Life Lessons from Cancer encourages those with cancer to build a network of support

By Melissa Patrick
Kentucky Health News

The fight against cancer requires not only a personal commitment to mind, body and soul; it also requires the support and physical help of family and friends.

That's one of the key messages in Life Lessons from Cancer, a book written by cancer patient Keen Babbage and his sister-in-law and caretaker, Laura Babbage.

Keen, a teacher and native Lexingtonian who has written 17 books about education, said at the first promotional event for the book in October, that he hopes the lessons in this book will be an inspiration and guidance for other patients with cancer as well as a resource for health-care providers.

Kentucky has both the highest rate of new cancers as well as the highest death rate for all cancers in the U.S., according to a report from the Kentucky Cancer Consortium. With a 2013 census report saying 27 percent of Americans live in one-person households, many cancer patients are likely fighting this battle largely alone.

Keen was one of those.

Two days after he was diagnosed with a rare form of nasal cancer, in October 2010, he began an aggressive, three-month regime of radiation and chemotherapy at the University of Kentucky Markey Cancer Center.

His mother died of widespread abdominal cancer after his first round of chemotherapy. As she lay dying, Laura promised her that she would look after Keen.

Here's a video clip of the authors talking about the book at UK:
With great insight, Keen knew he couldn't battle cancer by himself and immediately set about building a network of people who could support him both physically and emotionally. He even enlisted the love and affection of Laura's family dog. "Cancer, we have learned, declares war," Keen said at the promotional event. "It's not a battle, it's a war."

This cancer-fighting network, according to Keen, must not only include family, but also friends and your faith community if you have one. "Put together a network and never let it go, " Keen said at the promotional event.

When building this network, Keen advises in his book that "this is the time to abolish, delete, overlook and eliminate any animosities or disagreements."

Cancer patients' needs are many. Physically, they need help with shopping and food preparation, caring for pets, laundry, cleaning, transportation, making appointments and keeping up with insurance to name a few. Emotionally, they need support that comes with companionship and encouragement.

There are times cancer patients can't leave home or the hospital for long periods; it is in these times that life must come to the patient, Keen writes.  It is only with the help and support of others that this can happen.

You must fight with every possible resource available to you, including prayer. "When someone is praying for you, it means you are not alone," Keen writes.

In response to a question about how to battle depression at the promotional event Keen said, "Small victories.  Hold onto what you believe, hold onto the people you love, eliminate every limit, find something to look forward to that can be done and then realize that it is done with a multitude of people. An individual might feel discouraged, depressed, regret. Surround yourself whenever possible with a lot of people."

Keen and Laura at Bluegrass
10,000 race, July 2011

Laura Babbage is a registered nurse who has worked as a health-care executive and is a chaplain for both UK HealthCare and St. Joseph Hospital.

Laura maintained a website on CaringBridge.com during Keen's treatment to keep family and friends informed of his condition, care and needs. The entries are included in the book and are both forthcoming and explicit. They also offer insight into the role of the caretaker.

"The caretaker needs care as well," Laura said at the promotional event. "Caretakers need to recognize their limits" and put systems in place to make sure the patient is being cared for while also taking care of themselves, she said.

Life Lessons from Cancer offers insight and encouragement to those battling cancer as well as the caregiver. It is full of lessons that not only apply to those who have cancer, but can also be applied to life.

One of the sayings for which Keen is known is his message to his students at Henry Clay High School: "Read. Read More. Keep Reading."

His motto while battling cancer came to him in a card from one of his students: "Fight. Fight more. Keep fighting."

Doctors give nurse practitioners more leeway on prescriptions; senator says tort-reform lobbies should play hardball with money

"Concerns about a growing doctor shortage, especially in rural Kentucky, is fueling the urgency for lawmakers and medical groups to agree on an approach to allow nurse practitioners to be able to prescribe certain medicines without physician supervision," Ryan Alessi reports for cn|2's "Pure Politics."

Advanced-practice registered nurses want the legislature to free them of the requirement that they have an agreement with a physician in order to prescribe non-narcotic drugs. The House passed a bill to do that this year, but it stalled in the Senate. Now, "I believe that they have a resolution to that," Senate President Robert Stivers said at the Kentucky Hospital Association's annual health leadership conference Thursday in Louisville.

Stivers, a Republican from Manchester, said Sen. John Schickel, R-Union, has been negotiating with the nurse practitioners and the doctors' lobby, the Kentucky Medical Association. He indicated that the compromise would include an initial four-year period in which an agreement would be required, but with measures to help nurse practitioners and doctors reach such agreements. Schickel didn't immediately return a call seeking comment.

Stivers said he favored the bill that failed. "In rural areas, I believe nurse practitioners are part of the solution for lack of access" to medical care, he said. The access problem is expected to grow as thousands of Kentuckians gain health insurance or Medicaid coverage under federal health reform.

Also at the KHA meeting, Sen. Julie Denton, R-Louisville, chair of the Senate Health and Welfare Committee, said the hospital, doctor and nursing-home lobbies should refuse to give campaign contributions to any legislators who won't support their efforts for tort reform -- the latest attempt at which would create review panels for medical-malpractice lawsuits. The panels could not block the suits, but their findings could give defendants more advantage in settlement negotiations.

Denton's co-panelist, Rep. Jimmie Lee, D-Elizabethtown, chairman of the House budget subcommittee for health, took umbrage at the idea of such a policy for the lobbies' political action committees.

"It's very scary to me, that if you don't give me a PAC check, I'm not going to vote with you, or if you give me one, I'm going to vote with you," Lee said. "That's scary, folks, that your PAC check is going to determine how Jimmie Lee votes."

Denton said it was unfortunate that Lee portrayed campaign money as "influencing your vote or buying your vote. I don't consider you giving a PAC check as trying to buy somebody's vote or influencing it." Lee smiled gapingly in disbelief, and said in rebuttal, "You're saying, don't give 'em any money because they didn't vote with you."

House Speaker Greg Stumbo said on the earlier panel that there is no proof that such measures reduce malpractice and insurance costs, but Stivers, also a lawyer, said the fear of lawsuits results in many unnecessary diagnostic procedures. "I've tried a lot of these cases, and I've seen it," he said. "C.Y.A."

First diabetes educator license is issued in Kentucky

Kim DeCoste (photo via AADE)

Kentucky is the first state to issue a diabetes educator license, according to a press release from the Kentucky Board of Licensed Diabetes Educators.

Kim DeCoste of Richmond, a registered nurse and chair of the Kentucky Diabetes Educators Licensure Board, is the licensee.

"I am proud to represent diabetes educators throughout Kentucky as the first person to receive a license,” DeCoste said. “Kentucky’s legislation assures that the qualifications of diabetes educators have been thoroughly reviewed and that individuals are appropriately credentialed. Improved consumer safety is vital as diabetes care becomes increasingly complex.”

The release said Kentucky passed laws in 2011 to require licensing of diabetes educators in an effort to improve the quality of health care in the state, which has a high rate of diabetes. Ten percent of Kentucky adults, or approximately 370,000, had been diagnosed with diabetes in 2010, according to the latest Kentucky Diabetes Report. An additional 233,000 Kentucky adults have been diagnosed with pre-diabetes, and research from the federal Centers for Disease Control and Prevention has indicated that approximately 27 percent of people with diabetes have not been tested or diagnosed.

Because diabetes is controllable if diagnosed early and managed well, diabetes educators play a vital role in working with people who have or are at risk of developing diabetes and developing a plan of care, the report says.

The American Association of Diabetes Educators define a diabetes educator as “health care professionals—registered nurses, registered dietitians and pharmacists, among others—who specialize in helping people with diabetes understand how to best manage their health.”

Haynes asks hospitals for a truce as they and state work through problems with managed-care Medicaid

Health and Family Services Secretary Audrey Haynes won a smattering of applause from Kentucky hospital officials Thursday as she called for "not a surrender, but a truce" as her cabinet continues to address the hospitals' complaints about the state's managed-care system for Medicaid, which recently entered its third year.

Haynes drew the ire of hospitals last month when she said some needed to change their business models to emphasize prevention and wellness, not cashing in on Medicaid payments for emergency-room care. Thursday, she said in a speech to the Kentucky Hospital Association in Louisville that she wants "to work more closely together, not only to improve your business practices," but to improve the health of Kentucky.

Haynes also called on the hospitals to join Appalachian Regional Healthcare and the University of Kentucky hospital in contacting past patients who lacked insurance and urge them to sign up for expanded Medicaid or private insurance on the state's Kynect website, under federal health reform. "I need your help," she said. "we're very excited about the opportunity for dramatic improvements in Kentucky's health status."

Also at the meeting, state Rep. Jimmie Lee, D-Elizabethtown, the House's health-care budget subcommittee chair, said he thought Haynes and the administration of Gov. Steve Beshear had largely resolved the "prompt pay" problems of hospitals not getting money they are owed by insurance companies. But Senate Health and Welfare Committee Chair Julie Denton, R-Louisville, called for more action on the subject, such as an independent review panel to review disputed claims.

Ky. Hospital Association defends 'critical access' designation that gives small, rural hospitals a federal financial boost

The Kentucky Hospital Association came out strongly for continued federal support of small, rural hospitals Thursday, objecting to a proposal that the "critical access hospital" designation be based entirely on distance from other hospitals. Kentucky has 29 such hospitals, which get slightly higher Medicare and Medicaid reimbursements in return for limiting their size and services.

Until 2006, states were allowed to make the designation based on a community's health status, poverty rate, rural nature and other factors. So many were designated that they became the majority of critical access hospitals. That is also the case in Kentucky.

The Office of Inspector General of the U.S. Department for Health and Human Services said in August that the government could save up to $1 billion a year if the designation were limited to the original criterion, being at least 35 miles from another acute-care facility, or 15 miles in mountainous areas. KHA's initial repsonse is here.

"The OIG report seeks to eradicate rural health care by shutting down rural hospitals," said Charles Lovell, CEO of Caldwell Medical Center, a critical access hospital in Princeton. "People call us Band-Aid stations," but he could provide a long list of lives saved at his hospital, he said. Other speakers cited hospitals' important role in providing jobs and recruiting doctors for small towns. Cutting the list "would only hurt our communities' physical and economic health," said Susan Starling, CEO of Marcum and Wallace Hospital in Irvine.

Fran Feltner, director of the University of Kentucky Center of Excellence in Rural Health, noted that it was National Rural Health Day and said, "I believe every Kentuckian should have access to the right care at the right time, and close to home."

Critical access hospitals make up only 22 percent of Kentucky hospitals, but maintaining their extra reimbursement would also help the chains that own some of them, because costs of the chain can be allocated to individual hospitals. Here are the critical access hospitals in Kentucky, by county:
Allen: The Medical Center at Scottsville
Breckinridge Memorial Hospital, Hardinsburg
Caldwell County Hospital, Princeton
Carroll County Hospital, Carrollton
Casey County Hospital, Liberty
Cumberland County Hospital, Burkesville
Estill: Marcum and Wallace Hospital, Irvine
Floyd: McDowell Appalachian Regional Hospital; Saint Joseph Martin
Grant: St. Elizabeth Medical Center Grant County, Williamstown
Green: Jane Todd Crawford Hospital, Greensburg
Hart: Caverna Memorial Hospital, Horse Cave
Knox County Hospital, Barbourville
Leslie: Mary Breckinridge Hospital, Hyden
Lincoln: Ephraim McDowell Fort Logan Hospital, Stanford
Livingston Hospital and Healthcare, Salem
Madison: Saint Joseph Berea
Marshall County Hospital, Benton
Mercer: James B. Haggin Memorial Hospital, Harrodsburg
Morgan County Appalachian Regional Hospital, West Liberty
Nicholas County Hospital, Carlisle
Ohio County Hospital, Hartford
Owen: New Horizons Medical Center, Owenton
Russell County Hospital, Russell Springs
Simpson: The Medical Center at Franklin
Trigg County Hospital, Cadiz
Union: Methodist Hospital Union County, Morganfield
Wayne County Hospital, Monticello
Woodford: Bluegrass Community Hospital, Versailles

Beshear and two other Democratic governors say Obamacare is working in their states, and cite examples

Gov. Steve Beshear continues to be a major national cheerleader for the federal health-reform law, citing Kentucky examples in an op-ed piece he and the Democratic governors of Connecticut and Washington circulated to newspapers this week.

"People keep asking us why our states have been successful," they write. "Here’s a hint: It’s not about our websites. Sure, having functioning websites for our health-care exchanges makes the job of meeting the enormous demand for affordable coverage much easier, but each of our state websites has had its share of technical glitches. As we have demonstrated on a near-daily basis, Web sites can continually be improved to meet consumers’ needs. The [Patient Protection and] Affordable Care Act has been successful in our states because our political and community leaders grasped the importance of expanding health-care coverage and have avoided the temptation to use health-care reform as a political football."

All three governors expanded the Medicaid program to include people with incomes up to 138 percent of the federal poverty line. Beshear cites two independent studies that showed Kentucky "couldn’t afford not to expand Medicaid. Expansion offered huge savings in the state budget and is expected to create 17,000 jobs." The state will have to start helping pay for the expansion in 2017, but Beshear has argued that the economic activity from more health care will cover that bill.

At least one of Beshear's co-authors, Washington Gov. Jay Inslee, is not allowing insurance companies to renew policies that don't comply with the law, as President Obama allowed last week. But they wrote, "What we all agree with completely, though, is the president’s insistence that our country cannot go back to the dark days before health-care reform, when people were regularly dropped from coverage, and those with 'bare bones' plans ended up in medical bankruptcy when serious illness struck, many times because their insurance didn’t cover much of anything.
Thanks to health-care reform and the robust exchanges in our states, people are getting better coverage at a better price."

As an example, Beshear cited Howard Stovall, whose sign and graphics business in Lexington "has paid half the cost of health insurance for his eight employees" since it opened in 1998. "With the help of Stovall’s longtime insurance agent and Kentucky’s health exchange, Kynect, Stovall’s employees are saving 5 percent to 40 percent each on new health insurance plans with better benefits. Stovall can afford to provide additional employee benefits, including full disability coverage and part of the cost of vision and dental plans, while still saving the business 50 percent compared with the old plans." (Read more)

Most Kentucky hospitals will pay Medicare penalties under health reform, one the country's largest; look them up here

More Kentucky hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive programs, one of the federal health reform law’s changes designed to create financial rewards for doctors and hospitals to provide better care. Pineville Community Hospital is being assessed the highest penalty in the country for its readmission rates.

Medicare has two quality-care incentive programs for hospitals. Value-based purchasing gives bonuses and penalties based on 24 quality measures, and the other program levies penalties for readmissions. Thirty-one Kentucky hospitals were assessed a penalty while 26 were given a bonus for improved performance, says an analysis by Kaiser Health News. Here's a screen shot of the beginning of the list:

The law allows the federal government to withhold a portion of a hospital's Medicare reimbursement money, up to a 1.25 percent penalty or bonus for every bill paid between October 2013 and September 2014, based on assessments of these quality standards.

"The incentives are among the law’s few cost-control provisions that have kicked in, but it is too early to tell how effective they will be in making hospitals operate more efficiently," reports Kaiser's Jordan Rau.

Large value-based bonuses are going to some major teaching hospitals and smaller institutions, such as Pikeville Medical Center. The state's average bonus is 0.25 percent, compared to the national average of 0.24 percent; Kentucky's penalties averaged minus 0.20 percent, for a total average of zero. It won't be known how much hospitals will receive or pay in dollar figures until next October since this depends on how much the hospital ends up billing Medicare, Kaiser reports.

However, as a result of the readmission program, Pineville Community Hospital is losing 2.57 percent of its reimbursements,the largest penalty in the country. Considering the impact of both the value-based program and readmissions program, Kaiser reports, two out of three hospitals are losing money starting last month.

Here's how the value-based score was figured: 45 percent on hospitals' use of clinical processes of care; 30 percent on patient experiences; and 25 percent on death rates. Hospitals were are also assessed by how they compared to other hospitals and how much they improved from two years ago, says Qualitynet.org.

Researchers are unsure whether the penalties are significant enough to trigger major improvements, writes Rau. And, some hospitals that have made improvements are still losing money because they haven't improved as much as other hospitals. On the other hand, some hospitals with subpar quality rankings are still getting more money because they showed improvement.

Nationwide, Medicare has raised payment rates to 1,231 hospitals and reduced payments to 1,451. Hospitals that are designated as critical access facilities and certain cancer hospitals were excluded from the program. But these facilities aren't immune to other portions of the health law, such as cuts in Disproportionate Share Hospital (DSH) program payments,for having a high percentage of Medicare and Medicaid patients.

New quality measures will be added to the value-based program for 2015, including comparisons of how much patients cost Medicare at different hospitals and rates of medical mishaps. In addition, the maximum readmission penalties grow to 3 percent next year, and a third incentive program will take an additional 1 percent of payments away from hospitals that have the most injuries or infections during patients' stays.

"Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October," reports Rau.

Dr. Patrick Conway, Medicare’s chief medical officer, says "We're moving away from volume and toward quality." Yet, to remain viable, some hospitals are being forced to make up for payment cuts by seeing more patients. Click here for the interactive chart.

At least one insurance company will let Kentuckians keep their health insurance plan for another year if they like it

By Molly Burchett
Kentucky Health News

At least one insurance company, Humana, will be allowing Kentuckians to keep their insurance coverage for another year if they like it, even if the policies aren't compliant with the Patient Protection and Affordable Care Act.

Partially owning up to his reforms' rocky rollout last week, President Obama said people whose policies were being cancelled because they didn't comply with the law could renew their policies for another year -- if insurance companies are willing to do so and state regulators allow it. Kentucky is among the states allowing them to do so, and Humana is going along.

Humana -- and Anthem Blue Cross, if it follows suit -- will be required to tell such policyholders "what protections these renewed plans don't include" and that they have alternatives that may be better and cheaper on insurance exchanges, Obama said.

“Humana has been educating people about the full range of options, including the ability to retain their current coverage, in accordance and coordination with state law," a Humana spokesperson told Kentucky Health News. An Anthem spokesperson said the company is still reviewing its options.

About 280,000 Kentuckians -- almost all those in individual and small-group insurance market -- faced policy discontinuation, requiring them to get different insurance coverage.

Experts say there are a number of obstacles that could keep insurers from letting customers renew old policies, including the concern that the risk pools of the state's health-insurance exchange will be skewed. And, insurers will have to calculate how much they plan to charge for policies that were going to be discontinued.

“Changing the rules after health plans have already met the requirements of the law could destabilize the market and result in higher premiums for consumers,” Karen Ignagni, the president of America’s Health Insurance Plans, a lobbying group, told The New York Times.

Some insurers say the president's move is adding to the confusion that surrounds the health-care law and adding uncertainty to the insurance market. This may discourage participation from a key group, young and healthy people who are needed to make insurance exchanges sustainable, reports The Washington Post.

There is doubt that insurance companies can do all of this in less than a month to ensure coverage is in place by Jan. 1. It is unclear how, as a practical matter, the changes proposed by the president can be put into effect, National Association of Insurance Commissioners President Jim Donelon said last week. And, even if they do, the proposed changes only last a year.

UK is first in U.S. to conduct clinical trial for new Parkinson's treatment that shows improvement in all five patients so far

A new treatment strategy for Parkinson's disease at the University of Kentucky could change the way the ailment is treated, manage symptoms better and halt or reverse the progressive degeneration of the brain that comes with the disease, the university announced Monday.

Dr. Craig van Horne demonstrated a deep-brain stimulation
remote control unit on Parkinson's patient Rodney Parsons.
(Lexington Herald-Leader photo by Charles Bertram)

Read more here: http://www.kentucky.com/2013/11/18/2939114/uk-researchers-making-progress.html#storylink=cpy

UK is the first U.S. university to conduct a clinical trial of the strategy, led by principal investigator Dr. Craig van Horne, associate professor of neurosurgery in the College of Medicine, according to a news release from the university.

Parkinson's, a progressive and degenerative disease, affects around 1 million Americans and 10 million people worldwide, according to the release. Symptoms include both motor and non-motor symptoms including tremor, rigidity, slow movement and unstable posture. No cure exists.

The first course of treatment is medication, but any medication loses its effectiveness over time.The second line of treatment is deep brain stimulation, a surgical procedure that works like a "brain pacemaker." Electrodes are surgically implanted into the malfunctioning part of the brain where cells have died to emit electrical impulses to regulate the brain's abnormal impulses, according to the release.

Deep brain stimulation has improved the quality of life for many people with Parkinson's, but while it manages symptoms, it does not change the course or outcome of the disease, according to the release. UK's clinical trial explores an additional treatment option, and possibly a way to alter the course of the disease.

"They are conducting an innovative clinical trial that builds upon the established deep brain stimulation procedure by supplementing it with a nerve graft of patients’ own peripheral nerves," the release says. "The nerves in the brain do not regenerate when they are damaged, but peripheral nerves—nerves outside of the brain and spinal cord—can regenerate." The trial will "aim to use the regenerative capacity of peripheral nerves to allow the brain to heal itself."

The procedure will implant a small piece of a patient's peripheral nerve from just above an ankle. This can be done at the same time as deep brain stimulation, so the patient will get the benefit from both procedures, the release says. The effect of the implant will be tested by simply turning off the deep brain stimulator. The hope is that the peripheral nerve will "stimulate regeneration in the parts of the brain that have been damaged by Parkinson's disease."

So far, five Parkinson’s patients have undergone the combined procedure. The trial calls for six. All five have shown consistent improvement in symptoms and "were able to entirely go off the medication one month later, relying on the deep brain stimulation device to manage their symptoms," the release says. Normally, deep-brain stimulation patients are able to reduce their medication but not eliminate it.

"The patients can have more consistent 'on' times—fewer ups and downs with their symptoms," Van Horne said. "They’re not fluctuating due to meds if they’re just using the stimulation."

The trial has progressed quickly because it uses the patient's own tissue, with no risk of rejection or need for immuno-suppressant drugs, and takes only 30 minutes longer than standard deep brain stimulation.  If successful, this procedure could significantly change the treatment of Parkinson’s disease, the release says, and could have an impact on other neuro-degenerative disorders. To learn more click here.

New guidelines for cholesterol management spark controversy; faulty risk calculator could lead to over-prescribing statins

The American College of Cardiology and the American Heart Association released new guidelines for cholesterol management, a new formula to assess heart attack and stroke risk, and guidelines for lifestyle modifications and weight management to reduce heart attack and stroke risk.

“These guidelines will be helpful to all physicians and their patients, but they will be particularly relevant in Kentucky, where nearly 70 percent of Kentuckians are overweight or obese, we are the third highest state in rates of high blood pressure, five Kentucky counties are among the least active in the U.S. and the incidence of diabetes is above the national average,” Dr. Susan Smyth, director of the Gill Heart Institute at the University of Kentucky, said in an e-mail.

However, some experts have questioned the new guidelines, and the new formula for calculating cardiovascular risk appears to overstate the risk value used to determine who should receive cholesterol-lowering statin drugs.

"There may be no single perfect score that we can use to give statins the 'thumbs up' or 'thumbs down' for our patients without established cardiovascular disease," Smyth said. "Ultimately, physicians have many different tools at their disposal to evaluate CV risk in their patients, and they will review all of the available evidence to make a determination about who may be likely to benefit from statin therapy."

The new guidelines also change how statins should be prescribed. The drugs have been given to lower cholesterol to a specific numerical value, but now it is suggested that moderate to high doses of statins be given to patients who fall within four identified groups of patients who have been determined to get the most benefit from the drug:

• already diagnosed with heart disease or stroke
• with an LDL {"bad" cholesterol) of 190 mg/dL or higher, who may have genetic risk
• aged between 40 and 75, with Type 2 diabetes and high LDL levels, but without heart disease or stroke
• with an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75, without heart disease or stroke, but with high LDL levels.  

Instead of focusing strictly on patients' LDL and total cholesterol, the new guidelines suggest physicians treat patients based on their overall risk of heart disease or stroke, of which cholesterol levels are just one part, according to the report.

The guidelines in the report also call for lifestyle modification, including adhering to a heart-healthy diet, which includes vegetables, fruits, whole grains, low-fat dairy, poultry, fish, beans and healthy oils and nuts; 30 to 40 minutes of exercise three to four times a week; avoidance of tobacco products, and maintenance of healthy weight.

The guidelines use a cardiovascular risk calculator that considers age, race, sex, diabetes, smoking habits, blood pressure and low HDL, or "good" cholesterol levels, among other considerations.

But a problem has been identified with the risk calculator, so worrisome that a past president of the College of Cardiology called for a halt to the implementation of the new guidelines, reports Gina Kolata of The New York Times. The calculator appears to overestimate the risk group so greatly, Kolata reports, that it could mistakenly suggest that millions more people should be candidates for statin drugs.

"It's stunning," the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine of the Cleveland Clinic, told Kolata. "We need a pause to further evaluate this approach before it is implemented on a widespread basis."

After an emergency, closed-door meeting on Saturday night, the two organizations that published the guidelines said "that while the calculator was not perfect, it was a major step forward, and that the guidelines already say patients and doctors should discuss treatment options rather than blindly follow a calculator," Kolata reports.

Dr Sidney Smith, the executive chairman of the guideline committee, told Kolata that "the association would examine the flaws found in the calculator and determine if changes were needed."

Two Harvard Medical School professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the calculator was not working among the populations it was tested on by the guideline makers a year earlier, during an independent review for the National Institutes of Health's National Heart, Lung, and Blood Institute, which originally developed the guidelines, Kolata reports.

Dr. Donald Lloyd-Jones, co-chairman of the guidelines task force and chairman of the department of preventive medicine at Northwestern University, told Kolata that "the committee thought the researchers had been given these results."

Ridker and Cook evaluated the calculator again after they saw the guidelines and found that it over- predicted risk by 75 to 150 percent, depending on the population, Kolata reports. They wrote in The Lancet, a British medical journal, that the miscalibration be "reconciled and addressed" before implementation, saying: "If real, such systematic overestimation of risk will lead to considerable over-prescription."

Some doctors are concerned that because many people are already "leery of statins, the public would lose its trust in the guidelines or the heart associations," Kolata reports. Currently, it is only obvious that those in the highest risk groups, such as those who have heart attacks, strokes or have diabetes, should take statins, she reports.

Community paramedics program could help provide primary-care services, help address state's provider shortage

Next spring, the Kentucky Board of Emergency Medical Services could establish a community paramedics pilot program that has the potential to ease the state's shortage pf primary-care health providers.

The idea was prompted by the likelihood that the state's expansion of the Medicaid program would lead to a shortage of primary-care personnel. It would add community paramedics to a local health care delivery system, reports Chuck Mason of the Bowling Green Daily News.

“We’re in the first stages of looking into this,” Michael Poynter, executive director of the EMS board, told Mason. “Vulnerable populations with new health insurance plans will not have access to a provider because of the increase in demand.” The provider shortage, particularly in rural areas, especially affects those without to transportation, said Poynter.

Under the program, a primary-care partner could refer a patient to EMS personnel to provide services such as fall prevention, blood draws or medication administration, in the patient’s home. The paramedic would provide documentation to the patient’s primary care physician.

The program has the potential to allow paramedics to play a more active role in care delivery, changing the face of emergency medical services, writes Mason. "The big question at this point is how health care providers would receive reimbursement from the government for expenses related to community paramedics and how the concept would integrate into the health care systems already in place in Kentucky," Poynter told Mason.

Some say such a program could reduce overall health care costs, reports Mason. It could even help reduce hospital re-admissions, potentially saving them millions of dollars because federal health reform penalizes them for re-admissions.

EMS personnel "have the training, expertise and scope of practice to provide essential primary care services," Poynter told Mason. He said such programs have been successful in Colorado, Minnesota and Pennsylvania, where paramedics are practicing community medicine after completing a training program.

Kentucky's training could be provided by colleges and universities, Mason writes. Western Kentucky University is exploring coursework for emerging jobs in the health care field. "Patient education, teaching about healthy best practices and health care screening could be some of the roles filled by the community paramedic," Poynter told Mason. "The idea is not to replace home health or physician office visits, but rather to augment the health care." (Read more)

Great American Smokeout is Thursday, Nov. 21, featuring supportive characters to share on social media and a Twitter chat

The American Cancer Society's annual Great American Smokeout will be held Thursday, Nov. 21. The event encourages smokers to quit smoking, or make a plan to quit smoking, that day.

Quitting, even for one day, according to the Cancer Society, is an important step toward a healthier life, one that can lead to reducing cancer risk.

In Kentucky, according to the Centers for Disease Control and Prevention, 25.2 percent of adults are cigarette smokers, second highest in the nation. The Kentucky Tobacco and Cessation Program reports that each year more than 8,000 Kentuckians die of illnesses caused by tobacco use.

"Tobacco use remains the single largest preventable cause of disease and premature death in the U.S., yet nearly one in every five adults smoke," the Cancer Society says. It also notes that there are 13.2 million cigar smokers in the U.S. and 2.2 million who smoke tobacco in pipes, which are also dangerous and addictive forms of tobacco.

To celebrate quitters and their supporters, the American Cancer Society has designed a series of characters available to share on social networks. (See characters.)

They are also hosting, with Sharecare, a Great American Smokeout Twitter Chat on Wed., Nov. 20. This event allows you to post questions on Twitter to  @Sharecarenow  about how to quit smoking, smoking legislation or anything on your mind related to smoking.  You can also submit questions on Sharecare’s Facebook page.  The answers from the Cancer Society and other experts will roll out on Twitter at #quitforgood on Thurs., Nov. 21, between 11 a.m. and 4 p.m.

The health benefits of quitting are greater if you quit when you are young, but quitting at any age is beneficial. The Cancer Society lists the benefits chronologically:

• In 20 minutes: your heart rate and blood pressure drop
• In 12 hours: the carbon monoxide level in your blood drops to normal
• 2 weeks to 3 months: your circulation improves and your lung function increases
• 1-9 months: coughing and shortness of breath decrease
• 1 year: your risk of coronary heart disease is cut to half that of a continuing smoker
• 5 years: risk of certain cancers is cut in half, and stroke risk can fall to that of a non-smoker
• 10 years: the risk of dying from lung cancer is about half that of a person who still smokes and other cancer risk decrease
• 15 years: the risk of coronary heart disease is that of a non-smoker

The American Cancer Society is available to offer steps to quit smoking and to provide quit-smoking programs. To learn about the available tools, call 1-800-227-2345.