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Economic Barriers to Antiretroviral Therapy in Nursing Homes


OBJECTIVES

Our aim was to clarify if persons living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) have adequate economic access to antiretroviral therapy (ART) when admitted to nursing homes (NHs). Medicare Part A pays NHs a bundled skilled nursing rate that includes prescription drugs for up to 100 days, after which individuals are responsible for the costs.

DESIGN

A cross‐sectional study.

SETTING

NHs.

PARTICIPANTS

A total of 694 newly admitted long‐stay (>100 d) NH residents with HIV.

MEASUREMENTS

We used Minimum Dataset v.3.0, pharmacy dispensing data, NH provider surveys, and Medicare claims from 2011 to 2013. We assessed receipt of any HIV antiretrovirals or recommended combinations (ART), as defined by national care guidelines, and the source of payment. We identified predictors of antiretroviral use with risk‐adjusted generalized estimating equation logistic models.

RESULTS

All study persons living with HIV/AIDS in NHs had prescription drug coverage through Medicare’s Part D program, and ART was 100% covered. However, only 63.9% received recommended ART, and 15.2% never received any antiretrovirals during their NH stay. The strongest predictor of not receiving antiretrovirals was the first 100 days of a long NH stay (odds ratio [OR] = .44; 95% confidence interval [CI] = .24‐.80). The strongest predictor of receiving recommended ART was health acuity (OR = 1.51; 95% CI = 1.20‐1.88).

CONCLUSION

People living with HIV in NHs do not always receive lifesaving ART, but the reasons are unclear and appear unrelated to economic barriers.

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State leaders, UMMC break ground for state’s first skilled nursing facility for children

Published on Tuesday, December 10, 2019

By: Annie Oeth, [email protected]

A place where Children’s of Mississippi patients with medically complex conditions can live and where families can get the training needed to provide care at home will be under construction in 2021.

A groundbreaking for the facility, the first of its kind in Mississippi, was held Tuesday, with state and medical leaders in attendance.

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Having moved indoors due to rain, those breaking ground on the state’s first pediatric skilled nursing facility include, from left, nurse practitioner Regina Qadan, Mississippi Commissioner of Higher Education Dr. Alfred Rankins Jr., patient Deontay Isaac, Pediatrics Chair Dr. Mary Taylor, First Lady Deborah Bryant, patient DeAsia Scott, Gov. Phil Bryant, patient William Currie, Children’s of Mississippi CEO Guy Giesecke, nurse manager Wesley Smith, Chief Nursing and Clinical Services Officer Ellen Hansen, patient Willow Cannan, philanthropist James Ingram, who is executive vice president and chief investment officer of Hertz Investment Group, and Division Chief of Pediatric Palliative Medicine Dr. Christian Paine.

The home, designed for patients who need skilled, sometimes around-the-clock nursing care due to the complexity of their medical conditions, will be built in a wooded area off Eastwood Drive in Jackson, minutes from the University of Mississippi Medical Center campus.

“This is the start of something new, historic and very close to all of our hearts,” said Guy Giesecke, CEO of Children’s of Mississippi. “We have patients at our children’s hospital who could live in a more home-like space if skilled nursing care was available. We want for these patients what we want for all children: health, happiness and for them to reach their full potential.”

The idea of such a home took root when Deborah Bryant, wife of Gov. Phil Bryant, met Children’s of Mississippi patient DeAsia Scott, who has lived at the state’s only children’s hospital since being seriously injured in a car accident as a young child.

Mississippi's pediatric skilled nursing facility will be just minutes from the UMMC campus in Jackson.

Mississippi’s pediatric skilled nursing facility will be just minutes from the UMMC campus in Jackson.

The two met during one of the First Lady’s visits to the children’s hospital. “I had no idea there were children who had been there most of their lives, and that just broke my heart,” Bryant said.

Gov. Phil Bryant, who introduced his wife in the ceremony, said the founding of the facility has been a meaningful cause to them.

“My desire was that DeAsia would be able to have a home someday,” Deborah Bryant said. “DeAsia and I would start talking about it, and I would tell her, ‘DeAsia, we’re going to get you a home someday.’ She said, ‘Do you promise?’ Well, if I make a promise, I’m going to keep it.”

Dr. Mary Taylor, Suzan B. Thames Chair, professor and chair of pediatrics, said the home will be an integral part of Children’s of Mississippi, the pediatric arm of UMMC that includes the state’s only children’s hospital as well as clinics around the state.

“We have a special group of patients who need this facility,” she said. “We will give them and other children the care they need in a more homelike atmosphere.”

Gov. Phil Bryant looks on as wife Deborah Bryant and Dr. Mary Taylor, right, unveil a rendering of the state's first pediatric skilled nursing facility.

Gov. Bryant looks on as wife Deborah and Taylor, right, unveil a rendering of the state’s first pediatric skilled nursing facility.

The facility is being funded through bonds authorized by state legislation as well as through philanthropy. Mississippi Rep. Alyce G. Clarke was honored by name in the legislation for her efforts on such projects.

While the facility will be a skilled nursing facility, the space will have a home-like atmosphere, with areas for dinners and programs indoors, and outdoor space for recreation.

“I always had a vision that I wanted some place in the country, a house in the country for these kids to get to,” said Bryant. “I want them to see the birds and see the trees.”

When the architectural renderings of the facility were unveiled in Tuesday’s ceremony, William Currie, one of the patients who would benefit from it, let out a shout of joy.

“William, you are all about smiles,” responded Deborah Bryant. “You will be our cheerleader.”

Dr. Christian Paine tells of the need for the planned pediatric skilled nursing facility, which is shown in the renderings beside him.

Paine tells of the need for the planned pediatric skilled nursing facility, which is shown in the renderings beside him.

Dr. Christian Paine, chief of pediatric palliative care at UMMC, said the facility will be a home for the Children’s of Mississippi patients who have been unable to leave hospital care, but he notes that the true need may not be known yet.

“This may be a case of ‘If you build it, they will come,’” Paine said. “Once this center is open and available, we may find more patients in the state and region in need of this level of care.”

Conditions of patients will vary, he said. Some who will live at the center have been injured in accidents, while others have congenital or genetic conditions. Some may be dependent on technology such as ventilators or feeding tubes to survive and often rely on wheelchairs.

This architectural rendering of a recreation area in the home includes a view of its wooded surroundings.

This architectural rendering of a recreation area in the home includes a view of its wooded surroundings.

Families will be a valued part of the care team, Paine said. Through the facility, families can get the training needed for home care, and for patients whose conditions require a higher level of care, families will be welcomed for visits.

Nurse practitioner Regina Qadan applauds the facility plans, saying it will allow palliative care patients a chance to enjoy the pleasures of home.

“The children of complex care are so much more than their medical conditions,” she said. “They are brave, resilient, amazing and are so loved…this home is what they need, and more importantly, what they dream of.”

While some of these patients may not fully recover, Paine said, this facility will be a home for them. “That is the center of palliative medicine,” he said. “We want these children to have a place to call home and to have good lives.”

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Toxicology Rounds: Time to Abandon the Osmolal Gap Completely

Wolters Kluwer Health

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Photos: First Lady, Children’s of MS patient set season aglow

Published on Thursday, December 5, 2019

Continuing a decades-old tradition, BankPlus Presents Light A Light brought a dose of the joy of the season to the state’s only children’s hospital. First Lady Deborah Bryant and Peyton Strickland of Clinton, a Children’s of Mississippi patient, flipped the switch to light the hospital’s holiday display, while Ballet Mississippi dancers presented scenes from “The Nutcracker” in the Friends of Children’s Hospital fundraiser.

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A giant candy cane serves as the switch for the hundreds of lights that adorn the children’s hospital’s holiday display while Mississippi First Lady Deborah Bryant and Peyton Strickland, Children’s of Mississippi patient, flip the switch from “off” to “on.”

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Ballet Mississippi’s Frances Madden dances as the Sugar Plum Fairy.

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Jill Dale, chair of BankPlus Presents Light A Light and a Friends of Children’s Hospital board member, welcomes attendees to the traditional holiday event.

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Deidra Furr holds Evelynn Wipperling of Vicksburg, a Children’s of Mississippi patient, as they watch Ballet Mississippi dancers perform scenes from “The Nutcracker.”

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Bryant listens as Strickland wishes the audience a merry Christmas.

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Bryant, left, hugs Dale after receiving an eternal light from Friends.

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Sophia Killilea, a Ballet Mississippi dancer, plays the part of a toy soldier in a dance from “The Nutcracker.”

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Bryant, left, and Dr. Mary Taylor, UMMC pediatrics chair, chat before the start of the event.

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John Scarbrough, left, a Friends of Children’s Hospital board member, talks with Dr. Guy Giesecke, Children’s of Mississippi CEO.

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Taylor greets the audience at BankPlus Presents Light A Light. Next year’s event is scheduled to take place in the Children’s Hospital expansion, which is scheduled to open in fall 2020.

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Viewpoint: Press Ganey is a Worthless Tool for the ED

Wolters Kluwer Health

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CMNH selects Mississippi’s Children’s Miracle Champion for national role

Published on Monday, December 2, 2019

By: Annie Oeth, [email protected]

Aubrey Armstrong can add one more title to her resume: 2020 Children’s Miracle Network Hospitals National Champion.

The state’s 2019 Champion, the 15-year-old from Oxford is the first Children’s of Mississippi patient to represent patients of Children’s Miracle Network Hospitals at the national level. A part of the University of Mississippi Medical Center, Children’s of Mississippi includes the state’s only children’s hospital as well as general and specialty clinics around the state.

“We are so excited and humbled,” said Aubrey’s mom, Holly Armstrong. “After we got the news, we told her when she got home from school. She said, ‘Oh, my goodness! Really?!’”

The Armstrong family includes, from left, mom Holly, daughters Aubrey, Ann-Michael and Ava, and dad Brad.
The Armstrong family includes, from left, mother Holly, daughters Aubrey, Ann-Michael and Ava, and father Brad.

In October, the Armstrongs went to Children’s Miracle Network Hospitals headquarters in Salt Lake City for photos, media interviews and meeting the other 2020 national champions and their families. “The CMNH staff members were amazing, and they have been since day one,” Holly said.

Every minute, 62 children enter a Children’s Miracle Network Hospital for treatment. Included in that number are about 180,000 children treated through Children’s of Mississippi, the umbrella organization that includes all kids’ and teens’ care provided across the state by UMMC.

Whether they suffer from common childhood afflictions like asthma or broken bones, or fight bigger challenges like birth defects or cancer, patients such as Aubrey, who has Down Syndrome, receive the treatment they need to reach their full potential.

“I want to thank Children’s of Mississippi for an amazing year,” Aubrey said, “and I am so excited to help Children’s Miracle Network Hospitals as a national Champion!”

Each year, Children’s Miracle Network Hospitals chooses 10 of America’s state Champions to be advocates for patients on the national level, said Jason Myers, senior director of content development for Children’s Miracle Network Hospitals.

“We look at each of these 170 Champions and their stories and, from them, choose 10 each year based on their personalities, diversity of age, race, ethnicity, gender, condition and geography, and their ability to share their stories and to be advocates for patients and for philanthropy,” Myers said.

Marcus James of WJTV interviews Children's Miracle Network Hospitals Champion Aubrey Armstrong of Oxford before the start of the topping-out ceremony for Children's of Mississippi's expansion in June 2019.

Marcus James of WJTV interviews Aubrey before the start of the topping-out ceremony for the Children’s of Mississippi’s expansion in June 2019.

Known for her outgoing personality, Aubrey will be “a dynamic Champion,” Myers said. “She radiates joy.”

The 10 national Champions will represent Children’s Miracle Network Hospitals this spring during Children’s Hospitals Week April 6-12, 2020. The group will also attend an annual Children’s Miracle Network Hospitals conference in Orlando, where they will share their stories with attendees, including corporate sponsors.

They’ll also be the faces of Children’s Miracle Network Hospitals national fundraising efforts, which can range from being featured on magazine covers and in social media posts to being pictured on Cheerios cereal boxes.

“They’ll also travel to corporate events around the country to tell their stories and to share why it is important to give to local children’s hospitals,” Myers said. 

While serving as Mississippi’s Children’s Miracle Network Hospitals Champion, Aubrey was the 2019 Mississippi Miss Amazing Junior Teen. Miss Amazing seeks to provide opportunities for girls and women with disabilities to build confidence and self-esteem.

During 2019, Aubrey has supported Children’s Miracle Network Hospitals and Children’s of Mississippi, and those organizations have also supported her, Holly said.

“She has had an amazing year,” she said. “Aubrey has been a Pilot for the Day at Columbus Air Force Base, where she was fitted with a flight suit and even had her name on a plane. She caddied for Cameron Champ at the Sanderson Farm Championship and shot a video for the PGA. She went to Jackson with Rep. Jay Hughes on Feb. 5, where she was recognized by state Legislature, and that day was named Aubrey Armstrong Day. She participated in the Mississippi Miracles Radiothon and the topping out of the Children’s of Mississippi expansion. She threw out the first pitch at an Ole Miss baseball game and was recognized on stage at the Miss Mississippi Pageant, all while having a great freshman year at Oxford High. She was even elected to the homecoming court. We have had a busy year, but we’re looking forward to what’s to come.”

Children’s of Mississippi physicians have made a world of difference for Aubrey, said her father, Brad. “Aubrey is off the charts for highly functioning as a child with Down syndrome, and that is because of Children’s of Mississippi and the care she has received.”

New York Giants quarterback Eli Manning is shown holding Aubrey Armstrong during a visit to Batson Children's Hospital in 2008.

New York Giants quarterback Eli Manning is shown holding Aubrey during a visit to Batson Children’s Hospital in 2008.

Physical therapy, occupational therapy and speech therapy have been part of Aubrey’s care, and she continues to see specialists in otolaryngology, endocrinology and ophthalmology through Children’s of Mississippi.

“I never thought when Aubrey was small and growing up going to the children’s hospital that she would be able to use her personality and sass to return the favor,” Holly said. “We have been able to reconnect with so many of her physicians, nurses, therapists and friends at the hospital this year, and it has been wonderful. We have been very blessed with all she has gotten to do, and we feel so honored.”

Andrew Russell, a Children’s Miracle Network Hospitals specialist in UMMC’s Office of Development, said Aubrey lives the Champion lifestyle, raising funds for Children’s Miracle Network Hospitals by selling lemonade on Oxford’s downtown Square and participating in the events of 21 United, a Down syndrome support group.

“Aubrey is truly amazing,” Russell said. “She is a huge ball of positive energy who doesn’t mind the spotlight. She has been a great Champion for Mississippi, and she will be a great national Children’s Miracle Network Hospitals Champion.”

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InFocus: Acute Otitis Externa Pain Can Be Severe, but Relief Can Be Had in the ED

Wolters Kluwer Health

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Risks and Benefits of Screening for Dementia in Primary Care: The Indiana University Cognitive Health Outcomes Investigation of the Comparative Effectiveness of Dementia Screening (IU CHOICE)Trial


BACKGROUND/OBJECTIVE

The benefits and harms of screening of Alzheimer disease and related dementias (ADRDs) are unknown. This study addressed the question of whether the benefits outweigh the harms of screening for ADRDs among older adults in primary care.

DESIGN, SETTING, AND PARTICIPANTS

Single‐blinded, two‐arm, randomized controlled trial (October 2012‐September 2016) in urban, suburban, and rural primary care settings in Indiana. A total of 4005 primary care patients (aged ≥65 years) were randomized to ADRD screening (n = 2008) or control (n = 1997).

INTERVENTION

Patients were screened using the Memory Impairment Screen or the Mini‐Cog and referred for a voluntary follow‐up diagnostic assessment if they screened positive on either or both screening tests.

MEASUREMENTS

Primary measures were health‐related quality of life (HRQOL; Health Utilities Index) at 12 months, depressive symptoms (Patient Health Questionnaire‐9), and anxiety symptoms (Generalized Anxiety Disorder seven‐item scale) at 1 month.

RESULTS

The mean age was 74.2 years (SD = 6.9 years); 2257 (66%) were female and 2301 (67%) were white. At 12 months, we were unable to detect differences in HRQOL between the groups (effect size = 0.009 [95% confidence interval {CI} = −0.063 to 0.080]; P = .81). At 1 month, differences in mean depressive symptoms (mean difference = −0.23 [90% CI = −0.42 to ‐0.039]) and anxiety symptoms (mean difference = −0.087 [90% CI = −0.246 to 0.072]) were within prespecified equivalency range. Scores for depressive and anxiety symptoms were similar between the groups at all time points. No differences in healthcare utilization, advance care planning, and ADRD recognition by physicians were detected at 12 months.

CONCLUSION

We were unable to detect a difference in HRQOL for screening for ADRD among older adults. We found no harm from screening measured by symptoms of depression or anxiety. Missing data, low rates of dementia detection, and high rate of refusal for follow‐up diagnostic assessments after a positive screen may explain these findings.

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