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Happiness is Hot

Apr 30, 2012, 9:15 AM, Posted by Paul Tarini

Paul Tarini Paul Tarini

Happiness is gaining currency today, particularly in relationship to health and medicine. That’s what we’ve been hearing ever since Harvard School of Public Health researchers Julia K. Boehm and Laura Kubzansky published their report “The Heart’s Content: The Association Between Positive Psychological Well-Being and Cardiovascular Health” in the Psychological Bulletin, under a grant from Pioneer. This is the first study of its kind to look closely at how positive psychological well-being—including happiness and optimism—plays a role in heart health.

The story was indeed hot – gaining attention from USA Today, The Huffington Post, TIME’s Healthland blog, WebMD, The New York Times’ Well Blog, ABCNews.com, MensHealth.com, ModernHealthcare.com, Oprah.com, and hundreds more – and being shared throughout social networks and on the web.

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New Data Reveals High Death Rates From Clostridium Difficile (C. diff)

Mar 8, 2012, 11:35 AM, Posted by Pioneer Blog Team

A new Vital Signs report issued March 6 by the Centers for Disease Control and Prevention shows rates of infection with Clostridium difficile (C. diff) are at historic highs and must be curtailed. C. diff can cause cramps, severe diarrhea and, in some cases, death.

Also on March 6, Extending the Cure—a project funded by the Pioneer Portfolio that studies antibiotic resistance—released a new analysis showing high C. diff death rates in parts of New England. In fact, the Extending the Cure analysis shows that as of 2007 Rhode Island, Maine, and Connecticut had the highest death rates for C. diff in the nation.

These top three states had death rates that were more than double the national average of 2.15 deaths per 100,000 people.  The trend is visualized using the interactive mapping platform of ResistanceMap, Extending the Cure’s online tool that tracks antibiotic use and drug resistance in North America and in Europe.

At the same time, the mapshows that most Southern and Western states had death rates from C. diff that were below the national average. For example, Georgia, Colorado, and Idaho reported less than one death per 100,000 people from these infections in 2007. “The geographical variation points to the need for additional research to better understand the epidemiology of C. diff infections and highlight the most effective ways of preventing their spread,” says Ramanan Laxminarayan, director of Extending the Cure, the D.C-based research project funded in part by the Robert Wood Johnson Foundation’s Pioneer Portfolio.

While C. diff has long been linked to hospitals, the CDC report finds that patients can acquire the infection in all medical settings, including nursing homes and outpatient clinics. Those most at risk are patients who take antibiotics, which can wipe out the good bacteria living in the gut, allowing C. diff to thrive.

C. diff infections can be reduced by judicious use of antibiotics, according to the CDC, which notes that about 50 percent of all antibiotics prescribed are not necessary. Reducing unnecessary antibiotic use will not only help prevent C. diff infections, but also curtail the growing problem of antibiotic resistance.

Addressing the rising rates of C. diff infections will require a multifaceted approach.  In addition to promoting antibiotic stewardship, health officials must work towards better infection control and early diagnosis at hospitals and other facilities where C. diff and other health care-associated infections can spread from patient to patient or from one facility to the next.

 In addition, policymakers, researchers, and others can use visualizations, like the map from Extending the Cure, to identify regions of the country with the most serious problems and look for targeted solutions to the rising tide of C. diff and other disease-causing bacterial pathogens.

Check out the new data and let us know what you think: Do you have a story to tell about a solution to the problem with C. diff?

Follow @ExtendgtheCure on Twitter to track coverage of this study.

Health Games Research Profiled by Inside Healthcare IT

Feb 17, 2012, 12:26 AM, Posted by Pioneer Blog Team

The Pioneer Portfolio is committed to supporting trailblazers who are changing the way we think about health and health care.  Debra Lieberman, PhD, director of Health Games Research, a national program of Pioneer and headquartered at the University of California, Santa Barbara, is breaking ground by using health games to transform the way prevention, self-care, and health care are practiced.

The February 9 issue of Inside Healthcare IT profiles Lieberman’s research on how video games can be used to improve players’ health behaviors and health outcomes, and thereby reduce the cost of care.  After two decades of research on games that improve health behaviors in areas such as smoking prevention, diabetes self-management and asthma self-management, she has found that some games can have a dramatic impact on health.

“Video games can change people in fundamental ways that can lead to better health behaviors,” Lieberman said in the article. “Well-designed games can change people’s perceived risk for experiencing serious health problems, their sense of self-efficacy, or self-confidence, that they can carry out specific health behaviors successfully, and their perceptions of social norms. These and many other changes in people’s attitudes, emotions, understanding, and skills can tip the balance toward behavior change. While games can be fun and can teach health facts, they can do a great deal more to motivate and support better health.”

Check out the article to learn more about Lieberman’s research on health games and tell @pioneerrwjf or @gamesresearch what you think on Twitter.

Making Sense of the Debate Over Patient Access to Medical Information

Feb 16, 2012, 11:33 AM, Posted by Pioneer Blog Team

Lately, there’s been a lot of conversation about increasing patient access to medical information. Much of this debate was sparked when Kathleen Sebelius, secretary of the Department of Health and Human Services, stated, “When it comes to health care, information is power.” While many providers and most patients are in support of increasing patient access to medical information, there are some who feel this change will make doctors’ jobs harder.

OpenNotes, a Pioneer-supported program that makes it easy for patients to access their doctors’ notes after a visit, is at the heart of this debate, as was seen in a series of columns in February’s SGIM Forum. In this newsletter Tom Delbanco, MD,  and Jan Walker, RN, MBA,  the lead investigators working to determine the impact of sharing doctors’ notes with patients (Part 1),  debate the merits of this new level of transparency  with Douglas Olson, MD (Part 2), and well-known patient advocate e-Patient Dave (Part 3).

In a post on The Health Care Blog, John Lumpkin, MD, MPH, senior vice president and director of the Health Care Group at RWJF, weighs in on this debate.  Learn why Lumpkin thinks that increasing access is a good idea and tell us what you think.

Shorter Antibiotic Regimens Might Counter Antibiotic Resistance

Jan 12, 2012, 9:05 AM, Posted by Pioneer Blog Team

Antibiotics on the shelf today are increasingly losing their potency against resistant microbes or “superbugs” like the potentially lethal methicillin-resistant Staphylococcus aureus, or MRSA.

Extending the Cure researchers published an analysis this week that questions the conventional wisdom regarding antibiotic dosing practices and suggests rethinking the guidelines to minimize the growing public health crisis posed by antibiotic resistance. Ramanan Laxminarayan, director of Extending the Cure, and his colleagues, used mathematical models to study antibiotic treatment guidelines, the regimens physicians follow for the standard dose and duration of antibiotic treatment for common infections.

While antibiotic dosing regimens have typically been designed to cure bacterial infections, rarely have these guidelines taken antibiotic resistance into account.  All antibiotic use contributes to the development of antibiotic resistance, and the new research suggests dosing guidelines could be optimized to both treat infections and limit the spread of resistant microbes. The analysis, published January 11 in the online scientific journal PLoS ONE, indicates that in many cases, a shorter regimen of antibiotic treatment could work just as well as a longer course yet still reduce the risk of resistance.

Dosing strategies for antibiotics are not set in stone.  For example, many physicians have switched from the traditional 10-day course of antibiotics and now effectively prescribe a three-day regimen to treat otitis media, or middle ear infections. In some cases, the authors argue, shorter dosing regimens like this one could limit the selection pressure for resistant bacteria and thus reduce the threat of resistance.

Extending the Cure, a project of the Center for Disease Dynamics, Economics & Policy sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio, is working to change how we think about antibiotics, a resource that can be depleted with overuse. This study suggests that shorter treatment regimens, in some cases, may help us preserve the power of the antibiotics we still have left.

Let us know what you think:  Are there any risks to shortening current treatment regimens? Are there any other benefits? Leave a comment here or tweet at @ExtendgTheCure and @PioneerRWJF #SaveAbx to tell us what you think.