“Skillful Teaching through Facilitating Discussion—Teaching skills is an essential pillar of a competent CHW and CHWI,” a lecture by Dr. Shannon Cox-Kelley, summarized by J.D. Meyer

This was the first lecture at the 2018 Community Health Workers Conference for the NE TX CHW Coalition, July 13, 2018.

The NE TX CHW Coalition Conference featured two main lectures and three breakout sessions. The first main lecture was by Dr. Shannon Cox-Kelley –Dean of Health Science–who teaches in the Community & Public Health degree program at NE TX Community College. She received all of her degrees at Texas A&M at Commerce and is a noted online distance educator.

Dr. Cox-Kelly cited four occasions to use discussion: (1) Evaluate evidence. (2) Formulate application of principles. (3) Foster motivation for further learning. (4) Articulate what has been already learned—theory behind the discussion.

Memory is linked to how deeply we think about something. A research interest cited in Dr. Cox-Kelley’s biography really clicked with me: “the impact of educational attainment on health outcomes in diverse communities.” My disabling condition is COPD, but as a Master’s degree holder and former all-level teacher (mainly Developmental English/Writing: the Pre-College Composition course), I’ve learned to study my conditions. (Yes, I have other health issues). I write Word Press articles on health and make binders full of info on medicine, ER reports, and journal articles.

Returning to Dr. Cox-Kelley, she notes that relationships are key, and we have a need to know why and how information is needed. The CHW Instructor could start with controversy like a “devil’s advocate,” but one should announce it in advance to maintain trust. Uncertainty arouses curiosity; switch sides. Focus on solving problems rather than the solution.

Many students are passive and quiet since we’re taught to memorize in secondary education. An increasingly popular practice is to flip the class and have the lecture at night on You Tube or something like it. Then the classroom becomes a place for total discussion. This flip improved passing rates at Dr. Cox-Kelley’s junior college. Think, don’t memorize.

How to start with questions means to start with desired outcomes. Factual questions increase problem-solving. Application and interpretation questions find connections. Problem questions can induce critical thinking. Comparison questions can evaluate readings.

Dr. Cox-Kelley cites principles behind case studies: (1) Increase focus. (2) Break cases into sub-problems. (3) Socratic questioning, and (4) Lead students toward intended outcomes. Once again, passive students can be a possible barrier, as well as failure for students to see value.

Dr. Cox-Kelley cited Discussions as a Way of Teaching, by S.D. Brookfield and S. Breskill (1999) as a fine relevant book. Students can experience a fear of looking stupid and the inability to consider alternative sides because of emotional attachment. Are they trying to find a correct answer or explore? Helping emotional reactions includes asserting the value of discussion and keeping opinions and verbalization in perspective. To conclude, collaboration is better than competition.

“Skillful Teaching through Facilitating Discussion” lived up to its subtitle of teaching skills being an essential pillar of both the Community Health Worker (CHW) and CHW Instructor (CHWI). Furthermore, Dr. Cox-Kelley’s lecture reached out to teachers looking for a second career or a stimulating cause in retirement.

2017 NE TX Community Health Worker Coalition Conference, By J.D. Meyer

The 2017 Northeast Texas Community Health Worker (CHW) Coalition Conference was held on July 14th at TJC West. According to the official booklet, the CHW conference addresses “the role CHW Workers/Instructors play in creating access to care, reducing care costs, and promoting health and happy communities.” The Conference stressed “the importance of CHW(I)’s reducing health disparities; return on investment; and methods of overcoming barriers to CHW(I) program success.” Participants who attended the entire conference received six CEU (Continuing Education Units). “Presentations can be downloaded after the conference at the following link: http://tinyurl.com/y7brtht7

There were three main presentations. “The CHW and Public Health: The UT Health NE Experience,” was delivered by Jeffrey L. Levin, M.D. “Creating and Maintaining Health Workplace Environments,” was given by Terrence Ates, M.ED and Detective John Ragland. “CHW Self-Care—Focusing on You While Giving to the Community,” was presented by LaShonda Malrey-Horne, MPH.
The CHW of the Year was presented to the late Cynthia Keppard, the former director of the NE TX CHW Coalition. Several of her family members were in attendance.
There were three Breakout Sessions also—a choice of 18 sessions. First, I attended “Helping Clients Self Manage Chronic Disease,” by Marcus Wade, LMSW & CHWI. Then I went to “A Community Health Worker’s Guide to Texercise Classic,” by Jeanie Gallegly, MS & CHWI. The last breakout session for me was “Tobacco Danger,” by Lana Herriman, BS.
There were several organizations serving as vendors and sponsors. For example, I was able to pick up the Cigna Health Spring Provider Directory and Over-the-Counter Products Catalog in the lobby. Lunch was from Jason’s Subs; snacks were available too. Once again, the annual NE TX CHW Coalition Conference was a success that drew a huge crowd.

2016 Northeast Texas Community Health Worker (CHW) Coalition Conference

The Northeast Texas Community Health Worker (CHW) Coalition held its second conference at Tyler Junior College West on Friday June 15, 2016. The Keynote Speakers were David L. Lakey, M.D.; Paul McGaha, M.D.; and Ardis Green, MPH. To begin the conference, Dr. Lakey presented, “Improving Health in Northeast Texas.” After lunch, we heard Dr. McGaha speak about the “Zika Virus: Implications for East Texas and CHWs.” The final talk was by Ms. Green, and it was entitled, “The New Diabetes Educator Paraprofessional Competencies.”

We chose three Breakout Sessions from a choice of eight. My choices were “Hypertension,” by Debbie Warren–a CHW Instructor; “It Takes a Village–The importance of Partnerships,” by Lori Arteaga, M.Ed.; and “Helping Clients Self-Manage Chronic Disease,” by Marcus Wade, LMSW & CHW Instructor.

The other Breakout Sessions were “Suicide Prevention in Youth: Part 1 & 2,” by Carolyn Harvey, Ph.D.; “Preconception, Pregnancy, and Tobacco,” by Jeanie Gallegly, MS & CHW Instructor; “Compliance: Confidentiality/HIPAA/PHI,” by Christie M. Cofer, BS & CHW Instructor; and “Chosen–The True Story of America’s Trafficked Teens,” by LaJuan Scott, MPA and Dreka Strickland, BS & CHW.

My choice of Breakout Sessions reflect that I have a chronic disease-Asthma and COPD-that got me on SSDI, and Medicaid/Medicare; furthermore, sometimes I get hypertension. As you can surmise, I see plenty of medical personnel and volunteer, so I know the importance of partnerships.

Improving Health in Northeast Texas

This presentation by Dr. Lakey was the ideal opener because of its broad focus and a call for action because our area’s health fairs poorly. Like all the other talks, we saw a Power Point and received a handout of those Power Points. Dr. Lakey defined Population Health as examining the overall health of an area–together with groups based on gender,age, and ethnicity. The Triple Aim is to improve the individual experience of care (quality and personal satisfaction), improve the health of the populations, and reduce the per capita cost of health care.

Despite spending more money on heath care than any country in the world, the U.S. only ranks #34 in Life Expectancy and #42 in Infant Mortality. Coincidentally, Texas ranks #34 among the states. Lack of health insurance is the major problem. Senior health for Texas is just #41. Moreover, Northeast Texas health is clearly among the worst in the state. So it keeps getting worse as you narrow the territory from nation to state to region.

 

 

 

 

“Asthma-COPD Overlap Syndrome (ACOS),” Footnotes & a Commentary from a Patient (6th Edition), by J.D. Meyer

 

“Asthma-COPD Overlap Syndrome (ACOS): A diagnostic challenge,” was a Top 100 WebxMD article for 2015. http://onlinelibrary.wiley.com/doi/10.1111/resp.12653/full It caught my attention because I’ve had this condition for ten years; however, I never heard the two described as a unit in this manner! Three symptoms stood out on my first reading: increased sputum, more dyspnea (breathlessness), but better response to inhaled corticosteroids. At once, I told all my local health connections about ACOS. This article was written by three doctors in the Far East: Vietnam, Korea, and Japan. “Tho, N. V., Park, H. Y. and Nakano, Y. (2015), Asthma–COPD overlap syndrome (ACOS): A diagnostic challenge. Respirology. doi: 10.1111/resp.12653.”

Furthermore, a Google search for ACOS yielded nothing unless I entered the complete term. So the breakthroughs didn’t happen around here—adding to this disabled Developmental English/Writing—ESOL teacher’s sense of urgency!

Definition of Terms

I printed this article and started highlighting and making notes. Fortunately for me, many of these technical terms corresponded to familiar brand names for my many ACOS drugs. Symbicort is a Long-Acting Beta2-Agonist (LABA) and an Inhaled Corticosteroid (ICS). A LABA is a long-term brochodilator while an ICS decreases inflammation. Rinse your mouth with water after each use, and don’t swallow the water; spit it out. I was switched back to Advair (another LABA +ICS drug), which has bee my usual inhaled corticosteroid. Both drugs are used for asthma &COPD. A Muscarinic Antagonist is also a bronchodilator, such as tiotropium (Spiriva) and aclidinium.

Spiriva, an inhaled capsule, is used for COPD, including emphysema and chronic bronchitis. Later, I was switched to Montelukast, the pill version of this drug.

There is only one PDE4 inhibitor—Daliresp (roflumilast), and it works against excess bronchitis and phlegm. Daliresp decreases the number of exacerbations in severe COPD, and it’s not a bronchodilator. Daliresp decreases lung inflammation and prevents COPD flare-ups. Don’t use Symbicort, Spiriva, or Daliresp for an acute attack.

For an acute attack, use your “inhaler,” such as ProAir and Proventil; they’re examples of Short-Acting Beta2-Agonists (SABA); both are albuterol. Proair will open the airways and prevent a bronchospasm. You could go for your nebulizer for an acute attack, especially a bad attack. Our albuterol vials for the nebulizer could be called an”extra-strength” SABA. Iprat-Albut (Albuterol & Ipratropium) are two bronchodilators for the COPD patients’ nebulizer. For two decades, I was on pure Albuterol for my nebulizer. Now my inhaler is Combivent–a stronger ipratropium-albuterol inhaler.

Atopic is an allergic reaction, often hereditary. Atopy is a feature of ACOS and associated with a higher prevalence of chronic cough and sputum production, according to Tho, Park, and Nakano. Eosinophilic airway inflammation means there’s a higher than average number of white blood cells. It can be detected in mucus if it’s tissue eosinophilia. Tho, Park, and Nakano note that ACOS patients have higher sputum eosinophil counts than those with COPD alone, but sputum count profiles may change over time. Blood eosinophilia is over 500 in a microliter of blood. I found these definitions at Medicine Net and the Mayo Clinic websites too.  Much of the drug definitions came from the pharmacy’s medicine sheets themselves.

Economic Burden & Disability

Tho, Park, & Nakano note that the percentage of ACOS patients visiting the ER or admitted to hospitals is significantly higher than COPD alone in South Korea. A United States Medicaid population reports that ACOS patients have a higher rate of utilizing any service versus asthma or COPD alone. Moreover, the average annual medical cost for an ACOS patient in the US is $14, 914–much higher than asthma, $2307 or COPD,  $4879. ACOS is common in the elderly. It features more dyspnea (breathlessness), wheezing, and more frequent exacerbations. The respiratory quality of life and amount of physical activity for those with COPD alone.

Addendum to Tho, Park, & Nakano

Using my peak flow meter to check my forced exhale volume (FEV) always has been one of my strong points in managing my ACOS. I check my peak flow meter before I go for a walk, and if I’m under my usual low moderate level of impairment, I head for the albuterol nebulizer. Check my article https://www.newscastic.com/news/forced-exhale-volume-fev-lung-disease-your-peak-flow-meter-1155949/ The “whole story” includes a link to an About.com article on Pulmonary Function tests, by Deborah Leader, RN, COPD Expert.

Returning to the Tho, Park, and Nakano article, we see that a staggering 49% of smokers develop chronic bronchitis and 24% get emphysema or COPD. “Smoker’s cough” is worst upon arising. Dyspnea increases as the disease worsens. Quit smoking or else!

Guaifenesin (Mucinex) has been one of my favorite OTC medicines for years because it’s an expectorant. You can find a cheaper generic version in the dollar store too. Warn the doctor if you smoke, or have asthma or emphysema. It thins the mucus, so it’s less sticky and easier to cough up, according to www.drugs.com/mucinex.html  Take guaifenesin when you have a cold, bronchitis, flu, or allergies–whatever got your chest full of phlegm. Still drink plenty of fluids. www.webmd.com/drugs/2/drug-63818/mucinex-oral/details I’ve been told by my doctor to take a larger than average dose of guaifenesin during an ACOS attack.

I also take an over-the-counter allergy pill, for I’m allergic to Bermuda and Johnson grass. My choice is non-drowsy Loratadine Tablets, an antihistamine that’s another find at Family Dollar. Loratadine is a generic form of Claritin.

Beware of drinks with carbon dioxide (CO2) also, such as beer and soda. http://respiratorytherapycave.blogspot.com/2008/06/asthmacopders-should-avoid-pop-beer.html The ability to exhale carbon dioxide is vastly impaired for the bad lung crowd. “The normal human body breathes to eliminate CO2, producing 200 cc./minute. However, one can of soda has up to 1000 cc. of dissolved CO2. Most is absorbed by into the blood stream by the intestines.” This can lead to more dyspnea (breathlessness) in those with lung disease. Furthermore, beer can cause dehydration too–another cause of dyspnea. Maybe gas pills help; time will tell.

On the other hand, if you like alcoholic drinks and wish to be more careful, then try red wine. First of all, you won’t have to worry about bubbles. Red wine increases antioxidant status and decreases oxidative stress in circulation, mainly because of glutathione (GSH). The “French Paradox” is explained by their love of red wine lessening coronary heart disease despite a fatty diet. https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-6-27

In closing, there’s a rich amount of literature on asthma, bronchitis, and COPD. Learn to manage your illness before you continue to deteriorate, and get a pulmonologist if you don’t have one already.