Recovery Michigan

Kaiser Health News recently carried an article encouraging people to create videos to help explain what’s in their advance directives, which are often overly complex legal boilerplate or overly simplistic checkbox forms.

One thing I like about the article, Straight From The Patient’s Mouth: Videos Can Clearly State Your End-Of-Life Wishes, is the discussion of how different situations that might arise could impact an individual’s treatment decisions.

The article starts with an individual:

For years, Wendy Forman, considered how to make her wishes known if she became horribly ill and couldn’t speak for herself.

She prepared a living will refusing cardiopulmonary resuscitation.

She assembled orders instructing medical personnel to refrain from putting in a feeding tube or placing her on mechanical ventilation.

She told her husband and her daughters “no lifesaving measures” under any circumstances if she were unconscious and incapacitated.

“I was terrified of losing control,” this 70-year-old Philadelphia therapist said. 

Then, earlier this year, Forman heard of a Pennsylvania physician who was helping people prepare “video advance directives” — videotaped statements expressing their preferences for end-of-life care.

The article links to a few organizations that have video projects or resources for advance directives, and the formats vary. Here’s one of them described in the article:

The Institute on Healthcare Directives’ videos are carefully scripted and usually last 45 to 90 seconds. The goal is to convey essential information to physicians making crucial decisions (perform manual chest compressions? insert a breathing tube?) in time-pressed emergency medical situations. 

[Institute founder Dr. Ferdinando] Mirarchi helps draft scripts after taking a careful medical history, explaining various types of medical situations that might arise, and discussing clients’ goals and values in considerable depth.

And here’s my favorite part of the article:

After consulting with the doctor, Forman realized her “do nothing” instructions could prevent her from being treated for medical crises that she might recover from. Now, her video states that if someone witnesses her having heart attack and she can receive medical attention within 15 minutes, resuscitation should be tried.

“I came to see that in my zeal to have my wishes known and respected, I was going to an extreme that didn’t really make much sense,” she said.

Once upon a time, I was a vegetable farmer in Arizona. And I, too, called Rosmann. I was depressed, unhappily married, a new mom, overwhelmed by the kind of large debt typical for a farm operation.

We were growing food, but couldn’t afford to buy it. We worked 80 hours a week, but we couldn’t afford to see a dentist, let alone a therapist. I remember panic when a late freeze threatened our crop, the constant fights about money, the way light swept across the walls on the days I could not force myself to get out of bed.

“Farming has always been a stressful occupation because many of the factors that affect agricultural production are largely beyond the control of the producers,” wroteRosmann in the journal Behavioral Healthcare. “The emotional wellbeing of family farmers and ranchers is intimately intertwined with these changes.”

Last year, a study by the Centers for Disease Control and Prevention (CDC) found that people working in agriculture – including farmers, farm laborers, ranchers, fishers, and lumber harvesters – take their lives at a rate higher than any other occupation. The data suggested that the suicide rate for agricultural workers in 17 states was nearly five times higher compared with that in the general population.

After the study was released, Newsweek reported that the suicide death rate for farmers was more than double that of military veterans. This, however, could be an underestimate, as the data collected skipped several major agricultural states, including Iowa. Rosmann and other experts add that the farmer suicide rate might be higher, because an unknown number of farmers disguise their suicides as farm accidents.

The dilemma

It’s the dilemma that many of us have faced – me included. The fluctuating nature of many mental health conditions means that when you’re at your lowest, it’s hard to perform even basic tasks, let alone face the outside world. To give an example: even leaving the house or communicating by telephone can be beyond the capabilities of someone who is undergoing a crisis. I’ve been there, sitting by the phone, looking at it in my hand, for hours, unable to press the buttons, or dialing and then feeling sick straight away, then waiting until it rings and hanging up. How can you even begin to help yourself when simply reaching out is so hard in the first place?

It might sound straightforward, then, to ride out the worst parts of a mental health crisis, then seek help when you’re feeling better. But it’s not that simple, for several reasons. You might not want to think about mental health, let alone talk about times when you’ve been at your worst, when things are finally coming together. You may hope that it was a temporary blip that has been overcome.

But it gets worse. Attempt to seek help for a long-term problem when you’re feeling well, and some people will tell you that they aren’t fully understood by health professionals, up to and including GPs and mental health professionals. If you’ve got back to the part where you’ve managed to leave the house, go to work and even book an appointment, everything’s all right again, isn’t it?

Isn’t it?

Well, no. It isn’t. But the irony is painful: you can only be in a place where you’re able to discuss your symptoms at the very point at which they are least visible and least present. To the outside world, you are presenting the face you would like them to see: they are not seeing you in a crisis because the person you are in a crisis is one who might hide away and not even be able to speak to them at all.

Smart pills” that can track whether or when you’ve taken your medication might be helpful for some people. Unfortunately, the first smart pill approved by the Food and Drug Administration, Abilify MyCite, is a drug used to treat schizophrenia and bipolar disorder. That raises tricky ethical issues.

Decades of research and clinical experience support the fact that not taking medicines as prescribed is a significant problem across all domains of medicine. Smart pills might help people with memory problems, or those with diabetes, heart failure, or other medication-dependent conditions who want to do a better job of sticking with their prescribed regimens.

There will be a biologic for a major mental illness in the next few years. Brain inflammation is fairly obviously a part of mental illness, even though this article chooses sensationalism over real consideration of the problem......

https://goo.gl/jELvom

Dr. Joseph Masdeu is the Director of the Houston Methodist Nantz National Alzheimer's Center.  He came here from the National Institutes of Health, and he has been studying an auto-immune condition that can mimic mental problems, like Schizophrenia and Bipolar Disorder. He believes many patients are wrongly diagnosed with these conditions and that they may have an auto-immune disease that blocks important receptors in the brain.  "When we block that receptor, people have hallucinations. They can have thoughts of people reading their minds and delusions and it can be bipoloar - likely caused by an autoimmune attack," says Dr. Masdeu.  This causes the body to think of the brain as an enemy and attack it.

When mobile users perform a Google search for PTSD or a related query on their mobile device, the search engine will now automatically offer them resources and a validated screening questionnaire for the condition. 

The effort — a partnership between Google, the National Alliance on Mental Illness (NAMI) and the Department of Veterans Affairs’ National Center for PTSD — looks to increase the number of people with PTSD who seek help for their condition by conveniently surfacing an online version of the PC-PTSD-5 screening tool.

“To help people understand PTSD, we’ve collaborated with Google to provide simple, direct access to information that may help those who are suffering,” Paula Schnurr, executive director of the National Center for PTSD, and Teri Brister, director of information and support for NAMI, wrote in a recent Google blog post.

Currently, only about half of the estimated 14 million US adults who experience PTSD yearly will seek professional help for the condition, they wrote.

Following a mobile Google search for PTSD or related terms, the search engine will surface a “Knowledge Panel” that provides an overview of the condition consisting of facts and treatment information. The panel also includes an entry titled “check if you may have PTSD,” which directs users to the PC-PTSD-5 questionnaire. The anonymous tests assigns users a score that indicates the likelihood of PTSD, contextualizes the results, and offers suggestions on potential symptoms regardless of a high or low score. These information from the questionnaire can be a “crucial step” toward proper care, Schnurr and Brister wrote.

This article has more info than the one I posted a few days ago....

https://goo.gl/CZnnZz

Accenture has recently completed a pilot program in the UK, which uses its artificial intelligence platform to help seniors manage their care and daily lives. The technology was developed by Accenture Liquid Studio in London and is tailored for older people living independently. 

It can learn users’ behaviors and preferences and suggest activities to support their physical and mental health. 

“With the help of Age UK London, we identified the more common challenges of everyday life for older people – from setting daily reminders to the heartache of loneliness – and applied AI to create a human-centered platform to provide support and assistance,” Laetitia Cailleteau, head of Accenture Liquid Studio London, said in a statement.

The platform runs on the Amazon Web Services cloud and includes a portal that lets family members and caregivers check on the individual’s daily activities. The platform can also help spot abnormalities in the user’s behavior, such as a missed medication, then alerts family and friends.  

The pilot, which lasted three months, included 60 people aged 70 or older living independently. The company claims the pilot helped identify some of the most challenging tasks seniors deal with in the home and aided in the development of the Accenture platform. The platform used the self-service Amazon Alexa Skills Kit to customize the AI to power the devices.

The senior population is growing in the UK. Many of those seniors are living with loneliness. Age UK, a nonprofit dedicated to elderly services, reports that 200,000 older people in the UK are going a month or more without having a conversation with friends or family. The nonprofit also predicts that 3.9 million older people use TV as their main form of company. 

“Older people are not a homogenous group; the aging experience is very personal, with each person having different needs, and we now have technology that can deliver an increasingly personalized experience to them,” Paul Goulden, Age UK London’s chief executive, said in a statement. “The elderly care pilot has helped show how technology can improve the well-being of older people. The potential here is huge. I look forward to seeing how Accenture and Amazon Web Services technologies can positively impact future developments for the benefit of older people.”

Mental health-focused video consultation platform LARKR has launched in the Apple App Store. The service employs state-certified therapists across the country, and supports multi-user, multi-location conferences to enable group therapy sessions.

“When I learned of the massive void leaving 60 percent of the 50 million Americans who suffer from mental illness without care, I felt compelled to create a practical and effective solution,” CEO and cofounder Shawn Kernes, who previously held positions in StubHub and eBay, said in a statement. “LARKR breaks through roadblocks to care by providing meaningful therapy for anyone who needs it, at the moment they need it, even if they live in a remote area with no local therapists.”

After downloading the app and answering a few questions, LARKR users can access 50-minute live therapy sessions on-demand for a flat fee of $85 per session. Along with pick-up sessions, users can schedule recurring sessions from the same therapist without minimum commitments, monthly subscription plans, or other more involved payment systems. The developers noted in the statement that LARKR is currently seeking an additional 10,000 qualified mental health specialists from all 50 states for employment in its budding service.

LARKR’s platform is fully HIPAA compliant, and is staffed by confirmed licensed therapists. Along with multi-user sessions, the service also supports consultations with patients under the age of 18 years.