State Supreme Court strikes down medical review panels for suits against health-care providers; backers eye constitutional change

Filtering medical-malpractice lawsuits through panels of health-care professionals is unconstitutional, a unanimous Supreme Court of Kentucky ruled Thursday.

The General Assembly passed the law in 2017 at the behest of doctors and nursing homes, which had long lobbied for it, and also by "hospitals and other health providers as means to limit what they claimed were frivolous lawsuits," notes Deborah Yetter of the Louisville Courier Journal.

Franklin Circuit Judge Phillip Shepherd
(Courier Journal photo by David Lutman)

The court "said the law is unconstitutional because it delays access to the state’s courts for adjudication of common-law claims," Jack Brammer reports for the Lexington Herald-Leader.

Chief Justice John Minton wrote in the ruling, upholding Franklin Circuit Judge Phillip Shepherd, “Of all the rights guaranteed by state constitutions but absent from the federal Bill of Rights, the guarantee of a right of access to the courts to obtain a remedy for injury is possibly the most important.”

The bill's main sponsor, Sen. Ralph Alvarado, R-Winchester, said in August that if the law were overturned, he would favor a constitutional amendment to allow it. Section 64 of the state constitution bans limits on the right to recover damages, and business interests have long wanted to change or repeal it. When Republican Gov. Matt Bevin signed the measure into law, he called it it "the first step toward tort reform."

The Kentucky Medical Association said it was “extremely disappointed” because “Kentucky now remains one of the few states in the country with no meaningful tort reform.”

"The law requires that claims filed against doctors, hospitals, nursing homes, their executives and other health care providers must first be evaluated by panels composed of three medical providers before proceeding in court. The panels’ opinions could be entered as evidence in any subsequent litigation," Brammer recounts. "Shepherd struck down the law in October 2017, saying it 'protects the economic interests of the health-care industry at the expense of consumers, with no demonstrable benefit to the public at large.' The case bypassed the Kentucky Court of Appeals," but Shepherd allowed the law to remain in effect on appeal.

"The law had created a large backlog of several hundred malpractice cases awaiting assignment and review by state-appointed panels before they could proceed to court, while relatively few cases had been decided,' Brammer reports. "It's not clear what will happen to those cases now," Yetter writes.

Study of Ky. kids' well-being finds less smoking in pregnancy, fewer low-birthweight babies and pregnant teens; has local data

By Melissa Patrick
Kentucky Health News

Kentucky continues to make progress in expanding the number of children with health insurance, having fewer low-birthweight babies, and lowering rates of teen pregnancy and smoking during pregnancy, but it has high rates of children living in out-of-home care because of abuse or neglect, according to the annual Kentucky Kids Count report. It shows those rates vary widely by county.

The report, released Tuesday by Kentucky Youth Advocates and the Kentucky State Data Center at the University of Louisville, is part of the 28th annual release of the County Data Book, which provides data on overall child well-being through 17 measures in four areas: economic security, education, community strengths, and health and family. Nearly one in four Kentuckians are children.

Kids Count Data Center map of births to mothers who
smoked during pregnancy, 2014-16.

A bright spot in the report is that fewer Kentucky women are smoking during pregnancy.

Statewide, the report found that rates of smoking during pregnancy dropped to 18.1 percent in 2014-16, from 21.3 percent in 2009-11, with 110 of the state's 120 counties showing improvement.

"Tobacco addiction is so difficult to break, but this report is proof positive that women all over Kentucky are finding a way to protect their babies from the dangers of smoking while pregnant," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "They're reducing the risk that their babies will be born with birth defects or die suddenly without explanation during infancy. And they're increasing the chances their babies will be born full-term and at a healthy weight."

Seventy-three counties saw a reduction in low-birthweight babies. Statewide, this rate dropped to 8.8 percent in 2014-16, from 9 percent in 2009-11.

But amid the good news, there is bad news. Since 2009-11, 45 counties have seen an increase in their percentage of low-birthweight babies. Ten counties saw higher rates of women smoking during pregnancy, including: Allen (23.9 percent in 2014-16), Carroll (28.3), Clinton (28.8), Estill (33), Fulton (23.7), Graves (17.7), Henderson (21.2), Lewis (30.9), Magoffin (31.9) and Wayne (28.1).

And while smoking during pregnancy declined in Lee and Owsley counties, more than 40 percent of expectant mothers in those counties smoked in 2014-16 -- and 22 counties had smoking-during-pregnancy rates of 30 percent or higher.

The state's teen-pregnancy rate continues to drop. It declined to 31.7 teen births per 1,000 females aged 15-19 in 2014-16, down almost a third from 45.9 per 1,000 five years earlier. Kentucky's rate still remains about half again as high as the national rate, 20.3 teen births per 1,000.

Differences between counties remained great, ranging from a low of 7.9 teen births per 1,000 in Oldham County to a high of 79.5 teen births per 1,000 in Elliott County. And while 108 counties saw a drop in their teen-birth rates, several of the remaining 12 had large increases, including: Lawrence County by 14 points, to 52.4 per 1,000; Lee County, up 10 points to 49.6 per 1,000; and Menifee County, up by 12, to 59.6 per 1,000.

Other key findings about Kentucky's children in the report:

• Nearly 97 percent of Kentucky's children have health insurance, and all 120 counties showed improvement.
• One in four Kentucky children live in poverty, defined as annual household income of $24,339 or less for a family of four. The good news is that this rate decreased in 93 of the 120 counties.
• The rate of children in out-of-home care increased in 92 counties, "fueled by parents struggling with addiction." Elliott County had the highest rate, with 118.2 in out-of-home care per 1,000 children aged 10-17. The state rate is 43.7 per 1,000.
• The number of children being raised by a relative has increased by 75 percent, from 55,000 in 2012-14 to 96,000 in 2016-18.
• 119 of 167 school districts saw an increase in the rate of students graduating on time; graduation rates declined in 46 districts. About 90 percent of Kentucky's high-school students graduate on time.

This year's report also explores the issue of child abuse in Kentucky, noting that 20 of every 1,000 children in the state experienced abuse and neglect in 2016, more than twice the national average. As part of a five-page essay, titled "Putting a Plug in the Abuse to Prison Pipeline," the report calls for "collective engagement across systems" to tackle the issue.

“These pressing challenges call for smart policies, innovative solutions, and focused attention on our priorities,” Dr. Terry Brooks, executive director of KYA, said in a news release. “The more we support all Kentucky children to grow up healthy, hopeful, and contributing to the community, the brighter our future looks.” 

The Kids Count Data Center is also available for a deeper dive into the data. It offers a profile sheet for every county that shows rankings and can be used to create maps and charts for comparisons.

KYA will hold "Kids Count Conversations" in Paducah, Glasgow, Louisville, Manchester and Covington to help community leaders use local data to inform policy that impacts their youth. E-mail KYA at kidscount@kyyouth.org if you would like to have such a conversation in your community.

The 2018 County Data Book was made possible with support from the Annie E. Casey Foundation and local sponsors Passport Health Plan, Delta Dental of Kentucky and Kosair Charities.

Institute taking applications through Dec. 18 for assistance to health-related research projects in Kentucky

The Community Leadership Institute of Kentucky, which provides research and leadership training, funding and technical support for health-related research projects, is accepting applications for its 2019 class.

Among other things, participants will gain a broader perspective of community health issues, improve their grant-writing skills, learn how to create databases and better surveys, and enhance their leadership skills. The program's goal is to engage and empower communities to reduce health disparities, leverage funding and learn how to use data to improve services and programs.

Each participant's organization will also receive a $2,500 grant for their participation in the program and upon completion of their proposed project, with some additional requirements.

Priority will be given to leaders from Appalachian Kentucky and to projects related to cancer prevention (e.g., nutrition, physical activity, smoking cessation), reducing obesity and sedentary lifestyle, prevention and management of chronic diseases (e.g., diabetes and cardiovascular disease), and prevention and treatment of substance abuse.

The sessions will be held at the University of Kentucky Center for Excellence in Rural Health in Hazard. Click here for a list of dates. Applications are due by Tuesday, Dec. 18, for approximately 12 available slots. Contact Beth Bowling at beth.bowling@uky.edu or 606-439-3557, ext. 83545 for more information.

CLIK is offered through a partnership of the center, the UK Center for Clinical and Translational Science Community Engagement and Research Program and the Kentucky Office of Rural Health.

Cigarette smoking rates among U.S. adults are at a historic low, 14%, but one in five still use some type of tobacco-based product

By Melissa Patrick
Kentucky Health News

Cigarette smoking rates have hit their lowest level ever, but 47 million Americans still use some type of tobacco-based product, prompting government officials to say there's more work to do.

Smoking rates among adults dropped to about 14 percent in 2017 from 15.5 percent in 2016, according to the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Cancer Institute. That's a drop of two-thirds from 42 percent in 1965, the first year national smoking rates were recorded.

The current rate for young adults 18 to 24 dropped even more than the overall rate, to 10 percent in 2017 from 13 percent in 2016.

However, use of electronic cigarettes among young people is burgeoning, and one in five Americans, still use some type of tobacco-based product, and 34 million of the 47 million users still smoke. Kentucky's latest reported adult smoking rate is 24.5 percent.

The national figures were published in the CDC's Nov. 9 Morbidity and Mortality Weekly Report. Using data from the 2017 National Health Interview Survey, the CDC found that use of tobacco-based products was highest among people with a high-school equivalency diploma or GED (43 percent), those without health insurance (31 percent), people on Medicaid (28 percent) or other public insurance (27 percent), people who are lesbian, gay or bisexual (27 percent), people with an annual household income under $35,000 (26 percent), people with a disability (25 percent) and in the Midwest or South.

"Demographic and geographic tobacco-use disparities make clear that we have much work to do, especially in states like Kentucky," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "The latest numbers point the way for health advocates: we must focus our efforts to counter tobacco industry targeting of lower-income, less-educated, and minority populations."

In addition to the 14 percent of U.S. adults who self-identified as cigarette smokers in 2017, 3.8 percent said they smoked cigars, cigarillos or filtered little cigars; 2.8 percent said they used electronic cigarettes, 2.1 percent said they used smokeless tobacco, and 1 percent said they used pipes, water pipes or hookahs. About 9 million tobacco users, or 19 percent, reported using two or more tobacco products, with cigarettes and e-cigarettes as the most common combination.

Chandler stressed that it's important to continue to watch how e-cigarettes affect behavior and health.
"The jury is still out on whether they will reduce overall tobacco use and illness among adults or, because of the explosion in teen e-cigarette use, end up addicting a whole new generation or creating a whole new set of health issues," he said.

The CDC report calls for comprehensive tobacco-control programs at national, state and local levels, noting such strategies and interventions as its Tips From Smokers campaign, the FDA's "Every Try Counts" campaign and the cancer institute's Smokefree.gov and toll-free quitline (1-800-QUIT NOW).

The president of the Campaign for Tobacco-Free Kids, Matthew L. Myers, offered other policy suggestions.

"To win the fight against tobacco, policy makers at all levels must fully implement the proven strategies that have driven our progress," Myers said in a news release. "These include significant tobacco-tax increases, comprehensive smoke-free laws, well-funded tobacco prevention and cessation programs, hard-hitting mass media campaigns, barrier-free health insurance coverage for tobacco-cessation treatments, and laws raising the tobacco sale age to 21."

Smoking is considered the leading cause of preventable death, killing more than 480,000 Americans a year at a cost of $170 billion annually for related health care expenses, according to the CDC. About 16 million Americans suffer from a smoking-related illness.

“For more than half a century, cigarette smoking has been the leading cause of cancer mortality in the United States,” NCI Director Dr. Norman E. Sharpless said in a news release. “Eliminating smoking in America would, over time, eliminate about one-third of all cancer deaths.”

The latest report did not reveal updated youth tobacco use rates, which are expected to be released within the next few weeks. State-level data require more processing and are issued after national figures.

National Rural Health Day is Thursday, Nov. 15

Rural communities have unique health-care needs: accessibility, a lack of providers, the needs of an aging population suffering from a greater number of chronic conditions, and larger percentages of people without health insurance or enough insurance. On top of that, rural hospitals – many of which are local economic linchpins – struggle with declining government reimbursements and the lack of Medicaid expansion in many states.

For these reasons and more, the National Organization of State Offices of Rural Health observes each third Thursday of every November – this year, Nov. 15 – as National Rural Health Day. "First and foremost, National Rural Health Day is an opportunity to 'celebrate the power of rural' by honoring the selfless, community-minded, can-do spirit that prevails in rural America," NOSORH says. "But it also gives us a chance to bring to light the unique healthcare challenges that rural citizens face – and showcase the efforts of rural healthcare providers, state Offices of Rural Health and other rural stakeholders to address those challenges."

Larger Kentucky hospitals' average grade for patient safety declined, but their overall national ranking was about the same

By Melissa Patrick
Kentucky Health News

A nonprofit group that rates hospitals has released its latest grades for keeping patients safe, giving Cs to most of the 51 Kentucky hospitals it rated. Their average grade was worse than the spring 2018 ratings, but Kentucky's overall ranking among the states, based on the percentage of hospitals with A grades, improved one spot, to 33rd, from the spring report.

Ky. Health News chart based on Leapfrog Group data and logo

The Leapfrog Group, a nonprofit group based in Washington, D.C., rated over 2,600 hospitals. Most of Kentucky's 129 hospitals were not rated, since rural hospitals with "critical access" status don't have to report quality measures to the federal government.

The grades are calculated using 28 performance measures of patient safety that indicate how well hospitals protect patients from preventable medical errors, infections and injuries. The study notes that one in 25 patients leave hospitals with a new infection. It uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey, and the American Hospital Association's annual survey and information-technology supplement.

Leapfrog gave As to 12 Kentucky hospitals, or nearly 24 percent of those graded, lower than the national average of 32 percent. It gave Bs to 12, Cs to 23, and Ds to 4. None got a failing grade. Compared to the spring report, five fewer hospitals got Bs and 10 more got Cs.

Low scorers

Highlands Regional Medical Center in Prestonsburg got its second D in a row. Methodist Hospital of Henderson got its first D, and two Louisville hospitals that are consistent low scorers, Jewish Hospital and the University of Louisville Hospital, again got Ds.

Sts. Mary & Elizabeth Hospital in Louisville moved up to a C after receiving five Ds in a row.

Pikeville Medical Center kept its C for a second straight report card, after getting all As before that.

High scorers

The St. Elizabeth Healthcare hospitals in Edgewood, Florence and Fort Thomas all got As. so did Baptist Health Lexington, TriStar Greenview Hospital in Bowling Green and Whitesburg ARH Hospital.

Norton Audubon Hospital and Norton Hospital, both in Louisville, got their first As, both having received a mix of Bs and Cs since spring 2015.

Georgetown Community Hospital again got an A, after getting a B in the spring and a C last fall.

Clark Regional Medical Center in Winchester got its first A, having received two Cs and three Bs since spring 2016, the first time it was graded.

Harrison Memorial Hospital in Cynthiana and Middlesboro ARH Hospital, which had not been ranked for several years, also got As.

Moving down: examples

The two University of Kentucky hospitals dropped to a C. Both had received Bs since fall 2016.

Hardin Memorial Hospital in Elizabethtown got a C, dropping from an A in the last two reports.

Murray-Calloway County Hospital dropped to a C after having received all As since fall 2015.

Baptist Health Richmond got its first C, having received two As and five Bs since spring 2015.

Our Lady of Bellefonte Hospital in Ashland dropped to a C after having received all Bs since fall 2016.

Frankfort Regional Medical Center dropped to a B after receiving all As since spring 2015.

Moving up: examples

Lourdes Hospital in Paducah got a B, after having received Ds in the last two grading periods and Cs prior to that.

T.J. Samson Community Hospital in Glasgow got a B after receiving four Cs in a row.

Harlan ARH Hospital got a B, having received no score in the spring and Cs since the spring of 2017.

Jewish Hospital Shelbyville got a B after not getting a score since the spring of 2017 and having received two Cs prior to that.

Taylor Regional Hospital in Campbellsville moved back up to a C after getting a D in the spring. With the exception of that D, the hospital has received Cs since spring 2015.

The Leapfrog Group says its analysis was developed under the guidance of the nation's leading patient-safety experts and is peer-reviewed. Click here to see all of Kentucky hospital's Leapfrog hospital safety grades. Click here for Leapfrog recommendations on how to use the grades.

Study shows e-cigs don't keep teens from smoking cigs; health foundation calls for smoke-free schools; FDA to act on e-cigs

By Melissa Patrick
Kentucky Health News

Teens who use electronic cigarettes end up smoking traditional cigarettes at about the same rate as teens who first start with the traditional smokes, according to a recent study based on surveys in California and Connecticut.

“The findings show that e-cigs do nothing to deter the amount of combustible smoking in youth,” Jessica Barrington-Trimis, an assistant professor of preventive medicine at the University of Southern California and the study’s lead author, said in a news release. “On the contrary, they increase the likelihood that vaping teens will start smoking.”

The study, published in the medical journal Pediatrics, is based on surveys of 6,258 high-school students in three studies, including two from the Children's Health Study and Happiness and Health Study in Southern California and a Yale University survey in Connecticut. Participants were re-surveyed again six to 16 months later.

During the study period, 7 percent of the students initially identified as never-smokers, and 21 percent of those who were using e-cigs, began smoking traditional cigarettes. And once they started smoking them, the amounts the two groups smoked were similar.

The study also found that students who only smoked cigarettes, or used both products, were more likely to continue using cigarettes than they were to switch to e-cigs only, or to quit smoking altogether.

The report notes that numerous studies show that young people who use e-cigarettes are more likely to start smoking.

"Because e-cigarettes are used by at least some youth who likely would not ever have begun smoking without having been exposed to e-cigarettes, the potential negative impact of e-cigarettes on the health of youth via the effect of e-cigarettes on smoking uptake is concerning," the report says.

It called for policies to reduce teen use of both products "to prevent progression to more frequent tobacco-use patterns, and to reduce combustible cigarette use (with or without concurrent e-cigarette use) to lessen the adverse public health impact of e-cigarettes."

Coalition for a Smoke-Free Tomorrow chart

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release that it's time to make local and state tobacco controls include e-cigarettes and other vaping products, since research continues to show e-cigarettes are a "gateway to smoking for youth and young adults."

"Our tobacco-control policies at the national, state and local levels must be updated to reflect that youth e-cigarette use has risen to epidemic levels, potentially reversing all the progress we've made in reducing smoking rates over the past 50 years," Chandler said. "At a minimum, that means enacting tobacco-free school policies that prohibit the use of all tobacco products -- including combustible cigarettes as well as vapes, e-cigarettes and other electronic nicotine delivery systems, or ENDS -- on or in school property. And it means including these products in smoke-free community policies."

The latest Kentucky Health Issues Poll showing 87 percent of Kentucky adults support 100 percent tobacco-free schools, but state legislation to do that has failed, and as of July, only 42 percent of the state's 173 school districts were covered by 100 percent tobacco-free policies.

About the same number of Kentucky high-school students smoke cigarettes as use e-cigs, 14 percent. Nationally, 8.8 percent of teens smoke and 13.2 percent use e-cigarettes.

FDA action coming

The U.S. Food and Drug Administration has been cracking down on the sale of e-cigarettes and other vaping products to minors, and is expected to impose severe restrictions on their sale as early as next week, Laurie McGinley reports for The Washington Post.

Citing senior agency officials, the Post says FDA Commissioner Scott Gottlieb is expected to announce a ban on the sale of most flavored e-cigs in convenience stores and gas stations, impose age-verification requirements for online sales, and propose banning menthol in regular cigarettes.

"The FDA’s initiatives on vaping are spurred by preliminary government data that show ­e-cigarette use rose 77 percent among high schoolers and nearly 50 percent among middle schoolers in 2018. That means 3.5 million children were vaping in early 2018, up 1 million from 2017," McGinley reports.

Six organizations that have been on the front lines in the fight against tobacco asked Gottlieb in a letter Nov. 10 for "action that will ensure that we don’t addict another generation of American youth." The letter from the American Academy of Pediatrics, the American Cancer Society, the American Heart Association, the American Lung Association, the Truth Initiative and the Campaign for Tobacco-Free Kids lists "core principles essential to reducing tobacco use:"

Voluntary action by the industry, including the electronic cigarette industry, is insufficient. Industry-wide regulatory action is essential; FDA’s approach must be comprehensive and not be limited to sales restrictions to prevent illegal sales to youth. and it is essential to address the problem of youth use of other tobacco products as well as e-cigarettes.

The groups called for FDA to take specific actions, including immediate removal of all flavored tobacco products that have not been thoroughly vetted in advance by FDA to assess their public health impact; restrictions on e-cigarette marketing, including on social media, that are at least as stringent as those applied to cigarettes; restriction of online sales and continued aggressive enforcement of the law against sales to minors; and enforcement of the legal requirement for pre-marketing review of products that were not commercially marketed as of Aug. 8, 2016.

Food-service employee at UK hospital diagnosed with hepatitis A; if you ate at Pavilion A cafeteria Oct.11-30, get vaccinated

A food service employee at the Albert B. Chandler Hospital at the University of Kentucky has been diagnosed with hepatitis A, a highly contagious liver disease, the hospital announced.

The employee prepared food at the Pavilion A cafeteria, but was not involved in any food preparation for hospital patients. The hospital advises anyone who ate at the cafeteria between Oct. 11 and 30 to get a hepatitis A vaccination, which requires two shots, six months apart.

All food-service workers at UK HealthCare will now be required to get the vaccine, and the hospital will set up "vaccination stations" for that.

The Lexington-Fayette County Health Department and UK HealthCare have recommended that all Lexington residents get vaccinated as the number of cases continues to climb. Kentucky schoolchildren were required to have the vaccination at the beginning of the school year.

In the current outbreak, there have been no confirmed cases of hepatitis A being transmitted by food-service workers in Kentucky. The primary risk factors continue to be illicit drug use and homelessness.

Since August 2017, 2,410 cases of acute hepatitis A have been reported in 94 of the state's 120 counties, resulting in 1,267 hospitalizations and 16 deaths, according to the state Department of Public Health. The agency's weekly report has county-by-county figures.

Last week, two people died in Franklin County from the virus and an employee at Frisch's Big Boy on Harrodsburg Road was diagnosed with it -- the first time a restaurant worker had been diagnosed with the disease in Lexington since the outbreak, the Lexington Herald-Leader reported.

Hepatitis A is a contagious liver disease that is usually spread when a person unknowingly eats or drinks something contaminated with by small amounts of fecal material from an infected person. Washing your hands for about 20 seconds with soap and water after using the bathroom or changing a diaper, or before preparing food and drinks can help stop the spread of hepatitis A. It is important to note that hand gels are not an alternative because they do not kill the virus that causes hepatitis A.

Symptoms of hepatitis A are fatigue, decreased appetite, stomach pain, nausea, darkened urine, pale stools and yellowing of the skin and eyes (jaundice). Not everyone with the virus has symptoms and a person with the virus is contagious for up to two weeks before showing symptoms. People can become ill 15 days to 50 days after being exposed to the virus. Anyone experiencing symptoms should seek medical attention.

Drane named Ky. regional CEO of behavioral-health nonprofit

Abby Drane

Abby Drane has been named Kentucky regional CEO for Centerstone, a non-profit organization that cares for patients with mental, developmental and behavioral issues. She will replace Tony Zipple, who is retiring Nov. 30.

Drane was president and CEO of Uspiritus, which serves abused and neglected youth in Kentucky, and before that was Centerstone's chief operating officer. She has served as chief financial officer for two of Kentucky’s largest community mental health centers, Seven Counties Services (now Centerstone) and Communicare.

Drane earned a bachelor's degree in accounting from Central Missouri State University and her MBA from Western Kentucky University.

Electronic health records, touted as tool for efficiency and better care, are coming between doctors and patients, surgeon writes

Illustration by Ben Wiseman for The New Yorker

Electronic health records were supposed to "make medical care easier and more efficient," says The New Yorker. "But are screens coming between doctors and patients?" Yes, surgeon Atul Gawande writes in the magazine's latest issue, starting with a description of his 2015 training session on the Epic Systems Corp. system, which now has information on more than half of Americans.

"The new system would give us one platform for doing almost everything health professionals needed—recording and communicating our medical observations, sending prescriptions to a patient’s pharmacy, ordering tests and scans, viewing results, scheduling surgery, sending insurance bills. With Epic, paper lab-order slips, vital-signs charts, and hospital-ward records would disappear. We’d be greener, faster, better. But three years later I’ve come to feel that a system that promised to increase my mastery over my work has, instead, increased my work’s mastery over me. I’m not the only one," Gawande writes.

"A 2016 study found that physicians spent about two hours doing computer work for every hour spent face to face with a patient—whatever the brand of medical software. In the examination room, physicians devoted half of their patient time facing the screen to do electronic tasks. And these tasks were spilling over after hours. The University of Wisconsin found that the average workday for its family physicians had grown to eleven and a half hours. The result has been epidemic levels of burnout among clinicians. Forty per cent screen positive for depression, and seven per cent report suicidal thinking—almost double the rate of the general working population. Something’s gone terribly wrong. . . . We’ve reached a point where people in the medical profession actively, viscerally, volubly hate their computers."

Gawande offers many examples to show why. Here's one, gathered by talking to physician Susan Sadoughi: "Piecing together what’s important about the patient’s history is at times actually harder than when she had to leaf through a sheaf of paper records. Doctors’ handwritten notes were brief and to the point. With computers, however, the shortcut is to paste in whole blocks of information—an entire two-page imaging report, say—rather than selecting the relevant details. The next doctor must hunt through several pages to find what really matters. Multiply that by 20-some patients a day, and you can see Sadoughi’s problem."

Patience, counsels Gregg Meyer, chief clinical officer at Partners HealthCare, who supervised the software upgrade at Gawande's hospital. “We think of this as a system for us and it’s not,” he told Gawande. “It is for the patients.”

Gawande writes, "In Meyer’s view, we’re only just beginning to experience what patient benefits are possible. A recent study bolsters his case. Researchers looked at Medicare patients admitted to hospitals for fifteen common conditions, and analyzed how their 30-day death rates changed as their hospitals computerized. The results shifted over time. In the first year of the study, deaths actually increased 0.11 per cent for every new function added—an apparent cost of the digital learning curve. But after that deaths dropped 0.21 per cent a year for every function added."

“I’m playing the long game,” Meyer told Gawande. “I have full faith that all that stuff is just going to get better with time.”

Gawande concludes his long story with an episode involving a patient on whom he had turned his back to do a computer task during a pre-surgery visit. As they headed to surgery, he started to do that again, and thought better of it. He writes: "I angled the screen toward the couple. Side by side, we confirmed that his medical history was up to date, that the correct surgical site was marked on his body, that I’d reviewed his medication allergies. His shoulders began to relax. His wife’s did, too. 'Are you ready? I asked. 'I am,' he said."

UK, Lexington Clinic to team up on cancer treatment

https://www.kentucky.com/news/local/counties/fayette-county/article221137300.html

E-cigarette conference in Louisville Dec. 10 is full; remote viewing locations added in Bowling Green, Hazard, Paducah

The Coalition for a a Smoke-Free Tomorrow will hold a half-day conference on electronic cigarettes Dec. 10 in Louisville, and offer remote viewing locations in Bowling Green, Hazard and Paducah.

The conference, titled "Next Generation Tobacco: The Impact of E-Cigarettes on Kentucky's Future Health," will focus on the recent explosion in the popularity of Juul and other pod e-cigarettes, especially among youth and young adults, and potential policies for preventing associated disease and illness.

Speakers will focus on the role of flavors in encouraging underage vaping; the extent to which e-cigarettes and other vaping devices actually help people quit smoking; what's in vaping products; whether they are a safer alternative to combustible cigarettes; and the evidence that e-cigs are a gateway to smoking for youth and young adults.

The conference will be held Monday, Dec. 10 from 8:30 a.m. to 12:15 p.m. at the office of the Foundation for a Healthy Kentucky, 1640 Lyndon Farm Court in Louisville.

Remote viewing locations will be at the Bowling Green Chamber of Commerce, 710 College St.; Baptist Health Paducah, Barnes Auditorium in the Carson-Myre Heart Center, 2501 Kentucky Ave.; and the University of Kentucky Center of Excellence in Rural Health, Room 214, 750 Morton Blvd. in Hazard (which asks that you use the free parking and shuttle service on Roy Campbell Drive (see map).

The conference is free, but registration is required for all locations. A light breakfast will be served at all locations and continuing education credits have been approved for physicians, physician assistants, nurse practitioners and nurses. Click here to register for the Louisville location, which is fully booked and has a waiting list. Click here to register for the remote viewing locations. Click here for a full agenda.