Disease Management Update
Volume V, No. 50
April 30, 2009
Dear Healthcare Intelligence Network Client,
The country — and the world at large — has been swept up by the recent swine flu outbreak that has killed over 150 Mexicans and infected numerous Americans. Find out what the FDA is doing to contain the disease in this week's DM Update.
Your colleague in the business of healthcare,
Editor, Disease Management Update
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Table of Contents
1. FDA Authorizes Emergency Use of Influenza Medicines, Diagnostic Test in Response to Swine Flu Outbreak
In response to the CDC, the FDA is making available to public health and medical personnel important diagnostic and therapeutic tools to identify and respond to the swine flu virus under certain circumstances. The agency issued emergency use authorizations (EUAs) for the use of certain Relenza and Tamiflu antiviral products and for the rRT-PCR Swine Flu Panel diagnostic test.
The rRT-PCR Swine Flu Panel diagnostic test amplifies the viral genetic material from a nasal or nasopharyngeal swab. A positive result indicates that the patient is presumptively infected with swine flu virus but not the stage of infection. However, a negative result does not, by itself, exclude the possibility of swine flu virus infection.
The FDA has determined that it may be effective in testing samples from individuals diagnosed with influenza A infections, whose virus subtypes cannot be identified by currently available tests. This EUA allows the CDC to distribute the swine flu test to public health and other qualified laboratories that have the needed equipment and the personnel who are trained to perform and interpret the results.
The EUA authority allows the FDA, based on the evaluation of available data, to authorize the use of unapproved or uncleared medical products or unapproved or uncleared uses of approved or cleared medical products following declaration of emergency, provided certain criteria are met. The authorization will end when the declaration of emergency is terminated or the authorization revoked by the agency.
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2. Disease Management Q&A: Triage Psychiatric Patients in the Medical ED
Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Julie Szempruch, associate vice president and chief nursing officer for the Midtown Mental Health Center, part of Wishard Health Services in Indiana.
Question: What is the triage process that takes place when patients come into the regular ED and how do you determine that the patient should be referred to the psychiatric ED?
Response: If someone is brought to the regular ED by the police and/or ambulance under what is called an immediate detention — which is a legal hold to bring them in — they would be seen by the psychiatric nurse, and it would be known that they were there purely for psychiatric services. Regardless, the medical nurse at the door would check blood pressure, vital signs and look for any indications that there is another medical problem co-occurring. If the medical nurse doesn't see anything, then the patient would be directly admitted into the psychiatric ED.
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3. HealthSounds Podcast: Reducing Unnecessary Utilization Through Health Risk Stratification
Predictive modeling and health risk stratification can help providers identify members for case management and DM interventions, says Dr. William Vennart, vice president of medical management and national medical director with CareAdvantage Inc. These methods ensure that patients receive treatment for their chronic conditions early on and, in turn, reduce unnecessary utilization and lower acute and chronic care costs.
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4. Mental Health Problems More Common in Kids Who Feel Racial Discrimination
A new multicenter study involving UCLA and the RAND Corp. has found that perceived racial or ethnic discrimination among fifth-grade students may have a negative effect on their mental health. Study results show that 15 percent of children surveyed reported experiencing what they perceived as discrimination. The study also found that children who reported feeling discrimination were more likely to have symptoms of one or more of four different mental health disorders: depression, attention-deficit hyperactivity disorder, oppositional defiant disorder and conduct disorder.
Racial and ethnic discrimination and their effect on mental health have been studied in adults and adolescents, but less is known about the effects of perceived discrimination on children's mental health. For this study, researchers analyzed data from a 2004 to 2006 study of 5,147 fifth-graders and their parents from public schools in Los Angeles, Houston and Birmingham, Ala. The study found that a greater percentage of black children (20 percent), Hispanic children (15 percent) and children identified as "other" (15 percent) reported perceived racial or ethnic discrimination than white children (7 percent). The strongest and most consistent association of discrimination with mental health symptoms involved symptoms of depression in black, Hispanic and "other" children reporting discrimination. This association was not significant for whites.
"It was surprising to see positive associations between perceived racial and ethnic discrimination in the children and symptoms of all four examined mental health conditions," said lead author Dr. Tumani R. Coker, clinical instructor of pediatrics at Mattel Children's Hospital UCLA and an associate natural scientist at RAND. "Parents, clinicians and teachers should be aware that children may experience racial and ethnic discrimination in and out of school and that there may be detrimental effects on their mental health."
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5. Survey of the Month: Managing Care Transitions Across Sites
Today is the last day to share your organization's experiences with care transitions by completing HIN's Survey of the Month. You'll receive a free executive summary of the compiled results. Your responses will be kept strictly confidential.
To participate in this survey and receive its results, please visit:
6. Healthcare Organizations React to MRSA Outbreak
The Association for Professionals in Infection Control and Epidemiology reported that 1.2 million U.S. hospital patients are affected by MRSA each year. Cognizant of the rise in MRSA cases and increasing concern, HIN conducted a non-scientific online survey to determine what steps healthcare organizations are taking to prevent the infection.
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