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New on How Critical Your Sleep Is and How to Optimize It

By Hui Xie-Zukauskas

5 Sleeping babies_comboDo you toss and turn at night? Do you have difficulties in getting to sleep or staying asleep or both?

If the answer is “YES”, you are a part of the statistics as to an estimated 60 million adults in the US suffering from a sleep disorder. But, taking it lightly is risky.

Previously, I discussed about how sleep disorders may increase a risk to cancer by weakening or disrupting the immune functions and promoting inflammation (see CancerPreventionDaily.com). In this post, I’d like to share some intriguing updates emerged from a new perspective.

Notably, I’m also providing a “Sleep Regimen” in ROOM that is memorable and actionable for a better sleep.

First, let’s dive into recent interesting discovery on serious sleep disorder.

As you may know, sleep apnea is a serious sleep disorder with trouble breathing during sleep; in particular, a halt/stop to breathing may last 10 to 30 seconds and numerous episodes a night. So, it’s potentially life-threatening if left undiagnosed or untreated.

Sleep-disordered breathing, e.g. sleep apnea-hypopnea syndrome (SAHS), contributed to cancer development – based on the animal studies simulating SAHS’ characters, i.e. nocturnal irregular hypoxia (deprivation of oxygen to the tissue) and sleep breakup. Repetitive hypoxia and reoxygenation influenced tumor generation by fueling new blood vessel formation and cancer cell growth. Furthermore, human studies found that higher cancer incidence and mortality are observed in patients with severe sleep-disordered breathing.

Sleep disorders (varied from chronic insomnia to obstructive sleep apnea) have also been linked to many chronic conditions, such as stroke, heart failure, lung diseases, neurological disease, kidney disease, and depression, just to cite some, in both adults and pediatric populations.

Overall, insufficient/poor sleep can impact your health, happiness, safety, career, and quality of life.

Next, how to optimize your sleep

There are multiple ways to enhance the quality of your sleep, e.g. healthy lifestyle, exercise, stress-relief, pain management, etc. However, “sleep hygiene” is one of the top fundamentals, and you can gain direct benefit.

That’s why I’d prefer a non-pharmacological management, and recommend specifically a “Sleep Regimen” in a simple, memorable ROOM to assist you optimize your sleep. Here is how it works.

R: Rest, Relax, and have a Ritual to unwind before your bedtime.

O: O=0 Zero distractions. Distractions range from electronic/mobile devices, TV/radio, bright lights, noises, air, plus Temperature (an important factor – not too hot or too cold), so eliminate or minimize them from your night environment.

O: O=0 Zero food or stimulant drinks, including alcohol, coffee, sugary drinks and/or stimulant medications. Limit water intake too. No meal intake 2 hours prior to your bedtime.

M: Mandate the time and mattress. It is critical to ensure your premier sleep time (7-8 hours per night); go to sleep at the same time and wake up at the same time every day, and stick with it even during the weekend. Remember: Invest a really good, comfortable mattress.

Let me recap itDesign or create and utilize the R.O.O.M. consistently.

In addition, find out the cause of your sleeping problem(s), and don’t rely on “sleeping pills”, unless drug intervention is absolutely necessary.

At the end, I wish you sleep like a baby, and smile like a baby too, for your well-being and vitality.

 

Image Credits: Oseias Ferreira at FreeImages.com;

Claire57100, Zinz25, Esudroff, PubicDomainPictures at Pixabay.com

Medication Adherence Is No Trivial Matter

By Hui Xie-Zukauskas

Med.Adherence n ProvidersPayers_CPDn2otherImagine you want that magic pill to lose weight or you just got the right drugs to effectively cure your illness, but in either case, you let the pills sit somewhere around your house… How would it help you?

Sadly, failure to take prescribed medications causes about 125,000 deaths annually, according to the CDC.

That’s why I talk about medication adherence and the consequences of non-adherence. Medication adherence implies that a patient takes the medication(s) prescribed by his/her doctor, following the dosage, time or frequency, duration and direction.

Issues on taking medications have been an age-old yet multifaceted challenge, which has some across-the-board consequences. Adherence is especially low among patients with chronic illnesses. And it often happens among elderly people too.

It may surprise you how significant this matter is. Let’s start with reasons for adherence.

Why should a patient take medications faithfully and rigorously?

Medication adherence and therapeutic satisfaction are profoundly tied together.

  1. Your adherence to correctly prescribed medication is essential to clinical-efficiency, cost-effectiveness and positive outcomes.
  2. Adherence to the right regime or course of therapy prevents the development of adverse drug events (ADEs) or adverse drug reactions (ADRs) in many ways.
  3. In the sphere of “cost”, if you try to reduce medication cost by taking it irregularly or delaying the refills, the full therapeutic pay off will not be achieved, and worst, a risk of declining health and increasing cost will transpire.
  4. Non-adherence can lead to hospital readmission, esp. in cases of critical health problems, and potentially affecting clinical quality improvement.
  5. Non-adherence is a $ Multi-Billion problem. “Between $100 and $300 billion of avoidable health care costs have been attributed to nonadherence in the US annually.” (Iuga & McGuire. Risk Manag Healthc Policy. 2014; 7:35-44)

It’s worthy to emphasize that many biological events in the body take place between drug dose and its response, including the release of the drug, absorption, distribution, metabolism, secretion and clearance. Plus, drug interactions with coexisting substances or factors could be severe or subtle. So, non-adherence to medication could result in some unanticipated incidents.

So, what are likely roots of non-adherence?

They can be divided into TWO categories: System (external) and Patients (internal)

Systems / External to Patients – just name a few

  • Discontinuity of care – esp. from hospitalization to subsequent discharge home when lacking a proper direction
  • Multiple changes in medication regimens
  • Inadequate education or instruction of drug use to patients
  • Lack of information on side effects of drugs and preventative measures
  • Drug design itself: e.g. formulation, packaging, inconvenience or high cost, etc.

Patients / Internal Causes

  • Failure to fill the prescription at the start
  • Failure to refill the medications consistently
  • Forgetfulness – esp. in older people
  • Exhaustion of multiple medications
  • Discontinuity due to a side effect, fear of side effects, finance or misled information
  • Inappropriate use of medication
  • Intentional decision to not take the medication
  • Lack of understanding diseases or poor health literacy
  • Physical difficulties, esp. with swallowing big tablets or capsules, opening bottles or containers, or obtaining prescriptions.

Understandably, non-adherence may occur above all when a patient’s expectation for therapeutic benefits goes beyond the actual benefits, or when medication cost is greater than a patient anticipated.

If non-adherence is an issue for you, it’s time to reflect and deal with the root problem following the explorative list above. Surely it could be something outside it.

Finally – How can you stick to your medications?

Medical adherence is one of keys to better health care. Interventions to reinforce adherence from clinicians and allied health professionals need to be improved. On the other hand, I’d like to highlight what you can do to stay on your medication regimen and optimize your health.

10 Strategies & Tips for Medication Adherence

  1. Take a driver’s seat for your care. Before a drug prescription, talk with your physician to understand why the medication is needed and what benefits it produces. By making a mutual agreement or decision, it will enhance your adherence in the beginning.
  2. Counsel with a pharmacist at your local pharmacy if you have any concern or trouble with your drugs, and they are happy to help with adequate knowledge and advice. Bonus – it’s free of charge.
  3. Comply with the instruction. This is very important as mentioned earlier that drug dosing can impact your body in various ways. For example, some drugs need to be taken in the morning and others in the evening; some once a day, others four times a day; some with a full stomach, others with an empty one…
  4. Have a self-management system – i.e. use a pillbox, take the medication at the same time each day and ideally couple it with a specific daily task or routine, color-code different time points, refill the medications at the same time each week, and order your medications 7-10 days ahead… you got the idea. It’s practical and effective, esp. for older people who use multiple drugs or drugs that must be taken several times a day.
  5. Find a creative way to remind yourself. It could be a sign, a framed memo or a decorated item/box, or an alarm. And make sure it’s absolutely visible.
  6. Take advantage of technology. It could be a medication reminder app or a dedicated digital calendar. Most helpful, set the alarms, esp. smartphone reminders or some cell phones allow you to set multiple alarms a day.
  7. Reduce financial stress by trimming costs down. If your meds cost too much, consult with your pharmacist for a generic brand or current regimen adjustment. In addition, you can switch to a mail-order pharmacy, which certainly offers more savings.
  8. Get help and support from family members, care givers or doctors whenever necessary, e.g. reminder, refilling, or ideas.
  9. Change attitude and take control of your health. Concerns, denials or doubts are real, but none of them is the right solution to your illness. Find a motivation to take that pill, and it should be bigger than you.
  10. When you travel, make sure to take an extra 1-2 days of medications in case of a delayed schedule. Always keep your meds in your carry-on bag. On a similar note, if you’re dining out, take the required meds with you.

The Take-Home-Message:

#1  “Drugs don’t work in patients who don’t take them”. 

#2  Drugs don’t perform well in patients who don’t take them with a right dose, at a right time and in a right way.

#3  Medication adherence can maximize therapeutic benefits. Failure to do so causes considerable health, clinical and economic consequences.

 

Image Credits: Pharmaceuticalonline.com; Lifescript.com

 

Two Critical Matters in Colorectal Cancer Early Detection

By Hui Xie-Zukauskas

Time for cancer screening_Clipart library & CPDAccording to the American Cancer Society (ACS), an estimated 135,430 cases of colorectal cancer (CRC) will be diagnosed and an estimated 50,260 CRC deaths will occur in 2017 in the United States.

Zeroing in on the numbers: within the predicted colorectal cancer incidence, 71,420 will be men and 64,010 will be women, and deaths will be 27,150 among men and 23,110 among women. Consequently in cancer deaths, CRC is the second leading cause in men and the third leading cause in women among Americans. Worldwide, CRC is the third most common cancer.

These numbers make clear that CRC affects both men and women, in contrast to a myth that CRC is primarily a man’s cancer.

The good news is that most colon cancers are preventable! YES!

Yet, why are the statistics so large? Here are two areas many people often ignore or miss:

  •  Lack of adherence to the screening recommendation
  •  Delay in presenting symptoms to a physician/oncologist

Let me weigh in a bit more on each of these issues.

Adherence to screening and the value of colonoscopy

Let’s start with ACS screening guidelines: “Starting at age 50, men and women at average risk for developing colorectal cancer should use one of the screening tests…” This is because about more than 90% of this disease is diagnosed after age 50. For individuals who have a 1st degree family member or relative with colon cancer, exams should start at an earlier age (e.g. ages 40).

One recommended screening test is colonoscopy, because it can not only detect cancers at their earliest, most treatable stages; it can also detect pre-cancerous polyps that can be removed during the exam before they become cancerous.

In reality, 50-60 percent of Americans who are recommended to get screened comply with the guidance. The lower screening rate might partially explain why only about 40 percent of colon cancers are diagnosed at an early stage (i.e. localized in colon or rectum).

Why should you go for a colonoscopy screening?

  1. You gain significant value. Your anxiety, fear, or even feelings of embarrassment may be understandable. However, consider this: Individuals undergo this exam of high quality under a comfortable, sedated condition, during which the entire colon and rectum are visualized by a qualified gastroenterologist. Pre-cancerous polyps can be found and removed safely. Can you see that this is a very valuable package of diagnosis and therapeutics for your colon health care? 
  2. You acquire rigorous clarity concerning your colon health. We want rigorous clarity in science, and surely, everyone wants thorough clarity when purchasing a house or insurance policy. It makes sense to seek rigorous clarity about a matter so critical to your health. If the result is normal, the colonoscopy should be repeated every 10 years up to the age of 75. If the test detects pre-cancerous polyps, the physician will recommend repeating the exam more frequently.
  3. You benefit from one of the most effective cancer prevention methods, and it is often covered by insurance.

Help your physician to help you by presenting any indications

In some cases, especially at an early stage, colon cancer may present no symptoms. Again, that’s why screening is vital to identify cancer early when prognosis and cure are optimistic.

Nevertheless, other folks may experience symptoms such as:

-          Blood in the stool or rectal bleeding

-          Abdominal pain or discomfort

-          Feeling the bowel incompletely empty, or bloating

-          Sudden changes in bowel habits (diarrhea, constipation, or oddly narrow stools)

-          Unexplained fatigue or weakness

-          Unexplained weight loss

Remember, nobody can read what’s on your mind or what’s going on in your life. If you don’t visit or communicate with your doctor, it’s likely he or she won’t know about your cramps or unexplained changes in your bowel movements.

So, devoting yourself to meeting screening guidelines is a key preventive measure, but another critical area is to counsel with your physician about possible warning signs.

In addition, an important step to preventing colorectal cancer is to know its risk factors. These factors can be categorized as:

-          Uncontrolled: age, colon polyps, family or personal history of cancer, esp. CRC

-          Pathological: obesity, diabetes, inflammatory bowel diseases

-          Controllable or Preventable: sedentary lifestyle, tobacco smoking, heavy alcohol consumption, diet with low-fiber but high-fat (esp. animal fats)

To conclude, for colorectal cancer early detection, as for all cancer risks:

#1 Cancer screening is your first crucial preventive step.

#2 Recognizing risk factors and warning signs is your second vital protective weapon.

Image credit: Clipart library & CPD

22 Proactive Things You Can Do on World Cancer Day and Beyond

By Hui Xie-Zukauskas

Mid_Blue Globe Bkg. Red Ribbon for WCDFebruary 4th each year is designated as World Cancer Day. This day is significant because it

  • kicks off a drive to expand awareness of cancer and its prevention;
  • offers a chance to discover risk factors for cancer and take protective measures;
  • provides a time to reflect on what you can do to make a difference in the fight against cancer;
  • embraces people around the globe to fulfill whatever needs to be done to control this deadly disease; and
  • presents an opportunity to spread a message – We Can Save Millions of People from Preventable Deaths Each Year!

Lifestyle-centered cancer prevention is evidence-based and it’s science. It’s no longer a theory or hypothesis, or breaking news. Healthy lifestyle measures provide powerful ways to lower the risk for many types of cancer.

The theme of World Cancer Day for the current three years (2016-2018) is “We Can. I Can.” Surely, each of us can do something, no matter how small. So, I have compiled a list of actions you can take for World Cancer Day and every day after:

  1. Set a “Cancer Patients First” agenda: Whether from a note, gift, prayer, or—best of all—a visit, let your friend battling cancer know you are with him or her in this fight.
  2. Pack a tool kit for cancer awareness or a thoughtful kit for cancer care.
  3. Remind your loved one to get a cancer screening. Early detection saves lives.
  4. Change one unhealthy behavior, e.g., harmful sun exposure, intentional tanning, alcohol abuse, or tobacco smoking (smokeless tobacco causes cancer too). Importantly, stay on the right course.
  5. Do something about early childhood weight management, especially control obesity in childhood cancer survivors.  Unhealthy behaviors and overweight that develop early in life and persist over time can increase not only the risk for some types of cancer but also cancer-related mortality.
  6. Host a Veggies/Vegetarian party or gathering (the size doesn’t matter).  Alternatively, go on a Mediterranean diet. The point is to replace Western diet components, which are rich in refined grains, animal fats, excessive sugar, and processed meat but poor in fruits, vegetables, legumes, and whole wheat or whole grains. A substantial body of evidence has linked the Mediterranean diet to increased cardiovascular benefits and prevention of some chronic diseases.
  7. Make a “Cancer Prevention” family dinner, or make a “Cancer Prevention Salad.”  Family meals can be a cost-effective intervention for weight management. Evidence suggests that regular family meals protect against unhealthy eating and obesity in children. If time or schedule is challenging, get your teens and/or other family members involved.
  8. Start or improve your weight management plan and actions. Make sure to have a balanced diet and exercise regime.
  9. Enjoy an “Exercise Day” or “Move Day,” and at least, consider taking a 30-minute walk.
  10. Take a “NO JUNK FOOD Day,” and limit red meats. Then do it often.
  11. Drink filtered tap water at home. Drink plenty of filtered water away from home too.
  12. Drink tea to replace sugar-rich beverages.
  13. Better: Have a “Triple Combat” day, by combining three intensive but joyful actions together.
  14. Give your unexplained pain some TLC by paying attention to it, tracking its duration, frequency or pattern, and scheduling a visit to your doctor.
  15. Give cancer caregivers a token of love to honor their labor of love.
  16. Write or speak to your local/national legislator or lawmaker about a policy idea to make food systems safer or make the environment safer.
  17. Speak out or stand up against any external source that potentially promotes cancer.
  18. Volunteer for a cancer fundraising or a cancer care center.
  19. Support the great cause of fighting cancer in any form you can.
  20. Parents and teachers: Advise your girls and boys to vaccinate against HPV. Recommended vaccination starts at age 11 or 12.
  21. Go along with proven strategies to prevent cardiovascular disease (CVD). Why?  Because doing whatever is practical or plausible to lower your risk of CVD will enhance your potential to reduce the risk of cancer. For instance, research findings indicate that proven preventive measures for CVD are identical to preventive actions for prostate cancer.
  22. Take pancreatic cancer seriously. Based on the proposed “pancreatic injury−inflammation−cancer” pathway, it’s critical to avoid risk factors such as smoking, chronic pancreatitis, diabetes, and obesity.   Pancreatic cancer remains a complex, lethal malignancy with the worst prognosis, and a lack of early diagnostic symptoms. It’s also resistant to conventional chemo- and radiation therapies. The rate of its incidence is slowly increasing.

The list can go on and on…

By now, you likely see a clearly centered theme—prevention, which is the most cost-effective implement to fight cancer.

Remember: Cancer doesn’t develop overnight. It’s vitally essential to stick to a healthy lifestyle. Take protective measures such as enjoying a balanced diet, regular physical activity, and a healthy weight now and far beyond World Cancer Day.

And yes, every single small step counts! It’s a life-course approach.

 

Image credit: Designer at <a href=”http://www.freepik.com/free-photos-vectors/medical”>Medical vector designed by Ibrandify – Freepik.com</a>

Rethink Powerful Strategies for Cancer Prevention in 2017

By Hui Xie-Zukauskas

LoveHope 2017_Std.The holiday season is over and the new year started. Many of you probably have set some exciting goals or resolutions already. In reality, early or later, some folks would probably fall “off the wagon”? How would you do differently?

CancerPreventionDaily has provided plenty of practical advice, resources, and useful links on powerful strategies for cancer prevention over the years. Instead of reiterating those strategies here, I’d like to highlight a tool of “RETHINK”.

First, let’s cherish HOPE by celebrating recent scientific and medical advances in cancer treatment! Cancer Immunotherapy has been put on the spotlight – a therapy based on the principle of unleashing the body’s immune system to attack cancer. In addition, remarkable advances in other therapies (e.g. chemotherapy, targeted therapy, surgery and radiation therapy) all improved clinical outcomes, especially lives of people battling cancers.

Equally significant is advance in cancer prevention, specifically, HPV vaccine. As the human papillomavirus (HPV) is the major cause of cervical cancer – infected by passing the virus during sex, and the disease is preventable.

Now let me dive in a bit deeper on “Rethink”.

Consider Uber or Zipcar. Whether through Uber (providing you with a car and a driver) or Zipcar (providing you with a car), you can reach your desired destinies – a different approach from using traditional or old fashion rental cars. Note: These are good examples of innovation or rethinking, not paid Ads! :)

Next, how to rethink with regard to health?

Take weight loss as an example. Maintaining a healthy weight is one of the top powerful strategies for cancer prevention, as scientific evidence clearly indicate that obesity is a risk factor for several types of cancer in both men and women, needless to say risk for diabetes and heart disease.

Many folks are struggling with losing weight for various reasons. If one lesson we can learn from “Santa” to apply here, it is to lighten our load.

So, get motivated, get rid of all unhealthy baggage in all possible ways – dispose of fats, throw away junk foods, abandon extra sugar and extra salt, dispense or burn off some calories, thereby getting rid of “unwanted” pounds, consequently you will reach your goal of weight management. Certainly, you can discover creative ways that work best for you along the journey.

Rethink about cancer and prevention: Instead of fearing “Big C”, treat it as a life or health project with “small pieces”. This is because cancer is the mass (of tissues) on the surface but a collection of complex and multiple diseases in the hub, therefore, you need to tackle it with multiple approaches from genetic medicine, lifestyle to environment and early detection.

So, you got the idea.

In summary –

Rethink, Re-envision, Re-tweet, Re-evaluate and/or Re-calibrate, whatever works for you, so that you gain new perspectives and new approaches, which will help your new year’s resolutions stick, and reap your health benefits in the long run.

May more happiness and better health be all of yours throughout the year 2017!

 

Image credit: mozakdesign.com and CancerPreventionDaily

A Year End Note: Let Bundle of Love and Ray of Hope Continue

By Hui Xie-Zukauskas

A Year End NoteAs we approach the New Year, thank you for your time, reading, likes, comments and feedback in this past year!

I reach out to you because many of you are healthy but fearful of getting cancer, some folks survive cancer, while some are struggling with cancer or other chronic illnesses now.

At the beginning of 2016, one New Year’s resolution from CancerPreventionDaily.com was to bring a theme of love and hope for cancer prevention and care. Throughout the year, the site delivered this theme by serving you with knowledge and solutions for cancer prevention. Here are highlighted areas of the posts:

  • Steered self-care and preventive measures in the ways that foster your well-being from the cells to the whole body and lifestyle choices, from kids to seniors and all ages.
  • Updated serious epidemic and environmental factors.
  • Facilitated clinical care, primarily patient safety and engagement.

Many cancers are preventable; and there are so many things we can do to prevent cancer. Start within.

Let bundle of love and ray of hope carry on in 2017 and future!

The Power of Participation in Patient Surveys

By Hui Xie-Zukauskas

Survey-Feedback_CPD w-otherAfter a trip to the doctor, you or a family member may be requested to fill in a “patient satisfaction survey” or “patient experience survey.” Many folks, questioning what difference it would make whether they complete the survey or not, simply ignore it, as if there were more urgent issues in life at the moment. Sound familiar?

In a recent post, I talked about the issue of improving patient safety and quality of care. Well, participating in a patient experience survey is a key part of that issue. Here, I’m going to dive in a little deeper.

First, let’s start with difference between a “patient satisfaction survey” and a “patient experience survey”

Though wordings of the two are similar, a careful assessment reveals striking differences. Understanding these differences can help you collaborate with your providers effectively.

The essential difference between the two is that a patient satisfaction survey concentrates on making patients happy, while a patient experience survey focuses on making people well – beyond making them happy!

A patient satisfaction survey reflects perceptions or preferences of quality of care received, so it’s more subjective. In contrast, a patient experience survey exposes what happened during the care, so is more objective.

Experience reporting is a more reliable instrument because it tells about the patient’s actual experience of a specific service, clinician, or hospital incident. Questions are designed to be more meaningful to patients and more measurable for providers’ care, and the answers can be transformed into actions.

On the other hand, a satisfaction rating is merely a judgment on meeting one’s expectations. As you can understand, people’s expectations vary, and what matters to one person is different for another.

Take a particular example of waiting time:

When asked “How satisfied are you with the waiting time for your appointment” (e.g. setting up time for your visit, finally seeing your doctor), the results from a satisfaction survey could range from excellent through good, fair, and finally poor.

But in a patient experience survey, when asked “How long did you wait for an appointment when you needed care”, the choices are more concrete (e.g., 1 day, 2-3 days, 4-7 days, or longer than 7 days). To the question “How long did you wait to see your doctor”, the answers are specific (e.g., 15 minutes, 15-30 minutes, 30 minutes or longer).

In sum, to steer towards patient-centered care, it is better to ask patients to report their real experience rather than to put down their satisfaction ratings.

Next, how do patients benefit from patient experience surveys?

Patient experience is important because it not only stimulates a strong patient-provider relationship but also is a critical step toward improving quality of care.

In particular,

  1. Patient experience surveys communicate the best way to improve quality of care. Research indicates that improving patient satisfaction has not been linked to improving quality of care.
  2. Emphasizing patient experience means putting patients first, with healthcare providers being concerned more about “what matters to you” rather than “how are we doing”.
  3. Patient experience surveys value patients’ voices. With your voice, an actionable change can begin because your input reveals key indicators for delivering quality of care.

Eventually, greater patient experience will lead to greater quality of care, which will translate into greater patient satisfaction.

Good news for cancer patients ! – CAHPS for Cancer Care

The Agency for Healthcare Research and Quality (AHRQ) has advanced Consumer Assessment of Healthcare Providers and Systems (CAHPS®) to assess quality of care from the patient’s point of view in various healthcare settings.

CAHPS for Cancer Care has been developed by AHRQ to consistently measure and compare cancer care delivered by different providers and ultimately to provide information for quality improvement. CAHPS for Cancer Care includes three separate sets of questionnaires for surgical, radiation, and medical oncology respectively.

Although CAHPS® is the best tool for healthcare providers, patient engagement and participation are important parts of the process. More reasons for this survey, according to Dr. Caren Ginsberg, director of CAHPS® at AHRQ are:

  • CAHPS surveys are featured to capture information about patient experience rather than patient satisfaction;
  • The surveys are scientifically and statistically sound, thus the results are valid and reliable;
  • CAHPS is flexible to use and easily incorporated into any hospital existing surveys. 

Overall, CAHPS® also serves as a massive database that offer measurable and actionable information, as the surveys have been implemented for over 20 years.

How can you participate and cooperate?

As a final point, remember: one survey cannot change health care or save a life, but it represents one voice and constitutes a worthy part of a large set of valuable data. So, when requested next time, please complete the survey (via innovative technology, direct mail, or telephone), because your voice will be heard, and you can help improve healthcare and save lives!

 

Image credit: http://earlylearningwa.org/ and http://knswb.org.au/

Work Together to Reduce Errors in Cancer Diagnosis

By Hui Xie-Zukauskas

Patient engage comm._CPDHave you or your family member ever gotten a wrong diagnosis from your doctor? Have you heard that a doctor treated your friend for a disease or disorder that he/she actually didn’t have? “It is likely that most of us will experience at least one diagnostic error in our lifetime, sometimes with devastating consequences,” according to the experts on diagnostic safety.

Imagine you were diagnosed with breast cancer and went through cancer treatment, then found out the diagnosis was wrong and the treatment should never have happened. That could spell enormous damage from one diagnostic error!

Cancer diagnostic errors can be the most harmful and costly type of diagnostic errors in various ways. As many cancers are complex and multifaceted, a timely and accurate diagnosis for cancer is still often challenging. That adds weight to preventing cancer altogether and urgency to detecting cancer early.

That’s why I bring your attention to this issue: A diagnosis is something that’s done for a patient (you) and the patient (you) needs to be a part of the team in that process.

1.      Basics and facts

What is a “diagnostic error”?

The Institute of Medicine (IOM) defines a diagnostic error as the failure to:

a. Establish an accurate and timely explanation of the patient’s health problem(s); or

b. Communicate that explanation to the patient. 

What is the reality?

40,000 – 80,000 deaths each year are due to diagnostic errors, as reports vary. However, national diagnostic safety experts, Drs. Graber and Schiff, emphasize that the frequency of diagnostic error is in the range of 10%.

Does it sound like misdiagnosis happens far more frequently than you thought?

2.      When does diagnostic error occur and who may be involved?

No doubt, human factors contribute to diagnosis errors. Studies have reported that communication problems are the most frequent root cause of serious events threatening patient safety. Today’s health-care systems are transforming toward not only integrated care practice but also enhanced patient engagement, to this end, everyone is involved.

Let me bring cancer diagnosis to the forefront. A delayed cancer diagnosis may occur at various stages of the journey to fight cancer. It could be a delay in:

  • symptom recognition or interpretation,
  • decision or action to seek medical attention (e.g., putting off making an appointment due to fear or feeling embarrassed),
  • a care system’s scheduling (e.g., not being seen by a doctor in a timely fashion),
  • clinical tests or subsequent consultations, or
  • receiving cancer treatment.

In addition, putting off doing anything might simply be due to lack of insurance coverage.

Here is the key point: Delayed cancer diagnosis at an early stage may leave the cancer to progress or spread, leading to limited treatment options. Thus, a delay in cancer diagnosis can have devastating consequences, including poor clinical outcomes and a lower chance of survival.

3.      How can you help reduce or prevent diagnostic errors?

Here are 15 things you can do to enhance your communication with your doctor, medical care team, and health care system.

1)      Prepare for your visit: know or collect your medical records, medications, and family history.

2)      Remember your screenings and, importantly, follow up. Having a separate calendar can assist your memory.

3)      Always bring a list of questions or at least your top three questions when visiting your physician.

In case you don’t know where to start, Agency for Healthcare Research & Quality provides a list of questions to ask your doctor. You can also generate your own list using their Question Builder. It’s a fantastic tool!

4)      Bring your spouse or a family member to your doctor visit to facilitate communication and/or fill in missing information that might help with diagnosis or treatment.

5)      Use technology (e.g., a smartphone) to record the conversation or instructions.

6)      Feel free to ask the doctor to clarify terminology or procedure. If you don’t understand why a particular question is relevant to your situation, ask about it or let a family member do so.

7)      If you have a limited English proficiency, make sure you have a family member or a friend act as a translator.

8)      Participate in a patient experience survey to improve patient safety and care.

9)      Get involved in facilitating the chain of communication—e.g., in scheduling appointments, visits, follow-ups, and even questioning an insurance billing if you don’t understand it.

10)  Don’t self-diagnose, especially based on online information from an unreliable source.

11)  Do keep a diary or inventory of your symptoms for better recollections when needed.

12)  Seek a second opinion or multiple consultations on cancer diagnosis when in doubt or if necessary. The second opinion must be an expert’s one. Be proactive.

For example, if you have a lump in your breast but get a normal mammogram—after all, mammograms pick up only 80-90% of breast cancer. So, for your safety, you should ask for further screening, e.g., a breast ultrasound (sonogram) or even a test with a higher sensitivity like magnetic resonance image (MRI) to ensure accuracy if your physician doesn’t order such tests.

13)  If diagnosed with cancer, follow up vigorously and treat any referrals to specialists, tests, or care with urgency.

14)  Further the discussion about potentially discrepant diagnosis or different finding.

15)  When you have unintentional weight loss or unexplained pain, take it seriously and see your doctor.

One more point – Misdiagnosis may not be discovered for years if ever in some cases. That’s why I cannot emphasize enough how prevention and early diagnosis of cancer offer clear and significant benefits, especially concerning common cancers (the breast, prostate, colon, lung, and skin cancer).

Although I talked more about cancer, these principles can be applied to any other illnesses. And I’ll elaborate with more details in near the future. Stay tuned.

Finally, your take-home message: Actively engage in your health care!

Improving diagnosis for patient safety and for better health care is a responsibility of each of us. Doing that can alone save many lives.

 

Never Miss a Chance to Protect Children from Cancer

By Hui Xie-Zukauskas

Cancer Boy w-Ribbon_uthscsa.eduImagine that a tiny, precious life with a bright future was taken away by cancer, the “big C”… Nothing is more devastating than that.

That’s why I’m going to focus on what we can do about childhood cancers, so to prevent the worst loss by all means.

First, what exactly causes childhood cancers remains unclear. Risk factors of childhood cancers are different from those in adult cancers. For instance, lifestyle-related risk factors (such as tobacco smoking, alcohol intake, unhealthy diet, and sun overexposure) do not play a significant role in childhood cancers. Environmental factors have little influence, largely due to the lack of direct exposure of the fetus. Most childhood cancers result from genetic mutations, i.e. genetic errors occur randomly and unpredictably whether it’s inherited or acquired.

So, am I suggesting that there is nothing we can do to prevent childhood cancers or protect our children? No.

If you are not well-informed, you may miss a chance to prevent the unthinkable. Here is an example. Human papillomavirus (HPV) infection is linked to cancers of cervix, oropharynx, rectum, or at other body locations. Nearly 93% cancer due to HPV-infection could have been prevented with recommended HPV vaccine as routine immunization for adolescent girls and boys starting at ages 11 to 12 years, following specific guidelines.

Can you see how one could miss the chance by doing nothing? Let me expand a little more on preventative measures.

1.      Childhood cancer prevention can start before conception in young women.

The mother-to-be’s well-being has an impact on the babies. For example, a pregnant, smoking mom can affect the offspring’s health in a hazardous way. To say the least, alcohol consumption and drug abuse fall into the same category. To minimize a child’s risk of cancer, young women should stay healthy and fit, and avoid or limit the exposure to toxic chemicals and environmental pollutants in daily life. Detect cancer early by genetic testing or genetic consulting, especially when you have a history of familial cancers.

2.      Cancer prevention with a healthy lifestyle should begin early in childhood.

A lifestyle cannot be developed overnight. Lifestyle factors also take years or decades to influence a cancer risk. Fostering a lifestyle with nutrition-rich diet, regular exercises, and healthy weight from a young age forward can greatly lower the risk of several cancers in adults, as accumulating evidence shows. Childhood obesity prevention can produce considerable health benefits. Also, postpone the time for kids to use cell phone or mobile devices to prevent brain tumor, the leading cancer death in children. Growing studies reveal an association of radiation with pediatric brain tumors, especially when young kids have the thinner skulls, with still developing nervous system and brain.

3.      A long-term protection: prevent secondary cancer after childhood cancer.

Cancer treatment like radiation can harm young kids’ organs or tissues because of their vulnerability and developmental stages. Radiation or chemo therapies for childhood cancers increase a risk for secondary cancer as one ages. Particularly common are tumors of the brain, breast, skin or spine, and bones. The higher doses of radiation, the greater risk these individuals have. So, it’s important to detect cancer early in the population of childhood cancer survivors, and make sure they have regular visits or check-ups, in addition to living a healthy lifestyle.

Let me conclude with the Quote from Elizabeth Barrett Browning: Light tomorrow with today.All said and done, apply these outlined approaches today to protect every child, so that each child has a healthier, happier, and brighter life tomorrow.

 

Image credit: uthscsa.edu and CPD

5 Reasons for a Higher Awareness of Zika

By Hui Xie-Zukauskas

Zika_Pt.2_CPDZika virus continuously poses a public health threat in the U.S.. Since my last post “Zika Virus Infection and Cancer Care Indication”, as of August 24th, 29 people in Florida have been infected with Zika virus through local mosquito transmission, along with 2,487 travel-related cases across the country, according to the CDC.

This is a more alarming reality than that presented three months ago when all 544 Zika cases in the U.S. were travel-related. Regions along the Gulf Coast are at an elevated risk for Zika outbreak, especially Louisiana, because of recent devastating flooding.

Pregnant women are particularly vulnerable to the Zika crisis. Of importance is to avoid traveling to Zika outbreak areas and stay self-protected to prevent mosquito bites. I won’t get into details here because plenty of information or guidance is available elsewhere.

Based on some new research and clinical findings, I’d like to emphasize FIVE reasons why we need a higher alert and responsiveness to Zika infection. Here goes:

1.      There are various ways for Zika virus transmission.

A person who has acquired the Zika infection could pass virus along through mosquito bites, maternal-fetal and/or sexual transmission. Unmistakably, blood transfusion also becomes a major concern as Zika-positive blood donation is evident. That’s why the FDA recently recommended nationwide screening of blood donations for Zika virus. Thank about it – why is it necessary to run such a costly and time-consuming testing for a massive blood donation system? Remember that people infected with Zika virus could be symptomless.

2.      Zika virus can damage not only a baby’s brain but also an adult’s brain cells.

Painful scan images have shown that Zika infects a fetus, causes brain calcification, and destroys a baby’s brain. Severe brain damage may bring about long-term developmental problems or neurological complications affecting vision, movement and epilepsy. On the other hand, new research reveals that Zika virus impacts a different area of adult mice’s brain, such as a specific neural cell, and it could affect long-term memory in some adults.

3.      Zika virus affects the immune response, particularly in those whose immune system has been compromised due to a chronic disease or cancer therapy.

Infections by viruses can suppress the immune system. Moreover, a person’s inflammatory response to mosquito bites may augment the severity of arbovirus infection (e.g. Zika). Studies suggest that mosquito bites, especially in individuals hypersensitive to mosquito bites, may be linked to cancer development through activating cancer cellular pathways by mosquito-feeding, and/or through influencing human metabolic pathways leading to the initiation of cancer.

4.      It’s challenging to control mosquitoes.

Mosquito population is measured in the millions, and usually in the hundreds of millions. There is no way to distinguish Zika-infected mosquitoes from the rest uninfected. It’s virtually impossible to eradicate them all. But it doesn’t mean we should give up our effort.

Aerial spraying and backpack fogging carried out by the professionals can help reduce mosquito populations in epidemic areas. There are also effect measures that individual citizens can take right at home or the backyard with little or no cost. For instance, the best ways to control local mosquito population is to eliminate the places where mosquitoes breed, such as water-filled buckets, flowerpots, containers, puddles or pools of standing water outdoors.

Using pesticides to kill mosquitoes is delicate. Be cautious about unintended consequence, because pesticides often contain some toxic chemicals that can be harmful to human health if inhaled or ingested. 

5.      Finally, keep in mind those young women whose newborns suffering from microcephaly, neurological abnormalities and birth defects. What would their hardship be? – raising their ill babies, caring for the infants with various disabilities, and likely dealing with their own stress, anxiety, depression or quality of life.

 

Image credit: physio-pedia.com and CPD