daughter's immune system. I also called the local Urgent Care center explaining the situation: a mother immunosuppressed, her daughter is in the EMR system, she just wants a strep swab to avoid unnecessary antibiotics, to please have a nurse do the swab through the car window when she drives up - avoiding any cross contamination issues. They stated no problem.
The same week, a second mother of four small children, one being a seven year old who was having sore joints and some blood in her urine. The doctors in Green Bay did a wonderful job of a full, very detailed history and then exam with targeted tests, quickly diagnosing Rheumatic Fever. Her and her other three, healthy children were instructed to do proactive strep testing since they all had close exposure with the daughter. "The center made us feel like lepers. Instead of simply coming out to the car to meet us, they brought us to an empty lobby with a nurse who came out in a full hazmat suit to do simple strep swabs. The nurse freaked out when my son simply cleared is throat, creating anxiety, complaining, "He just coughed." The clinicians throughout both cases should have been calming, simply asking good questions, and then only ordering the correct test before ordering medication. And, in both cases, clinicians could have had the tests quickly, avoiding the waste of hazmat gear, not frightening healthy family members as well as not exposing them to potential germs in the health facilities - avoiding cross contamination issues. What we need to focus heavily on:
One point stood out regarding their focus that is so often missing in health systems: seeing 'clean' patients first, and then seeing contagious patients grouped together, ensuring avoidance of cross contamination, and minimizing the volume of masks, gowns or hazmat suits used. Hopefully, many good things will come from this virus experience to positively shake up our healthcare system, including basic sense procedures, with the importance to rebuild and focus on great primary care again. Another glaring issue to address is the role of clinicians as cool, calm professionals, removing emotion when instructing with full information, with clearly explained options for informed consent and decision-making for delivery of quality care. by Rose Rohloff |
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| A Wall Street Journal (WSJ) article https://lnkd.in/e9awgQT 1/24/2020 posted wrote: "Nearly 150 years ago, a German physician analyzed a million temperatures from 25,000 patients and concluded that normal human body temperature is 98.6 degrees Fahrenheit. That standard has been published in numerous medical texts and helped generations of parents judge the gravity of a child’s illness. But at least two dozen modern studies have concluded the number is too high. Or was it? In a new study, researchers from Stanford University argue that Wunderlich’s number was correct at the time but is no longer accurate because the human body has changed. Today, they say, the average normal human-body temperature is closer to 97.5 degrees Fahrenheit." | Championing your own health is about understanding your healthy baselines. Just as individuals have a variable "healthy" baseline for their blood pressure and heart rate, why would an individual not have an individualized, normal baseline for their temperature? And, temperatures are now measured using different methods: forehead-ear-mouth-rectal, producing deviations based upon how the temperature is obtained. It is important to understand, compare what mechanism was used to take the temperature. Is your normal 98 degrees, while another may run 97 degrees? Is the person normally running 97 degrees now have a temp of 99 along with malaise, dehydration because they are fighting a virus or bacteria? Assessment/vital sign numbers provide more information for clinicians (Doctor, PA, Nurse, etc.) when provided in context of associations, trends, baselines and influencing factors. |
by Rose Rohloff
It is known taking medications will impact various lab values. For example, Diuretics e.g. Lasix (Furosemide), can cause low potassium levels. There is an interesting article in Medscape, Which Drugs Interact With Lab Tests? Jun 18, 2019., addressing the fact that certain medications can also interact with the actual processing of certain lab tests causing inaccurate results.
It is known taking medications will impact various lab values. For example, Diuretics e.g. Lasix (Furosemide), can cause low potassium levels. There is an interesting article in Medscape, Which Drugs Interact With Lab Tests? Jun 18, 2019., addressing the fact that certain medications can also interact with the actual processing of certain lab tests causing inaccurate results.
A recent view of the prescribing information for 1368 prescription drugs found that 134 (9.8%) included information about a specific lab test interaction, 31 (2.3%) stated that the drug did not interfere with lab tests, and four stated that there was no available information.[1] ... |  Patients, families and caregivers need to be aware of what name, class, internal action, as well as all other medication interactions for every medication, vitamin and supplements being taken. As Dr. Scott shares as insightful, it is also important before getting lab values done to understand if any medications being taken will impact labs to be processed and cause false results. |
By Linda Lybert President/ Healthcare Surfaces Expert, Founder/Executive Director Healthcare Surfaces Institute
Privacy curtains must be addressed and as I talk with healthcare professionals about this issue I get mixed reactions. Digging deep into the issue the biggest problem is the amount of time and labor it takes to actually change the curtains out. "It is backbreaking and we don't have enough staff to actually do this on a regular basis." Every facility sets its own standards for changing privacy curtains and the responsibility lays with operations. Policies range from change when visibly soiled (NOTE: microbes can't be seen) to once a quarter and even once a year and any time in-between. As research continues to be published it is clear to mitigate the spread of infections solutions this must be part of a solutions bundle addressing all surfaces! See LinkedIn Post with full Study: Patient Privacy Curtains represent Infection Risk
Privacy curtains must be addressed and as I talk with healthcare professionals about this issue I get mixed reactions. Digging deep into the issue the biggest problem is the amount of time and labor it takes to actually change the curtains out. "It is backbreaking and we don't have enough staff to actually do this on a regular basis." Every facility sets its own standards for changing privacy curtains and the responsibility lays with operations. Policies range from change when visibly soiled (NOTE: microbes can't be seen) to once a quarter and even once a year and any time in-between. As research continues to be published it is clear to mitigate the spread of infections solutions this must be part of a solutions bundle addressing all surfaces! See LinkedIn Post with full Study: Patient Privacy Curtains represent Infection Risk
Linda Lybert is an amazing expert in healthcare surfaces. The same circumstances existed 20 yrs ago, but clinicians were properly trained & executed safety processes/avoided cross contamination; learning in school movement memory e.g. wash hands after closing curtains before touching patients, use elbows to open curtains to enter or push all the way open, etc. #1 issue - lack of clinical training, laziness, and inadequate adherence of movement memory for proper safety protocols. Rose Rohloff
by Rose Rohloff
The 2009 HITECH Act and the Center for Medicare Medicaid Services’ (CMS) Meaningful Use regulations caused a massive spend for electronic medical records (EMRs), the push for interoperability, as the solution to healthcare quality. However, EMRs are not solutions - along with massive IT overhead spend with decreasing quality - because in a high percent of instances, nurses and doctors don’t even read them.
A 40-year old mother went to the doctor after treating herself holistically for some laryngitis, stuffy nose, congested sinus, with continued symptoms after five days. After an exam, the doctor stated, “I am not going to give you antibiotics. You do not have a fever; your lungs sound clear. It looks like a little virus with severe allergies. I recommend an antihistamine.” The patient told him, “Thank you for not putting me on antibiotics when they are not needed, that makes me happy.” He responded, “I am glad you are glad.”
A 40-year old mother went to the doctor after treating herself holistically for some laryngitis, stuffy nose, congested sinus, with continued symptoms after five days. After an exam, the doctor stated, “I am not going to give you antibiotics. You do not have a fever; your lungs sound clear. It looks like a little virus with severe allergies. I recommend an antihistamine.” The patient told him, “Thank you for not putting me on antibiotics when they are not needed, that makes me happy.” He responded, “I am glad you are glad.”
He then said something and the patient responded, “I have MS.” He responded, “Oh wait, you have Multiple Sclerosis?”
This story is sadly too often the new normal, numerous instances of patients and their caregivers stating issues of diagnosing with medication prescription, or misdiagnosis; the doctor or nurse having no idea of pre-existing conditions or a full list of medications currently being taken, a lack of care coordination or care planning because the time was not taken to simply read the chart (whether written or electronic), and ensuring a comprehensive history followed by the necessary physical assessment.
No physician or nurse should walk in to care for a patient without first having read the patient’s record, knowing all current information, the last visit/healthcare encounter, chronic conditions/comorbidities, and all medications; then, asking for updates of changes. Unfortunately, even without having to decipher poor handwriting, being able to read clean typed text, clinicians are not simply reading the basics of information they should before doing any diagnosis, planning and care, or prescribing of medications.
This story is sadly too often the new normal, numerous instances of patients and their caregivers stating issues of diagnosing with medication prescription, or misdiagnosis; the doctor or nurse having no idea of pre-existing conditions or a full list of medications currently being taken, a lack of care coordination or care planning because the time was not taken to simply read the chart (whether written or electronic), and ensuring a comprehensive history followed by the necessary physical assessment.
No physician or nurse should walk in to care for a patient without first having read the patient’s record, knowing all current information, the last visit/healthcare encounter, chronic conditions/comorbidities, and all medications; then, asking for updates of changes. Unfortunately, even without having to decipher poor handwriting, being able to read clean typed text, clinicians are not simply reading the basics of information they should before doing any diagnosis, planning and care, or prescribing of medications.
by Rose Rohloff
The baby boomer generation is now the growing population of elderly with more care needs in home health. As the current generation is being faced with the care responsibilities, many are still unaware concerning various facets of caring for others: advanced directives and living wills; stimulation and diets for mental sharpness, questions to ask and quality of care considerations with becoming power of attorneys - the core of healthcare awareness. One area is focused heavily within hospitals and other care delivery environments, but yet over looked in private homes – surface areas and cleanliness.
A popular trend in houses is the use of marble and granite as counter tops. A leading surface expert, Linda Lybert President of Healthcare Surface Consulting stated, “Granite and Marble are like large sponges you cannot wring out.” The photo displayed shows the build up of E. coli bacteria in the pores of stone. According to Ms. Lybert, even when sealed, the porousness is reduced, but not eliminated. And, bleach is not able to eliminate once they reside in the crevices.
A popular trend in houses is the use of marble and granite as counter tops. A leading surface expert, Linda Lybert President of Healthcare Surface Consulting stated, “Granite and Marble are like large sponges you cannot wring out.” The photo displayed shows the build up of E. coli bacteria in the pores of stone. According to Ms. Lybert, even when sealed, the porousness is reduced, but not eliminated. And, bleach is not able to eliminate once they reside in the crevices.
All surfaces in the home, counter tops, floors including laminates, tile and grout need diligent daily cleaning and disinfection. However, Ms. Lybert brings awareness that regarding "stone surfaces, including granite/marble, there is no effective means to disinfect these surfaces." Consider, "granite is an underground aquifer for our water filtering out all kinds of things. Given the right kind of environment, heat and moisture, bacteria will grow."
As the elderly begin to lose their mobility and agility, it is important to maintain clean surfaces in bathrooms and bedrooms, along with the most important surface being the skin. Diligent hand washing and bathing is important throughout the day to avoid cross contamination from the loved one you are caring for, as well as to them. The other surface area to be conscientious of is bedding. When excrement accidents occur, it is important to wash bedding with very hot water to not only clean them, but also kill the microbes.
Clostridium difficile (commonly known as C-diff) "is in the community and found in outpatient settings. There are significant risk factors in patients who are immunosuppressant, individuals who have been on antibiotic therapy, and the elderly population." C-diff is a secondary, very dangerous and potentially deadly infection after antibiotic use. [read article] It is important to those in the community to have appropriate antibiotic prescriptions and use, especially avoiding unnecessary broad spectrum antibiotic use which targets the "good" bacteria you need internally (and not on external surfaces) to kill off C-diff.
As the elderly begin to lose their mobility and agility, it is important to maintain clean surfaces in bathrooms and bedrooms, along with the most important surface being the skin. Diligent hand washing and bathing is important throughout the day to avoid cross contamination from the loved one you are caring for, as well as to them. The other surface area to be conscientious of is bedding. When excrement accidents occur, it is important to wash bedding with very hot water to not only clean them, but also kill the microbes.
Clostridium difficile (commonly known as C-diff) "is in the community and found in outpatient settings. There are significant risk factors in patients who are immunosuppressant, individuals who have been on antibiotic therapy, and the elderly population." C-diff is a secondary, very dangerous and potentially deadly infection after antibiotic use. [read article] It is important to those in the community to have appropriate antibiotic prescriptions and use, especially avoiding unnecessary broad spectrum antibiotic use which targets the "good" bacteria you need internally (and not on external surfaces) to kill off C-diff.
by Rose Rohloff
But, what is value? Is society conditioned to accept low quality as value, because a lower standard has become the norm?
| Value is a relative term based upon personal perception, and oftentimes great marketing. True value is based upon insightful knowledge of what entails quality along with the cost of delivering goods and services. Value-based care is the new buzz for basing reimbursement in the healthcare industry. But again, what is value care: personal perception, marketing, cost? |  |
This article was conceived after several conversations regarding what defines quality care, with veteran clinicians (nurses and doctors), insurance brokers, as well as numerous 40-80 year olds who make up the typical population across the country. Using the following encounter as an example, I want to review what determines true value of care delivery compared to the normal perception being marketed.
A surgeon office within a surgical center, (the surgeon with privileges at two leading health systems), has 5-star Healthgrades ratings, including comments: the staff is courteous; appointments start on time; the Physician Assistant (PA) is very intelligent, knowledgeable, articulate and caring; and the surgeon with a benchmark performance staff. There are also one star ratings including a comment the staff is not properly trained and do not know how to maintain a sterile environment.
The primary issue with such score deviations is determining if poor marks are isolated instances (one offs); or, if the variance of only highest and lowest reflect the knowledge of reviewers. Are the high ratings from non-healthcare persons based on perception of the veneer friendliness and scheduling, with one star comments based on specific quality requirements, care competency posted by those with healthcare insight/experience?
As a 35+ year healthcare veteran, an answer was determined accompanying a Medicare patient ‘John’, in his mid-80s who experiences early stage dementia, to the office for a post-op visit for a leg stint placement.
The primary issue with such score deviations is determining if poor marks are isolated instances (one offs); or, if the variance of only highest and lowest reflect the knowledge of reviewers. Are the high ratings from non-healthcare persons based on perception of the veneer friendliness and scheduling, with one star comments based on specific quality requirements, care competency posted by those with healthcare insight/experience?
As a 35+ year healthcare veteran, an answer was determined accompanying a Medicare patient ‘John’, in his mid-80s who experiences early stage dementia, to the office for a post-op visit for a leg stint placement.
| Upon arriving, another elderly patient (80s) was sitting outside, unattended in wheelchair, hot sun, 100 degree weather, no water. When asked why he was there, he stated, “I can’t stand the freezing air conditioning inside while waiting for a ride.” After walking John into the lobby, the gentlemen clearly seen through the glass door was pointed out to the receptionist stating that he was left in hot sun, no water, unattended. The receptionist stated, “It is his choice to stay out there.” I then stated, “Get someone to check on him, give him water, put him in the shade and check when his ride is supposed to arrive and monitor him if it is delayed or bring him inside.” One person escorted us back to exam room. She did not introduce herself or her title. She proceeded to take the blood pressure with no other vital signs (unknown if a secretary, an aide, a nurse or tech). She then asked the patient, “How much do you weigh?” He gave a number. As patient champion I responded, “He doesn’t know, he has not weighed himself. You need to weigh him yourself.” She responded, “We don’t have a scale.” She then left. I followed her witnessing her documenting the incorrect data. | I reiterated he has dementia with no idea how much he weighs. She replied, “It doesn’t matter anyways, we just need to put something in the record.” She was reflecting an 11 pound weight loss from previous recording. It is unclear if they performed the previous weighing, if it was done just prior to surgery to determine proper anesthesia delivery for his surgery.  Another woman in scrubs entered the exam room without introducing herself or her title, asking John to remove his shoes and socks. (The scheduled appointment was with the PA so the patient assumed her identity.) She asked him if his wound was healed and he replied, “Yes.” She documented something in the chart without ever assessing his wound for healing or determining if there was infection. She bent down and felt his feet with her whole hands stating they feel warm, and then asked if he had numbness in his feet. John responded, “Yes.” | Having worked as a registered nurse (RN) in cardiovascular and neuro intensive care units (ICUs), I know she never did pedal (foot) pulse checks x4 comparing both feet. She never assessed location of numbness, or if chronic/intermittent, positional with sitting/, standing, walking, etc. The family had asked if aspirin could be stopped as the patient has experienced nose bleeds in the past. The staff person responded yes and since there was 90% blockage of the previous stint, it was cleaned out and continue Plavix. There was no establishment of lab work as part of care plan determining effectiveness of the medications, especially since the previous stint occluded. "1,750 or so stent patients are also prescribed Plavix to prevent clots from forming around the stent, but of that group, approximately 500 (29%) carry a genetic variation that prevents them from converting Plavix into its active form. This gene-related lack of response stands to be "especially severe" in about 50 (3%) of those patients, who won't derive any benefit from Plavix - 2010 Vanderbilt Medical Center |
She then stated they would be ordering an ultrasound as a standard post-op test to determine the effectiveness of the stint - over three weeks after the procedure.
Why didn't they do the ultrasound during the post-op visit to have results to make sure the stint was effective? No doppler was used to assess extremity blood flow.
She stood up, touched the paperwork, the marker and laminate sheet then touched the door handle leaving – never having washed her hands before assessing the patient, nor after putting her hands on his feet.
Perceived value based on quality versus true value and cost
The office visit was charged to Medicare, with an elderly patient perceiving the staff as nice during the office visit.
The care competency and quality as true value-based care during the visit includes:
- lack of basic cleanliness standards with severe cross contamination practices
- no introduction of name or title of any staff member
- fraudulent documentation in the electronic medical record (EMR)
- no assessment performed during a specific post operative visit (a family member could have taken the BP and said his feet felt warm.)
- lack of care planning and evaluation of medication regime
- unnecessary secondary office visit charging for follow up
- another elderly patient left unattended in the hot sun
If the U.S. healthcare system wants to achieve true value-based care, we need an educated population, higher accountability of staff standards with the ability to send evaluations direct to payers based on specific facts and not emotion, and surveys must include care competency reviews versus only veneer questions of politeness, room appearances, and on time scheduling.
The care competency and quality as true value-based care during the visit includes:
- lack of basic cleanliness standards with severe cross contamination practices
- no introduction of name or title of any staff member
- fraudulent documentation in the electronic medical record (EMR)
- no assessment performed during a specific post operative visit (a family member could have taken the BP and said his feet felt warm.)
- lack of care planning and evaluation of medication regime
- unnecessary secondary office visit charging for follow up
- another elderly patient left unattended in the hot sun
If the U.S. healthcare system wants to achieve true value-based care, we need an educated population, higher accountability of staff standards with the ability to send evaluations direct to payers based on specific facts and not emotion, and surveys must include care competency reviews versus only veneer questions of politeness, room appearances, and on time scheduling.
by Rose Rohloff
Mayo Clinic Launches $1B Upgrade To Electronic Records System
CBS Minnesota 7/13/2017
Mayo Clinic has launched a $1 billion project the health care provider says will combine all of its electronic health records into a single, upgraded computer system ... Mayo Clinic Health System sites switched to the new system, Wisconsin-based Epic Systems Corp.
Mayo Clinic defends executive raises
Molly Gamble (Twitter), Becker's Hospital Review 12/8/2022
Mayo Clinic returned to raises for its executive team in 2021 with top-paid employees seeing the largest increases of 20 percent or more, the Rochester Post Bulletin reported Dec. 8.
Financial hits brought on by the COVID-19 pandemic in 2020 left many Rochester, Minn.-based Mayo Clinic executives taking small pay cuts. Compensation for CEO Gianrico Farrugia, MD, dropped 1 percent, for instance.
The next year, Mayo returned to raise executive pay, with a total of 26 employees reporting compensation of more than $1 million in 2021. That tally is up from 23 in 2020 and 21 in 2019.
In 2021, Dr. Farrugia's compensation increased by 27 percent to $3.48 million. Then-Chief Administrative Officer Jeff Bolton's compensation increased by 24 percent to $2.11 million. Kent Thielen, MD, CEO of Mayo Clinic in Florida, saw his compensation increase by 20 percent to $1.79 million and Richard Gray, MD, CEO of Mayo Clinic in Arizona, saw his compensation increase 26 percent to $1.78 million in 2021.
Financial hits brought on by the COVID-19 pandemic in 2020 left many Rochester, Minn.-based Mayo Clinic executives taking small pay cuts. Compensation for CEO Gianrico Farrugia, MD, dropped 1 percent, for instance.
The next year, Mayo returned to raise executive pay, with a total of 26 employees reporting compensation of more than $1 million in 2021. That tally is up from 23 in 2020 and 21 in 2019.
In 2021, Dr. Farrugia's compensation increased by 27 percent to $3.48 million. Then-Chief Administrative Officer Jeff Bolton's compensation increased by 24 percent to $2.11 million. Kent Thielen, MD, CEO of Mayo Clinic in Florida, saw his compensation increase by 20 percent to $1.79 million and Richard Gray, MD, CEO of Mayo Clinic in Arizona, saw his compensation increase 26 percent to $1.78 million in 2021.
| As the dark side of IVF slowly comes into focus, even more transparency is needed by Pamela Mahoney Tsigdinos, July 27, 2018 |  |
There are pitfalls with IVF that are not discussed. And, this business end of reproduction is more often than not cash only. There are virtually ZERO long term studies regarding what effect-impact freezing, and a host of other ‘things’, that are done to the egg, or sperm, or the embryos that have (or could have) on the child that is produced. This 'miracle of modern medicine' could be good ... or just OK ... or it could be very, very bad. Science has rubbed the lamp and we cannot put the genie back in the bottle. After counseling many women in my career, the great emotional toil let alone the finances are not discussed. The ethical check is also missing regarding instances of doctors using their own sperm such as the Indiana doctor who in 2016 used his own sperm at least 50 times.
As the character Dr. Ian Malcom (played by Jeff Goldblum) said in the 1993 movie Jurassic Park, “Your scientists were so preoccupied with whether they could (create life) that they didn’t stop to think if they should.” by Karen F., (Ret) RN, NP OB & Palliative Care
by Rose Rohloff
The June 29, 2018 BECKER'S Hospital Review article shares the viewpoint "Froedtert CEO Cathy Jacobson: Not every patient needs a primary care physician" (PCP). The article is the perspective from the viewpoint of a health system CEO. The following is a perspective, counterview from patients, the individuals in the population.
The June 29, 2018 BECKER'S Hospital Review article shares the viewpoint "Froedtert CEO Cathy Jacobson: Not every patient needs a primary care physician" (PCP). The article is the perspective from the viewpoint of a health system CEO. The following is a perspective, counterview from patients, the individuals in the population.
In speaking with individuals across the country, spanning several major health systems and states, 100% of the comments and feelings are that health systems are large, top-heavy and more inefficiently run because of their size.
Many people have expressed utter frustration from lack of a good Primary Care Doctor, warranting unnecessary ER visits because a doctor will not call back; the lack of one doctor in charge who would simply LISTEN to them, who knows them - not as personal friends, but with an in-depth professional relationship.
I have been asked several times in various states, "Do you know of any good Primary Care Doctors? I cannot find one." Universally, I am hearing: a gross lack of comprehensive assessments from doctors; clinicians not taking the time to get to know and listen to what is going on, causing the passing through of patients to specialists versus a primary care doctor creating a plan of care and focused tests for getting an actual diagnosis; lack of avoidance for hospital visits with increasing costs that could and should be avoided because conditions allowed to worsen; and doctors simply writing prescriptions for symptoms.
Many people have expressed utter frustration from lack of a good Primary Care Doctor, warranting unnecessary ER visits because a doctor will not call back; the lack of one doctor in charge who would simply LISTEN to them, who knows them - not as personal friends, but with an in-depth professional relationship.
I have been asked several times in various states, "Do you know of any good Primary Care Doctors? I cannot find one." Universally, I am hearing: a gross lack of comprehensive assessments from doctors; clinicians not taking the time to get to know and listen to what is going on, causing the passing through of patients to specialists versus a primary care doctor creating a plan of care and focused tests for getting an actual diagnosis; lack of avoidance for hospital visits with increasing costs that could and should be avoided because conditions allowed to worsen; and doctors simply writing prescriptions for symptoms.
Health systems are relying on data analysis, defining as population health, as Froedtert is quoted, "As we start stratifying our patients into distinct populations based on their health needs." The issue with this premise is that the data is not always clean, and it will never tell the story, the whole story, of the realities going on with the patients. (See I Wish I Had Known stories.)
Her quote continues, "... insight further into consumer driven wants, we are finding that a substantial sector of the population does not want or need a primary care physician relationship. People need primary care but not necessarily a physician relationship." The issue is the primary care physician practices have been acquired by the hospital-health systems, with the biggest complaint from people in the population not being able to find a PCP; and those now under health systems, the doctor only giving 10-15 minutes of time, before passing off to specialists with no plan of care, and/or simply writing another prescription. Many in the public just find it faster or are being told to just go to the ER. From the perspective of health system CEOs, it would appear primary care is not wanted or needed, which drives up the hospital ER and inpatient business. When actually speaking with individuals across the country, it is the opposite, people complain lack of care coordination, and "the doctor doesn't know me and is not taking the time to listen to me - I want them to actually figure out a diagnosis of what is wrong."
Her quote continues, "... insight further into consumer driven wants, we are finding that a substantial sector of the population does not want or need a primary care physician relationship. People need primary care but not necessarily a physician relationship." The issue is the primary care physician practices have been acquired by the hospital-health systems, with the biggest complaint from people in the population not being able to find a PCP; and those now under health systems, the doctor only giving 10-15 minutes of time, before passing off to specialists with no plan of care, and/or simply writing another prescription. Many in the public just find it faster or are being told to just go to the ER. From the perspective of health system CEOs, it would appear primary care is not wanted or needed, which drives up the hospital ER and inpatient business. When actually speaking with individuals across the country, it is the opposite, people complain lack of care coordination, and "the doctor doesn't know me and is not taking the time to listen to me - I want them to actually figure out a diagnosis of what is wrong."
by Rose Rohloff
A Memorial Day quote yesterday regarding veterans also exemplifies much of what has happened in healthcare over the last 10 years, regarding the focus on Population Health, meaningful use reporting, value based analysis, big data analytics-claims data, and mergers of health systems with large EMRs, with focus on reporting.
“We are arguing over a statistical analysis. This is the challenge that we face in society today ,,, we are quantifying numbers because it’s easy to look at a number, and it’s not easy to look at the value of a human life. I would say to you today that (losing) one a day, one a year is too many.”
Kyle Reyes, CEO, The Silent Partner Marketing
Kyle Reyes, CEO, The Silent Partner Marketing
When the primary focus is on data (the multiple of numbers/records-statistics), singular records and numbers or outliers are not worth the time and effort of analysts and executives. And yet, they should be as each record is a real patient, a friend, a loved one.
The solution is bringing analysis down to the most base level of management with front line analysis, to coincide with first-hand observation, the voice of the patient & their caregivers/champions, and reducing the ever growing administrative overhead. Bigger is not better for addressing health and care of populations, when the focus is shifted upward with large systems where individuals are lost: Especially when the individual issues are indicative of the core problems that need to be addressed for quality care delivery.
The need for P&P Reviews
The solution is bringing analysis down to the most base level of management with front line analysis, to coincide with first-hand observation, the voice of the patient & their caregivers/champions, and reducing the ever growing administrative overhead. Bigger is not better for addressing health and care of populations, when the focus is shifted upward with large systems where individuals are lost: Especially when the individual issues are indicative of the core problems that need to be addressed for quality care delivery.
The need for P&P Reviews
| by Rose Rohloff  | HealthLeaders published an article Proper Sharps Management in Senior Living Helps Reduce Risk for Needle Stick Injuries Feb. 9, 2018, addressing the need for proper containers to safely dispose of used needles. Sadly, stories have been relayed regarding used syringes being left in the beds of patients in hospitals and rehabilitation facilities. As trained clinicians, this circumstance should never happen. The issue of needle-syringe safety, however, transcends all environments, including the increasing use in homes. Safety guidelines for syringe use |
- Have designated, well marked containers for immediate disposal (reference the Healthleaders article above)
- Use the one touch rule: after injecting medication, do not set the needle down; immediately drop into the designated, marked container.
- Do not recap the needle unless necessary. To avoid sticking oneself, drop the syringe directly into the container without recapping after used. If the needle requires coverage for immediate safety, keep the cap on a flat surface (such as a table) while inserting the needle. Then, lift the syringe with the cap on to firmly secure it against the table; avoiding needles accidentally being pushed through a cap, or missing the cap opening and puncturing your finger.
- Properly dispose of needle containers. See CDC recommended guidelines.
Photo: Gabrielle Lurie, Special To The Chronicle: Dirty needles at UN Plaza in San Francisco, CA
Numerous reports of discarded, used syringes in the streets of major cities, such as San Francisco, also necessitate being aware of 'sharp safety' in the community. Whether a street, park or playground, it is good to have knowledge of what to do, and teach your children, regarding needle-syringe safety. The following are just a couple example guidelines:
by Rose Rohloff
Naloxone is an emergency medication; it is temporary and doesn't stop or eliminate opioid abuse, addiction.
This week, reports were released in the media that US homes need Narcan to aid in opioid overdose epidemic, surgeon general advises
This week, reports were released in the media that US homes need Narcan to aid in opioid overdose epidemic, surgeon general advises
Dr. Delos Marshall "Toby" Cosgrove, the previous CEO of Cleveland Clinic, spoke to a room of healthcare leaders from across the country about the Opioid Crisis in April 2017. The discussion centered around the abuse of taking prescribed medications - legally and illegally - with the current trend of NARC Parties. He explained that NARC Parties entail the supply of Naloxone (the common brand name is Narcan, used by hospital-emergency personnel as the medication to temporarily counteract a narcotic or heroine overdose.) He continued that having Naloxone allowed people to overdose, the person(s) were then given Narcan in order to continue partying.
The general public needs to be aware: Naloxone has been reported to foster increased abuse of drugs by allowing revival of overdosing for continuing to take more drugs. Naloxone is the generic of Narcan. Just as EpiPen is only the delivery system and not the generic drug Epinephrine, It is important to know the difference between the brand name versus the generic drug name.
The general public needs to be aware: Naloxone has been reported to foster increased abuse of drugs by allowing revival of overdosing for continuing to take more drugs. Naloxone is the generic of Narcan. Just as EpiPen is only the delivery system and not the generic drug Epinephrine, It is important to know the difference between the brand name versus the generic drug name.
The danger of advising the untrained public to distribute emergency medicine
"A serious problem is many doctors and many more nurses are unaware of the different mode of metabolism of Fentanyl and Methadone. With various dosages of Fentanyl and Heroin or combinations of other opioids, the efficacy of Naloxone or Naltrexone is compromised. The general public (let alone many new doctors and nurses) do not have a working understanding of the differences in these competitive antagonists." "There may not be any impact for at least 30 minutes with a basic spray." 45 year RN, BSN, NP, MSN, Committee Member Opioid Crisis, Board of Directors Health Facility
Many clinicians, let alone the general public, are not specifically trained in the proper dosage and treatment with Naloxone for the various forms and dosages of opioids and heroin.
FDA Advisory Committee on the Most Appropriate Dose or Doses of Naloxone to Reverse the Effects of Life-threatening Opioid Overdose ... Sept 2016
"The effectiveness of naloxone, and thus the exposure required, will depend on the opioid dose, the potency of the opioid in binding receptors, the lipophilicity of the opioid in crossing into the CNS system and the elimination half-life of the opioid, together with patient factors (7, 26). Appendix [2] and [2a] includes further information on naloxone pharmacology. The complex pharmacology of appropriate dosing is further compounded as often the fentanyl involved is illicitly manufactured without normal procedures or controls and may be introduced surreptitiously into heroin or prescription painkillers. Reports from the field confirm the need for additional naloxone doses to reverse opioid overdoses including those involving more potent fast onset synthetic opioids."
Many clinicians, let alone the general public, are not specifically trained in the proper dosage and treatment with Naloxone for the various forms and dosages of opioids and heroin.
FDA Advisory Committee on the Most Appropriate Dose or Doses of Naloxone to Reverse the Effects of Life-threatening Opioid Overdose ... Sept 2016
"The effectiveness of naloxone, and thus the exposure required, will depend on the opioid dose, the potency of the opioid in binding receptors, the lipophilicity of the opioid in crossing into the CNS system and the elimination half-life of the opioid, together with patient factors (7, 26). Appendix [2] and [2a] includes further information on naloxone pharmacology. The complex pharmacology of appropriate dosing is further compounded as often the fentanyl involved is illicitly manufactured without normal procedures or controls and may be introduced surreptitiously into heroin or prescription painkillers. Reports from the field confirm the need for additional naloxone doses to reverse opioid overdoses including those involving more potent fast onset synthetic opioids."
Narcan (Naloxone HCL) Use in Opiod Overdose: A Perspective
4/10/2018
An important point for the general public who is not used to or trained in emergency medicine, this “rescue” drug is only the first step in the opioid crisis ... not the end all and be all of treatment. I would like to respond to this “advisory report” from the Surgeon General as a pharmacist, an Emeritus Professor, Pharmacy Practice from a College of Pharmacy, former President/Chair of the Michigan Pharmacist Association (MPA) and Fellow of this Association; and lastly as a chronic pain patient.
I have used opioids now for chronic pain management after a car accident almost twenty-years ago. I will admit, I was taken aback by my family physician about a month ago being given a prescription for Narcan (generic name Naloxone) as a “precautionary measure” for my chronic opioid use. The form I was prescribed is a nasal formulation vs. the oral/injection form. When I took it to a pharmacy to be filled, I had to undergo “special counseling” by a pharmacist (even with my credentials) which consisted of a video on proper use and a warning that after use, 911 had to be called and I was to be taken to the emergency room for follow-up. This is the proper follow-up when someone is prescribed any rescue medication for a drug reaction. The Naloxone is only to be given when a known opioid (i.e. codeine and it’s derivatives; Fentanyl, Meperidine, etc...) is given or taken in life-threatening incidences. I was instructed, "Were you aware that Naloxone has two elimination half-lives because this drug has an active metabolite; and, were you aware that Naloxone and Naltrexone are different agents, but are easily confused."
I believe giving someone this agent for overdose situations is giving a false sense of security that nothing else needs to be done. Nasal Naloxone is like putting a bandage on a cut artery. You may stop the blood flow at the moment, but the wound will continue to bleed if the wound isn’t sutured properly. Without appropriate emergency room follow up of an opioid overdose the person may die from that overdose.
Many opioids vary in dose, strength, predictability and most of all drug half-life. Knowing the half-life of drugs is essential to know how long the drug is going to last in your body. Drug half-life’s, drug absorption, distribution and elimination is well covered in Colleges of Pharmacy in courses such as pharmacology, pharmacokinetics and pharmacotherapeutics. Pharmacists do not know the pharmacokinetics on every drug substance out there by memory, and we are called the drug experts. Physicians do not have nearly as much education on medications as pharmacists, yet they are the first line of treating drug overdoses in emergency situations along with the nurses, Physician Assistants and Nurse Practitioners.
The general public is being provided a false sense of security by the media to carry this drug in their homes to address the opioid crisis. The public needs to be AWARE there is more to treating an opioid overdose than just squirting this agent up their nose.
Joan M. Rider-Becker, BS, PharmD, FMPA
Retired, Emeritus Professor, Pharmacy Practice Ferris State University College of Pharmacy
Education/Training
B.S. Pharmacy-Ferris State University College of Pharmacy-1987
Pharmacy Practice Residency-Bronson Hospital Kalamazoo, MI-1987-1988
Doctor of Pharmacy (PharmD), University of Michigan-College of Pharmacy Ann Arbor, MI 1990
An important point for the general public who is not used to or trained in emergency medicine, this “rescue” drug is only the first step in the opioid crisis ... not the end all and be all of treatment. I would like to respond to this “advisory report” from the Surgeon General as a pharmacist, an Emeritus Professor, Pharmacy Practice from a College of Pharmacy, former President/Chair of the Michigan Pharmacist Association (MPA) and Fellow of this Association; and lastly as a chronic pain patient.
I have used opioids now for chronic pain management after a car accident almost twenty-years ago. I will admit, I was taken aback by my family physician about a month ago being given a prescription for Narcan (generic name Naloxone) as a “precautionary measure” for my chronic opioid use. The form I was prescribed is a nasal formulation vs. the oral/injection form. When I took it to a pharmacy to be filled, I had to undergo “special counseling” by a pharmacist (even with my credentials) which consisted of a video on proper use and a warning that after use, 911 had to be called and I was to be taken to the emergency room for follow-up. This is the proper follow-up when someone is prescribed any rescue medication for a drug reaction. The Naloxone is only to be given when a known opioid (i.e. codeine and it’s derivatives; Fentanyl, Meperidine, etc...) is given or taken in life-threatening incidences. I was instructed, "Were you aware that Naloxone has two elimination half-lives because this drug has an active metabolite; and, were you aware that Naloxone and Naltrexone are different agents, but are easily confused."
I believe giving someone this agent for overdose situations is giving a false sense of security that nothing else needs to be done. Nasal Naloxone is like putting a bandage on a cut artery. You may stop the blood flow at the moment, but the wound will continue to bleed if the wound isn’t sutured properly. Without appropriate emergency room follow up of an opioid overdose the person may die from that overdose.
Many opioids vary in dose, strength, predictability and most of all drug half-life. Knowing the half-life of drugs is essential to know how long the drug is going to last in your body. Drug half-life’s, drug absorption, distribution and elimination is well covered in Colleges of Pharmacy in courses such as pharmacology, pharmacokinetics and pharmacotherapeutics. Pharmacists do not know the pharmacokinetics on every drug substance out there by memory, and we are called the drug experts. Physicians do not have nearly as much education on medications as pharmacists, yet they are the first line of treating drug overdoses in emergency situations along with the nurses, Physician Assistants and Nurse Practitioners.
The general public is being provided a false sense of security by the media to carry this drug in their homes to address the opioid crisis. The public needs to be AWARE there is more to treating an opioid overdose than just squirting this agent up their nose.
Joan M. Rider-Becker, BS, PharmD, FMPA
Retired, Emeritus Professor, Pharmacy Practice Ferris State University College of Pharmacy
Education/Training
B.S. Pharmacy-Ferris State University College of Pharmacy-1987
Pharmacy Practice Residency-Bronson Hospital Kalamazoo, MI-1987-1988
Doctor of Pharmacy (PharmD), University of Michigan-College of Pharmacy Ann Arbor, MI 1990
| by Rose Rohloff  | Another common practice over the past decade is the prescription of broad spectrum antibiotics for non-life threatening conditions. Broad spectrum antibiotics are for use in life threatening conditions/sepsis when there is no time to wait for a culture, or the inability to do a culture. Broad spectrum antibiotics target the necessary bacteria needed in the adult intestinal tracts; and so, the standard practice has become the second prescribing for probiotics; the requiring of multiple medications to be taken. Additionally, numerous reports over the last 10 years have shown the continued misuse of antibiotics (e.g. CDC Grand Rounds) causing antibiotic resistance, with the need for more and more antibiotics to be created and used. |
What has caused the layering of medications
The country is currently facing increased antibiotic resistance, opioid crisis, etc. due to our culture being conditioned in the taking of medications versus alternative treatments, or prescriptions of medications without diagnosis. A mother of a small child was recently told by a doctor as part of her son's care, "It is very important for you to teach your child how to swallow pills. Start with candy sprinkles, then swallow mini M&Ms, and then have him swallow large M&Ms so he can take multiple pills at the same time." This instruction was given to the mother without a diagnosis for her son, no plan to achieve understanding of what was causing his pain to then create a plan of care - which may or may not have needed to include medication.
Consumer engagement is needed with all medications being prescribed to be fully empowered, to understand: 1) the need for prescriptions, why and when appropriate, 2) the side effects of medications to determine alternatives versus adding on more medications, and 3) to eliminate the misuse of medications without the continued layering of additional drugs. Antibiotics should only be used when the body, given time, cannot fight a severe bacterial infection. And, antibiotics should only be given out after a culture is performed to eliminate a virus as the cause, or to target the specific bacteria. Broad spectrum antibiotics should only be used with life threatening-septic issues while waiting for a culture, or there is not the ability to perform a culture.
Consumer engagement is needed with all medications being prescribed to be fully empowered, to understand: 1) the need for prescriptions, why and when appropriate, 2) the side effects of medications to determine alternatives versus adding on more medications, and 3) to eliminate the misuse of medications without the continued layering of additional drugs. Antibiotics should only be used when the body, given time, cannot fight a severe bacterial infection. And, antibiotics should only be given out after a culture is performed to eliminate a virus as the cause, or to target the specific bacteria. Broad spectrum antibiotics should only be used with life threatening-septic issues while waiting for a culture, or there is not the ability to perform a culture.
by Rose Rohloff
A middle aged male was recently experiencing severe abdominal pain, subsequently prescribed three (3) medications in two (2) weeks from three (3) different sources (an Emergency Room, a primary care doctor, a Gastroenterologist). There was no diagnosis, no care coordination within an established plan of care, no thorough instruction in the medications, with the last prescription based on a guessed misdiagnosis which worsened his pain. One prescription was a steroid with the patient being instructed to take as he needed it; the second was an offering by the office secretary blindly asking if he wanted an Epipen when he called to actually speak with the physician for worsening abdominal pain, swelling and to discuss his lab work.
The common standard operating procedure (SOP) in medicine has become symptom and write a prescription, another symptom and write another prescription, etc. This SOP has lent to the opioid crisis, antibiotic resistance, as well as many other drugs being dispensed routinely with side effects causing secondary prescriptions for the side effects of the existing medications being taken.
Several variables cause the use of this SOP beginning with the lack to get a full, detailed history - taking time to speak with patients - to establish a diagnosis and then plan of care, determining if simple steps are first needed such as icing and therapy for pain before opioids, or to remove foods and medications isolating side effects or allergies. Last week, I attended the HIMSS conference, the largest healthcare conference in the country, with attendees from around the world. One executive stated, "I just returned from Finland where they have an effective health system, because people live healthy, and the doctors appropriately tell their patients NO when seeking a simple, quick fix of a drug that is not needed."
Reasons for the mainstream SOP?
I think there are always multiple reasons for issues within healthcare. The symptom=prescription issue can be: Doctors are processing patients through with 'factory-care', Physicians receiving kickbacks from pharmaceutical companies; The lack of proper clinical training; Protocols blindly being followed without individual evaluation (e.g. Vanderbilt University study on Plavix standard for all Cardiac Cath Patients); as well as the alliance of public policy and pharma, direct consumer marketing without proper education.
A healthcare executive summarized the situation well last week when stating to me, "I ultimately make the decision for my own care, with the advice of the physician. It is the doctor's role to diagnosis, and then we discuss all options, along with a plan of care, coordinated with speaking with all other involved physicians." It is important for consumers to understand the need to champion their own care working with physicians, determining what options should be used before medications (diet and some of the old fashioned home remedies still hold true), addressing underlying issues versus only symptoms, and removing or changing medications to eliminate side effects when there are alternatives. Questions to have answered:
An example of direct consumer marketing lacking in education: In 2016, there was broad publication when the company Mylan raised the prices of the Epipen after State Law was passed to stock it in every school. Many individuals and groups were upset because there is not a generic offering. With proper information, the public would be educated that Epipen is the patented delivery system, not the drug epinephrine. The generic already existed in the form of a $15-$18 sterile needle. It is also necessary to establish where and when is it appropriate to stock epinephrine, not specifically the Epipen.
Why are you prescribing this medication, what is it specifically doing in my system?
What are non-medication alternatives, what are other medication alternatives?
How long should I take this, what is the outcome? How does it interact with my other medications?
What should be monitored for an outcome, side effects?
A middle aged male was recently experiencing severe abdominal pain, subsequently prescribed three (3) medications in two (2) weeks from three (3) different sources (an Emergency Room, a primary care doctor, a Gastroenterologist). There was no diagnosis, no care coordination within an established plan of care, no thorough instruction in the medications, with the last prescription based on a guessed misdiagnosis which worsened his pain. One prescription was a steroid with the patient being instructed to take as he needed it; the second was an offering by the office secretary blindly asking if he wanted an Epipen when he called to actually speak with the physician for worsening abdominal pain, swelling and to discuss his lab work.
The common standard operating procedure (SOP) in medicine has become symptom and write a prescription, another symptom and write another prescription, etc. This SOP has lent to the opioid crisis, antibiotic resistance, as well as many other drugs being dispensed routinely with side effects causing secondary prescriptions for the side effects of the existing medications being taken.
Several variables cause the use of this SOP beginning with the lack to get a full, detailed history - taking time to speak with patients - to establish a diagnosis and then plan of care, determining if simple steps are first needed such as icing and therapy for pain before opioids, or to remove foods and medications isolating side effects or allergies. Last week, I attended the HIMSS conference, the largest healthcare conference in the country, with attendees from around the world. One executive stated, "I just returned from Finland where they have an effective health system, because people live healthy, and the doctors appropriately tell their patients NO when seeking a simple, quick fix of a drug that is not needed."
Reasons for the mainstream SOP?
I think there are always multiple reasons for issues within healthcare. The symptom=prescription issue can be: Doctors are processing patients through with 'factory-care', Physicians receiving kickbacks from pharmaceutical companies; The lack of proper clinical training; Protocols blindly being followed without individual evaluation (e.g. Vanderbilt University study on Plavix standard for all Cardiac Cath Patients); as well as the alliance of public policy and pharma, direct consumer marketing without proper education.
A healthcare executive summarized the situation well last week when stating to me, "I ultimately make the decision for my own care, with the advice of the physician. It is the doctor's role to diagnosis, and then we discuss all options, along with a plan of care, coordinated with speaking with all other involved physicians." It is important for consumers to understand the need to champion their own care working with physicians, determining what options should be used before medications (diet and some of the old fashioned home remedies still hold true), addressing underlying issues versus only symptoms, and removing or changing medications to eliminate side effects when there are alternatives. Questions to have answered:
An example of direct consumer marketing lacking in education: In 2016, there was broad publication when the company Mylan raised the prices of the Epipen after State Law was passed to stock it in every school. Many individuals and groups were upset because there is not a generic offering. With proper information, the public would be educated that Epipen is the patented delivery system, not the drug epinephrine. The generic already existed in the form of a $15-$18 sterile needle. It is also necessary to establish where and when is it appropriate to stock epinephrine, not specifically the Epipen.
Why are you prescribing this medication, what is it specifically doing in my system?
What are non-medication alternatives, what are other medication alternatives?
How long should I take this, what is the outcome? How does it interact with my other medications?
What should be monitored for an outcome, side effects?
by Rose Rohloff
| Dr. Lee Beecher and David Racer in their book Passion for Patients wrote, "Dr. Kübler-Ross … called me to her office … “Ach, you’ve got a problem.” She said I needed to more clearly communicate... You have to learn about how to be a good son-of-a-bitch.” Pritzker (medical school at University of Chicago) taught me how to be a problem solver ... No one told me what I had to believe or how I had to think. They taught me how to think and apply what I learned to help my patients." (pages 55-57) Today I read someone describing the Forbes article by Brent Gleeson, “Apparently, during SEAL training, peer reviews are a weekly event. They have a process called top five, bottom five. Every week you anonymously rank the top five performers in the class as well as the bottom five.” Unfortunately, with political correctness and mandating diversity in healthcare, leaders and peers cannot or choose not to do ranking and hiring based upon performance. I have seen in the health industry that no one is allowed to hurt a doctor/nurse's feelings because they are being incompetent or under-performing, with patient's lives at stake. | It is a wonderful idea of ranking on performance so everyone pushes each other to excellence. But when a 30 year veteran nurse is told to shut up because she was holding accountable the new doctors and nurses not performing, competency rating (especially by knowledgeable veterans) was a great practice that worked 20-30 years ago - but one that is not tolerated today. The result, medical errors are now the #3 cause of death. The industry is killing people with our focus on kindness versus caring competency.  Personally, I want a well trained, experienced, compassionate son-of-a-bitch taking care of me, as opposed to someone who is being nice while not knowing what they are doing. I want a doctor and nurse who takes care of me so I can go home and I don’t have to see them again because they are my quality clinicians, not my pals. |
“We think sometimes we’re only drawn to the good, but we’re actually drawn to the authentic. We like people who are real more than those who hide their true selves under layers of artificial niceties.“
Elisabeth Kübler-Ross, Passion for Patients, (page 62)
Elisabeth Kübler-Ross, Passion for Patients, (page 62)
by Rose Rohloff
Last week, Jeff Bezos, Warren Buffett and Jamie Dimon (I reference as the BBD solution) announced their focus for healthcare. Here are thoughts from an industry insight perspective to think about. The industry needs major shakeup for transformation to occur. BBD are technology giants focused on technology and employer offered care. This expansion will likely be predominantly that of Telemedicine, Amazon electronic medical record (EMR), and investment in technology companies. Our current system is the push for capitation (covered lives/socialized medicine, Medicaid expansion) with the focus of technology as the solution. BBD is moving this model under companies, and will impact costs. However, technology without personal and personnel intelligence with sound processes is the continued automation of bad practices and "garbage in - garbage out" data, with the potential for expanding the 'fast food healthcare' of symptom=prescription, unless we start addressing the true underlying issues impacting quality, the needed personal and personnel intelligence with mutual accountability on consumers & providers. We currently have the increasing issue of people causing accidents and walking into walls with the advancement of cell phone technology, with more and more technology trying to replace basic awareness and personal intelligence. We need to avoid the same mistake with healthcare delivery with more and more expensive technology driving up costs, without first addressing basic sense solutions.
February 14, 2018 Telemedicine is a tool that can be very effective depending upon how it is used. Top 5 Ways Telehealth Will Change Under the New Federal Funding Bill, "The new federal Bipartisan Budget Act of 2018, signed into law by the President on February 9, 2018."
by Rose Rohloff
The media writes about the desire for transparency with many in the public demanding posted costs for healthcare; however, the public fails to understand - healthcare is not the same as other businesses. First, in business production & marketing creates increased sales volume. Whereas, in healthcare volume is driven by need, and the primary goal of providers should be getting, keeping people healthy, in effect driving away their business. Second, the highest percent of revenue for hospitals comes from the government agency Health and Human Services (HHS), especially the Medicare division. Below is the formula for calculating inpatient payment. So unlike businesses, utilities, or other services, healthcare costs, prices and payments are not simple amounts to readily comprehend. Healthcare information has been publicly available, now is the time to educate consumers in the population of how to find and understand it to champion their care.
The media writes about the desire for transparency with many in the public demanding posted costs for healthcare; however, the public fails to understand - healthcare is not the same as other businesses. First, in business production & marketing creates increased sales volume. Whereas, in healthcare volume is driven by need, and the primary goal of providers should be getting, keeping people healthy, in effect driving away their business. Second, the highest percent of revenue for hospitals comes from the government agency Health and Human Services (HHS), especially the Medicare division. Below is the formula for calculating inpatient payment. So unlike businesses, utilities, or other services, healthcare costs, prices and payments are not simple amounts to readily comprehend. Healthcare information has been publicly available, now is the time to educate consumers in the population of how to find and understand it to champion their care.
 Centers for Medicare & Medicaid Services (CMS), page 6 |  CMS Inpatient payment rate, page 7 |
