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Which drugs and therapies are proven to work, and which ones don't, for COVID-19? Print E-mail
Written by William Petri, Professor of Medicine, University of Virginia   
Wednesday, 01 July 2020 18:26

I am a physician and a scientist at the University of Virginia. I care for patients and conduct research to find better ways to diagnose and treat infectious diseases, including COVID-19. Here I’m sharing what is known about which treatments work, and which don’t, for the new coronavirus infection.

Keep in mind that this field of medicine is rapidly evolving as our understanding of the SARS-CoV-2 virus improves. So what I am writing today may change within days or weeks.

Below are the treatments that have been tried and for which we have the best knowledge.

Hydroxychloroquine or chloroquine – no evidence they work

There are three randomized controlled trials of hydroxychloroquine, all of which have failed to prove or disprove a beneficial or harmful effect on COVID-19 clinical course or clearance of virus. Given this current lack of evidence, these drugs, which normally are used to treat arthritis, should only be used within the context of a controlled clinical trial.

Lopinavir/ritonavir – not helpful

The drug Lopinavir is an inhibitor of an enzyme called HIV protease which is involved in the production of viral particles. Protease inhibitors for HIV were revolutionary, leading to our current ability to effectively treat HIV. Lopinavir also can inhibit enzymes that perform similar functions as the HIV protease in the SARS and MERS coronaviruses. Ritonavir increases the level of Lopinavir in the blood so the lopinavir/ritonavir combination was tested in a randomized controlled clinical trial for COVID-19.

Unfortunately, there was no impact on the levels of virus in the throat or duration of viral shedding, nor did patients’ clinical course or survival change. There therefore is no role for lopinavir/ritonavir in the treatment of COVID-19.

Steroids – yes for almost all COVID-19 patients

When a synthetic steroid hormone, called dexamethasone, was given to patients with COVID-19 the drug decreased 28-day mortality by 17% and hastened hospital discharge.

This work was performed in a randomized and controlled clinical trial of over 6,000 patients, and while not replicated in another study or yet peer reviewed, is certainly enough evidence to recommend its use.

Tocilizumab – too early to judge

Tocilizumab is an antibody, that blocks a protein, called IL-6 receptor, from binding IL-6 and triggering inflammation. Levels of IL-6 are higher in many patients with COVID-19, and the immune system in general seems to be hyperactivated in those with the most severe disease. This leads many physicians and physicians to think that inhibiting the IL-6 receptor might protect patients from severe disease.

Tocilizumab is currently FDA approved for the treatment of rheumatoid arthritis and several other collagen-vascular diseases and for “cytokine storm” – a harmful overreaction of the immune system – that can be caused by certain types of cancer therapy and COVID-19.

A retrospective observational study found that COVID-19 patients treated with tocilizumab had a lower risk of mechanical ventilation and death. But we lack a randomized controlled clinical trial so there is no way to ascertain if this apparent improvement was due to tocilizumab or from the imprecise nature of retrospective studies.

Convalescent plasma – too early to judge

Convalescent plasma, the liquid derived from blood after removing the white and red blood cells, contains antibodies from previous infections that the plasma donor had. This plasma has been used to prevent infectious diseases including pneumonia, tetanus, diphtheria, mumps and chickenpox for over a century. It is thought to benefit patients because antibodies from the plasma of survivors bind to and inactivate pathogens or their toxins of patients. Convalescent plasma has now been used in thousands of COVID-19 patients.

However, the only randomized clinical trial was small and included just 103 patients who received convalescent plasma 14 days after they became ill. There was no difference in the time to clinical improvement or mortality between those who did and did not receive treatment. The encouraging news was that there was a significant decrease in virus levels detected by PCR.

It is therefore too early to tell if this will be beneficial and controlled clinical trials are needed.

Remdesivir – yes, decreases hospital stay

Remdesivir is a drug that inhibits the coronavirus enzyme that makes copies of the viral RNA genome. It acts by causing premature stoppage or termination of the copying and ultimately blocks the virus from replicating.

Remdesivir treatment, especially for patients who required supplemental oxygen before they were placed on a ventilator reduced mortality and shortened the average recovery time from 15 to 11 days.

ACE inhibitors and ARBs – keep taking them

There was a concern that drugs called ACE inhibitors or angiotensin receptor blockers (ARBs), which are used to treat high blood pressure and heart failure, could increase levels of the ACE2 proteins, the receptor for SARS-CoV-2, on the surface of cells in the body. This would, physicians hypothesized, allow more entry points for the virus to infect cells and would therefore boost the severity of new coronavirus infections.

However, there is no evidence that this is the case. The American Heart Association, the Heart Failure Society of America and the American College of Cardiology all recommend that patients continue to take these medications during the pandemic as they are beneficial in the treatment of high blood pressure and heart failure.

We have made amazing progress in the treatment of COVID-19. Two therapies – steroids and Remdesivir – have already been shown to help. Those who benefit from these treatments owe thanks to patients who volunteered to participate in controlled clinical trials, and the physicians and pharmaceutical companies that lead them.

[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]The Conversation

William Petri, Professor of Medicine, University of Virginia

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Last Updated on Wednesday, 01 July 2020 19:07
 
Joe Stuczynski Named Chief Executive Officer of Memorial Hospital Pembroke Print E-mail
Written by MHS News   
Friday, 12 June 2020 08:03

Joe Stuczynski has been named Chief Executive Officer of Memorial Hospital Pembroke, a community-based hospital offering worldclass care through its Emergency Department, freestanding 24/7 Care Center, medical and surgical services, Memorial Weight-Loss Surgery Program, Comprehensive Wound Healing Center and Hyperbaric Oxygen Therapy, Memorial Medical Detoxification Program and more. Since 2005, Stuczynski has been with Memorial Healthcare System, most recently as Chief Financial Officer of Memorial Regional Hospital South and previously served as CFO of Memorial Hospital Pembroke from 2005 to 2015.

“It is an honor to return to Memorial Hospital Pembroke and be given the opportunity to collaborate with a team of skilled health professionals who are leading the way through innovation and high-quality service,” said Joe Stuczynski, CEO, Memorial Hospital Pembroke. “Together, we will continue to put our patients first, as we help our community find its way back to health during these unprecedented COVID-19 times.”

Stuczynski has more than 25 years of progressive administrative experience in large integrated healthcare organizations with almost two decades at the executive level. His strengths include extensive financial and operational leadership, long-range forecasting, service line and program development and innovative growth strategies. In his recent role as CFO of Memorial Regional Hospital South, he was responsible for the Rehabilitation Institute, Memorial Manor Nursing Home and Home Health Services. Previously, he served as CFO for Memorial Hospital Pembroke, where he also had responsibility for a number of operational departments.

Stuczynski holds a Bachelor of Science in Business Administration/Accounting from John Carroll University and a Master in Business Administration from Florida International University. A resident of Coral Springs, Joe and his wife Deneen have four children.

“Joe is a talented financial strategist with a keen eye for innovations that continue to position Memorial as a leader in providing excellent patient-centered care,” said Aurelio M. Fernandez, III, FACHE, Memorial Healthcare System President & Chief Executive Officer. “For 15 years, Joe has been an insightful leader within our healthcare system, and we are proud to have him take the helm of Memorial Hospital Pembroke.”
 
Remote Healthcare Administration Internship (RHAI) Seeks Funding Print E-mail
Written by LIFT   
Monday, 18 May 2020 16:44

A Call to Help Make a Difference


Pembroke Pines, FL, May 18, 2020 – The Leadership Innovation Foundation Team (LIFT) is delighted to announce the development of the Remote Healthcare Administration Internship (RHAI) which is an innovative program that provides an immersive healthcare administrative internship experience in a virtual setting. The RHAI is an eight (8) week dynamic and virtual program that will serve to fill the gap experienced by many current and prospective interns who are unable to participate in a summer internship program as a result of the impact of COVID-19 pandemic by simulating the experience of a typical internship online to the extent possible. The RHAI program is seeking funding support.

Oyinkansola “Bukky” Ogunrinde, a co-founder of the company and co-director of the RHAI program explains, “I am always moved to help early careerists gain entry into healthcare management. This endeavor can be challenging for many early careerists who often find themselves in the paradoxical situation of not having the expected experience and skill requirement and yet cannot seem to get the opportunity to acquire those experiences and skills in the first place. However, my inspiration to help comes from the raw talent, precocious disposition, learning agility and tenacity observed in many seeking training opportunities. After learning that many interns had lost their internships due the impact of COVID-19, I jumped at the opportunity to work with my partner to create an internship program that is adapted to the current environment through technology and that helps our future leaders receive the training that they need.” 

Each week of the program is dedicated to a core area of healthcare management discipline and special topics in the industry. Curriculum includes sessions that provide insightful and practical experience from professional healthcare leaders, actionable assignments, case studies, career and leadership development workshops, community engagement, a key project and a virtual career fair. The number of early careerists that will be enrolled in the program which is set to run from June 15, 2020 to August 14, 2020 will be based on funds raised.

Claslyne “Doris” Jean Pierre, the co-founder of the company and co-director of the RHAI program explains, “as a former graduate intern at Kaiser Permanente of the Northwest, I can attest to how instrumental this experience has been in my professional career. As a result of the internship program, I gained confidence in my skills and ability to contribute to the healthcare industry. Early careerists like me look forward to summer internship programs as they prepare us for a life-long and impactful career in healthcare. Without a doubt, the RHAI will empower early careerists, and provide them with valuable resources & experience during these uncertain times.”

The goal is to raise funds for the program by Friday, May, 29, 2020 and we need your support.  Please join the Leadership Innovation Foundation Team (LIFT) in “lifting” the RHAI program to develop our future healthcare leaders. To be a sponsor or make a donation, please CLICK HERE and visit our website at www.myrhai.org for more information.  Let’s make a difference!
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The Remote Healthcare Administration Internship (RHAI) was developed by the Leadership Innovation Foundation Team (LIFT). LIFT is operating through a fiscal sponsorship with Players Philanthropy Fund (Federal Tax ID: 27-6601178), a Maryland charitable trust with federal tax-exempt status as a public charity under Section 501(c)(3) of the Internal Revenue Code. Contributions to LIFT are tax- deductible to the fullest extent of the law.

Last Updated on Friday, 22 May 2020 13:12
 
North Miami Beach Based Primary Care Group Practice Launches Telemedicine Platform Print E-mail
Written by Jeffrey Herschler   
Thursday, 26 March 2020 09:19

CCMS-ACO, a Primary Care Group Virtual Practice based in North Miami Beach, launched its new telemedicine platform earlier this week. With the ongoing COVID-19 health crisis creating unprecedented demand for telemedicine services, this new option could not have come at a better time. The company provides HIPAA and HITECH compliant, online access to licensed clinicians. MDsOnDemand.com accepts Medicare, Medicaid, commercial insurance and credit cards. Cash pay patients can receive their initial consultation for $59.95; this price is reduced from $79.95 due to the crisis.

“Once the COVID-19 situation accelerated, we realized it was our duty to get this up and going as quickly as possible,” states Mario Espino, CEO of CCMS-ACO. “Successful deployment of telemedicine services is critical in coping with the crisis,” he adds. “Telemedicine keeps people out of busy medical facilities and contributes to the goal of social distancing.”

Telemedicine has been a fast-growing industry for at least a decade, but it’s always been held back by tradition and regulations. The government and other payers feared fraud and abuse. Practitioners feared out of state competition and patients often preferred the traditional face-to-face encounters. But now all of that has changed. The Trump administration on Tuesday, March 17 announced expanded telehealth benefits for Medicare beneficiaries, giving the country's older population access to medical care without having to leave their homes during the outbreak of the Coronavirus causing COVID-19. The black swan event of Coronavirus has now accelerated the pace of telehealth adoption dramatically.

At CCMS-ACO the original intention was to offer telehealth services in conjunction with meeting regulations based around Transitional Care Management. However, it was decided that a fully integrated platform that most resembled the experience of a real practice visit with electronic prescribing, security, and the ability for patients to access their information through a portal was necessary. “It had to integrate with our EHR,” states Mr. Espino. The MDsOnDemand.com platform automatically enters the video and audio consultation into the patient’s health record. Diagnoses are added to the record in real time. “We can coordinate all of the various medical records and then run the algorithms before creating the care plan, when we are doing chronic care management,” he states.

“We are not just a telemedicine company, we are primary care providers and a technology company,” states Mr. Espino highlighting the differences between his current venture and others in the telemedicine space.

And telemedicine will be a big part of CCMS-ACO’s strategy long after the COVID-19 crisis resolves. 

“There is propensity to be more vulnerable when visiting doctors’ offices or medical facilities – it’s very stressful,” he asserts. “These people are frail, immunocompromised. What you can’t quantify is: How many patients become sick because they went to the doctor’s office, emergency room or urgent care?”

Mario Espino has been in healthcare in one way or another for over 30 years and it looks like he is just getting started!

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To learn more, please visit www.MDsOnDemand.com or https://ccms-aco.com.

Last Updated on Thursday, 26 March 2020 10:18
 
Telehealth: Get ready for big changes in healthcare Print E-mail
Written by Paul D. Kivela, MD | KevinMD   
Tuesday, 17 March 2020 17:17

The year 2020 might bear witness to a significant shift in control of health care from the providers, insurers, and the government to actual healthcare consumers. First, it was the politicians, then the tech conferences and promises of 5G, and now global pandemic scares are all signaling the demand for remote healthcare. The delivery of healthcare has been in the hands of hospitals and physicians for nearly a century. The government really started to exert their control when Medicare and Medicaid started in the 1960s. Large private insurance companies started to significantly exert their control in the 1970s. With the coming of Obamacare almost exactly a decade ago, the structure of health plans changed as their profit model counted on greater patient responsibility through high deductible and co-pays. The failure of hospitals, physicians, pharmaceutical companies and insurance companies to be able to work together has caused consolidation.

Last Updated on Tuesday, 17 March 2020 17:44
 
The financial hole for patients begins on the first day of diagnosis Print E-mail
Written by Wendy A. Rhoades, MD | KevinMD   
Friday, 28 February 2020 17:42

I pushed open the door with a huge smile on my face while my eyes searched the room for the chubby toddler that was my patient. One sweep across the roomful of siblings, and my eyes stopped on the child crinkling the paper on the examination table. I could see the long, smooth scar poking out from beneath the hemline of her skirt.

She smiled and waved at me with a skinny, little arm. It had only been three months since I had seen her - not nearly enough time to lose all that toddler chubbiness. My mind rewound instantly; I had reviewed her scans the day before finding no signs of tumor recurrence. 

I began to chat with her mother and father about her health and did a complete review of symptoms. I was searching for a sign - any sign that would tell me that I had missed a relapse to explain the obvious weight loss. Childhood cancer relapses can sometimes unexpectedly sneak up like that, and I was inwardly panicking that this was the case. 

After a complete review of symptoms and full physical exam, I was reassured that I had not missed anything. I paused and opened up her growth chart. There it was: the little, black dot staring back at me. It had plummeted off of a previously solid trajectory of expected weight gain for a child her age that we had maintained through months of grueling chemotherapy and surgery.

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Last Updated on Monday, 06 April 2020 17:02
 
How to care for someone with dementia Print E-mail
Written by AHHC News   
Thursday, 13 February 2020 08:30

The majority of us take our good memory for granted. It’s easy to recall a recent conversation with a friend. However, for patients suffering from dementia, even remembering the name of a loved one can pose as an overwhelming challenge. Stringing together words into complete sentences is a form of communication we practice daily with ease. A person who has developed dementia, however, struggles to even find words, if their condition enables them to speak at all.

Dementia damages brain cells and takes its toll on the minds of many older adults. Depending on what area of the brain is affected, the changes impair memory, thinking and social function, enough to hinder normal, daily function. Dementia is not a specific disease. Rather, dementia is an umbrella term used to describe a variety of symptoms, like the loss of memory, thinking and other mental abilities.

Alzheimer’s is the most prevalent type of dementia. Healthcare professionals estimate that 60 to 80 percent of dementia cases are classified as Alzheimer’s. Parkinson’s disease is a common form of progressive dementia, where sufferers experience difficulty with movement. Huntington’s disease, also categorized as dementia, affects patients who have a defective gene in a certain chromosome. Patients with Huntington’s disease experience abnormal involuntary movements, mood disturbances and an overall decline in the ability to think and reason. Dementia covers a range of other brain diseases, as well, like vascular dementia, mixed dementia and frontotemporal dementia, among others.

Patients with dementia suffer from stages of the condition, ranging from mild to moderate to severe. The three stages of dementia, as they progress, carry with them increasing losses of memory and function. No matter what type of dementia an elderly individual has, dementia care is necessary to help the patient live as comfortably as possible.

Preparing the home with safeguards is essential to managing complications associated with dementia. The living environment, however, is secondary to communicating empathetically with a person suffering from a degenerative condition, like dementia.

Connect Positively

Communicating with a loved one with dementia becomes stressful without key strategies that improve the relationship. Tips to ease communication include the following:

• Speak slowly, clearly and use simple sentences.

• When asking questions, phrase the question to encourage either a yes or no response.

• Redirect the conversation or change the environment if the loved one becomes agitated.

• Serve up good humor whenever possible. Even a person with dementia enjoys a hearty laugh.

• Inquire about the loved one’s fond memories. The patient’s short-term memory will yield a blank, but they will remember with ease what happened four decades ago.

Limit Wandering

Wandering is often a symptom of dementia. Patients with dementia may walk aimlessly for a number of good reasons, including to find the toilet, to overcome boredom, to cope with medication side effects, to “search” for someone or to simply exercise. Whatever the trigger, a caregiver can take steps to manage the unpredictability of wandering:

• Reduce the possibility for restlessness by scheduling daily exercise.

• Install key locks on doors, preferably not at eye level (where most dementia patients will look).

• Consider installing a home security system specifically designed to monitor patients with dementia. You’ll easily keep a close eye on your loved one.

• Make sure your loved one wears an ID bracelet in the event he or she is missing.

Reduce Emotional Disturbances

Often associated with the downward spiraling stages of dementia are irritability, aggression and sleeplessness. Agitation results from the patient feeling a loss of control, stress, fatigue or fear. Handle emotional outbursts with compassionate tactics:

• Establish daily routines to inspire feelings of comfort and security.

• Limit noise and clutter in the home; also keep the number of persons in the room to a minimum.

• Support your loved one’s independence, allowing him or her to accomplish as many self-care tasks as possible unaided.

• Avoid confrontation. Distract the patient from any unpleasant situation with snacks or an activity.

Ensure Eating and Drinking

Dementia patients’ memories do not include a timetable for meals and proper hydration. They literally forget to eat and drink. A lack of nutrition is unhealthy, leading to weight loss, sleeplessness, irritability, disorientation and bowel problems. Keep your loved one’s food and drink intake steady with these tips:

• Portion five to six small meals per day rather than three large ones.

• Support independent dining. Finger foods are preferable to traditional etiquette. You may also want to pre-cut food and replace drinking glasses with plastic cups.

• Share mealtime with your loved one and offer caring companionship.

• Give the dining environment a soothing atmosphere with flowers and music, for instance, to make mealtime special.

Promote Good Sleep Patterns

Day and night can become confusing events for a person with dementia, especially if their biological clock has become impaired. Counter the effects of sleeplessness with a good plan:

• Increase daytime physical activities, which will lead to a better night’s rest. Avoid napping midday.

• Take safety precautions at home: add a gated barrier to staircases, lock kitchen doors and put away dangerous items.

• Emphasize quiet, structured activities later in the day that promote rest, such as listening to relaxing music, playing card games or going for a leisurely stroll.

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AHHC News is published by Assisting Hands Home Care. With offices in Kendall and N. Miami, the organization works with families throughout Miami-Dade County to develop the most optimum care plan to keep their loved one safe and engaged at home. Qualified caregivers are trained to provide non-medical care for all three stages of dementia. Families feel a sense of ease in knowing that their loved one is receiving reliable service. Assisting Hands Home Care serves the elderly populations with skill, compassion and dedication. To learn more visit www.AssistingHands.com/Miami. 

Last Updated on Friday, 14 February 2020 17:57
 
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