Research Roundup: Guardianship Guides For End-Of-Life Decisions; Rudeness In The Hospital

JAMA Internal Medicine: Guardianship And End-Of-Life Decision Making
As the population ages, more adults will develop impaired decision-making capacity and have no family members or friends available to make medical decisions on their behalf. In such situations, a professional guardian is often appointed by the court. ... Physicians are well positioned to assist guardians with these decisions and safeguard the rights of the vulnerable persons they represent. ... we analyzed state guardianship statutes and reviewed recent legal cases to characterize the authority of a guardian over choices about end-of-life treatment. We found that most state guardianship statutes have no language about end-of-life decisions. We identified 5 legal cases during the past decade that addressed a guardian’s authority over these decisions, and only 1 case provided a broad framework applicable to clinical practice. (Cohen et al., 8/10)

Centers for Disease Control and Prevention/Mortality and Morbidity Weekly: Assisted Reproductive Technology Surveillance — United States, 2012
[T]he use of advanced technologies to overcome infertility and the number of fertility clinics providing [assisted reproductive technology] ART services have increased steadily .... Because more than one embryo might be transferred during a procedure, women who undergo ART procedures, compared with those who conceive naturally, are more likely to deliver multiple birth infants. Multiple births pose substantial risks to both mothers and infants .... This report provides state-specific information .... In most reporting areas, multiples from ART comprised a substantial proportion of all twin, triplet, and higher-order infants born .... Of the four states (Illinois, Massachusetts, New Jersey, and Rhode Island) with comprehensive statewide-mandated health insurance coverage for ART procedures ...., two states (Massachusetts and New Jersey) had rates of ART use exceeding twice the national level. (Sunderam et al, 8/13)

Pediatrics: The Impact Of Rudeness On Medical Team Performance: A Randomized Trial
Our objective was to explore the impact of rudeness on the performance of medical teams. ... Twenty-four NICU teams participated in a training simulation involving a preterm infant whose condition acutely deteriorated due to necrotizing enterocolitis. Participants were informed that a foreign expert on team reflexivity in medicine would observe them. Teams were randomly assigned to either exposure to rudeness (in which the expert’s comments included mildly rude statements completely unrelated to the teams’ performance) or control (neutral comments). ... Rudeness had adverse consequences on the diagnostic and procedural performance of the NICU team members. Information-sharing mediated the adverse effect of rudeness on diagnostic performance, and help-seeking mediated the effect of rudeness on procedural performance. (Riskin et al., 8/10)

The Kaiser Family Foundation: Racial And Ethnic Disparities In Access To And Utilization Of Care Among Insured Adults
[M]any factors beyond health insurance influence individuals’ ability to obtain care. ... this analysis examines differences in access to and utilization of care for Black and Hispanic adults compared to White adults among those who are uninsured, enrolled in Medicaid, and privately insured. It is based on data from the 2014 Kaiser Survey of Low-Income Americans. The findings show that, consistent with other research, both Medicaid and private coverage are associated with improvements in access to and utilization of care compared to being uninsured, and these differences generally hold true for White, Black, and Hispanic adults. However, privately insured Black and Hispanic adults fare worse than privately insured White adults along several measures of access to and utilization of care and have less confidence in their ability to afford medical costs. (Artiga et al., 8/6)

Centers for Disease Control and Prevention/Mortality and Morbidity Weekly: QuickStats: Percentage Of Office-Based Primary Care Physicians Not Accepting New Patients, By Source Of Payment — United States, 2013
In 2013, overall, 8.4% of primary care physicians reported that they did not accept new patients. However, acceptance varied by the patient's expected payment source: 35% of physicians did not accept new Medicaid patients, 27.7% did not accept new Medicare patients, and 19.3% did not accept new privately insured patients. (8/13)

The Commonwealth Fund: Lessons From The Small Business Health Options Program: The SHOP Experience In California And Colorado
The Small Business Health Options Program (SHOP) got off to a slow start, , with lower-than-expected enrollment and a public perception problem. This report examines California and Colorado’s small-business marketplaces, which opened on schedule in October 2013. For business owners, employee choice was the most important reason cited for considering SHOP, with ease of administration a distant second. ... Interviews also revealed that business owners consider insurance brokers to be an important source of enrollment assistance. Those in the insurance and policy communities perceived small-business owners to be poorly informed about available tax credits; business owners disagreed, saying the credits were simply not key to their decision to elect SHOP. (Haase, Chase and Gaudette, 8/12)

The Kaiser Family Foundation: Trends In Medicaid And CHIP Eligibility Over Time
This analysis examines trends in Medicaid and CHIP eligibility limits .... Eligibility for children and pregnant women has been consistently higher than for parents and other adults over time. The ACA Medicaid expansion narrowed the gap ... but median eligibility limits for parents and other adults still are lower than those for children and pregnant women. Across eligibility groups, the Northeast generally has had the highest median eligibility limits. The South has the lowest median eligibility limits for all groups, except pregnant women, for whom the West has the lowest .... eligibility levels vary substantially across states and across eligibility groups. Eligibility remains higher for pregnant women and children compared to parents and other adults. (Artiga and Cornachione, 8/6)

Here is a selection of news coverage of other recent research:

Medscape: Young People Benefit From Integrated Behavioral-Medical Care
Integrating behavioral healthcare within primary medical care leads to significant advantages in bettering outcomes in child and adolescent behavioral health, researchers have found. A meta-analysis of randomized clinical trials by Joan Rosenbaum Asarnow, PhD, from the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, and colleagues showed that youth who had integrated care had a 66% higher probability of having a better outcome than children or adolescents who received usual care .... Results were published online August 10 in JAMA Pediatrics. (Frellick, 8/11)

MedPage Today: Evidence Spotty For Hospital Cleaning Practices
Environmental cleaning is known to prevent the spread of healthcare-associated infections (HAIs), yet hospital cleaning practices varied, and not much quality data exists on the science of proper environmental cleaning methods, according to a systematic review. Among 80 studies, 49 examined cleaning methods, while 14 evaluated monitoring strategies, and 17 addressed challenges or facilitators to implementation, reported Jennifer Han, MD, of the University of Pennsylvania in Philadelphia, and colleagues. But only five studies were randomized controlled trials -- most simply compared microbial counts before and after cleaning -- and there was a lack of studies on disinfecting methods and monitoring strategies, they wrote in a technical brief in the Annals of Internal Medicine. (Weitering, 8/11)

Reuters: European Doctors Often Reject Assisted-Suicide Requests
Even when physician-assisted suicide is legal, doctors often have reservations about helping patients die, two European studies suggest. (Rapaport, 8/10)

NPR: More Evidence That Music Eases Pain, Anxiety After Surgery
Hospitals have a free and powerful tool that they could use more often to help reduce the pain that surgery patients experience: music. Scores of studies over the years have looked at the power of music to ease this kind of pain; an analysis published Wednesday in The Lancet that pulls all those findings together builds a strong case. (Harris, 8/13)

Medscape: Young Nurses' Injury Risk Increased By Overtime, Night Shifts
Newly licensed registered nurses (RNs) were likely to work schedules associated with significantly increased risks for occupational injuries, including overtime (61%) or night shifts (44%), according to a major new analysis of occupational injuries published online June 29 in the International Journal of Nursing Studies. (Kelly, 8/10)

Medscape: Prescription Meds Common In Pregnancy; Maybe Too Common
Although most physicians acknowledge the complexity of prescribing drugs to pregnant women, they nonetheless prescribe them frequently. More than four of five (82.5%) pregnant women were prescribed at least one medication, and 42.0% were prescribed a drug that is potentially harmful to the developing fetus, researchers found in a large, population-based study. The study, which details the type and timing of medications prescribed to pregnant Medicaid patients, presents a disturbing pattern, according to Kristin Palmsten, ScD, from the University of California, San Diego, in La Jolla, and colleagues. (Pullen, 8/7)

Reuters: Sexting, Internet Safety Loom Large As Childhood Health Concerns
As more kids use mobile phones and surf the web at increasingly younger ages, sexting and Internet safety are becoming bigger childhood health concerns, edging out longtime worries like smoking and teen pregnancy, a new poll suggests. Internet safety rose to become the fourth most commonly identified major problem in the 2015 C.S. Mott Children’s Hospital national poll on children’s health, up from eighth the year before, with 51 percent of adults this year citing it as a top concern. (Rapaport, 8/10)