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LitScan for Case Managers
FOR CASE MANAGERS
LitScan for Case Managers reviews medical literature and reports abstracts that are of particular interest to case managers in an easy-to-read format. Each abstract includes information to locate the full-text article if there is an interest. This member benefit is designed to assist case managers in keeping current with clinical breakthroughs in a time-effective manner.
AIDS. 2022 Apr 20. doi: 10.1097/QAD.0000000000003229. Online ahead of print. Coordination of inflammatory responses in children with perinatally-acquired HIV infection
Weinberg A, Giganti MJ, Sirois PA, et al.
OBJECTIVE: We investigated dynamics of inflammatory biomarkers in children with perinatally-acquired HIV (PHIV) who started antiretrovirals at age <3 years and achieved sustained virologic control (HIV plasma RNA<400 copies/mL).
DESIGN: This was a retrospective analysis of inflammatory biomarkers in children enrolled in a randomized trial of early (<3 years of age) PI-based versus NNRTI-based regimens (P1060), who achieved sustained virologic control and participated in a neurodevelopmental follow-up study (P1104 s) between ages 5-11 years.
METHODS: We measured 20 inflammatory biomarkers using ELISA or chemiluminescence at onset of sustained virologic control (Tc) and at P1104 s entry (Te).
RESULTS: The 213 participants had median ages of 1.2, 1.9, and 7.0 years at antiretroviral initiation, Tc, and Te, respectively, with 138 on PI-based and 74 on NNRTI-based regimens at Tc. Eighteen markers decreased and two increased from Tc to Te (TeTc). Biomarker subsets, particularly cytokines, the chemokine IP-10, and adhesion molecules sICAM-1 and sVCAM-1, correlated at Tc, Te, and Te-Tc. At Tc, higher biomarker levels were associated with younger age, female sex, HIV plasma RNA ≥750,000 copies/mL, lower nadir CD4+%, lower nadir weight z-scores, and NNRTIbased treatment. Greater Te-Tc biomarker declines were associated with younger age, male sex, higher Tc biomarker levels, lower nadir CD4+%, and NNRTI-based treatment. Duration of controlled viremia and nadir height Z-scores showed mixed associations.
CONCLUSIONS: Biomarker expression showed substantial coordination. Most markers decreased after virologic control. Demographic and clinical variables associated with biomarker patterns were identified. Mechanistic studies of these biomarker patterns are needed to inform interventions to control inflammation. AIDS Res Hum Retroviruses. 2022 Apr 22. doi: 10.1089/ AID.2021.0178. Online ahead of print. A heavy burden: preexisting physical and psychiatric comorbidities, and differential increases among male and female participants after initiating antiretroviral therapy in the HIV Outpatient Study, 2008-2018
Tedaldi EM, Armon C, Li J, et al.
Attention to non-AIDS comorbidities is increasingly important in the HIV care and management in the United States. We sought to assess comorbidities before and after antiretroviral therapy (ART) initiation among persons with HIV (PWH). Using the 20082018 HIV Outpatient Study (HOPS) data, we assessed changes in prevalence of physical and psychiatric comorbidities, by sex, among participants initiating ART. Cox proportional hazards models were fit to investigate factors associated with the first documented occurrence of key comorbidities, adjusting for demographics and other covariates including insurance type, CD4+ cell count, ART regimen and smoking status. Among 1,236 participants who initiated ART (median age 36 years, CD4 cell count 375 cells/ mm3), 79% were male, 66% non-white, 44% publicly-insured, 53% ever smoked, 33% had substance use history, and 22% had body mass index ≥ 30 kg/m2. Among females, the percentages with at least one condition were: at ART start, 72% had a physical and 42% a psychiatric comorbidity, and after a median of 6.1 years of follow-up, these were 87% and 63%, respectively. Among males, the percentages with at least one condition were: at ART start, 61% had a physical and 32% a psychiatric comorbidity, and after a median of 4.6 years of follow-up, these were 82% and 53%, respectively. In multivariable Cox proportional hazards analyses, increasing age and higher viral loads were associated with most physical comorbidities, and being a current/former smoker and higher viral loads were associated with all psychiatric comorbidities analyzed. HOPS participants already had a substantial burden of physical and psychiatric comorbidities at the time of ART initiation. With
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advancing age, PWH who initiate ART experience a clinically significant increase in the burden of chronic non-HIV comorbidities that warrants continued surveillance, prevention, and treatment.
J Infect Dis. 2022 Apr 28;jiac156. doi: 10.1093/infdis/ jiac156. Online ahead of print. Machine learning quantifies accelerated whitematter aging in persons with HIV
Petersen KJ, Strain J, Cooley S, et al.
BACKGROUND: Persons with HIV (PWH) undergo white matter changes which can be quantified using the brain age gap (BAG), the difference between chronological age and neuroimaging-based ‘brain-predicted age.’ Accumulation of microstructural damage may be accelerated in PWH, especially with detectable viral load (VL).
METHODS: 290 PWH (85% with undetectable VL) and 165 HIV-negative controls participated in neuroimaging and cognitive testing. BAG was measured using a Gaussian process regression model trained to predict age from diffusion MRI in publicly available normative controls. To test for accelerated aging, BAG was modeled as an age×VL interaction. The relationship between BAG and global neuropsychological performance was examined. Other potential predictors of pathological aging were investigated in an exploratory analysis.
RESULTS: Age and detectable VL had a significant interactive effect: PWH with detectable VL accumulated +1.5 years BAG/ decade vs. HIV-negative controls (p = 0.018). PWH with undetectable VL accumulated +0.86 years BAG/decade, though this did not reach statistical significance (p = 0.052). BAG was associated with poorer global cognition only in PWH with detectable VL (p < 0.001). Exploratory analysis identified Framingham cardiovascular risk as an additional predictor of pathological aging (p = 0.027).
CONCLUSIONS: Aging with detectable HIV and cardiovascular disease may lead to white matter pathology and contribute to cognitive impairment.
Infect Control Hosp Epidemiol. 2022 Apr 19;1-17. doi: 10.1017/ ice.2021.510. Online ahead of print. Hospital-acquired COVID-19 among patients of two acute-care hospitals: implications for surveillance
Trick WE, Santos CAQ, Welbel S, et al.
OBJECTIVES: We quantified hospital-acquired COVID-19 during the early phases of the pandemic, and we evaluated solely temporal determinations of hospital acquisition.
DESIGN: Retrospective observational study during early phases of the COVID-19 pandemic, March 1-November 30, 2020. We identified laboratory-detected SARS-CoV-2 from 30 days before admission through discharge. All episodes detected after hospital day 5 were categorized by chart review as community or unlikely hospital-acquired, or possible or probable hospital-acquired.
SETTING: Two acute-care hospitals in Chicago, IL.
PATIENTS: All hospitalized patients including an inpatient rehabilitation unit.
INTERVENTIONS: Each hospital implemented infection-control precautions soon after identifying COVID-19 cases, including patient- and staff-cohorting, universal masking, and restricted visitation policies.
RESULTS: Among 2,667 patients with SARS-CoV-2, detection before hospital day six was most common (n=2,612; 98%); days 6-14 uncommon (n=43; 1.6%); and, after day 14, rare (n=16; 0.6%). By chart review, most episodes after day 5 were categorized as community-acquired, usually because SARS-CoV-2 had been detected at a prior healthcare facility (68% of cases on days 6-14; 53% of cases after day 14). Incidence for possible and probable hospital-acquired cases, per 10,000 patient-days, was similar for ICU- and non-ICU patients at Hospitals A (1.2 vs 1.3, difference = 0.1; 95% CI, -2.8 to 3.0) and B (2.8 vs 1.2, difference = 1.6; 95% CI, -0.1 to 4.0).
CONCLUSIONS: Most patients were protected by early and sustained application of infection-control precautions, modified to reduce COVID-19 transmission. Using solely temporal criteria to discriminate hospital- vs community-acquisition would have misclassified many “late-onset” SARS-CoV-2 positive episodes.
PLoS One. 2022 Apr 28;17(4):e0267512. doi: 10.1371/journal. pone.0267512. eCollection 2022. Transient elastography score is elevated during rheumatoid factor-positive chronic hepatitis C virus infection and rheumatoid factor decline is highly variable over the course of direct-acting antiviral therapy
Auma AWN, Kowal C, Shive CL, et al.
BACKGROUND: Elevated rheumatoid factor (RF) levels and systemic immune activation are highly prevalent during chronic hepatitis C virus (HCV) infection. Direct-acting antiviral (DAA) therapy has been associated with normalization of various soluble immune activation parameters. Whether the RF levels relate to soluble immune activation markers during chronic HCV infection, and over what time frame RF levels normalize during and after DAA treatment is unknown and was investigated here.
METHODS: In a longitudinal study, plasma and serum was
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obtained from HCV infected RF positive (RF+) and RF negative (RF-) participants. The levels of RF, HCV RNA and soluble markers of inflammation were determined before (week 0), during (weeks 4, 8 and 12) and after (week 24) treatment with HCV DAA therapy. In a subset of RF+ participants, the analysis was extended to over 70 weeks after therapy initiation. Hepatic and other clinical parameters were determined at baseline (week 0) in all participants.
RESULTS: Before therapy, transient elastography (TE) score was greater in RF+ compared to RF- HCV infected participants, while the systemic levels of soluble inflammatory markers were comparable. Following DAA therapy initiation, HCV RNA levels became undetectable within 4 weeks in both the RF+ and RF- groups. RF levels declined in the first 6 months in most RF+ persons but most commonly remained positive. The levels of some soluble inflammatory markers declined, mainly within 4 weeks of DAA therapy start, in both the RF+ and RF- groups. The baseline (week 0) TE score correlated with RF levels before, during and after DAA therapy, while plasma IL-18 levels correlated with RF level after DAA therapy.
CONCLUSION: During chronic HCV infection, TE score is elevated in RF+ HCV infected individuals and factors other than HCV viremia (including liver stiffness or fibrosis and select markers of inflammation) likely contribute to persistence of RF after treatment of HCV with DAA.
Am J Cardiol. 2022 Apr 23;S0002-9149(22)00331-9. doi: 10.1016/j. amjcard.2022.03.026. Online ahead of print. Patient perceptions of exertion and dyspnea with interleukin-1 blockade in patients with recently decompensated systolic heart failure
Mihalick V, Wohlford G, Talasaz AH, et al.
Interleukin-1 (IL-1) blockade is an anti-inflammatory treatment that may affect exercise capacity in heart failure (HF). We evaluated patient-reported perceptions of exertion and dyspnea at submaximal exercise during cardiopulmonary exercise testing (CPET) in a double-blind, placebo-controlled, randomized clinical trial of IL-1 blockade in patients with systolic HF (REDHART [Recently Decompensated Heart Failure Anakinra Response Trial]). Patients underwent maximal CPET at baseline, 2, 4, and 12 weeks and rated their perceived level of exertion (RPE, on a scale from 6 to 20) and dyspnea on exertion (DOE, on a scale from 0 to 10) every 3 minutes throughout exercise. Patients also answered 2 questionnaires to assess HF-related quality of life: the Duke Activity Status Index and the Minnesota Living with Heart Failure Questionnaire. From baseline to the 12-week follow-up, IL-1 blockade significantly reduced RPE and DOE at 3- and 6-minutes during CPET without changing values for heart rate, oxygen consumption, and cardiac workload at 3- and 6-minutes. Linear regression identified 6-minute RPE to be a strong independent predictor of both physical symptoms (Minnesota Living with Heart Failure Questionnaire; β = 0.474, p = 0.002) and perceived exercise capacity (Duke Activity Status Index; β = -0.443, p = 0.008). In conclusion, patient perceptions of exertion and dyspnea at submaximal exercise may be valuable surrogates for quality of life and markers of response to IL-1 blockade in patients with HF.
Cardiol Clin. 2022 May;40(2):183-189. doi: 10.1016/j. ccl.2021.12.006. Sleep breathing disorders in heart failure
Coniglio AC, Mentz RJ.
Sleep-disordered breathing (SDB), including obstructive sleep apnea, central sleep apnea (CSA), and Cheyne-Stokes respiration, is common in patients with heart failure (HF) and associated with lower left ventricular ejection fraction (EF), increased arrhythmia burden, and increased mortality. Continuous positive airway pressure therapy improves short-term and long-term outcomes in HF patients. Adaptive servoventilation (ASV) therapy in patients with low-EF HF with predominant CSA is not recommended. Ongoing trials are evaluating whether ASV will have a role in SDB treatment. Phrenic nerve stimulation is an emerging treatment option that has shown promising outcomes. All HF patients should be screened for SDB.
Ann Thorac Surg. 2022 Apr 14;S0003-4975(22)00516-1. doi: 10.1016/j.athoracsur.2022.03.065. Online ahead of print. Improvements in extracorporeal membrane oxygenation for primary graft failure after heart transplant
Guo A, Kotkar K, Schilling J, et al.
BACKGROUND: Severe primary graft failure is a life-threatening complication of heart transplant that may require veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. Surgical practices and management strategies regarding VA-ECMO vary between and within centers.
METHODS: We performed a single center retrospective cohort study on adult patients who received VA-ECMO for primary graft failure between 2013 and 2020. Clinical data were obtained from chart review and national databases. Patients were stratified by transplant before or after 2017, when our center adopted additional objective criteria for VA-ECMO, partial-flow support, and changed
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from central cannulation to chimney graft arterial cannulation of brachiocephalic, axillary, or aorta. Primary outcome was survival to device weaning. Secondary outcomes were survival to discharge, survival to one year, complications on support, and time to sedation weaning and extubation.
RESULTS: From 276 heart transplant recipients, 39 severe primary graft failure patients requiring VA-ECMO were identified. Incidence of graft failure was 13% (18/135) pre-2017 and 15% (21/141) post-2017. Survival at all timepoints improved significantly after 2017 with greatest difference in survival to device weaning (61% pre-2017 vs. 100% post-2017). After controlling for other factors in multivariable Cox regression modeling, transplant after 2017 was a predictor of reduced mortality (HR 0.209 [0.06 - 0.71], p = 0.01). Significant differences were not observed in other secondary outcomes of recovery.
CONCLUSIONS: The new VA-ECMO strategy displayed reasonable survival and a remarkable improvement from the prior system.
J Thorac Cardiovasc Surg. 2022 May;163(5):1873-1885.e7. doi: 10.1016/j.jtcvs.2020.09.044. Epub 2020 Sep 16. Trends in the use of hepatitis C viremic donor hearts
Li SS, Osho A, Moonsamy P, et al.
OBJECTIVE: To examine trends in utilization of hearts from hepatitis C virus (HCV) viremic donors for transplantation, a strategy to expand organ availability.
METHODS: The United Network for Organ Sharing (UNOS) registry was queried for adult patients undergoing heart transplantation between 2015 and 2019. We excluded multiorgan transplants, incomplete data, and loss to follow-up. Nucleic acid testing (NAT) defined HCV status.
RESULTS: Between 2015 and 2019, a total of 11,393 adults underwent heart transplantation: 326 from HCV NAT+ donors and 11,067 from NAT- donors. The use of NAT+ hearts increased from 1 in 2015 to 137 in 2018 against a static number of NAT- organs. The use of NAT+ hearts varied significantly across regions and individual centers. More than 75% of NAT+ hearts were transplanted in the Northeast region, leading to further travel (mean, 299 miles vs 173 miles for NAT- transplantations; P < .001), with longer ischemic times (mean: 3.52 hours vs 3.10 hours; P < .001). More than one-half of NAT+ transplantations were performed by 5 individual centers, and a single institution accounted for >20% of all transplantations from viremic donors. Survival in the 2 groups did not differ by Kaplan-Meier analysis (P = .240), and multivariable regression showed no differences in acute rejection (P = .455) or 30-day mortality (P = .490). Of the 326 recipients of NAT+ hearts, 38 seroconverted and 14 became viremic within 1 year. Survival was 100% in the viremic patients and 97.4% in seroconverted patients at 1 year.
CONCLUSIONS: Heart transplantation from HCV viremic donors continues to increase but varies significantly across UNOS regions and individual centers. Short-term outcomes are comparable, but effects of seroconversion and long-term outcomes remain unclear.
Diabetes Care. 2022 Apr 27;dc212472. doi: 10.2337/dc212472. Online ahead of print. The importance of office blood pressure measurement frequency and methodology in evaluating the prevalence of hypertension in children and adolescents with type 1 diabetes: The SWEET International Database
Vazeou A, Tittel SR, Birkebaek NH, et al.
OBJECTIVE: The prevalence of hypertension is higher in children and adolescents with type 1 diabetes (T1D) compared with those without. This retrospective analysis of a large cohort of children and adolescents with T1D from the SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) international consortium of pediatric diabetes centers aimed to 1) estimate the prevalence of elevated office blood pressure (BP) and hypertension and 2) investigate the influence of BP measurement methodology on the prevalence of hypertension.
RESEARCH DESIGN AND METHODS: A total of 27,120 individuals with T1D, aged 5-18 years were analyzed. Participants were grouped into those with BP measurements at three or more visits (n = 10,440) and fewer than 3 visits (n = 16,680) per year and stratified by age and sex. A subgroup analysis was performed on 15,742 individuals from centers providing a score indicating BP measurement accuracy.
RESULTS: Among participants with BP measurement at three or more visits, the prevalence of hypertension was lower compared with those with fewer than three visits (10.8% vs. 17.5% P < 0.001), whereas elevated BP and normotension were higher (17.5% and 71.7% vs. 15.3% and 67.1%, respectively; both P < 0.001). The prevalence of hypertension and elevated BP was higher in individuals aged ≥13 years than in younger ones (P < 0.001) and in male than female participants (P < 0.001). In linear regression models, systolic and diastolic BP was independently determined by the BP measurement methodology.
CONCLUSIONS: The estimated prevalence of elevated BP and hypertension in children and adolescents with T1D is ∼30% and depends on the BP measurement methodology. Less frequent BP evaluation may overestimate the prevalence of hypertension.
Case Managers: There’s no better time to advance your career than now!
Whether you're an experienced Certified Case Manager (CCM), a new case manager looking to earn your CCM credential, or a case manager thinking about starting your own case management practice, Catherine M. Mullahy, RN, BS, CRRN, CCM and Jeanne Boling, MSN, CRRN, CDMS, CCM can help. Their award-winning case management education and training resources incorporate their decades of experience, leadership and success in case management. These CMSA Lifetime Achievement Award Winners and veterans who helped develop case management standards and codes of conducts have created ™Best in Class∫ tools to address your career needs and goals.
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“You’ve Got This:” The Message to CCM and CDMS Exam Candidates —and All of Us continued from page 8
“something that can heal all wounds and right all wrongs.” When we focus on our strengths, we reinforce a positive state of mind. This, in turn, helps us become more resilient.
To become more aware and more resilient, we ground ourselves in the moment. We stay out of past and let the future unfold as it will. The present moment is rich with opportunity and potential. In a state of mindfulness, we remind ourselves of the truth we hold in our core: We’ve got this. We can do our best—and that is the best we can do. CM
Journey of Care Coordination and Integrated Case Management in the Veterans Health Administration
continued from page 9
in providing input and information to complete the facility readiness assessment and resource survey.
The facility readiness assessment and resource survey examines ten domains of systems integration of care coordination, care management, and case management services across the organization. Stakeholders prioritize and identify system integrations opportunities by assessing the impact and effort required for each domain. The readiness assessment will assist in developing the facility implementation plan to deliver CC&ICM practices across the organization.
The following critical action is the completion of the resource survey. The resource survey demonstrates the current state of care coordination staffing and resource perspective to obtain information on where care coordination occurs within the VA health care system. Additionally, the survey may assist the sites in identifying those who may fill the lead coordinator role, which is an integral component of the CC&ICM framework.
The lead coordinator is a supporting role that provides a single, readily accessible, and identifiable point of contact for a military service member, veteran, their family members, or caregiver. Lead coordinators offer effective communication and collaboration between veterans and VA health care or community providers, which contributes to improved veteran health outcomes and experience.
Systems changes involving multiple services and programs require a high level of collaboration and, therefore, can be difficult to achieve. The CC&ICM model with systems integration provides stability, structure, and standards across VA health care systems. The overall goal is to provide veterans with consistent, equitable, compassionate, and coordinated care. CC&ICM believes in a proactive and whole health approach to veteran care to ensure core case management functions and best practices are deployed. CM
Celebrations and Reflections
continued from page 3
We hope you have many special moments to enjoy yourself with family and friends this summer.
We’ll be here when you return, as you continue to strive to “…make a difference…one patient at a time…”!!
Warmest regards,
Catherine M. Mullahy, RN, BS, CRRN, CCM, FCM, Executive Editor cmullahy@academyccm.org
continued from page 10
with their travel nightmare. The hospital did not know how to deal with the angry, exhausted, sleep deprived husband who was irrational in his expectations. We all believed the best chance for dual stability was to return them home as soon as possible. A return home meant that Carol could rehab near her family and friends, and Bob could get rest and support.
We consulted with a personal injury attorney to determine if a suit should be filed for the broken hip. The family concluded that their goal was to get Carol home and not pursue fault in this case. This is where the family allowed us to negotiate with the hospital to get Bob and Carol home. We insisted that the hospital coordinate and pay for an air ambulance, fully staffed with a physician and nurse, to fly them home. The hospital agreed. Furthermore, we asked them to pay for transporting the car home so Bob could ride in the air ambulance with his wife. And finally, we asked for the hotel and all co-pays to be waived to which they also agreed.
The couple was transferred to a hospital in their hometown within three days of their call to us. Once she was in her hometown, Carol was able to focus on getting better. She completed her rehabilitation in a center one mile from their home. Bob was supported by family and friends, used his sleep apnea equipment, and visited Carol daily.
This was over two years ago. Carol was able to come home after her rehabilitation stay and the couple is living independently in their home. Carol is going to water exercise classes three days a week and is a social butterfly. After sufficient rehabilitation, she expressed a desire to drive again, continues on page 37
Far Away continued from page 36
which after significant testing and coordination, was granted.
This family needed to be home and together to recover from their ordeal. They are planning more trips this year, but before they go they are providing us the itinerary and will call us at the first sign of trouble, not after the fact. It is delightful to participate in improving the quality of life for these two people. We welcome the opportunity they provide us to help them face the challenges they encounter in the future.
This situation called upon us to calm a chaotic situation, for clients with different needs, all from thousands of miles away. Taking the time to meet Bob and Carol where they were, allowed us to accurately evaluate their needs, understand their perspectives, and develop a care management plan that successfully returned them to stability. This case has proved to us, we can still meet clients where they are… even if that happens to be thousands of miles away! CM
Reprinted by permission from “Case Management: Elevate, Educate, Empower” by Colleen Morley and Eric Bergman, Editors, CMSA Chicago, Westchester, Il 2021.
PharmaFacts for Case Managers continued from page 30
of 18 years who received bevacizumab. Bevacizumab products are not approved for use in patients under the age of 18 years.
Antitumor activity was not observed among eight pediatric patients with relapsed GBM who received bevacizumab and irinotecan. Addition of bevacizumab to standard of care did not result in improved event-free survival in pediatric patients enrolled in two randomized clinical studies, one in high grade glioma (n= 121) and one in metastatic rhabdomyosarcoma or non-rhabdomyosarcoma soft tissue sarcoma (n= 154).
Based on the population pharmacokinetics analysis of data from 152 pediatric and young adult patients with cancer (7 months to 21 years of age), bevacizumab clearance normalized by body weight in pediatrics was comparable to that in adults.
Geriatric Use
In an exploratory pooled analysis of 1,745 patients from five randomized, controlled studies, 35% of patients were ≥65 years old. The overall incidence of ATE was increased in all patients receiving bevacizumab with chemotherapy as compared to those receiving chemotherapy alone, regardless of age; however, the increase in the incidence of ATE was greater in patients ≥65
HIPAA (Part 1): What Is It and Why Should I Care?
continued from page 26
7. Bergland, C. (2015). Unconscious memories hide in the brain but can be retrieved. Psychology Today. 8. Gustafson C., Lipton, B. (2017). The jump from cell culture to consciousness. Integrative Medicine (Encinitas, Calif.), 16(6), 44-50. 9. Lipton, B. H. (2005). The Biology of Belief. Second Edition, New
York, Hay House, Inc 10. Bourbonnais R, Comeau M, Vézina M (1999). Job strain and evolution of mental health among nurses. Journal of Occupational Health
Psychology, 4:95-105. 11. Porges, W. S. (2001). The polyvagal theory: phylogenetic substrates of a social nervous system. International Journal of
Psychophysiology, 42, 233-146. https://doi.org/10.1016/S01678760(01)00162-3 12. Porges S. W. (2009). The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic
Journal of Medicine, 76(Suppl2), S86–S90. https://doi.org/10.3949/ ccjm.76.s2.17 13. Gerritsen, R., & Band, G. (2018). Breath of Life: The Respiratory
Vagal Stimulation Model of Contemplative Activity. Frontiers in Human Neuroscience, 12, 397. https://doi.org/10.3389/ fnhum.2018.00397
years (8% vs. 3%) as compared to patients <65 years (2% vs. 1%)
CLINICAL TRIALS
Various clinical trials have been conducted in specific cancer sites. Please see Product Insert for information.
How Supplied
Alymsys (bevacizumab-maly) injection is a clear to slightly opalescent, colorless to pale brown, sterile solution for intravenous infusion supplied in a carton containing single-dose vial in the following strengths and packaging configurations: • 100 mg/4 mL (25 mg/mL): carton of one vial (NDC 701211754-1); carton of 10 vials (NDC 70121-1754-7). • 400 mg/16 mL (25 mg/mL): carton of one vial (NDC 701211755-1); carton of 10 vials (NDC 70121-1755-7).
Store refrigerated at 2°C to 8°C (36°F to 46°F) in the original carton until time of use to protect from light. Do not freeze or shake the vial or carton.
Please consult Product Insert for full prescribing information.
Alymsys is manufactured and distributed by Amneal Pharmaceuticals LLC.
Becoming Patient Centric
continued from page 2
and caring. We make sure family and friends are involved as determined by the patient. We make sure the entire healthcare team is working together. We support the patient and family emotionally.
The transition to a patient-centric approach can be time consuming and somewhat expensive, but perhaps the biggest challenge is changing the culture. We need buy-in from everyone to ensure that all staff are prepared and adequately trained and that the proper expectations are set across the organization. The patient-centric organization will have new experiences that will have an immediate impact on patient care. Reimbursement policies will have to be adjusted. New tools and systems will be introduced. Change will be inevitable and, in some cases, difficult.
Case managers are pivotal in creating patient-centric organizations. As patient advocates, we are patient centric, and thus case managers should lead the charge in reforming the healthcare delivery system. It would be easy for your organization to become patient centric. Start by having open discussions with your coworkers about what patient-centric means, and be sure to include patients in the discussion. Listen to each other and be respectful of all ideas. As the discussion grows, involve key decision makers in your organization. There will be a groundswell of enthusiasm, which will speed implementation.
A truly patient-centric organization will improve healthcare delivery for patients, providers, and everyone involved in healthcare delivery. Case managers can play a leading role in this healthcare reorganization.
Gary S. Wolfe, RN, CCM, FCM, Editor-in-Chief gwolfe@academyccm.org
Applying Standards to Persons Served with Limb Loss, Brain Injury, and Spinal Cord Injury
continued from page 7
arrange for services for these patients.
Mobility is of critical importance to persons with SCI, and it is essential that the program work with patients to learn that same mobility in home and community settings and not just in the environment of the program. This may include trialing different types of wheelchairs (power and manual) and also training and assessing patient mobility on varied surfaces that will be found in the community (eg, uneven grassy surfaces, gravel, and ramps).
For persons with SCI, intimacy and sexual health may be areas of concern after the injury takes place. Having a concrete plan in these areas will give patients a clear understanding of what next steps can be taken and also provide the team with structure to understand what services can either be provided by the program or arranged by an outside provider. Because of the mobility limitations of a person with SCI, it’s not uncommon for individuals to need to hire and manage a personal assistant, and there is guidance from the CARF standards on what specific areas to educate a patient on in this area.
If you are interested in receiving more information about CARF accreditation in your setting or to identify IPR programs in your area, contact Terrence Carolan at tcarolan@carf.org.
CM
ACCM: Improving Case Management Practice through Education
Nurses! continued from page 5
become a task-oriented profession.
She said that nursing needs to be
“re-humanized.” It’s important to stop performing tasks, make eye contact, smile, have a discussion and sit down when clinicians are talking to patients. • The importance of remaining calm regardless of the circumstances was important to the well-being of patients, according to another practitioner. No matter the situation, don’t let patients see you sweat. Clinicians can’t freak out and provide effective assistance to patients! • Finally, a nurse reminded clinicians about the importance of what they do: “Every day you wake up and you get out of bed and you know you’re going to help at least ten people today...You could possibly be what stands between life and death for them. If that’s something you want to take on, it’s a calling you have to approach with the utmost respect and compassion.”
This may be the most important point. Nurses work hard every day because it’s a calling, not a job. We cannot lose sight of the fact that nurses are the heart of healthcare. We simply must treasure and cherish those who make it possible to provide care to patients. CM
©2022 Elizabeth E. Hogue, Esq. All rights reserved. No portion of this material may be reproduced in any form without the advance written permission of the author.
Why Every Provider Must Establish and Maintain a Fraud and Abuse Compliance Program
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We have read that, before implementing Compliance Programs, providers must conduct expensive internal audits that can take many months to complete. Is this true?
While beginning the compliance process with an extensive internal audit is certainly one way to proceed, it is not the only viable way to work toward compliance. It is equally valid to begin with Compliance Programs that are customized for the organization that includes training for all employees about fraud and abuse and Compliance Programs. Then all staff members can subsequently participate in internal compliance activities, including audits, with a process in place to handle any issues that arise as a result of the audits,
We have all sorts of policies and procedures in our organization. Why do we need something else called a Compliance Program?
Greetings from the New President
of CMSA continued from page 6
Case Management Fellow
The Case Management Fellow program launched last year with the announcement of the CMSA Founding Fellows. Case Management Fellows (FCM) will represent a diverse community of thought leaders who take an active role in identifying future trends and issues affecting case management and serve the public and the case management profession by advancing the standards of practice through excellence. The 2022 Class of Case Management Fellows were inducted in June during the CMSA annual conference.
Case Management Boot Camp
Case management is a growing health care profession, with a presence in every health delivery setting. Professionals moving to case management positions may or may not have access to adequate orientation and training. They often learn on the job and are not exposed to skills that advance the practice of case management. CMSA is excited to fill this gap with a newly developed CMSA CM Boot Camp for case managers looking to build their skills and practice. Ideal for the case manager with less than 5 years of experience and those looking to change their area of practice, the CM Boot Camp program will include interactive exercises, activities, and case studies to provide real-life scenarios and practical application. CM Boot Camp officially launched in June, with a preconference session available for in-person attendees, with more to come this year.
What’s Next?
New programs, benefits, and opportunities are planned throughout the year, and we can’t wait to share them all with you in future CMSA updates. And let’s not forget to celebrate Case Management Week in October! I am looking forward to seeing and hearing all about the celebrations that will be going on. CM
Compliance Programs are specific types of documents that routinely address issues that providers do not usually cover in internal policies and procedures. In addition, providers may not gain benefits under the Federal Sentencing Guidelines described in paragraph one (1) above if there is no formal document called a Compliance Program.
We just spent a lot of money to become accredited or reaccredited. Doesn’t certification mean that we are in compliance?
On the contrary, Compliance Programs appropriately address potential fraud and abuse issues. They also include mechanisms for helping to ensure compliance such as processes for identification and correction of potential problems that are not addressed during the certification process. In other words, organizations may be accredited but fail to meet applicable compliance standards for fraud and abuse.
Will the fact that our organization has a Compliance Program make any difference with regard to the outcome of fraud and abuse investigations and the imposition of Corporate Integrity Agreements (CIA’s)?
Yes, it may make a considerable difference based on statements from the OIG. If providers have Compliance Programs in place that are current and fully implemented, the OIG may be less aggressive in pursuing potential violations. When the OIG actually discovers problems with fraud and abuse in organizations, providers are usually asked to develop and implement a Corporate Integrity Agreement (CIA). The OIG often requires CIA’s to include a process for stringent monitoring by the OIG on a continuous basis. These monitoring activities can be extremely burdensome to providers in terms of both time and money. Providers with valid Compliance Programs are not necessarily asked to develop and implement CIA’s.
Now is the time for all providers to recognize and act upon the need to establish and maintain Compliance Programs. “Working on it” is no longer good enough. CM
©2022 Elizabeth E. Hogue, Esq. All rights reserved. No portion of this material may be reproduced in any form without the advance written permission of the author.
