Clinic, art museum joining to provide art experiences for dementia patients

By Kaye Spector
Plain Dealer Health and Medical Writer

Alzheimer’s disease begins in the brain’s memory center, destroying
cells and causing problems with thinking and behavior. But in the
disease’s early- to midstage, areas of the brain that govern emotion,
perception and creativity often remain intact.
Those undisturbed areas of the brain make it possible for patients to
respond to the visual arts and music, even when they’ve lost
connection to the everyday world.

A symposium today on making the arts accessible to dementia patients
kicks off a new collaboration between two of the town’s venerable
institutions, the Cleveland Museum of Art and the Cleveland Clinic.

One of the workshops: Forty docents from the art museum and the Clinic
will learn to tailor tours to patients with dementia. The Clinic, with
it 3,500-object art collection, has its own curator and docents. It will
offer the special tours beginning this summer; the art museum will offer
its in the next few months.

Clinic physicians will be encouraged to advise their patients — and
their caregivers — to sign up for the tours, said Iva Fattorini,
executive director of the Clinic’s Arts and Medicine Institute. The
tours are patterned after a program at the Museum of Modern Art in New
York City.

“It makes good sense if you think about the neurology of the
disease,” said Dr. Randolph Schiffer, director of the Clinic’s Lou
Ruvo Center for Brain Health in Las Vegas. “Art can be a way to reach
and maintain the healthy areas” of the brain.

Medicine has few treatments to offer Alzheimer’s patients; scientists
have yet to answer basic questions about the disease, including its
cause.

The number of people diagnosed with Alzheimer’s is expected to
skyrocket over the next few decades. Ohioans with the disease will
number some 230,000 this year.

Schiffer, a symposium speaker, said the program highlights a trend
among physicians to approach Alzheimer’s treatment in less of a
medical model way. For example: Schiffer no longer asks his patient to
disrobe.

“I try to talk to them and relate to them and hold on to that sense
of who they are,” he said. “Our task is to help the person hold
themselves together as long as possible and help with transitions.”

There is not a lot of research to prove Alzheimer’s patients respond
to art and music, but Schiffer says he and other physicians have seen
it.

“People are using art as a therapeutic thing, as a healing milieu,”
said Dr. Alan Lerner, director of University Hospital’s Memory and
Cognition Center and neurology professor at Case Western Reserve
University. UH is a co-sponsor of the symposium.

The new collaboration also includes a distance-learning program, in
which Clinic patients — here or in other cities — can “attend”
an art lecture by art museum experts.

“This partnership speaks to the role that visual arts can play beyond
aesthetic enjoyment,” said Dale Hilton of the museum. “Every time we
work with a different audience, we learn so much more about how our
works of art are meaningful to other people.”

Nancy Udelson, executive director of the Alzheimer’s Association
Cleveland area chapter, said patients in the early stages of disease
will benefit most from the art tours.

“People with early-stage disease want to lead happy, fulfilled,
enriched lives,” she said. “Many cannot work, but can do other
things. Their families are looking for things to do together as well.

“It’s exciting to see Cleveland at the forefront of this kind of
programming.”

Nearly 200 docents, caregivers and health care professionals from
across the state signed up for the symposium. Registration is closed.

Grading system for Cuyahoga County restaurants under discussion

By Kaye Spector

Plain Dealer Health and Medical Writer

The new online access to Cleveland food inspection reports may be dandy, but in other cities, diners only have to look at a restaurant's front window to find out how it fared with the local health department.Such a system -- in which every restaurant or food vendor prominently displays a sign that announces how well the establishment complies with food safety codes -- might be in store for Greater Cleveland diners, too.

The Cuyahoga County health department this week began what's expected to be a yearlong discussion on creating and implementing a restaurant grading system, said County Health Commissioner Terry Allan.

Restaurant food safety grabbed the spotlight last month after the Cleveland Health Department put its food inspection reports -- which always have been available to the public in paper form -- online.

Cleveland health officials made the reports more accessible to educate consumers about where they are buying prepared food; and to increase vendors' motivation to comply with food safety laws.

The database was so popular at first that users briefly crashed the system. Views now have slowed to about 100 a day, Cleveland Health Director Matt Carroll said.

Carroll said that his department, too, is interested in a restaurant grading system, but is far from any serious discussion.

Online reports are certainly a step up in user-friendliness from paper inspection reports, but grade cards reach more consumers and are more readily available. The cards make a restaurant's degree of hygiene immediate visible to all -- especially those deciding where to eat on the fly.

"Our ultimate goal is to reduce the potential for food-borne disease," the county's Allan said. "We just haven't decided the approach."

Such a system can work, says a often-cited independent study of a decade-old restaurant grading program in Los Angeles County, Calif.

Introduction of the grade cards there corresponded to a 20 percent decrease in food-illness-related hospitalizations, while restaurateurs were more motivated to improve hygiene quality, says the study, published in 2005 in the journal of the American Agricultural Economics Association.

Eateries may actually benefit from the grade cards, the study said: revenue went up 5.7 percent for restaurants with an A grade and by 0.7 percent for restaurants with Bs. Restaurants with Cs saw revenue decrease by 1 percent.

The study hypothesized that the grade system magnified economic incentives for restaurateurs to maintain good-quality hygiene, while consumers became more confident about trying new restaurants and were less captive to those where they'd had good experiences.

Whatever shape the Cuyahoga County system ultimately takes, it likely will be years in the making, Allan said.

It took the Columbus Department of Health nearly three years to launch its colored-coded restaurant grading system in 2006.

The initiative began with the board of health, whose members wanted a system similar to what they'd seen in other cities, said Health Commissioner Teresa Long.

Nearly a year was spent studying those programs in places such as Los Angeles, Sacramento, Calif., and Toronto. The rest of the time was spent making the case to the public and restaurateurs.

The public, for the most part, strongly supported the initiative, Long said. Many who spoke in favor were from communities that had similar programs.

But the restaurant owners were a different matter.

"Of course our initial reaction was, 'No way do we want this,' " said Gail Baker, executive director of the Central Ohio Restaurant Association.

Restaurateurs worried they would be stuck with a designation that only reflected a one-day snapshot based on a single inspection, rather than a long-term look, Baker said.

The health board's advisory group, which had members in the restaurant business, demanded -- and were given -- a major role in developing the program's procedures.

The advisory group proposed professional-looking, unobtrusive durable plastic signs that could be updated with the most recent inspection date.

The group also won its request that only supervisors -- not inspectors --make the decision to place a yellow sign, which means the restaurant has not made progress in correcting its health violations.

Having the supervisor place the yellow sign averts friction that can spring up between operator and inspector and helps the operator feel the decision is getting as fair a review as possible.

"Having looked at all sorts of programs around the country, I feel ours is the best in the country," Baker said. "I have a lot of confidence in it. Our members accepted it very well."

Baker said restaurant owners also are happy that they have two weeks to fix any problems the inspectors find -- while keeping their green sticker, the highest-quality designation.

"At first they hoped it would go away," Long said of the restaurant owners. "But once they understood that there could be an opportunity to shape it, at some point they jumped on and said, 'We want the state-of-the-art model.' That was a big turning point."

After two public meetings, the Columbus health board approved changes to city health code to create the program. Then health officials held 14 educational forums to teach local businesses about it.

"We weren't asking for anything that good operators weren't already doing," Baker said. "So it pretty much was an easy sell and the right thing to do."

Matty Lucarelli, executive director of the Cleveland Area Restaurant Association, said that a grading system would be welcome here.

"We're very happy, obviously, when anything like that occurs in the food service world," she said. "It's a very good thing, and hospitals, as well as restaurants, are more than happy to comply."

Many restaurateurs in New York City, however, are less enthusiastic about that town's grading system, which will go live in July.

The restaurant operators' trade group opposes the grade cards, calling it a gimmick and a poor regulatory tool.

Chief among their criticism is that inspectors will issue letter grades on the spot after inspections. Also earning their disapproval is that it will take at least three weeks to challenge the findings.

But in Los Angeles County, 91 percent of the population like the grading system, says a study by the county's health department.

"This is something that over this year we are going to look at and weigh our best options," Allan said. "We want to understand where the successes are."

Therapist's efforts spark sale of special masks to ease patients' breathing in cold air

By Kaye Spector

Plain Dealer Health and Medical Writer

There's nothing that registered respiratory therapist Nick Orosz won't do for his patients.

Just ask Cindy Kreuscher.

After being diagnosed with stage 3 chronic obstructive pulmonary disease in 2007, Kreuscher began therapy with Orosz. She couldn't walk 3 feet without getting weak and stopping to gasp for breath. Her heart would start racing. Often, she would experience a panic attack.

The Navy veteran cried on her first day with Orosz after he asked her to step on a treadmill. Just three months had passed since her last hospitalization, for pneumonia. Up to that point, she only had lasted 60 seconds on the machine.

But with Orosz's encouragement and tips on how to breathe properly, she managed 15 minutes that day, at the highest setting of 10, wearing an oxygen mask.

Today, she can do 30 minutes on the treadmill at a setting of 8, walking at 2 mph, with only an oxygen tube in her nose. Her new year's goal is to increase her speed every week.

All because of Orosz and his passion, Kreuscher says.

“He’s always looking for better ways for his programs,” she says.

“You can tell he loves his job.”

Orosz, who works for Southwest General Health Center, has helped his patients get special equipment to ease their breathing problems. He helped Kreuscher obtain a machine to remove phlegm from her lungs.

Most recently, he wheedled the director of the hospital’s community pharmacy to sell, at a discounted price, a special kind of cold-weather mask.

Frigid air can be scary and dangerous for people with breathing problems.

The cold constricts the body’s blood vessels, increasing the demand for oxygen and worsening breathing disorders, leaving patients coughing, weak and gasping for air. Wearing a muffler or scarf over the mouth can help a little bit. But anyone who has worn a scarf tied around their face knows it can become a soppy, unpleasant mess.

Orosz says many of his patients with breathing disorders won’t venture out in the cold. He hopes the CT Mask (made by Airguard Medical Products), which Southwest sells for about $43 plus tax, will help them. (The mask is available at the hospital pharmacy in the main lobby, 18697 E. Bagley Road, Middleburg Heights. For hours and more information, call 440-816-8410. It’s also sold online, for $50 plus $7 for shipping, at airguardmedical.com.)

The masks contain a device that warms air before it is inhaled and prevents re-inhaling exhaled breath. There’s also room for a nasal oxygen tube.

“I hate to be a shill for the company, but I felt it was too important to pass up for a lot of people,” says Orosz, a respiratory therapist for 30 years. About a dozen people have expressed interest in the masks so far.

“If I see something in my trade journal that will benefit my pulmonary rehab patients, I’ll do it,” he says. “That’s part of our profession.”

Parma Community General Hospital will no longer hire smokers

By Kaye Spector

Plain Dealer Health and Medical Writer

Parma Community General Hospital has been smoke-free since 2006. On March 1, the hospital will be smoker-free -- at least when it comes to new hires.

The hospital said Monday it will no longer hire smokers. Job applicants will have to take a nicotine test as part of the pre-employment physical exam.

A job offer will be withdrawn from any candidate who tests positive for nicotine. Quit-smoking resources will be made available to the candidate, who may be reconsidered in 90 days if a retest is negative. The policy does not apply to the current workforce.

Parma joins the Cleveland Clinic and Akron Children's Hospital in refusing to hire smokers. The Clinic stopped hiring smokers in 2007; Akron Children's stopped in 2008.

Larry Jeffries, senior director of human resources at Parma Community, said the decision was an extension of several wellness steps already in place at the hospital, including a new employee fitness center, more nutritious choices in the cafeteria and cash incentives for health screenings.

"From a community standpoint, we are trying to move step by step toward what we are promoting and our values," he said.

Jeffries said hospital officials don't expect cost-savings right away.

"Down the road we'll be better able to measure it," he said. "In the interim, it's hard to get an immediate cost-savings. I think we are years away from knowing what that will be."

It's legal in Ohio for companies to refuse to hire tobacco users, the American Medical Association says. The Americans with Disabilities Act does not cover discrimination against those who smoke or have a nicotine addiction.

Some companies have started charging employees who smoke more for health insurance coverage, the AMA says.