Tag Archives: James C. Sherlock

Virginia Has an Opportunity to Take the Lead in Nursing Home Technology Insertion to Improve Care with Existing Staff

by James C. Sherlock

A pending new federal rule defining strong nursing home staffing minimums has finally accomplished something that I thought unlikely in my lifetime.

It has in a single stroke aligned the interests of patients and their loved ones, nurses, nursing homes, state and federal governments, and taxpayers in finding ways to make existing nursing home staffs more efficient and effective.

That alignment brings the miracle of the loaves and fishes to mind.

It takes some explaining.

  1. The value of the new regulations to patients and loved ones and nurses is clear. Better quality of care for patients and better working conditions — less stress and better job satisfaction — for the nurses.
  2. The nursing homes and their lobbyists oppose the new rule, but it appears that it will happen. They face a significant shortage of registered nurses in Virginia and competition for nurses from hospitals with deeper pockets. So, they very much want to somehow reduce the new minimum federal requirements.
  3. The state and federal governments, and thus the taxpayers, will inevitably see demands for Medicare and Medicaid payment increases to pay for the new staff. So, it would benefit taxpayers and the national debt to reduce those ratios as long as the desired levels of care could be maintained.

One answer to address all of those interests is extensive automation of processes in which nurses are involved. Just some of the requirements:

  • Integrate electronic health records (EHR) and nurse support apps for real-time data entry on mobile devices;
  • Remotely pre-screen, prioritize and automate alert and alarm workflows;
  • Alert to medication administration requirements and help prevent medication errors;
  • Enable nurses to notify the appropriate responders to crises with one click on a mobile device.

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Child and Adolescent Mental Health and Virginia Public Schools – Big Complications and Major Changes

Credit JAMA Pediatrics, April 6, 2020

by James C. Sherlock

Rebecca Aman, a member of the Newport News School Board, is frustrated. She told me in an interview that:

Without sufficient discipline and access to clinical mental health services, behavioral intervention does not work to make schools safer and healthier.

She believes that Newport News schools need to improve both discipline and the effectiveness of behavioral interventions.

She is absolutely right.

But school-based mental health services offer different, very complex and rapidly changing challenges.

The profession of psychology has recognized that the one-on-one clinical treatment model is permanently out of reach for the broad communities needing assistance because the supply of qualified professionals cannot now and will never meet the demand.

So the delivery model is in the midst of profound change.

Three key changes being pursued are

  • a far bigger emphasis on prevention, much of it to be delivered by school staff;
  • better diagnosis; and
  • “school based” (their term) group treatments.

Which raises at least three questions:

  • Are the pediatric mental health delivery models changing so much that the schools are “shooting behind the rabbit” in the hunt for more services?
  • What does the profession of psychology mean when it describes massively expanded “school-based” services? The schools and parents better find out.
  • Should schools even be in the hunt for more in-school services? I say no. They are already trying to do too much.

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Threat Assessment Done Right — Virginia Tech

by James C. Sherlock

Yesterday I harshly critiqued the structure, authorities and actions of the University of Virginia Threat Assessment Team.

Today, in stark contrast, I offer Virginia Tech. Tech has complied with state law by simply doing what the law requires, and done it thoughtfully.

As a result, Tech has established a far more professional approach and an unbroken case flow from threat assessment to intervention to sanctioning.

Which some commenters have insisted was impossible at Virginia.

Where three young men are dead. Continue reading

Virginia Must Ensure Transgender Medical Treatment Is Safe

by James C. Sherlock

Attorney Hans Bader and I in parallel articles have pointed out the serious questions posed by national and international experts about current medical practices in gender transitions for minors.

Those questions include both the ethics of the diagnosis and treatment processes in use and the safety of the puberty blockers and cross-gender hormones used in those treatments. Hormone treatments are administered to hundreds of minors annually in Virginia in the face of both new FDA warnings and other major open questions about their safety and long-term outcomes.

Virginia taxpayers pay for a lot of these treatments in state hospitals and clinics with state-funded private insurance plans and now Medicaid.

I will recommend the Virginia Secretary of Health and Human Resources organize and oversee practice and research networks in Virginia that mirror the recommendations of the Cass Review in the U.K. to make it safe.

Virginia has the assets necessary to carry out those recommendations and the state has the authority. It must demonstrate the will.

No new law appears necessary. Continue reading

Progressive Dogma Untethered to Results – Voter Laws Edition

by James C. Sherlock

The armies of the progressive left are what the great political scientist George Edwards called “Prisoners of Their Premises.” Many persons and institutions are captives, to a greater or lesser degree.

Lesser is better in this case. Mistakes flow from the best of intentions. You can learn from them or repeat them.

The United States military late in the Vietnam war mandated and then made a science out of analyzing its mistakes in order to learn from them.

At the unit level, soldiers, sailors, airmen and Marines debrief after every training and combat mission. At higher levels the reviews are periodic, but also professionally honest. Combat training schools capture, but do not enshrine those lessons. Because there is always a next time, newer equipment, newer force compositions, newer enemies and newer lessons.

It is the only way to improve systematically.

Many progressives, in solitary confinement with their dogma, are often wrong but always certain. When their policy prescriptions fail to provide the predicted results, which is most of the time, outcomes are ignored or blamed on outside factors beyond their control. Core beliefs, unchallenged, are undisturbed.

Consider for illustration recent voting law changes. Continue reading

Update: Virginia COVID-19 Testing and Nursing Home Data

by James C. Sherlock

I update here the continuing scandals in Virginia nursing home understaffing and COVID-19 testing.

In a quarterly update, the percentage of understaffed nursing homes and the Virginia’s relative standing among the states and D.C. in that statistic every quarter are posted on Medicare Nursing Home Compare. Here are the data from 03/30/2020:

  • Fifty-one percent of Virginia nursing homes are understaffed (below average or much below average).
  • Virginia ranks 45th worst of 51 among states and D.C. in percentage of nursing homes understaffed.
  • Forty-two Virginia nursing homes are rated one star (much below average)

I will update Virginia COVID-19 testing data weekly.

  • Virginia testing per million persons ranks 50th of 51 among states and D.C. (Only Kentucky is worse).  Source covidtracking.com uses only official state government data and is updated daily. This ranking is from 04/24/2020

A Source of Doctors, Nurses for COVID-19 Response

by James Sherlock

This morning, March 15, I sent an email to Dr. Dan Carey, Virginia Secretary of Health and Human Resources, to the Medical Society of Virginia and to the Medical Society of Northern Virginia. I offered a concept for significantly and quickly increasing the number of medical personnel available for COVID-19 response in Virginia and perhaps across the nation. The gist of that email was as follows:

There are a lot of medical specialties that will see a decrease in patient visits while the emergency is in effect. Perhaps you can figure (or have figured) out a way to organize that situation into an informal reserve force for the hospitals and primary care providers. I have an idea on how to do that. You may have better ones.

My idea is to organize a voluntary signup program for doctors, nurses and technicians built around doctors’ practices that will have a much lower influx of patients during this period. You know the specialties that fit that description better than I. Examples may include ophthalmologists and dermatologists. One way to do that is for those specialty offices to organize their reduced patient loads into say four days a week rather than five, or maybe even more if their practices are more heavily impacted by near-term cancellations. They could then sign up for that day or days as available for temporary call-up by local hospitals, primary care practices, nursing homes and others for emergency assistance.

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