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In My Opinion

Rural Hospitals Are An Endangered Species
September 15, 2014 9:35 AM by Jimmy Thacker

Today, I watched my Kansas City Chiefs lose to the heavily favored Denver Broncos. They tried, and they kept it close. In the end, all that matters is that they lost. I fear that rural hospitals are in the same situation. Whereas these bastions of care used to dot the landscape, times are tough for rural facilities. Some have been bought out by corporate systems, and have probably improved from the infusion of money and talent. Still, many are left without access to quality care because the sheer numbers of hospitals are declining. Politicians have done little to save them, and regulations and technology have left the small, country hospital out in the cold.

Like the Chiefs, it has been a good run. I love small hospitals. I always liked everyone knowing everyone else by first name. I liked when people asked about my kids, and I heard their stories of how the soccer game went or when the next county fair was from the guy or gal who was showing pigs. I think patients liked it, too. True, the bigger hospitals are blessed with the latest and greatest equipment. True, the bigger places have an abundance of doctors and specialists that can better treat many. But for a patient, the benefit of being close to home, of being taken care of by the same person you saw in the grocery store last week, has given way to a cold, sterile, institutional recovery period when you are ill.

It is difficult to get talent to a small hospital, too. Usually the pay is less, the excitement is lower, and the prestige is just not there. As healthcare has turned into a business more than a calling, the bigger places flourish while the small, rural hospital continues to fall further behind. There is no competition here. Money is power, and the bigger places have both.

In my opinion, it is sad to see the small facilities go. I admire anyone who takes on a job where you have to be both the respiratory therapist and the janitor; the clinical nurse and the mental health nurse; the doctor and the caretaker of the budget.

I remember a day when I got interviewed by the hospital administrator in Arkadelphia, Arkansas. He did all his own interviewing because he wanted to know who was being hired. I was very young then, but thought he was the coolest guy ever, and I enjoyed working for him. Now it is all about online applications on websites that seldom work and human resource people who have their own agendas.

Now you can work at a hospital for years and never even know the administrator's name, let alone recognize him or her when they grace you with their presence. I have said before on here that we need to put the "care" back in healthcare, and I stand by that. I hope that departments are more accessible and that noone works for a respiratory manager they do not know or cannot call a friend. It is when we invest ourselves in our community, when we invest ourselves in each other, and when we invest ourselves in our patients rather than getting "x" amount of treatments done that we have real healthcare.

Otherwise, it is just the health business, and like any other business, success and failure are only separated by a very fine line because there is only monetary investment, not personal investment. I am old-fashioned in my thinking, I know. Many of you will disagree with me; I know that, too. I respect that. I am not saying that bigger facilities are bad. I am only suggesting that in this hurry up world we focus on numbers more than the people we all say we want to help and heal, and this old man thinks that is sad.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C, Wellington, MO

Get Ready to Toot the Respiratory Horn
September 8, 2014 4:19 PM by Jimmy Thacker
Noone likes to toot their own horn, but with all the competing services, we literally fight for survival in healthcare. As respiratory therapists, it is our job not only to care for our communities, but to let them know that we are available, in many cases 24 hours a day, seven days a week. Respiratory Care Week is October 19-25. What better time to do a little public relations and marketing?

There are many things you can do to increase awareness of your department. Hold an open house and highlight the impact you have on the community with conditions such as asthma, COPD and post-operative care. Show off your department. Clean it up first, but allow the community to come in and tell them about your ventilators, your nebulizer systems and your specialized equipment, such as those for pediatric and neonatal patients. Make a video and give a speech. Arrange with the local health department or school to show your video, and highlight the "normal" day of a respiratory therapist. Enlist doctors and nurses to help out, and appear on the video explaining why respiratory care is vital.

The fact is, no one thinks about us until they need us. Those who know us, know us well; everyone else knows nothing about us. Respiratory Care Week is your chance to change that; your chance to shine. It is your chance to form bonds with the community, the hospital or clinic staff, and each other. Use this opportunity to show your stuff.

For directors, it is also an opportunity to show your employees a little appreciation. No CEO or COO is going to let you give everyone the day off, nor are they going to let you give everyone a raise. That does not mean that you cannot do something meaningful. Thank your staff. Individually, one at a time, face to face. Let them know you appreciate the overtime, the call ins, and the excellent care they provide. Even if there are therapists in your area not working for you, give them a shout out and check in with them. You never know what they may be up to and how it may apply to you. Don't try to recruit the competition, but be mindful of who is in your area; you never know when you may need them.

For employees, re-commit yourself to your personal and professional growth. Get back in school. Take that NALS class that everyone else says is too hard. For departments, use the time to reflect on the past year. Clean the department. Inventory your stuff. Review the schedule and make sure it works for everyone. You have a week, and I know respiratory therapists can accomplish a lot in seven days.

We all know how important respiratory care is. Let's show everyone else. Respiratory Care Week can be just another week going by on the calendar, or it can be something meaningful to both the department and the community. It's up to you. We struggle daily to stay relevant in healthcare. We are working on getting bills and laws passed to acknowledge our accomplishments.

My father was a preacher. He used to say there is an "I" right in the middle of revival, meaning that until you revive yourself, you cannot revive anyone else. We face the same dilemma. Unless we toot our own horn once in a while, everyone else in the hospital who toots theirs gets a little of our glory later on. Toot your own horn. For one week, toot it loud and toot it often. Let people know why you matter, the hours you work, the lives you save. Let your CFO know how you contribute to the "bottom line" when you work. Let doctors know that you are there for them, and are open to their suggestions on how to improve care. Invite your CEO and/or COO to lunch, and talk to him or her about your accomplishments over the last year. Better, invite him or her to lunch with all your staff; it may be the first time they have met. Toot your own horn a little. You've earned it.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

Make the Right Impression on Patients
September 2, 2014 8:23 AM by Jimmy Thacker

As medical professionals, it is important that we project a certain image to our patients. We need to be professional, intelligent, curious and caring -- all at the same time. The biggest detractor we face is our interactions with other professionals, which are sometimes in a very unprofessional manner. The therapist at the nurses' desk chatting with the nurses are noticed by those family members on the way to the ICU to visit their loved one on the vent. The loud music from the department's radio is heard not only by staff, but by visitors on the way to see friends and relatives. Instances like this cause our patients and visitors to form opinions of us. We need to make sure we are putting our best foot forward and realize how we spend our "down time" appears to the communities we serve.

Now, I am not suggesting that chatting with others is bad, nor is music on the department radio. We do need to understand that we see people at their worst; unlike us, they are not having a good night -- otherwise they likely would not need our services. I used to work nights. It was common for me to have a radio on in the department. I just didn't let it get so loud that visitors would hear it. I like to talk to people, especially smart people. Some of the smartest people I know work in healthcare, so talking to them was always a pleasure. Still, I tried to be mindful of who else was listening or watching my interactions with my colleagues. 

     We are in the unenviable position now of fighting for professional survival. Respiratory therapists have to justify their existence to have their services ordered and paid for by insurance companies. Other healthcare workers are also under a microscope with rising costs and lessening reimbursement.

We do not help ourselves by appearing to be anything less than the caring professionals our patients are counting on to save their lives.

Most of us have learned this and have a handle on it. So let's do this: let's police our own. If you see a colleague acting out inappropriately, correct him or her. Explain the problematic behavior and why you feel it undermines the impression you want your clients to have of you. Responsible, mature colleagues will be shocked and correct themselves. Those who do not may need more aggressive correction from management. Either way, as the old saying goes, "You only get one chance to make a first impression." Let's make sure the impression we leave is the one we like. 

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C, Wellington, MO

U.S. Needs to Get Serious about Smoking Cessation
August 25, 2014 8:29 AM by Jimmy Thacker
Let's imagine a better world for a minute. Imagine a United States that actually wanted to cut down on smoking. Imagine what kinds of programs would be instituted. Graphic images on cigarettes, ads educating the public about the risk of not only lung cancer, but of stroke and other diseases. We could imagine that, and we could have had that years ago, but the CDC and seemingly everyone else has to have their say first. Approval has to come from everyone it would seem. Meanwhile, while the U.S. has been talking about curbing smoking, the country of Uruguay has actually been doing it. For six years now!

Uruguay has seen a decrease in smoking in both males and females over the last six years, when they implemented a new, tougher program. These featured graphic pictures on packs of cigarettes, getting rid of misleading terms like "light" and other sub-brand names such as colors (reds, blues, etc) that suggested a different, safer smoke. A wonderful public education program that links smoking cigarettes to not only lung disease, but heart disease and stroke, has opened the eyes of many. Smoking bans are in place almost everywhere and are very popular, so much so that even smoking in cars with passengers is now under the microscope. Six years into the new program, Uruguay is saving lives, while the United States continues to "talk" about how to save lives.

In my opinion, we have neither the federal, state, or local concern to do anything about our smoking rates, which is on the rise. We look for substitutes like electronic cigarettes rather than solutions like bans. We lack any professional organization with enough respect or clout in our society to make a difference. The U.S. likes to think we are miles ahead on many things, but curbing one of our deadliest habits is not one of them. The United States needs to get serious about curbing the smoking habit, and then, rather than "talk" about it more with governmental agencies and companies who stand to lose money when everyone quits, actually "do" something. It would be a nice change.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C

Are You a Workaholic?
August 18, 2014 8:25 AM by Jimmy Thacker
A new addiction is hitting us now. Workaholism is an acceptable addiction in society, but costs money, productivity, relationships and enjoyment of life. In Japan, it is called "karoshi," which means "death by work." Ben Franklin thought we would be advanced enough that by now we would only work 4 hour work weeks. In 1933, the Senate passed a bill for a 30 hour work week, which President Roosevelt vetoed. In the last 20 years, the hours we work in a week has steadily risen. Some will question what "work" is, but for this blog, we will call it anything that contributes to your employment, your employer's bottom line and time away from your own interests. For some, this is not clear enough, because their only interests are only work.

In the United States, the top 0.1% of the people, around 14,000, hold 22.2% of the wealth. The bottom 90% of us hold only 4%. That creates a class system and the rich keep getting richer, and the poor get poorer. Some extra work is needed to change classes, but is it fruitless? Most people are brought up to think that hard work pays off. Actually, it does not in some cases. Warren Buffet works three hours a day, but is the richest man on the planet. Bill Gates is a college dropout. George W. Bush and Ronald Reagan were high school dropouts, but became popular presidents of this country. Workaholics are also ineffective. They are less productive and pose a higher risk to their employers, especially in health care, which demands you pretty much bring your "A-game" every day.

Are you a workaholic? Answer these questions: 1) Is work a regular part of your evenings and weekends (your "time off")? 2) Do you spend less time with family or regular activities than you used to, like church, exercise or reading? 3) Do you talk faster, walk faster, and feel like you have to "catch up" constantly? 4) Are you developing health issues from too much work such as joint pain, stress-related injuries, chronic headaches, etc? 5) Have you lost your focus and have trouble completing tasks before starting a new one? If you answered yes to any or all of these, you may be a workaholic. The News Tribune says that workaholism makes us sick, stressed, stupid, off balance, and disengaged. Many other sources, including Psychology Today and Inc. agree. Young adults are the most severely affected, and often become even more stressed if they are denied the opportunity to work extra.

In the medical field, you have to be on every day. You never know whose life will depend on it. But here are 13 things you may not know about your work environment. 80% of people are dissatisfied with their jobs. The work is not challenging or you just don't feel like it means anything. The average person will spend 90,000 hours working over their lifetime. Couples in which one partner spends more than 10 hours extra at work are twice as likely to divorce. Americans hold seven or eight different jobs before the age of 30. The economy dictates how many jobs they hold after 30. 25% of workers in the U. S. say their work is their highest source of stress. 13 million days are lost yearly to stress-related issues and we spend many more days just "dealing" with stress in our own way while at work. Americans spend an average of 100 hours a year commuting to work. Obviously the city people deal with this more than the rural folks. Women still make around $0.80 per dollar a man is paid for the same job. 15% of women at the director level slept with their boss, and 37% of them were promoted afterward, which explains why it is hard for you to get promoted, leading to more stress. Half of Americans gain weight at their jobs due to stress. 64% of Americans cancelled or changed their vacation plans last year because of work. Americans only use 57% of their vacation time, giving more time to employers than to their families. 25% of people check in often with work while they are on vacation and 59% check in on holidays such as Christmas and Thanksgiving. Work is everywhere thanks to technology, and it is slowly killing us. 

In my opinion, no other industry needs to police our own people more than health care. We cannot care for others when we do not care for each other. How many therapists do you know who work multiple hospitals? How many nurses are in such high demand they work nonstop for days in a row before taking a breather? How many doctors seem to be constantly "on call" with little or no down time to rest? The medical field is great. It offers opportunity, growth, and the ability to be mobile and have a flexible enough schedule that we should be enjoying life. But are we? If not, you are missing the point of living.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C

Wellington, MO.


How Does Your Boss Stack Up?
August 11, 2014 10:06 AM by Jimmy Thacker

One of my favorite people to "read" is Peter Economy. You can often find his work in "Inc." magazine. Recently, I read a post of his on the Seven Things Every Great Boss Should Do. Here is his list. If you are a supervisor, see how you stack up. If you are an employee, this may help you determine the kind of boss you deserve to work for.

Acknowledge. Everyone likes a pat on the back once in a while. I remember working for an administrator who would serve cake and punch at the monthly "employee of the month" ceremony, held in the cafeteria in front of everyone else on the staff who was available to attend. His handshake meant much more to me than the little bit of a bonus I received, the parking space I never got to use, or the certificate. Just shaking my hand in front of my colleagues was acknowledgement that he thought I did well and wanted everyone else to know about it, and motivated me to try to do even better.

Motivate. Enlist employees to produce results. Rather than wasting time assigning blame, get them to think through problems and come up with results that meet your high standards. Never lower the standards, but instead motivate employees to reach and exceed the standards you have in place. I think supervisors are surprised how smart some of their employees are. If you give a problem to the group, it is likely the group will solve your problem.

Communicate. The days of departmental meetings have gone in many facilities, and that's too bad. If you cannot have meetings, at least call your employees in once in a while to talk to them. Ask them what is going on in their world. It may be different than what is going on in yours. Does your night shift get the same respect from the doctors as you do? If not, why? Effective communication can often give you a heads up on potential problems, long before your dirty laundry is aired out for everyone to see. It can also be a way of modifying behavior, if needed, and save a good employee from going bad. Employees do not like feeling as if they cannot speak, or they are not listened to. If they feel that way, it is your fault, not theirs.

Trust. If you do not believe in your employee, why did you hire them? Trust goes back to communication, but it also brings an element of support. Supervisors have to get employees the support they need, and trust they will use resources well to meet standards.

Develop. This one is the thing I see the least in departments. Develop the next leader. Yes, train someone to take your job. Someday. A smart administrator may realize your employee can do your job, but will also realize the reason your employee can do it is because you trained him or her. Development takes work. You must know what each employee's strengths and weaknesses are, and train them accordingly. Some people are clearly not meant for leadership roles. But some are, even if you are not a good enough boss to see it in them. They can lead and do great things for your organization, or the one you are competing with; your choice.

Direct. Once you know strengths and weaknesses, assign tasks that will develop those traits. Yes, give your employees tasks. If they are interested in developing into great employees, they will accept the challenge and flourish. If they only want to be good employees, then look for their replacement. We do not need good therapists and leaders, we need great ones!

And finally, partner. Your department should be an exclusive "club" that your therapists belong to. Not everyone is allowed. As a part of that club, members should always be looking for ways to excel, ways to improve both in and out of the department. We do serious work; being a member of a club can be fun. There is a camaraderie that develops into trust and leads to accountability. Once you have that in your staff, then you can provide the very best care for your patients while employing a worthy group of professionals that can take on any challenge day or night.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C

Wellington, MO

New Drug in COPD Arsenal
August 4, 2014 8:06 AM by Jimmy Thacker

The FDA has approved a new tool for fighting COPD. Olodaterol (Striverdi Respimat) is a once-daily spray made by Boehringer Ingelheim. It is a maintenance drug that will be used to deal with the third leading cause of death among Americans. Olodaterol, a long-acting beta adrenergic agaonist (LABA) helps the muscles in the airways and lungs stay relaxed. Side effects may include a runny nose, bronchitis, cough, upper respiratory tract infection, urinary tract infectino, rash, diarrhea, dizziness, back pain, and other joint pain. "Olo" has not been approved for use in asthmatic patients because of a lack of research for that population thus far. It is not to be used as a rescue medicine.

In my opinion, it is good that we continue to find new ways to fight breathing diseases and conditions. Many of our patients suffer debilitating issues with their breathing, and often some of us can get them back on the right path. Olo may help you in your practice to ease that suffering.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

Take Care of Each Other
July 28, 2014 8:27 AM by Jimmy Thacker
We all do it. We get sick or hurt a little and ignore it. We think it will go away in time. There is no reason to seek a doctor's attention. We "tough it out" and get through the day. In the old days, one of the "perks" of working in healthcare is that you could always get some free medical advice or even an examination from the doctor on the side, while he or she was in the hospital. Rules and regulations the way they are now, many doctors are very uncomfortable with doing that service any more. So, like everyone else, we go to the office. We wait. We sit in the room with all the other bugs, the chairs that have not been wiped down with disinfectant, and we see the doctor for our allotted 7 or 8 minute time frame. Only now we are carrying more germs than ever. 
    Rules and regulations have purpose, but so does common sense and professional courtesy. It takes a lot to keep our healthcare force healthy. We get exposed to everything everyday. Bodily fluids are not the exception; they are the rule. Infectious disease is not the aberrant threat, it is the only constant we have when we work. We have to take care of ourselves and each other. Honest evaluation and caring about our co-workers is how we prevent sickness among ourselves. Along with washing hands, eating right, getting exercise, and brushing our teeth, we need to include self-checks and checks on our colleagues. In many cases, early detection is a start to ending whatever we are getting, and we may not be objective enough ourselves to admit that something is going on. That is why we have each other. 
    In my opinion, as healthcare regulations become more stringent and care is harder to get, even for those responsible for caring for the rest of the world, now is the time to band together and take care of each other. Put aside petty differences. Put aside pre-formed opinions about colleagues. Look out for each other. Sure, have differences, but do not let those differences cloud your professionalism and all the things you agree on. Ask someone how they feel. Find out if they have been sleeping well. Listen if they need to talk about what is bothering them. Someone once said "no one will care how much you know until they know how much you care." Fall is coming. Allergy season will soon give way to cold and flu season. Hospital populations will increase as staff rates stay the same or become less. Take care of each other. We all need each other to make it through the day and to best serve our communities. 

That's just my opinion, Jim Thacker, MBA, MHA, CRT, AE-C Windsor, MO

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Asthma in Schools
July 21, 2014 7:52 AM by Jimmy Thacker
Ads are appearing all over for back to school sales, book and supply drives, and other activities aimed at arming students with the necessary equipment to return to school. The school year is closer than you think and before long, those big yellow buses will be filled again, going to and from the local school house. To my dismay, one of the things that many students will not be ready for is an asthma attack at school. Schools have some plan for it to happen, but are normally very unprepared, creating unnecessary excitement and confusion during a high stress time. 
    Students with asthma know. Many school nurses know. Parents know. Yet many school districts fail to take advantage of resources they have available to handle students in their schools with asthma. The school nurse may not be in. It could happen on the football field instead of the classroom. Many districts are still arguing over whether or not a student should be able to carry his or her inhaler, or if they have to leave it in an office somewhere. Others are still missing out on the benefits of spacers. A dysfunctional void is present and whether through avoidance, ignorance, or a "I never thought it would happen to me" attitude, schools may not be ready for a life-threatening attack to a student's airways. 
    Resources can be found through several sites. A "Google" search yields many results. Advice from doctors, the American Lung Association, the AARC, and local asthma educators can all help, but only if asked. Partnerships should exist between schools and local hospitals, EMS crews, and emergency room physicians who may be responsible for timely treatment of an asthma attack. All the burden should not be placed on the school nurse. Teachers, coaches, sponsors of after school activities, and bus drivers should all have some exposure to instructions on what to do if they witness or are called to a student in crisis. 
    Parents expect schools to care for their children. Parents should be asking who in the school knows what to do when their son or daughter has an attack. Ask at the school board meeting. Ask when you register. Ask! The kids spend more than 8 hours a day in school; are you too busy to ask a question that affects one-third of their life? 
    In my opinion, schools do what they can. Budget constraints, lack of developed programs, lack of partnerships with outsiders who possess knowledge and expertise, and a lack of human resources that cannot be everywhere at the same time are all problems. Local hospitals need to step up. Send a doctor or respiratory therapist to the school and talk with them. Evaluate their plans. Get a feel for the number of asthmatic kids you may have to treat. Agencies need to step up, too. National groups like the American Lung Association or local asthma clinics need to get involved and offer their insight. Most of this costs the school districts nothing. We all want the best for our kids. The best education, the best after school activities, and we should want the best health. Schools are not healthy places, so let's not send our kids into a bacteria, virus, allergen-infested place for a third of their lives without having some resources available to help them survive. 

That's just my opinion, Jim Thacker, MBA, MHA, CRT, AE-C

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Depression's Impact on Therapy
July 14, 2014 8:08 AM by Jimmy Thacker

It makes sense. Depressed people have trouble completing pulmonary rehabilitation. Depression hits so many, and comes in so many different forms. Researchers at the Miriam Hospital have seen a big rate of "non-completers," as they are called, in their pulmonary rehab programs, and those working in rehab facilities should take note.

COPDer's who attend pulmonary rehab are much less likely to get all the benefits of their program if they have to deal with depression during their rehab period.     

A study of 111 COPD patients used a self-reporting scale to discover why people were dropping out of the program. The results showed that depression was one of the main reasons. More common in women than men, depression was the number one reason in women, though men seldom picked the condition as the main reason. The study shows that when enlisting patients in a pulmonary rehab program, it is important to address psychological issues as well as physical. In fact, since the psychological issues can be a barrier to healing the physical issues, it could take center stage. 

Even if you are not in the rehab sector, treating patients on the floor could have barriers. The COPDer's worries about their hospital bill, concerns over the care they can provide themselves after discharge, or other issues can take a toll and lead to depression. Depressed people simply do not respond to treatment as well, and chances of leaving the treatment plan are increased. It is important then to use clinical skills of observation and talk to the patient to see if depression is a possibility, then formulate a plan to combat both the depression and treat the COPD. 

In my opinion, depression is a huge barrier to any treatment plan, respiratory or other. Depression makes a patient less aggressive, more apt to find excuses on why not to adhere to a physician's or therapist's orders, and makes the "will to live" less prominent in a person's mind. It destroys one's ability to reason and see the proverbial light at the end of the tunnel.

Treating the whole patient needs to involve the physical realm, as well as the psychological realm. And do not just go by looks. Many depressed people are struggling with the condition while appearing on the outside to be in total control. They are ducks in the water; calm on top, floating around the pond, but underneath, their feet are moving very quickly trying to keep their head up.

Talk to your patients. Use the skills you are taught and your own common sense to see where they are in their minds. COPD is no joke; we need our patients to have their heads in the game so we can help them, and it may be up to you to figure out if your patient has the right mindset to succeed. Think outside the box and take "total" care of the patient to ensure your program is serving your community.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C

Windsor, Mo.

End to Tuberculosis?
July 7, 2014 9:09 AM by Jimmy Thacker
The World Health Organization (WHO) has announced a plan to eradicate turberculosis (TB) from 33 countries and territories by 2050. In 2012, about 1.3 million people died from TB, with another 8.6 million falling ill. A benchmark set by WHO sets a goal of fewer than 10 cases per million people in the target areas, which include the United States.

TB is an infectious disease caused by bacteria. It is spread by germs sent through the air by coughing, sneezing, or spitting. WHO believes that a thrid of the world's population is infected, whether people know it or not. Even when there are no symptoms, TB can be spread, which is one of problems in containing it. Ten percent of people infected will develop symptoms. The risk increases in people with compromised immune systems. Symptoms include coughing, especially with blood or mucous, chest pain, fever, night sweats, fatigue, and unexplained weight loss. TB is curable and preventable. Sadly, 2/3 of people who do not receive treatment will die from the infection.

We tend to think of TB as a problem for other countries. Few of us have treated anyone with TB, though it is likely that over an average 40-year career in health care, you will be exposed. The framework will attempt to address funding, discover who the most vulnerable populations are, address needs of those crossing borders, become more active on TB screening, optimize multi-drug care, improve surveillance, invest in research, and support global TB control.

In my opinion, though it is easy to consider TB the problem of other countries, it is important that we, as respiratory therapists, understand that in 2010, the CDC reported 11,182 cases of TB in the United States. It isn't just a problem in other countries; it is everyone's problem -- including ours.

Even if you have no physical or lifestyle issues that would increase your chances of TB, it is still possible to become infected while working on your next patient. Be proactive. Make sure you know your facility's protocols on suspected cases of TB and that they are enforced. Lastly, make sure you are getting yourself checked with a TB Tine test performed by most infection control offices or your county health department. Take care of yourself, so you can take care of your patients.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.
Are We at Risk for TB?
June 30, 2014 9:26 AM by Jimmy Thacker

A new study indicates that people on corticosteroids may be more prone to TB than we thought. Dr. Nicholas Vozoris, a respirologist at St. Michael's Hospital, concludes that people on drugs such as prednisone be screened more often. Prednisone, it seems, can turn latent TB into active TB. These patients are also screened for TB much less often. His suggestion is to not only screen more often, but to also prescribe TB-fighting drugs prophylactically. Current guidelines say that if the bump after a TB tine test is 5mm long, TB should be considered. Dr. Vozoris suggests that a bump of only 3.5mm is more accurate. Corticosteroids are common in our line of work. They are given to people with asthma, COPD, inflammatory bowel disease, arthritis, and cancer. 
    Studies are inconclusive, however. The National Health and Nutrition Examination Survey disagrees with Dr. Vozoris' findings. The implications are that some of our patients we see every day may or may not have active TB, and we simply do not know. When patients cough on us, that disease may be spreading into our own lungs. Even if we do not develop active TB ourselves, we are then carriers to our other patients and other staff members we are working with. 
    In my opinion, this obviously needs more study, and quickly! If Dr. Vozoris is correct, we may have a TB outbreak we are not even aware of. If the Survey is correct, then bad information from Vozoris needs to be disproven and put away so there is not a "TB scare" in the United States. I have always been a proponent of early caution, placing patients in negative pressure rooms until I know for sure if TB is present. This practice has always caught many by surprise and resulted in more than a little "ribbing" from colleagues, but I believe in being safe rather than waiting to find out later my suspicions were correct all along and I did nothing about it. With the resurgence of other diseases we thought we had killed off or treated into submission, the last thing we would seem to need is another TB scare. Let's get some definitive word on this and decide one way or the other. Lives, including our own, depend on it. 

That's just my opinion, 

Jim Thacker, MBA, MHA, CRT, AE-C

Windsor, MO

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US Ranks on Bottom of Healthcare Study

Healthcare reformers need to focus on health, not money.

US Ranks on Bottom of Healthcare Study
June 23, 2014 8:35 AM by Jimmy Thacker
The latest "Mirror, Mirror" analysis is out. It is a study funded by the Commonwealth Fund, ranking the world's healthcare systems. The United States has come in last of the nine rated countries. The study ranks countries on quality, access, efficiency, equityand healthy lives. The study, which admits it always has some bias because of "opinions" used by doctors and patients, is one of the benchmarks that should be used by smart folks running a nation's healthcare. Individual hospitals may have scores worse or better, depending on their own data, but it does raise the same questions I have raised on this blog for years now.

On quality, the main things that held our score down were safety and coordinated care. The two things that seem to U.S. citizens to be top priority simply are not being done well. Lack of involvement of subject matter experts seems to be the main culprit; the wrong people are attending those meetings about discharge planning and noone is asking the night shift nurse for his or her suggestion on how to improve things. Access goes without saying; there simply is not equal access in the U.S. If you are rich or well-insured, you have access. If you are not because you live check to check, are on Medicare or T, or work a job that does not offer benefits at all so all the expense comes out of your pocket, you have little access. It is noteworthy that the other eight countries in the study all have universal healthcare, and the study points out that the Affordable Care Act is likely to improve access in the U.S.

We are dead last in efficiency, mostly because we spend so much of our GDP on a healthcare system that simply does not work. We scored last in equity, too, because of the one-third of Americans who have a below-than-average income cannot afford to go to the doctor or hospital. The healthy lives category again ranked us at the bottom, because our healthcare system does not produce results.

The rankings were (1) United Kingdom, (2) Switzerland, (3) Sweden, (4) Australia, (5) Germany and the Netherlands, (6) New Zealand and Norway, (7) France, (8) Canada, and (9) the United States. Of note, the U.K. has the highest in-hospital death rate while the U.S. had the lowest. Still, overall, the U.K. has a higher life expectancy than the U. S.

In my opinion, this points out the broken system we operate in. A multiple payer system which allows some to have access while it denies others makes this study seem worse than it may be. The scores would be different statistically if everyone in the U.S. had access to the same healthcare. Sadly, this is not the case as it is in other countries. \

The U.S. spends money on treating disease, not prevention. There are far too many legal battles fought by people not involved in healthcare, and who focus only on how health organizations, insurance companies, and pharmacies can make money. The approval process for new medications that could save lives is long and tedious, and while we invest billions of dollars in additions to our hospitals, corporate takeovers of rural facilities, and the common "Wham-Bam" clinics that have popped up in nearly every metropolitan area, we have failed to address the root problem: our healthcare system stinks.

We must get rid of the "good-ol'" boy system in place now that does not invite new thoughts and solutions. We must get people in our political system who understand healthcare and see their post as a voice for healthcare advocacy, rather than a political position. We must do our best at our own level to improve service, safety and customer satisfaction. We need to get rid of CEOs and COOs who are money-minded and get ones that are community-minded. Our healthcare system is salvageable, and it will be interesting to see the effect of "Obamacare" on our rankings, but it all starts with a complete overhaul of our entire system.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

E-cigarettes Another Route to Nicotine Addiction
June 16, 2014 9:25 AM by Jimmy Thacker

Talking to some friends, I realized there is confusion about electronic cigarettes -- a lot of confusion.  At a conference recently, one speaker told the crowd that nothing in an e-cigarette causes cancer. Many others have told me they switched to e-cigarettes specifically because they were safer. Yet an e-cigarette contains the same nicotine that a regular smoke has, although in a much smaller amount. The "vapor" still gets nicotine, which is what makes it a suitable replacement for that pack of Marlboros.

The nicotine in the cigarette, whether it be a regular smoke or an e-cigarette, is carcinogenic -- one of many (about 19) carcinogenics found in your pack of Lucky Strikes. Though the amount is reduced, the whole basis of an e-cigarette is to breathe in nicotine heated by a lithium battery. At one point, we will have a discussion on the effects of hot lithium on the airways, but that is for another blog. For now, let's just acknowledge the fact that e-cigarettes can still lead to cancer.

I appreciate those trying to quit. "Vaping," as it is known, has become common and is a good try, but not perfect. My fear is that people will use the electronic device for the rest of their lives. They have not made any behavior modification, which is what is needed in any habit-breaking effort; they have only substituted a cigarette for a less potent cigarette.

If an e-cigarette is a step-down device to help the smoker quit, I am all for it. If it is a replacement for a regular cigarette so that you can look cool lighting up in your favorite restaurant or club, then I am not. So let's stop the flow of misinformation. One of the problems with e-cigarettes is that they are used more often to get the same affect. A person "vaping" uses their device much more often than those who have to go outside for a smoke. The frequency of use makes me question the benefit.

In my opinion, e-cigarettes may hold some value if they are used on the path to smoking cessation. For those who are just substituting one bad habit for another, there is no pot of gold at the end of that rainbow.

Getting hooked on e-cigarettes is just as likely, if not more likely, than getting hooked on regular cigarettes. That is why there is so much concern over kids using them. Kids may believe, as many adults may, too, that e-cigarettes are safer. My opinion is that there is not much difference, and a problem still exists, whichever you decide to smoke.

Bad information will kill you, and I believe in years to come we will see just that as nicotine addiction continues to rise for those who only smoke the electronic versions. Nicotine is bad. There. I said it. Like any other drug, it has side effects, the most dangerous of which is death. Use your e-cigs if you must, but only behavior modification can help you in the long run.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

Outdoorsy Kids May Have Fewer Allergies
June 9, 2014 7:29 AM by Jimmy Thacker
It is something many of us have known for some time. If you have ever lived on a farm, you have no doubt. A new study shows that kids who play outside may be more protected from allergens and asthma attacks than those who do not. When I was a kid, we barely knew what the inside of our houses looked like. Kids these days are much different. For many, it seems to be an effort to get them to go outside and play. Computer games and massive amounts of homework consume time rather than imaginary friends, pretending the bicycle is a truck, and making mud pies. Come to find out, parents who are concerned about letting their kids outside may be hurting them, rather than helping.

Now, having said that, it is under the assumption you live in a neighborhood safe enough to let your child out. Some neighborhoods are not. The study, conducted by the John Hopkins Children Center in Baltimore, Md., suggests that playing outdoors in nature actually boosts the immune system. The study followed over 400 children and used skin *** tests, physical exams, and parental surveys. Dust from over 100 of those homes was also collected and studied. Those living in areas where playing outside was not practical, dangerous, or just not done out of fear, were more likely to show signs of allergies and asthma by the age of 3 than those who were outside routinely.

It seems to be particularly crucial in the first year. After that, the boosting of the immune system has a sharp decline. Further study is needed to show what happens after the age of one.

In my opinion, let the kids be kids. Kids belong outdoors, when it is safe, and should be allowed to have some old fashioned fun by rolling around in the dirt, skinning knees, and running, jumping and enjoying the sweet smell of grass, flowers and the open air. If some parents were correct today, I would have been dead long ago from eating bugs, scuffing my elbow in a bicycle wreck with no antibacterial soap or ointments, or just from pollution. We never came in until the street lights came on or Mama called us for dinner. On Saturdays, you seldom saw us at all. I lived in a small town with great neighbors; a distinct advantage over some kids, but the point is that the immune system must be exposed to things in order to build up defenses. Let the kids be kids!

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C

Windsor, Mo.



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