Disease Management Update
Volume V, No. 45
March 26, 2009
Dear Healthcare Intelligence Network Client,
As we approach April and Parkinson's Disease Awareness Month, the DM Update highlights two new developments in Parkinson's Disease treatments.
And there's still time to take part in HIN's Disease Management Update Readership Survey by clicking here by April 1, 2009.
Your colleague in the business of healthcare,
Editor, Disease Management Update
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Table of Contents
1. UF Doctors Test Targets for Parkinson Surgery
Doctors may be able to tailor a specialized form of brain surgery to more closely match the needs of PD patients, according to results from the first large-scale effort to compare the two current target areas of deep brain stimulation surgery (DBS). Called the COMPARE Trial, the study evaluated 45 patients for mood and cognitive changes related to DBS. University of Florida (UF) investigators found that DBS in either brain target effectively treated motor symptoms such as tremors, stiffness and slowness. However, DBS also produced unique effects depending on the target location, especially in patients’ moods and mental sharpness.
Before surgery, UF scientists evaluated the patients’ verbal fluency, memory, attention and cognitive processing. Patients were retested about seven months later during four conditions — with stimulation at the optimal contact point on the lead as determined during previous programming sessions, with stimulation at contact points adjacent to the optimal one, and with stimulation turned off. Examiners and patients were blind to the conditions as well as to the brain target. Generally, the target choice produced no major differences in motor function, mood or cognition in the patients. However, patients whose leads were implanted in the subthalamic nucleus, the most common surgery target, did have increased problems with verbal fluency and mood, and they tended to be more angry and irritable.
“We think it will be important to tailor the therapy to the patient,” said Dr. Kelly D. Foote, an associate professor of neurosurgery at the College of Medicine and a co-director of the UF Movement Disorders Center. “Targeting the traditional location — the subthalamic nucleus — might be better for someone who is younger and healthier. But for someone who is older with memory problems, or perhaps in the early stages of dementia, it would be important to consider the alternative.”
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2. Disease Management Q&A: Challenges of Psychiatric Triage
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Joe Eppling, assistant vice president of post acute and behavioral health services at East Jefferson General Hospital in Louisiana.
Question: What are the particular challenges of triaging the behavioral health patient?
Response: (Joe Eppling) We face a challenge in trying to do a psychiatric triage in a busy ED. We do not have a separate facility where we can calm a patient down and create an environment where they feel comfortable sharing information. Providing psychiatric care in a busy setting is very difficult and offers us many challenges.
For more details on ER triage and the mental health patient, please visit:
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3. HealthSounds Podcast: IBM Banking on Medical Home to Deliver Healthcare ROI
IBM spends about $2 billion a year on healthcare for its 500,000 employees but doesn't believe it's getting its money's worth from the current system, explains George Chedraoui, healthcare leader with IBM and immediate past president of Bridges to Excellence. Chedraoui explains why IBM is banking on the patient-centered medical home (PCMH) — with its focus on disease prevention and wellness — to deliver this value, what impact $19 billion in health IT incentives will have on physician practices, and why it will take more than technology to transform a physician practice into a medical home.
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4. Novel Spinal Cord Stimulator Sparks Hope for Parkinson’s Disease Treatment
The first potential therapy to target the spinal cord instead of the brain may offer an effective and less invasive approach for PD treatment, according to pre-clinical data by researchers at Duke University Medical Center. Researchers developed a prosthetic device that applies electrical stimulation to the dorsal column in the spinal cord, which is a main sensory pathway carrying tactile information from the body to the brain. The device was attached to the surface of the spinal cord in mice and rats with depleted levels of the chemical dopamine — mimicking the biologic characteristics of someone with PD along with the impaired motor skills seen in advanced stages of the disease. When the device was turned on, the dopamine-depleted animals' slow, stiff movements were replaced with the active behaviors of healthy mice and rats. Improved movement was typically observed within 3.35 seconds after stimulation.
"We see an almost immediate and dramatic change in the animal's ability to function when the device stimulates the spinal cord," says senior study investigator Miguel Nicolelis, M.D., Ph.D., the Anne W. Deane professor of neuroscience at Duke. "Moreover, it is easy to use, significantly less invasive than other alternatives to medication, such as deep brain stimulation, and has the potential for widespread use in conjunction with medications typically used to treat Parkinson's disease."
Researchers tested mice and rats with acute and chronic dopamine deficit using varying levels of electrical stimulation and in combination with different doses of dopamine replacement therapy to determine the most effective pairing. When the device was used without additional medication, Parkinsonian animals were 26 times more active. When stimulation was coupled with medication, only two L-DOPA doses were needed to produce movement compared to five doses when the medication was used by itself.
To learn more about this research, please visit:
5. Survey of the Month: Medical Homes in 2009
In less than five years, the PCMH model has quickly grown from a pediatrics-based concept to a care approach embraced by thousands of healthcare organizations hoping to improve care and costs for the chronically ill. Complete HIN's third annual survey on the PCMH's role in your organization by March 31 and get a free executive summary of the compiled results.
To participate in this survey and receive its results, please visit:
6. Offering Incentives for Health & Wellness Programs
Health and wellness programs can do wonders in reducing healthcare costs and increasing productivity for any organization — as long as individuals enroll and participate. As more healthcare organizations use rewards and incentives to drive participation and engagement in health improvement programs, HIN asked over 200 healthcare professionals to share their organization’s experiences with health incentives and rewards
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