Collaborative Family Healthcare Association

Call for Papers

Journal of Families, Systems and Health

Department of Collaboration in Action

Editors: Jennifer Hodgson, PhD, and Angela Lamson, PhD

The department of Collaboration in Action was created to publish articles detailing innovations in collaborative care and integrated care models. Authors are encouraged to submit 12 page manuscripts that include the background of the location, disciplines represented in the model, description of the model, case vignette of the model in action, and a three world view (C.J. Peek) summary of its (operational, clinical, and financial) strengths and growth points, and sustainability of the collaboration/project.

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Evidenced Based Medicine?

Believing in Treatments That Don't Work

NYT - David H. Newman, MD

In the early throes of a heart attack, caused by an abruptly clotted artery, the stunned heart often beats quickly and forcefully. For decades doctors have administered “beta-blockers” as a remedy, to reduce consumption of limited oxygen supplies by calming and slowing the straining heart. Giving these drugs in the early stages of a heart attack represents elegant medical ideology.

But it doesn’t work.

Studies show that the early administration of beta-blockers to heart attack victims does not save lives, and occasionally causes dangerous heart failure. While two studies support the use of beta-blockers after heart attack, there are 26 studies that found no survival benefit to administering beta-blockers early on. Moreover, in 2005, the largest, best study of the drugs showed that beta-blockers in the vulnerable, early hours of heart attacks did not save lives, but did cause a definite increase in heart failure.

Remarkably, the medical community has continued to strongly recommend immediate beta-blocker treatment. Why? Because according to the theory of the straining heart, the treatment makes sense. It should work, even though it doesn’t. Ideology trumps evidence.

Health Literacy

Do You Know What Your Doctor Is Talking About?

NYT - Pauline W. Chen, M.D

Lately when I see patients nodding their heads at the end of a visit, as if in agreement with the therapeutic plan, I can’t help but remember Jack.

Jack (not his real name) had barely entered middle age when I met him, a hospital patient who suffered from diabetes, high blood pressure, vascular disease and kidney failure. I spent about a week caring for him, covering temporarily for a colleague who was away, and I quickly learned from the nurses that Jack was a well-known figure on the ward. A former professional athlete and a gifted raconteur, Jack never tired of recounting his past glories to anyone who would listen, even if his audience happened to be the one person in the hospital who had no idea of how his sport was played. Over the course of that week, I heard about his last-minute triumphs against opposing teams, the coaches and fans who followed his every move, and the perks, financial and otherwise, that came with being part of a winning team. I remember Jack’s eyes lighting up during these stories; his arms would wave wildly as if he were about to catch a ball, and his mouth would open so wide with laughter that I could see the fillings glittering within.

Sleeping, Stress, and Money

Sleeping Pill Use Grows as Economy Keeps People Up at Night

LA Times

Lost jobs and lost careers. Promising businesses in shambles. The college acceptance letter returned to its envelope. This is how President Obama recently described the effect of the tanking economy on ordinary Americans -- and the stresses keeping them up at night.
Sleeplessness is a problem even in good times. One in 10 U.S. adults routinely has trouble getting to sleep or staying asleep, and 3 in 10 experience occasional sleeplessness, federal statistics show.

But these are definitely not good times. More than 1 in 4 -- 27% of Americans -- say anxieties about personal finances, the economy or a job loss kept them awake in the previous month, according to a new poll by the National Sleep Foundation.
If that isn't enough evidence of our increasingly sleep-deprived state, consider this: Since September, audiences of such after-prime-time network shows as "Late Night With Conan O'Brien" have risen. No wonder the collective experience of "sleepless nights" found its way into a presidential address.

Stress and the Mind

The Psychology of Stress

MSNBC

In the economic tailspin of the late 2000s, loss is part of life. Workers are losing their jobs, employers are losing their businesses, and as credit becomes more and more scarce, everyone is losing confidence. What's more, entrepreneurs are grappling with a sense that they've lost control of critical factors that could determine their futures. Those psychological hurdles are perhaps the biggest challenges facing today's business owners; after all, it was probably that shining confidence and ability to innovate that got you started in the first place, right?

"So much of it has nothing to do with you," says Tarek Tay, 36, co-owner and managing partner of Atlanta's Zaya Restaurant, which launched strong in February 2008, boomed through the summer--and then saw business drop 30 percent in September. Although well-reviewed, it has operated in the red since, even with $1.2 million in 2008 sales. "If your food isn't good, you can improve the quality," he says. "If service is the problem, you can train your staff. But if the problem is that no one's going out to eat because of the economy, what can you do?"

As he and his partners fund Zaya with profits from the New Orleans restaurants they also own, Tay works tirelessly on cost cutting and marketing. "It makes me feel like I'm not giving up," he says. "When I'm out there working and I end up with a busy night, then I get to experience some sense of return. If you sit at home, your worries just fester in your mind."

Work - Life Balance

Basic Steps Toward Work-Life Balance

Forbes

Among the many things the average professional deals with daily: getting ahead at work; helping the kids with their homework; driving the school carpool; spending quality time with their significant other; caring for elderly parents; dealing with chores in the home; trying to get in just a few minutes to catch up with friends.

Life can feel like a constant battle between our professional and personal lives, especially now, with the economic distress making our lives more challenging than ever in so many ways. Before you beat yourself up about not being able to get everything done, consider these tips for achieving a better balance between your work and the rest of your life this year.

Brain and Body

To Work Your Brain, Work Your Body

Chicago Tribune

Problem:I lost my car keys. What kind of training will make my brain work better?
Solution: Brain-boosting software programs are a booming business. And studies show that both computer exercises and old-fashioned mental activities—reading or crafting—can affect memory.
But the best thing you can do for your brain is to move your body. "If I had to pick between fitness training and brain training, I'd go with fitness," said Sam Wang, an associate professor of neuroscience and molecular biology at Princeton University. So far, he said, exercise has been shown to have an effect several times larger than computer-brain exercise.
But Wang noted that "fitness training only lasts as long as the benefit to your cardiovascular system." Brain exercise, on the other hand, "might last longer."

Emotions and Diabetes

Teens' Emotions May Affect Diabetes Control

Reuters

Teenagers with type 1 diabetes may have a tougher time managing their blood sugar on days when they are feeling angry or down, a new study suggests.

The findings, published in the Annals of Behavioral Medicine, suggest that emotions may affect teens' blood sugar control by making them less confident in their ability to manage their diabetes.

For the study, Katherine T. Fortenberry and colleagues at the University of Utah in Salt Lake City recruited 62 subjects between 11- and 16-years old with type 1 diabetes, an autoummunne disorder that res caused by an abnormal immune system attack on the body's insulin-producing cells. People with the disease have to take daily insulin injections, closely monitor their blood sugar levels and be careful about their diets to avoid sugar highs and lows.

Tobacco Use and Healthcare

Can One Drug Cure Addiction to Another?

John Cloud - Time

Americans are fond of the idea that they can keep from doing "bad" drugs by taking "good" ones instead. The heroin/methadone model has actually been institutionalized: you can go to government-funded clinics to get methadone as "maintenance treatment" for heroin addiction — since both drugs bind to the same brain receptors. Experimental types in the '60s believed that LSD was a wonder drug that could cure alcoholism. The same claim was made during the '80s for a drug that was, at the time, perfectly legal and even used by a few psychotherapists: MDMA, a chemical now better known as ecstasy.

For decades, the holy grail in the search for good drugs to supplant bad ones has been a pill that might replace nicotine, which is powerfully addictive and — especially when delivered through cigarette smoke — incredibly dangerous. And in 2006, the holy grail seemed to have been found. Pfizer released Chantix, a drug the Food and Drug Administration (FDA) approved in May of that year to help smokers quit. Since then, doctors have written more than 6 million prescriptions for Chantix. It's no magic bullet. Chantix fails with most people who take it; fewer than half of those on the drug actually stop smoking. But going cold turkey works for fewer than one in 10 smokers, so in comparison Chantix is considered a great advance.

Economy and Sleep

Economy Doing a Number on People's Sleep

Mary Brophy Marcus - USA Today

Plump up your pillows and get more sleep or your overall health may decline, sleep experts say on the heels of a survey that reports more Americans are losing sleep because of financial worries. And other data show sales of sleep aids are up.

"Something's happening out there. People are losing sleep," says National Sleep Foundation board member Woodie Kessel. "There needs to be a public health message, because sleep is not something you can compromise on — it has consequences. It is as important as diet and exercise."

According to the 2009 Sleep in America poll by the National Sleep Foundation, out today, more than a quarter (27%) of Americans are losing sleep over financial worries.