The End of It All

Welcome to my last blog post! This blog is meant to recap what my blog has mainly been about, and what my future plans continue to be. 

Throughout my blog I tried to touch on many different topics in healthcare, from many different aspects.  I also tried to use my personal experiences and goals, as well as ideas from outside knowledge to give you an interesting way to hear about new, as well as old, things happening in the world.  In writing these blog posts I have learned a lot.  This includes, more out-of-the-box thinking, time management, and writing your thoughts pen-to-paper (or in today's world, fingers-to-keyboard!)  These blogs have allowed me to express what I have learned about healthcare, and I am grateful I got to experience writing them. 

In my first post, I talked a lot about becoming a Radiation Therapist once graduated from my undergrad.  I still stand with that career goal, even though I know it will be a lot of work before I can get there.  I want to fully devote myself to my initial plan to help cancer patients as much as I can. I have seen many people who I know, some I am very close with, suffer from cancer.  Some of which have had worse outcomes than others.  I will continue to follow my personal mission of "wanting to help people" as much as I can in the process. I feel as though HMP is helping me prepare my knowledge to be thrown into the real world, and pursue my career path.  I am confident in my choice to become an HMP major, and am excited to see how I will excel upon graduating.

Overall, learning about any aspect of healthcare is important for people of all ages to know.  These blogs are just one of the many ways everybody can help spread their knowledge of healthcare topics to the world.  That is all I have for my blog posts, and I appreciate the people who took the time out of their day to read them! Thanks so much, and goodbye for now!

Greys Anatomy Season 14 Episode 8: Out of Nowhere

Since Greys Anatomy is my favorite show, and is very relevant to my major as well as my future career path, I knew I needed to blog about it at one point.  In watching last weeks episode, the first thing I thought of was our management class.

There was a crisis in the hospital where a cyber attack took place.  All of a sudden, there was a mass failure throughout the hospital on all of the heart monitors.  It sounded as if everybody was coding (or flat lining) which definitely does not happen every day.  They soon realize that this was a hospital-wide issue.  A message popped up on every piece of technology asking for a specific sum of money, with a message stating that the hackers "controlled their system now".  This meant that complete strangers now had access to every patient in Seattle Grace Hospital's medical records. This is when the Chief of Surgery had to step in to assess the situation.  The Chief's first goal was to remind all of the doctors that they need to continue to do their jobs, but the old fashion way.  Check, double check, and check again every test you do on the patients and write EVERYTHING down. Next, she had to assure the patients and their families that everyone was going to be okay. Then, she had to deal with the FBI.  The Chief thought everybody was calm, and dealing with the situation until the FBI showed up, and this sparked controversy again.  They went into a separate room with the Chief, and the old Chief and discussed the next steps quietly.  The hackers were asking for a large sum of money (Bit coins) in order to give back control to the hospital.  The Chief wanted to give the money, because patient care comes first, however, the situation was torn because the FBI said this was an ongoing investigation.  If the hospital gave the hackers the money, it would help Seattle Grace out of this hack, but allow the hackers to realize they won, and will probably strike somewhere else again.    
You will need to watch the episode to see how it turned out, but I felt as if this was the most relevant episode to what we learn about in Management. 

This episode goes hand-in-hand to the idea of Crisis Management that Susanna Fier spoke about in our class on November 27th. I was able to relate the stories Fier spoke about in class to this episode, and it was able to give me a visual representation of what a person in charge during a crisis has to undergo.  Although Greys Anatomy is a television show, with a lot of crazy, unimaginable things that happen in it, it can be very informative.  I definitely have learned a lot of interesting facts, and seen cool cases over the 14 seasons of the show!

A Young CNA During the Holidays

As the holiday seasons are fast approaching, I start to think about the people who cannot spend time with their families, have great food, and be in the comfort of their own home.  It is sad to see people who are alone on the holidays, but you know what is worse than that? Being alone and in the hospital as well.  One of my best friends is a Certified Nurses Assistant (CNA) at Mount Auburn Hospital in Cambridge. She is an aspiring future Nurse, and is gaining a lot of knowledge and experience through this job at Mount Auburn.  She works long hours at the hospital, and has to travel over an hour away from school to home every weekend to donate her time to these sick patients.  She experiences a lot for a young college student working in a hospital.  As we know, this past week was Thanksgiving.  She explained to me that every day is a tough day for the patients, but holiday's are amongst the hardest.  She said the hospital does get busy with visitors during this time, however, there are still a good amount of people who do not get any visitors at all.  This is extremely saddening.  Not only do some people get no visitors, but there are many patients who are admitted into the hospital during the holidays with excessive alcohol consumption.  This goes to show you another example of how many people suffer with loneliness on the holidays.  It is a difficult job to do what my friend does at such a young age, but she is experiencing a lot of real-world situations that will help her better prepare to become a successful nurse one day.

One specific area in which she said is emotional, especially during the holidays, is when she has to take care of a suicidal patient.  This is a tough job, because as a CNA, you have to be aware and attentive at all times.  "If a patient is suicidal, they cannot have phones with cords, knives, forks, razors, anything sharp, or anything they could put around their neck", says my friend.  Her daily tasks in supervising a suicidal patient would be to just sit with the patients, watch them, and take them to the bathroom.  Although it is not the busiest of work, it is a very important job.  She did say, depending upon the case, some patients need more than one supervisor at once.  For example, if they are violent or a threat, there usually would need to be more than one supervisor.  Overall, my friend has a very important, yet tough job.  She explains it is very hard to see what she sees at such a young age, but she is grateful that she gets to help people every day, while doing what she loves.  I think she is going to make a great Nurse one day!

     

Hospitals Carry Infections Too

Although people may think that hospitals are the safest, cleanest place to be when your sick, those people are wrong.  Hospitals are "breeding grounds" for infections.  You can get an infection from any of the equipment, supplies, and other sicknesses that are traveling through the hospital.  Methicillin-Resistant Staphylococcus Aureus (MRSA) is the most common infection to travel around a hospital. It is resistant to all antibiotics, and you can receive it from dirty equipment.  It is an infection in your skin and can be very dangerous. It is spread by contact, and can also be called a staph infection.  This is the most common disease that spreads, but how is it controlled?

There are many precautions when it comes to controlling the spread of MRSA.  Six standard precautions hospitals have to follow are hand washing, gloving, mouth, nose, eye protection, gowning, important device handling of patient care equipment, and appropriate handle of laundry.  The same procedures, and then some, go for contact precautions as well.  It seems as if the reoccurring theme is to protect anything used in the hospital that could potentially spread this disease.  This is difficult because staff, nurses, and doctors need to make sure they do not skip the step of putting on gloves or wiping down a machine after it is used. If something were to go wrong, there would be a huge liability on their hands.

Therefore, be cautious when your in the hospital, and make sure you are receiving sterilized supplies and any one who is working on you has gloves on! You can never be to careful.   

https://www.sharecare.com/health/infectious-disease/what-kinds-infections-get-hospital
https://www.cdc.gov/mrsa/

Finally, Maine's Medicaid Expansion

It is official as of yesterday, November 7, 2017 Maine, the last state in New England who had yet to expand Medicaid, did it! This vote makes Maine the 32nd state to expand Medicaid under Obamacare.  This will now benefit all of the low-income adults who qualify for coverage in Maine.  This also represents a set back for the Republican party, who continues to try and veto the expansion of Medicaid.  This ballot was known as "Question 2".  Over $1.5 million dollars was invested into the expansion in Maine.  "Some 80,000 adults will qualify under the expansion, according to independent estimates from a Maine legislative fiscal office, adding to the nearly 12 million people in the 31 states and District of Columbia who have already obtained coverage through the program" (Politico-Maine Voters Approve Medicaid).  We actually just had a question on our Health Policy exam last week that asked, 'what is the only state in New England who has yet to expand Medicaid?'. The timing is pretty ironic.  Until this Policy class, I had no idea all of New England expanded, except for Maine. 

It will now remain difficult for Medicaid to expand in many of the other states because they are mostly predominately "red states".  This means that Republicans control the governors "mansion or state legislature".  However, if people continue to push as they did for Maine, it will eventually become easier to expand Medicaid in those states if that is what people wanted.  There are now 18 states that have not expanded Medicaid under Obamacare.  All are led by Democrats, except for Virginia and North Carolina, who are led by Republicans.  Those might be the more difficult ones to budge. 

https://www.politico.com/story/2017/11/07/maine-voters-medicaid-obamacare-244675

Halloween Health and Safety

Happy Halloween! Today is one of those holiday's where you can dress up to be any person or any thing you want.  That can be a lot of fun, but it can also be very dangerous and cause chaos to many communities.  Aside from the psycho people who use halloween for crime,  Halloween is known to be the "deadliest day" for children pedestrian fatalities.  "One hundred and fifteen child pedestrian fatalities occurred on Halloween over the 21 years of our analysis.  This is an average of 5.5 fatalities each year on October 31, which is more than double the average number of 2.6 fatalities for other days" (Halloween Deadliest Day Article).  Car crashes/accidents are what kill most pedestrians on this day.

Emergency-room visits are said to be the "scariest" part of Halloween for hospitals.  "We can't say for sure that Halloween is the most-dangerous holiday of all.  But it wasn't Valentine's Day that sent 4,400 people to hospitals last year.  That's the number of emergency-department visits attributed to Halloween activities between Oct. 1and Nov. 30 in 2013, according to the Consumer Product Safety Commission" (The Columbus Dispatch-Emergency-room visits scariest part of Halloween).  The accidents range from carving pumpkins, to people getting hit with cars.  People are advised to wear bright clothing and carry flash lights.  The holiday is meant for fun and games, not to be stuck in an emergency room dressed up in your favorite costume. 

http://www.dispatch.com/content/stories/local/2014/10/28/Halloween_scares.html

http://www.bestplaces.net/docs/studies/halloween_deadliest_day.aspx

Long-term Care

I thoroughly enjoyed our class speaker, Tom Lavallee, from Monday's lecture on long-term care.  He talked about many interesting points of his experience in working in these types of facilities.  Part of my reasoning for wanting to become a radiation therapist was because I liked to help people will cancer, of all ages, but specifically, I like working with the elderly.  I have a strong place in my heart for the elderly, and always have.  They are so sweet (most of the time), and always look at you as if they see themselves in you, so many years ago.  I find their stories and compassion for things so interesting.  I somehow get along very well with them as well.  It takes certain people, and specific characteristics to be able to be a good employee in a long term care facility.  You have to love what you do, and want to do it. 

 My grandmother is currently struggling with huge health obstacles, and was just moved from a hospital into a long-term care facility.  She is not an easy patient to have.  She likes her meals exactly right, when she rings the buzzer she expects someone to be there instantly, and she does not like people telling her what to do.  That is how she felt while she was staying in the hospital.  However, since placed in this long-term care facility, although she is in pain, she is more comfortable here than she was in the hospital.  She has told me all of her nurses are extremely kind and generous, and help her whenever she needs help.  She is now happy because she is able to eat turkey and mashed potatoes, not only because of her diet change, but because it is actually edible!  That goes to show how much of an upgrade long-term care facilities are from hospitals.  It seems as if their goal is to just keep the patient as happy and comfortable as they can.  Long-term care facilities used to be a place people were sent to live out the rest of their lives comfortably.  Now, they are looked at more as rehabilitation centers.  I agree with that statement because yes, my grandmother is very sick, but she is out of a hospital now and in a place of rest.  She is here in order to make her feel better and work to getting stronger, and that is just what they are doing.  

Overall, I think long-term care is a great part of healthcare.  It shows that our elderly are treated with the most care and compassion.  It is hard for some elderly people to move out of their homes, and become dependent on other people.  But with a good, welcoming staff, it will help them make their stay as "home-y" as possible.  

The ACA and Pre-Existing Conditions

I have always wondered how some people diagnosed with AIDS in the 1980's were able to pay for treatments and medicine revolving around their pre-existing conditions.  Through research, I came to realize that before the the Affordable Care Act, many people with these conditions struggled with coverage.  It is a huge contributor to the allowance of healthcare to people suffering with AIDS, Asthma, and Cancer.  The ACA has allowed no American to be denied healthcare who has a pre-existing health condition.  "The Access, Care, & Engagement TA Center provides tools and resources to support the enrollment of people living with HIV in health care coverage" (The Affordable Care Act and HIV/AIDS). This is a great center to have in order to guide HIV patients to the right path to finally get the healthcare coverage they have been longing for.

In terms of Medicaid expansion and eligibility, the ACA has allowed for the expansion of Medicaid to those with low incomes and below the poverty line.  It is said in the HIV.gov website, that today, Medicaid is the largest payer for HIV in the U.S. This is a fact I was surprised about, because you do not hear to much, publicly at least, about HIV and those who are affected still.  "In states that opt for Medicaid expansion, people living with HIV who meet the income threshold will no longer have to wait for an AIDS diagnosis in order to become eligible for Medicaid.  That means they can get into life-extending care and treatment before the disease has significantly damaged their immune system" (The Affordable Care Act and HIV/AIDS).  This is a great expansion that the ACA is allowing because it can help so many suffering AIDS victims.  However, the population under the poverty line do not benefit from this.  There is only so much Medicaid can fund, and if people cannot pay for needs such as blood tests and other testing, it will be hard for them to receive the care they need to stay alive.

Overall, the ACA has definitely been a huge contributor to the HIV/AIDS community.  It has given ample opportunities for coverage that was not given to the sick in the 80's.  The ACA is able to give people of the proper income the treatment they need in order to become healthy and live a normal life as best they can. 



https://www.hiv.gov/federal-response/policies-issues/the-affordable-care-act-and-hiv-aids   

The Opioid Heroine

As we all know, the abuse of opioids now is extremely exponential.  Tracey Helton, also known as the "Heroin heroine", is taking a different approach to the abuse of opioid usage today.  She mails out dosages of the generic version of the drug, which revives people of an overdose, only if they want it.   Although she is aware that what she is doing is illegal, she is saving many lives.  "This epidemic kills tens of thousands of people in the US each year", says CNN.  She feels as if the law is wrong and being a "civil disobedience" by counting what she is doing as illegal.  There is a case in which Helton helped save a young mans life.  Ryan Coleman, 36, met Helton in 2013.  She mailed him the drug called Naloxone, to use in case of an overdose.  Coleman explained to his roommate how to use the drug if he ever overdosed, and needed to be revived.  A case happened where Coleman did overdose, and his roommate injected him with the Naloxone, and he turned pink again and was revived.  The same event happened another time, however, this time Coleman was with another friend, and he was the one who overdosed.  This time, the Naloxone did not work until the third time.  It did end up finally saving his friend on the third time.  However, I have some skeptic in this method of saving young people from opioid abuse. This method produced by Helton still allows the people to do the drugs just as much as they were before, but it gives them the reassurance that there is a backbone there that will save their life.  In this case, after these two events happened to Coleman, he decided to become sober, but he was lucky.  The reverse drug worked for him in both overdoses, but for some, they might not get that second chance.

I believe the overall motive Helton is trying to proclaim is a good start.  However, in my opinion, it could also rub people the wrong way in a certain sense.  Some might take this method as a lesson learned, that they cannot live off this reverse drug their whole life and that they should just quit using drugs in general.  Others might use it as just a simple crutch in their life.  Something that enables them to keep doing what they do in their every-day lives, but helps them stay alive along the way.  Helton's method could go two ways.  As readers, which route do you think drug abusers might be prone to lean towards more?

http://www.cnn.com/2017/10/02/health/heroin-heroine-naloxone-eprise-profile/index.html

How Does a Hospital Manage a Mass Shooting?

As many of you may know, on Sunday, October 1, the deadliest mass shooting massacre in the U.S. took place at a country concert in Las Vegas, Nevada.  59 people were killed, and 527 were injured.   After killing that many people, the gunman then killed himself.  As of right now there is no ulterior motive to the actions of the shooter.  This current event inspired me to think of the question 'How does a hospital manage a mass shooting?'.  On the CNBC website, I read about how the Las Vegas hospitals are dealing with this crisis.  "Nevada has just one Level-1 trauma center in the state, University Medical Center in Las Vegas" (How Las Vegas hospitals prepared for a massacre-CNBS). I can only imagine how packed this hospital must have been when the shooting first occurred, and even now.  It says that officials have asked many people to donate their blood to patients in need, probably because of how busy the hospitals are.  "As the numbers go by, the umbers continue to increase," said Clark Country Sheriff Joseph Lombardo.  Since 9/11, these hospitals in Nevada, as well as over the world probably, are increasing their "hospital preparedness" to allow them to be ready for situations as horrible as this one.   In July, this Level-1 trauma center hospital held a training session involving the first responders from around the area.  This seems extremely beneficial and almost strange timing in the sense of preparedness for the shooting.  It is definitely a good tactic for hospitals to have in order to be ready for any tragedy that could take place.

One of the specific methods the University Medical Center of Southern Nevada used during the events of the massacre were "to prioritize patients, first responders and hospital staff use triage, evaluating who needs emergency treatment immediately, who can wait a bit longer, and who can wait beyond that" (CNBC article listed above). The article also noted that the "triage at mass shooting incidents can be complicated by the ongoing threat and mechanism of injury". I can see how using the triage method could raise anger to patients and their families because everybody wants to be healthy fast.  I believe it is the most fair, and efficient method in a time like this one.  Overall, I have learned that these tragic events do happen, and it is good that this Nevada hospital was prepared at best they could be.  All hospitals should be ready for anything that comes their way because you never know what can happen.

https://www.cnbc.com/2017/10/02/las-vegas-hospitals-dealing-with-hundreds-of-mass-shooting-victims.html

Italian Healthcare

The inspiration that drove me to write this blog post on the Italian Healthcare system was my Mother and my Nonna.  They are currently in Italy together visiting my family and relatives.   My Nonna has been there for two months, and my Mom is spending two weeks there.   Since I have never been there before, I have so many questions and wonders about what life is like in Italy.   In thinking about what to write, I thought it would be cool to look into their healthcare system.  I want to get more of an insight on the type of healthcare my relatives have access to in their every day lives.  

Italy is ranked among the World Health Organizations's top 10 countries for quality health services.  Private medical insurance seems to be what most patients have.  In small towns, mostly in the South, it is more common to have private doctors and hospitals, all of which are covered by the private medical insurers.   For example, my Mother's cousin is a doctor in a small town of Italy called Naples.  He works in a very small hospital there as well. From what I have read in this 'International Living' article on Italian healthcare,  the best medical care is located in northern Italy in cities such as  Milan, central Italy, and Rome.  That makes the most sense because those seem to be the biggest cities in Italy, where the most tourist attend to.  It is also said, these have the best emergency hospitals, because they have the most English-speaking doctors. 

The national health plan Italians use is called Servizio Sanitario Nazionale.  Like many other countries, this system provides them medical benefits for the people and hospitals.  If you are a legal resident of Italy, you are provided this healthcare.  With this plan, everything is either universal or very low costs.  This includes everything from consults with a physician, to hospital visits, and prescribed medications.  This is something that the U.S. does not fully cover.  We have copays, and less access for certain citizens to have health care.  There must be requirements.  However, the main thing Italian's need to pay a small co-pay for is a non-urgent hospital visit.  Urgent visits are reported free. 

From my readings, I learned a whole lot of things about what access my ancestors have in living in the great country of Italy.  Overall, it seems as if they are treated fairly in the aspects of healthcare.  It is interesting to compare where I live, and what systems and rights I have access to, to my family in a different country.  I look forward to learning more about other countries healthcare systems, and look forward to hearing about my Mother and Grandmother's experience back in their homeland when they return!  I am sure I will have many questions! 

Harvey and Irma

The recent destruction that hurricane Harvey and Irma has left on many states in the South has left many people, places, and infrastructure completely ruined.  Almost everything in different parts of Florida, as well as parts of the Caribbean is underwater.  With Harvey hitting the U.S, it has affected many of the health care companies within those areas.  It has affected hospital chains to medical technology facilities, as well as pharmaceutical chains.  "We estimate that the two storms (Harvey and Irma) could result in a procedural growth drag of ~30 bps for each week that hospitals are out of commission and/or patients are displaced," Matson said.  "We believe this impact could last anywhere from 2-4 weeks, resulting in an estimated 60-120 bps drag on U.S. procedure growth in 3Q17" (Needham analyst Mike Matson).   With all of this decrease and damage, I cannot even imagine how the patients and employees dealt with incoming patients in the middle of the hurricane. 

Pharmacies also were affected by the hurricanes.  Each chain, such as CVS and Walgreens, number percentages decreased in their income.  These hurricanes are not only affecting the hospitals physically, but financially as well.  It is terrible to see the hospitals in such destruction, but the cost to rebuild and resupply is equally as devastating.  The article also compares this to hurricane Matthew that hit Florida last October at a ranking of Category 5.  "Hurricane Matthew affected companies in different ways.  It cost Tenet hospitals an estimated $5 to $10 million and Tenet surgery centers an estimated $1.5 to $2 million, and cost Surgery Partners about $1.5 to $2 million, Ransom noted" (Analyst John Ransom).  This is only a few of the payments the state of Florida had to pay in order to rebuild.  

It is a terrible thing that there is nothing you can do about preventing the destruction of a hurricane.  It is hard to find a solution on how to keep everyone healthy and safe, when a lot of the destruction is in the hospitals and pharmacies themselves.  As long as the communities work together to the best of their abilities, that will keep everyone as safe as possible.  

http://www.marketwatch.com/story/how-hurricanes-harvey-and-irma-are-affecting-health-care-companies-2017-09-07

Lost in Cancer

Cancer is an ongoing battle that countless amounts of people all over the world are fighting every single day.  From all ages, whether you are 5 or 75, cancer is effecting the lives of people we all care about.  In the song, ‘I’m Gonna Love You Through It’ by Martina McBride, it says, “Cancer don’t discriminate, or care if your just 38”.  And it is sad, but true.  I decided I wanted to work with cancer as a future career because of the people it has struck, and tortured in my life already.  Cancer is becoming so common in our nation, that it seems as if it should just be a part of people’s everyday life now.  Not to say researchers and doctors aren’t sufficiently searching for a cure, but sometimes they could lose sight of the actual pain, unconmfort, and distress their patients are feeling in the process.   That should not be the case.  As I read in a New York Times article, ‘Cancer Patients, Lost in a Maze of Uneven Care’, this article talks a lot about how specific patients, as well as patient feel there is not one person throughout their battle who they can fully count on or call their “champion”.  Karen Pasqualetto is a 35-year-old woman who had just discovered she had colon cancer.  She is so young, and has already realized that the cancer is not just in her colon now, but her liver too.  Her life is slowly slipping away right before her, and her newborn babies, eyes.  “I don’t feel I have a doctor who is looking out for my care. My oncologist is terrific, but he’s an oncologist. The surgeon seems terrific, but I found him through my own diligence. I have no confidence in the system”, says Pasqualetto.  She knows each doctor is doing their job, but it seems as if she wants more of a fight or an effort in her situation. Yes, I do believe the doctors are all doing their jobs, very well I might add, however, Pasqualetto’s frustration makes sense to me.  As a cancer patient, you are seeing more than one doctor, more than one time a week.  It is a lot of tireless work, stress, and a lot of new levels of patient-doctor trust you need to learn to build.  Your main goal as a person living with cancer is to get better, and all these patients want is some answers. 

From my readings, I have come to understand that “death rates from cancer have been dropping for about 15 years in the United States, but experts say far too many patients receive inferior care. Mistakes in care can be fatal with this disease, and yet some people do not receive enough treatment, while others receive too much or the wrong kind” (Cancer Patients, Lost in a Maze of Uneven Care).  This makes the patient’s battle that much more difficult.  In reading articles as upsetting as these, it only makes my aspirations to help people with cancer grow stronger.  I hope that one day I can connect with these patients to make them feel as if I am their “champion”, and their hope to becoming healthy again.  Cancer is a terrible disease that is hurting so many people. With the help of countless doctors trying to find a cure, and support of family and friends, we can all help fight cancer together, one step at a time.  

http://www.nytimes.com/2007/07/29/health/29Cancer.html