Start Over Date 2017

11. Preventing gun deaths: a public health perspective (59:56)

Date:
2017-11-01
Main contributors:
University of Virginia. School of Medicine
Summary:
In a year that has seen gun violence in the U.S. escalate even more—consider the almost-daily gun deaths on the streets of Chicago or the recent Las Vegas massacre—this Medical Center Hour looks anew at this urgent public health problem. Distinguished bioethicist Steven Miles presents a comprehensive status report on gun deaths (homicides and suicides), including issues of gun supply, the relevance of mental illness, race, and poverty to firearm deaths, the effects of gun law reforms, and the prospects for better prevention of gun violence. A John F. Anderson Memorial Lecture

12. Reducing over-treatment in the era of health care reform (57:53)

Date:
2017-02-08
Main contributors:
University of Virginia. School of Medicine
Summary:
Health care information can confuse doctors and patients alike. What are the risks and benefits of mammograms, of aggressive blood pressure control, of EKGs, of lung cancer screening, of heart stents? When patients can’t accurately answer these questions, they find it difficult to have sensible conversations about their health care with their doctors. And lack of comprehensible medical information not only interferes with shared decision-making between physician and patient but can also lead to over-screening and over-treatment, with deleterious consequences for patients as well as for the health care delivery system and medical reform. In this Medical Center Hour, internist Andy Lazris and scientist Erik Rifkin assess this challenging situation and then present, as one solution, a novel decision aid called a Benefit Risk Characterization Theater (BRCT). When health care information is conveyed simply, factually, and in a non-numerical format, true shared decisions become possible. They offer BRCTs to explain the risks/benefits of some common medical interventions and demonstrate how this approach can improve health care delivery, lead to greater patient satisfaction, and result in less over-treatment, one of the main drivers of low-value health care cost. Co-presented with the Department of Medicine

13. Stacking stones: the art and science of improving care of older adults (57:51)

Date:
2017-11-15
Main contributors:
University of Virginia. School of Medicine
Summary:
Our society is aging, and, thanks partly to the science and success of advanced health care, the journey into one’s last years is often long and richly rewarding. But our medicalization of aging also means that older adults are longtime patients entangled in complex, costly, fragmented, and sometimes ad-libbed “systems” of individualized care that are challenging for them and their caregivers to navigate. When elders’ health and functional status changes, ways of managing their care may come undone, just when robust attention is most needed to effect transitions in their care—and the goals of care. In this Medical Center Hour, distinguished gerontologist Mary Naylor offers her pioneering approach to the design, evaluation, and dissemination of health care innovations that has at once improved outcomes for chronically ill older adults and their caregivers and lowered health care costs. Her collaborative work with an interprofessional team has yielded the Transitional Care Model, a cost-effective model led by an advanced-practice nurse that improves the transitions of frail elders as they move through both their final years and our fractured health care system. The Zula Mae Baber Bice Memorial Lecture, School of Nursing The Koppaka Family Foundation Lecture in Medical Humanities, School of Medicine Co-presented with the School of Nursing and the Center for Biomedical Ethics and Humanities, School of Medicine

14. The changing healthcare landscape: preventing the preventable healthcare-associated infections (1:01:24)

Date:
2017-10-11
Main contributors:
University of Virginia. School of Medicine
Summary:
The Affordable Care Act (ACA) has brought transformational changes to the healthcare system, including, in some ACA programs, movement away from a pay-for-volume system to pay-for-performance or outcome. Three programs exemplify this approach: readmission penalties, no payment for selected hospital-acquired conditions (HACs), and value-based purchasing. To date, the HAC nonpayment program has targeted prevention of central-line-associated bloodstream infections, catheter-associated urinary tract infections, selected surgical site infections, and methicillin-resistant Staphylococcus aureus (MRSA) or Clostridium difficile infections. With better understanding, improved procedural practices, and closer monitoring, more of these infections are proving preventable; infection rates, including for MRSA, have dramatically decreased. In this Medical Center Hour, distinguished medical epidemiologist Dr. William Jarvis discusses these successes, including their financial implications, and how further collaboration between clinicians and infection control programs can prevent even more hospital-acquired conditions. The Hayden-Farr Lecture in Epidemiology and Virology/Medical Grand Rounds Co-presented with the Department of Medicine, UVA

15. The continuing relevance of America's eugenic legacy (1:00:21)

Date:
2017-03-29
Main contributors:
University of Virginia. School of Medicine
Summary:
The history of eugenics is often characterized as a cautionary tale of life in the bad old days, when pseudoscientific assumptions about genetic determinism provided a respectable veneer that enabled barely submerged racism, xenophobia, and blatant discrimination against persons with disabilities to take root in American law. Some argue that, today, our science is sound, our attitudes enlightened; we need not be hobbled by fear of long-expired bad eugenic habits. In this Medical Center Hour, Paul Lombardo, who has written extensively on eugenics and the law in America, challenges such assumptions, asserting that the same tendencies that led to a century of eugenic law and policy continue to inform our public debate over democratic values and the proper role of science as a tool for solving social problems. The Joan Echtenkamp Klein Memorial Lecture in the History of the Health Sciences Co-presented with the History of the Health Sciences Lecture Series, Historical Collections, Claude Moore Health Sciences Library

16. The opioid epidemic's impact on public health and patient care (59:55)

Date:
2017-10-04
Main contributors:
University of Virginia. School of Medicine
Summary:
The opioid epidemic raging in the U.S., including in Virginia and neighboring states, took nearly two decades to develop and will take years to quell. So says the recent National Academy of Medicine (NAM) report, Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use (July 2017). Drug overdose due to opioid medications is now this country's leading cause of unintentional injury death. The current crisis is particularly challenging because the epidemic's broad reach "has blurred the formerly distinct social boundary between prescribed opioids and illegally manufactured ones, such as heroin," asserts the NAM committee's chair, UVA law professor Richard J. Bonnie. In this Medical Center Hour, Professor Bonnie and palliative care specialist Dr. Leslie Blackhall address the impact of this epidemic on public health and patient care and discuss what actions regulatory bodies, health care organizations, and health care professionals could take. A John F. Anderson Memorial Lecture

17. Transforming Virginia Medicaid's Addiction and Recovery Treatment Services (ARTS) benefit (59:44)

Date:
2017-10-18
Main contributors:
University of Virginia. School of Medicine
Summary:
The opioid epidemic is currently exacting a terrible toll on the health, lives, safety, and livelihood of persons and communities across Virginia, the Appalachian region, and, indeed, much of North America. What is being done to address this crisis at the levels of policy and practice in the Commonwealth of Virginia and in Charlottesville-Albemarle and environs? In this Medical Center Hour, the Honorable William A. Hazel Jr MD, Secretary of Health and Human Resources for the Commonwealth, discusses Virginia’s five-pronged approach to the epidemic and the impact of that approach to date. He is joined in this conversation by a primary care physician and community mental health professionals. The Jessie Stewart Richardson Memorial Lecture of the School of Medicine Co-presented with the Office of Quality and Performance Improvement, UVA Health System

18. What matters most when there's nothing left to give (58:32)

Date:
2017-09-20
Main contributors:
University of Virginia. School of Medicine
Summary:
What still resonates with you when you're spent? What can a caregiver—or a teacher, a leader, a colleague—offer and do when all else fails, when all that's left is our humanity? In this Medical Center Hour, Tim Cunningham weaves together three stories from disparate sites and desperate situations—the Ebola crisis in West Africa, rural Haiti, and an elite pediatric emergency unit on the Upper East Side of New York City—to inquire into what might matter the most at trying times. A clown, then a nurse, and now the director of the Compassionate Care Initiative and an assistant professor in UVA's School of Nursing, Cunningham shares what he believes matters most when all else is lost—and shows how we all have the capacity to access it. Co-presented with the Compassionate Care Initiative, School of Nursing