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In My Opinion

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
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.

Stem Cell Regeneration
June 2, 2014 9:26 AM by Jimmy Thacker

Hello, Star Trek! According to Medical News Today, low level laser treatments may cause stem cells in living tissue and bone to regenerate.The initial study focuses on regenerating dentin in teeth. A Harvard-led team is laying the foundation for laser use in healing wounds, regenerating bones and teeth, and other applications that could change survivability rates and shake the medical world. 

Right now, scientists must remove a body part to get to the stem cells. Though many hurdles stand in the way, including regulatory and practical ones, the thought that the use of lasers to draft stem cells into use throughout the body is an exciting twist. The lasers do not introduce any foreign substances into the body and are already in use in many dental practices. In teeth, this means that teeth could be regenerated rather than replaced with false teeth or implants. In other parts of the body, figuring this out could lead to regeneration of tissue after a stroke or heart attack, and may help patients waiting on tissue transplants, such as a lung transplant patient, live more comfortably and even avoid the transplant altogether. 

Early success has been shown in laboratory rats. The rats had the laser used on their molars, and then were re-examined 12 weeks later. The laser treatment stimulated dentin reformation with no other procedures done on them. The key is the activation of a protein called transforming growth factor beta-1(TGF-B1), which normally is dormant through our lives. The laser stimulates the protein by using reactive oxygen species science, which triggers the TGF-B1to differentiate into dentin. Low level light therapy, also known as photobiomodulation, has been used since the 1960's for rejuvenating skin tissue and stimulating hair growth, among other things. This is the first scholarly study that has shown practical use in stem cell activation in tissue reformation. Now you can go get a laser treatment to grow hair or strengthen those teeth that have given you problems because we are now using the lasers for more, testing the boundaries, and exploring unknown areas of science. 

In my opinion, this technology could be a game changer. Imagine a lung transplant patient not having to wait for a new lung, but going under low-level laser treatment to fix his breathing bags. Imagine a stroke patient having parts of the brain reactivated afterwards with a laser rather than hoping his recovery is complete enough he can walk or feed himself. Imagine an ischemic heart patient getting parts of her heart rejuvenated through laser technology. Though it is way too early to tell what the final outcome of this science will be, I think it is well worth more investigation and funding, and trials in humans as soon as possible.

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

When RTs Are Laid Off
May 27, 2014 7:49 AM by Jimmy Thacker

An item has shown up on the Kentucky Society for Respiratory Care Facebook page, one that I hope does not signify a trend. KentuckyOne Health, based in Lexington, has decided to remove respiratory therapists from the emergency rooms of some of their facilities. About 20 therapists have been laid off, among 500 total. Two hundred other positions were done away with, so clearly KentuckyOne Health is suffering from low revenues.

The system says it needs to improve its financial performance by $218 million by mid-2015. Cutting RT's from the ED is one way. Their solution is to give nurses "refresher" courses in respiratory care, and let them do RT in the ED. Respiratory therapists are up in arms, as are the nurses, who depend on respiratory for their specialized training and expertise for asthmatics and COPD'ers who show up year round.

Though most respiratory care is within the nurses' scope of practice, cutting RT's, especially from emergency departments, seems to me like the worst solution. Though KentuckyOne Health does not say how much training is given to nurses, emergency room nurses that are unhappy with the change say it is a four-hour refresher course. 

I have crazy respect for nurses. I have worked with them all my life. I have a sister who is an RN. I have, and would again, put my own life in their hands. Still, if I have to go on a ventilator, I would prefer a respiratory therapist. I know some nurses who could manage a vent with the best of them, but give me an old CRT or an RRT who has done this a few times any day, please. Though KentuckyOne Health says it will never put patients lives in danger, it seems that it is exactly what they are doing, as evidenced by the level of discomfort of the nursing staff there. 

KentuckyOne Health's Facebook page has several posts on it from angry patients, too. Many say they will never return for fear that the care is no longer as good as it was, for the hospital system putting money before the safety and treatment of patients. Oddly, I read nothing about a single doctor who has an opinion, at a time when the input from a doctor may make the difference between executing this poor plan or not. It seems that doctors should have an opinion on this, too, since this will ultimately affect outcomes, readmissions and the ability to help patients under their care. 

In my opinion, this is a stupid move. Not because I am in respiratory care, but because it makes no sense. If you are looking to reallocate duties, take mindless nebulizer treatments off the therapists task list, not emergency care. For those who have worked in the ED, you know when you need respiratory care, you needed them five minutes ago. Taking respiratory therapists out of emergency rooms is wrong on so many levels.

The "plan" of KentuckyOne Health and their vision statements do not support this move, and I cannot imagine anyone in the emergency room, from the doctors and nurses to the patients, can support it, either. I believe this is a case of gross mismanagement by a CEO who is under pressure to pare the budget and improve the bottom line. The result is poorly managing a system by completely cutting off some services  and blaming it on the Affordable Care Act (ACA). 

It is strange that under the ACA, some hospital systems are doing so well, while apparently KentuckyOne Health is not. Other hospital systems are undoubtedly watching KentuckyOne Health to see what happens. The organizations who will flourish, as I have written two years ago, are those interested in preventative medicine, not treating illnesses after patients are already affected. In fairness, Kentucky has some of the worst health outcomes in the country. Instead of taking away services, perhaps the state and its corporate hospitals should invest money in adding services, adding qualified people and preventing disease and conditions that lead to death. This may help to correct their outcome scores when they hire competent, rational administrative people who are progressive enough to run their facilities well, be responsive to the needs of the communities they serve, and are capable to deal with governmental regulations under the ACA, without sacrificing patient safety.

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



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