What s Up Doc? USDA and HHS Announce New Dietary Guidelines to Help Americans Make Healthier Food Choices and Confront Obesity Epidemic

Transcription

1 Spring 2011 JCMH Medical Staff Newsletter What s Up Doc? USDA and HHS Announce New Dietary Guidelines to Help Americans Make Healthier Food Choices and Confront Obesity Epidemic WASHINGTON, Jan. 31, 2011 Agriculture Secretary TomVilsack and Secretary of the Department of Health and Human Services (HHS) Kathleen Sebelius today announced the release of the 2010 Dietary Guidelines for Americans, the federal government's evidence-based nutritional guidance to promote health, reduce the risk of chronic diseases, and reduce the prevalence of overweight and obesity through improved nutrition and physical activity. Because more than one-third of children and more than two-thirds of adults in the United States are overweight or obese, the 7th edition of Dietary Guidelines for Americans places stronger emphasis on reducing calorie consumption and increasing physical activity. The 2010 Dietary Guidelines are being released at a time when the majority of adults and one in three children is overweight or obese and this is a crisis that we can no longer ignore, said Secretary Vilsack. These new and improved dietary recommendations give individuals the information to make thoughtful choices of healthier foods in the right portions and to complement those choices with physical activity. The bottom line is that most Americans need to trim our waistlines to reduce the risk of developing diet-related chronic disease. Improving our eating habits is not only good for every individual and family, but also for our country. The new 2010 Dietary Guidelines for Americans focus on balancing calories with physical activity, and encourage Americans to consume more healthy foods like vegetables, fruits, whole grains, fat-free and low-fat dairy products, and seafood, and to consume less sodium, saturated and trans fats, added sugars, and refined grains. Helping Americans incorporate these guidelines into their everyday lives is important to improving the overall health of the American people, said HHS Secretary Sebelius. The new Dietary Guidelines provide concrete action steps to help people live healthier, more physically active and longer lives. The 2010 Dietary Guidelines for Americans include 23 Key Recommendations for the general population and six additional Key Recommendations for specific population groups, such as women who are pregnant. Key Recommendations are the most important messages within the Guidelines in terms of their implications for improving public health. The recommendations are intended as an integrated set of advice to achieve an overall healthy eating pattern. To get the full benefit, all Americans should carry out the Dietary Guidelines recommendations in their entirety. More consumer-friendly advice and tools, including a next generation Food Pyramid, will be released by USDA and HHS in the coming months. Below is a preview of some of the tips that will be provided to help consumers translate the Dietary Guidelines into their everyday lives: Enjoy your food, but eat less. Avoid oversized portions. Make half your plate fruits and vegetables. Switch to fat-free or low-fat (1%) milk. Compare sodium in foods like soup, bread, and frozen meals and choose the foods with lower numbers. Drink water instead of sugary drinks. Upcoming Meetings 05/23/11 HHC/HHP Board Meeting 11:30 am, Boardroom 05/23/11 Board of Trustees 6:00 pm, Large Conference Room 06/01/11 PI Committee Noon, Large Conference Room 06/06/11 Clinical Services Noon, Large Conference Room 06/13/11 Credentials Committee 5:45 pm, Boardroom 06/13/11 Medical Executive Com 6:30 pm, Large Conference Room 06/20/11 M&M Committee 6 pm, Large Conference Room This edition of the Dietary Guidelines comes at a critical juncture for America s health and prosperity. By adopting the recommendations in the Dietary Guidelines, Americans can live healthier lives and contribute to a lowering of health-care costs, helping to strengthen America s long-term economic competitiveness and overall productivity. USDA and HHS have conducted this latest review of the scientific literature, and have developed and issued the 7th edition of the Dietary Guidelines for Americans in a joint effort that is mandated by Congress. The Guidelines form the basis of nutrition education programs, Federal nutrition assistance programs such as school meals programs and Meals on Wheels programs for seniors, and dietary

2 Page 2 What s Up Doc? New Dietary Guidelines Cont. advice provided by health professionals. The Dietary Guidelines, based on the most sound scientific information, provide authoritative advice for people 2 years and older about how proper dietary habits can promote health and reduce risk for major chronic diseases. For more information on dietary guidelines, see and The Dietary Guidelines aid policymakers in designing and implementing nutrition-related programs. They also provide education and health professionals, such as nutritionists, dietitians, and health educators with a compilation of the latest science-based recommendations. A table with key consumer behaviors and potential strategies for professionals to use in implementing the Dietary Guidelines is included in the appendix. The 2010 Dietary Guidelines is available at JCMH Lower Sodium Menus By Danielle Jensen, MS, RD/LD Director of Food and Nutrition Due to the newly publicized 2010 Dietary Guidelines for Americans, the patient menus were revised to comply and should begin the end of May The main change is the Regular Diet Menu will have less than 2,400 mg sodium and if the patients on Regular Diets choose to put salt on their food then they will be consuming less than 3,500 mg sodium. This change decreased the sodium by about 1,000 mg. You can order 2,000 mg, 1500 mg, or a 1000 mg sodium diet for your patients. Please let us know if you have any questions or concerns by calling extension Since January 2011, the following providers have been acknowledged with an ABCD award, for going above and beyond the call of duty. Thank you for your great service to our patients! Dr. Anderson Dr. Burton Dr. Gallagher Dr. Glasgow Dr. Goddard Dr. Katseres Dr. Pickett Dr. Rivera Dr. Savath Dr. Shurley Dr. Willis Dr. Zakhary Brian Knight, CRNA Nicole Nelson, CRNA Jessica Poe, CRNA Holly Register, CRNA Johnny Sacco, CRNA Mark Vadney, CRNA

3 Page 3 JCMH Medical Staff Comments from Case Management With the closing of JCMH s SNF, the Case Managers have been utilizing area SNFs, LTACs, Inpatient Rehab facilities and nursing homes in an even greater number. We are now holding Multidisciplinary Meetings on the 3 rd floor twice weekly and on the 4 th floor once weekly. Since many of the SNFs require 1-3 days to evaluate and some of the Inpatient Rehab units may require up to 5 days to make a decision, it is very important that we identify these patients needing longer-term placement as quickly as possible to start working on discharge plans. For those patients with pre-planned procedures, if you could start the conversation about rehab or post-hospital care/placement with your patients prior to their hospitalization, it would allow your patients time to start thinking about their options and possibly even visit facilities prior to having surgery. Another patient population that requires a lot of planning is the patient with a wound vac. The SNFs in Altus do not currently accept patients with wound vacs. We have located SNFs in Vernon and Crowell that do provide this level of care. These patients may also qualify for an LTAC. We have encountered difficulty placing self-pay patients with wound vacs so we would ask that you involve Case Management as early as possible on any complicated wounds that will require long-term treatment. We appreciate your patience as we continue to look for another RN Case Manager. If you have suggestions about anything else Case Management can do to assist with the care of your patients, please contact Kim Mosley ( ). PET/CT is coming to Jackson County Memorial Hospital starting June 17, 2011 PET/CT consists of two parts, a CT scan for attenuation correction localization and the PET scan. A mobile unit from Insight will come every Friday to serve our community. This will be a GE PET scanner with multi-slice CT. The PET image will be color coded to show various levels of metabolic activity and a low dose CT will be done to show exact anatomy. We can pinpoint the exact location of the abnormal metabolic activity when the CT is fused with the PET. Even when the abnormal growth is not yet visible on a CT scan this will also show the level and extent of activity. PET/CT is effective on identifying the presence of cancer. If the cancer is present, spread or responding to treatment. PET/CT is very effective for the evaluation of lung, head, neck, colorectal, ovarian, breast, esophageal, melanoma, and lymphoma cancers. PET/CT will primarily be used for the early diagnosis of cancer, evaluation of nodules, staging and restaging tumors, determining tumor response to treatment, diagnosing recurrence of tumor growth, and planning the best location of biopsy. JCMH is pleased to announce this new service with our mobile GE Lightspeed Discovery ST full diagnostic 8-slice PET/CT scanner. Please stop by Radiology for any questions you may have. All exams will be scheduled through our Centralized Scheduling Department by calling We will have the unit here on June 10 th for a site visit and set up. Ultimately we ll start seeing patients on June 17 th, 2011.

4 PET Scanning: The Basic Facts A Brief Overview for Referring Physician Office Staff What is PET Scanning? PET is an acronym for Positron Emission Tomography. PET is a new nuclear medicine test that uses different types of imaging cameras and radioactive drugs. PET is different from traditional x-ray, CT and MR imaging because the imaging agent that produces the pictures acts as a tracer of function and metabolism of the cells in the body, rather than of the anatomy of the body s structures. PET provides information about different body functions and more detailed pictures than are possible with most Nuclear Medicine procedures. PET scans do have some unique characteristics, as described below. How is a PET scan done? Like nuclear medicine procedures, a PET scan is usually a simple, non-invasive test that provides no side effects to most patients undergoing the procedure. The PET Scheduling Center will tell the patient about any preparation required for the procedure. Sometimes it is important that patients not exercise extensively in the 24-hours prior to the scan. Patients will generally need to arrive at their appointment NPO except for water for at least 4-6 hours. It is especially important that no sugar be ingested, because the glucose in foods would compete with the uptake of the radioactive glucose. Medications should be taken as scheduled, however, only with a cracker if food is required. At the PET Scan appointment, the patient will be injected intravenously with the 18 FDG. There are no side effects from the injection. The patient will be asked to wait for minutes for the imaging drug to distribute in the body. Movement, reading, or any other activity during that time will affect the pattern of uptake of the drug, so the patient will be asked to rest quietly. After that, the patient will be escorted to the imaging camera, which resembles a CT scanner a large donut with a table that moves through the hole. Much like a CT, there are no loud noises or feeling during the picture-taking, which will last approximately minutes. The images will undergo reconstruction and filming. The PET physician will review the images, often comparing and fusing the functional images by PET with any CT or MR scans the patient has had.

5 What does the PET scan show? Most PET scans today are performed with an imaging drug that acts like a tracer amount of a sugar when it is administered intravenously. The imaging drug most commonly used is FDG ( 18 Fludeoxy-glucose). FDG provides a signal that the PET scanner detects tissues that are under-using or over-using glucose can be shown on the pictures. Cancer cells, because they are dividing faster than normal cells, use more glucose than normal tissues. The PET Scanner, with its ability to image these radionuclides is able to demonstrate the distribution of the FDG in the body. The FDA has found that FDG is indicated in positron emission tomography (PET) imaging: to assist in the evaluation of malignancy in patients with known or suspected abnormalities found by other tests, or in patients with an existing diagnosis of cancer in patients with coronary artery disease and left ventricular dysfunction, when with myocardial perfusion imaging, to identify left ventricular myocardium with a reversible loss of systolic function for the identification of regions of abnormal glucose metabolism associated with foci of epileptic seizures Important information to know about referring a patient: The basic principle behind PET scanning functional imaging requires that information about the general health and status of the patient be gathered. Diseases, infections, or surgeries can affect the use of glucose in tissues, so it is important that the PET physician has access to information about the patient. Progress notes and a recent history and physical is usually sufficient. Patients with diabetes can have a PET scan the FDG does not affect blood glucose levels. It is very important that the PET Scheduling Center know that the patient is a diabetic for optimal scheduling and patient preparation. Diabetic patients must have good control of their blood glucose levels at the time of the PET scan for optimal results. Because the PET scan provides a picture of the function of cells and tissues in the body, it is often important that anatomic imaging studies (like CT, MR or x-rays) be available for comparison during the interpretation of the PET scan. What PET Scans are covered by insurance? An insurance company may scrutinize PET scans for coverage. Many private insurance carriers require a pre-authorization or pre-certification be obtained before the scan to assure coverage. In some cases, the insurance company may need detailed information about the usefulness of PET in order to make a decision about its use in a specific patient. The PET Scheduling Center will assist you with this process. The PET Scheduling Center will screen all patients prior to scheduling in accordance with set guidelines. The PET Scheduling Center will contact the patient s insurance provider and obtain pre-authorization when necessary.

6 The Medicare program, administered by the Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), reimburses health care providers for a variety of PET procedures, as indicated below: (Indications with FDG as radiopharmaceutical, except for Rubidium 82 Cardiac Perfusion) Solitary Pulmonary Nodule Lesion characterization Lung cancer Colorectal Cancer Lymphoma Melanoma (but not for evaluation of regional nodes) Head and Neck Cancer (excludes central nervous system or thyroid cancers) Esophageal Cancer Breast Cancer Refractory Seizures Myocardial Viability Thyroid Cancer Staging, re-staging and monitoring therapy Pre-surgical evaluation After inconclusive SPECT; Initial assessment Restaging For each of these indications, Medicare imposes certain conditions and restrictions for coverage. For more complete information about Medicare s coverage policy for PET, we urge you to review carefully the Medicare Coverage Issues Manual, Section This document can be accessed at - _50_36. CMS continuously reviews its coverage policy for PET, based on advances in the technology, as well as evidence available on medical effectiveness for selected indications. To confirm coverage policy inclusions and restrictions, consult with your local Medicare carrier or fiscal intermediary. Coverage and reimbursement policies of private payers will vary, depending on a variety of factors including location, payment arrangement, patient volume, etc. While some private payers may rely on Medicare reimbursement coverage as the basis for their reimbursement policies, many others may consider alternative information. Please consult with individual payers for more information on PET procedures.

7 DRUG PRODUCT SHORTAGES May 2011 Dexamethasone Sodium Phosphate Injection (4mg/ml vials) Erythromycin Injection Folic Acid Injection Fosphenytoin Injection Levothyroxine Sodium Injection Magnesium Sulfate Injection Methylprednisolone Dose packs Multiple Vitamins for Infusion Vasopressin Injection C:\Documents and Settings\bet2499\Local Settings\Temporary Internet Files\Content.Outlook\864LBH28\drugshortages0511.doc

8 Reasons for Drug Shortages May 2011 DEXAMETHASONE SODIUM PHOSPHATE INJECTION American Regent voluntarily recalled all dexamethasone sodium phosphate due to the presence of particulate matter in the solution and discontinued further manufacture of all dexamethasone 4 mg/ml presentations in March, APP is allocating dexamethasone sodium phosphate due to supply and demand. Baxter could not provide a reason for the shortage. ERYTHROMYCIN LACTOBIONATE INJECTION Hospira is the sole supplier of erythromycin lactobionate. The company will not provide a reason for the shortage. 1 The 1 gram Add-Vantage vials have been discontinued. 1 FOLIC ACID INJECTION APP has folic acid available with an expiration date of less than one year. There are no other manufacturers of folic acid injection. LEVOTHYROXINE SODIUM INJECTION Levothyroxine injection is on a nationwide back order due to increased demand for product. MAGNESIUM SULFATE INJECTION APP has magnesium sulfate injection on shortage due to increased demand for the product. Hospira has magnesium sulfate injection on shortage due to increased demand and manufacturing delays. MULTIPLE VITAMINS FOR INFUSION Hospira states the shortage is due to a recall of the 10 ml MVI adult twochambered vials.

9 Baxter had voluntarily halted Infuvite distribution due to manufacturing delays. Baxter has Infuvite on allocation to prevent excessive purchases. VASOPRESSIN INJECTION ESTIMATED RESUPPLY DATE (CONTRACTED PRODUCTS ITALICIZED) American Regent has vasopressin 20 units/ml injection on back order and the company cannot estimate a release date. APP has available short-dated vasopressin 20 units/ml injection in 1 ml vials (NDC ) with an expiration date of May, 2011 and October, The company cannot estimate when additional supplies will be available. JHP has Pitressin on back order and the company cannot estimate a release date.

10 June 2011 Medical Staff Calendar Sun Mon Tue Wed Thu Fri Sat 1 PI Council 12:00PM LCR 2 3 BLS 8:00AM-12:00PM EDU Clinical Services 12:00PM LCR Please submit ER schedule requests Credentials Committee 5:45PM BDR MEC 6:30PM LCR 14 BLS 8:00AM-12:00PM EDU 15 Infection Prevention Committee 12:00PM-LCR 16 OBI Blood Drive 7:00AM-6:00PM LCR/BDR M&M Committee 6:00PM - LCR 21 Tumor Board 12:00PM LCR Board of Trustees 6:00PM LCR BLS 8:00AM-12:00PM EDU LCR-Large Conference Room BRD-Boardroom GFCR-Ground Floor Conference Room EDU-Education Conference Room