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Tuesday, April 12, 2011

Unnamed 04/13/2011

Patient complaints do not fit the primary care office visit

We know this, yet scary to read that example. RT @kevinmd: Patient complaints do not fit the primary care office visit http://is.gd/vgGNFj
PreOp - Your Procedure | Gallbladder Removal Cholecystectomy

Gallbladder Removal , You will then be transferred to the operating table.... http://bit.ly/Gallbladder_procedure #Surgery #MD #RN #health

tags: Surgery MD RN health
If there is no struggle, there is no progress. - F

If there is no struggle, there is no progress. - Frederick Douglass
A real woman is so hard to find men are intimidat

tags: ItsSadWhen

A real woman is so hard to find #ItsSadWhen men are intimidated by her & pass her up for some trash because they don't want a challenge. R-T
LTC facilities and Home Health Agencies--Build you

LTC facilities and Home Health Agencies--Build your I.V. team- Increase your census and reimbursement levels. Pedagogy can show you how.

Posted from Diigo. The rest of my favorite links are here.

Monday, April 11, 2011

Patient complaints do not fit the primary care office visit

by Kevin Pho, MD
Primary care physicians often have to see patients with a litany of issues. Often within a span of a 15-minute office visit.
This places the doctor in the middle of a tension — spend more time with the patient to address all of the concerns, but risk the wrath of patients scheduled afterwards, who are then forced to wait.
And, in some cases, it’s simply impossible to adequately address every patient question during a given visit.
It’s a situation that internist Danielle Ofri wrote recently about in the New York Times.
In her essay, she describes a patient, who she initially classified as the “worried well”:

via kevinmd.com

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How Vaccinations Work | International Medical Council on Vaccination

Philip F. Incao, MD

In order to use vaccinations wisely, we need to understand exactly how they work. Until recently, the mechanism of action of vaccinations was always understood to be simply that they cause an increase in antibody levels (titers) against a specific disease antigen (bacterium or virus), thus preventing infection with that bacterial or viral antigen. In recent years science has learned that the human immune system is much more complicated than we thought. It is composed of two functional branches or compartments that may work together in a mutually cooperative way or in a mutually antagonistic way depending on the health of the individual.

One branch is the humoral immune system (or approximately Th2 function), which primarily produces antibodies in the blood circulation as a sensing or recognizing function of the immune system to the presence of foreign antigens in the body. The other branch is the cellular or cell-mediated immune system (or approximately Th1 function), which primarily destroys, digests and expels foreign antigens out of the body through the activity of its cells found in the thymus, tonsils, adenoids, spleen, lymph nodes and lymph system throughout the body. This process of destroying, digesting and discharging foreign antigens from the body is known as the acute inflammatory response and is often accompanied by the classic signs of inflammation: fever, pain, malaise and discharge of mucus, pus, skin rash or diarrhea.

These two functional branches of the immune system may be compared to the two functions in eating: tasting and recognizing the food on the one hand, and digesting the food and eliminating the food waste on the other hand. In the same way, the humoral or Th2 branch of the immune system tastes and recognizes and even remembers foreign antigens and the cellular or Th1 branch of the immune system digests and eliminates the foreign antigens from the body. But just as too much repeated tasting of food will ruin the appetite, so also too much repeated stimulation of the tasting humoral immune system by an antigen will inhibit and suppress the digesting and eliminating function of the cellular immune system. In other words, over stimulating antibody production can suppress the acute inflammatory response of the cellular immune system! 1

via vaccinationcouncil.org

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PreOp - Your Procedure | Gallbladder Removal Cholecystectomy

This information is not intended to replace the advice of your doctor. MedSelfEd, Inc. disclaims any liability for the decisions you make based on this information.

Now it's time to talk about the actual procedure your doctor has recommended for you.

On the day of your operation, you will be asked to put on a surgical gown.

You may receive a sedative by mouth...

...and an intravenous line may be put in.

You will then be transferred to the operating table.

via preop.com

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McDonald's Medicine: Too Impatient to Wait for Care, Time

Doctor asks, "Why did you come to the ER today?"

This question — emphasizing today is common practice in emergency departments — helps us figure out how urgent a patient's illness might be. But it's a loaded question. Rephrased, it could easily mean, "Do you really believe you are seriously ill, or is it just that you couldn't wait to see a regular doctor?"

Behind the sanctimony is a cliché: McDonald's medicine. Spend time in a busy ER and you'll hear a recurrent theme among the harried staff: patients in the U.S. want their health care like they want their food — served up speedily and made "your way." According to the conventional wisdom among medical professionals, overcrowding in the ER is exacerbated by America's culture of instant gratification. (See Healthland's 5 rules for good health in 2011.)

via time.com

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With the high value we put on Instant Gratification, have to say they have a point here.

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Hospital scrubs and sandwiches should not mix | Reporting on Health

You probably have been to a restaurant near a hospital (or a café inside a hospital) and seen a doctor, nurse or medical assistant wearing scrubs and standing in line for a sandwich. You probably didn’t give this a second thought, the way you wouldn’t if you saw a police officer in uniform or a priest wearing a collar.

Dr. David C. Martin, a retired Sacramento anesthesiologist a former assistant professor in the Department of Anesthesiology and Pain Medicine at UC Davis Medical Center, thinks you should be alarmed. He has a niche mission that Antidote has never seen championed before. He wants to rid America’s restaurants of medical staff eating in scrubs. He makes his case over a three-part series that begins today. The first part is below.

Part two will run later this week and conclude with part three, in which I will bring in some voices from the larger health care community to talk about this confrontational approach to a covert public health issue. Here’s Dr. Martin.

I was enjoying lunch at a popular Sacramento restaurant last week, when two patrons walked in wearing green surgical attire, “scrubs” as they are commonly called. Both were wearing official badges from a large, local hospital, revealing one to be a physician, the other a registered nurse. Concerned that these scrubs had been exposed to communicable bacteria, I politely asked that the healthcare workers leave the restaurant, and return only in regular attire. Both were mildly annoyed but agreed to depart. I asked them to leave because the use of scrubs in the community can create a serious and avoidable public threat. I am also convinced that simple public action can play a powerful role in effecting change. I hope to bring misuse of hospital attire to greater public awareness and to solicit broader public action in addressing this potentially dangerous problem of scrubs transmitting pathogens from the hospital into the public and from public places back to the hospital, where these pathogens may cause grave harm to vulnerable patients.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which certifies and accredits healthcare organizations, has launched a bold initiative called “Speak Up,” which encourages individuals to take an active role in reducing our risk of infection by assuring that our providers wash their hands and wear gloves. JCAHO has even published a coloring book for children, to teach, early in life, that it is not disrespectful or inappropriate to speak up and remind our physicians and other providers to take appropriate safety measures.

For adults, the Joint Commission issues buttons, to be worn by healthcare providers, which say, “Ask me if I’ve washed my hands.” This initiative is supported by the American Hospital Association and the Centers for Disease Control and Prevention, among many other quality and safety organizations. Some hospitals and clinics have embraced and enforced rigorous hand washing protocols have reduced their rate of institution-acquired infections, in some cases quite dramatically.

Yet, believe it or not, many healthcare workers have not complied with institutional policy on hand washing.

At a forum on hand hygiene organized by Loyola University Medical Center and Medline Industries in March, experts reported that hand-hygiene compliance was lax nationwide. But it takes a lot of effort to get everyone “on board.” I believe that the growing concern over scrubs as a vector of disease, while less important than sound hand-washing practices, is a substantial problem that merits similarly aggressive action.

Most California hospitals have official or unofficial policies, which restrict the use of hospital scrubs to surgical suites and related patient-care areas. Wearing them or laundering them outside of the hospital is forbidden or discouraged, but enforcement of such policy is a difficult task.

I spoke about this concern with quality assurance personnel at two of the four major hospital organizations in the Sacramento area. The two others failed to return several calls. One of the quality assurance staff members shared an observation that her organization had been effective in curtailing scrub misuse by non-physician staff, but that physicians were frequently allowed to break the rules. She said that many considered themselves to be “above the law” in this regard. Some travel to and from their own homes in contaminated scrubs, which suggests that this practice stems less from a disregard for others and more from a curious type of denial and disbelief that hospital-contaminated scrubs offer any real threat. Are these the same professionals who have resisted aggressive hand-washing protocols, which make a huge difference in institutional infection rates? As a physician who has spent most of my career in the surgical suite, I find this perplexing.

The notion that our physicians and nurses are immune to error, or unapproachable regarding its potential should have been laid to rest long ago. None of us should share public space with those who unnecessarily risk compromising public safety, knowingly or otherwise. I believe, as does the medical community at large, that it is time for all of us to take responsibility for our health and safety, rather than displacing the entirety of this onus to our caregivers. Purging public spaces of hospital-exposed garments could make more than a public fashion statement. It could reduce illness and even death from infectious disease.

Next: Why superbugs may show up wearing scrubs

via reportingonhealth.org

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Popular drug for mild Alzheimer's largely a flop - Health - Alzheimer's Disease - msnbc.com

A drug frequently prescribed to treat people with mild Alzheimer's disease does not appear to be an effective therapy for many of these patients, according to a new study.

The results show the drug, memantine, is no better than a dummy pill when it comes to ameliorating disease symptoms, including the decline of mental abilities, the researchers say. There is also meager evidence that the drug works for patients with moderate Alzheimer's, the researchers say.

Memantine is approved by the Food and Drug Administration to treat patients with moderate and severe Alzheimer's. However, physicians often prescribe it off-label to those with mild forms of the disease. About 19 percent of U.S. patients with mild Alzheimer's disease take the drug, the researchers say. The drug is intended to improve cognitive functions and make it easier for patients to perform daily activities.

via msnbc.msn.com

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Unnamed 04/12/2011

The happiest people dont necessarily have the best

The happiest people dont necessarily have the best of everything but they make the most of everything
RT : Never, under any circumstances, take a sleepi

RT @grattonboy: Never, under any circumstances, take a sleeping pill and a laxative on the same night.
The drowning man is not troubled by rain. -Persian

The drowning man is not troubled by rain. -Persian Proverb
Motivation is what gets you started. Habit is what

Motivation is what gets you started. Habit is what keeps you going. - Unknown "Happy Sunday."

Posted from Diigo. The rest of my favorite links are here.

Is the US healthcare system too litigious or too careless? | boxcuttersinc

In a recent study published in Health Affairs, researchers at the University of Utah and the Institute for Healthcare Improvement found that errors “occurred in one-third of hospital admissions”. Moreover, they “found at least ten times more confirmed, serious events than … other methods.”

Commenting on this study, Health Affairs Editor-in-Chief Susan Dentzer said:

Without doubt, we’ve seen improvements in health care over the past decade, and even pockets of excellence, but overall progress has been agonizingly slow. It’s clear that we still have a great deal of work to do in order to achieve a healthcare system that is consistently high-quality–that is, safe, effective, patient-centered, efficient, timely, and devoid of disparities based on race or ethnicity.

Wow, what an indictment of a healthcare system that many consider to be the best in the world!

via boxcuttersinc.wordpress.com

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Should Emergency Departments Turn Away Nonurgent Patients? - TIME

A few weeks ago, the American College of Emergency Physicians (ACEP) launched a campaign to derail proposed policies to reduce the use of emergency departments (EDs). ACEP's problem with the campaign is the logic that underpins it: policymakers think that ED use, in aggregate, is a costly problem and a major driver of unnecessary health care costs in the U.S. ACEP claims that rather than delivering unnecessary care, EDs treat many patients who have no alternative when they need comprehensive medical care in a timely manner; that is, EDs deliver altogether necessary care.

ACEP has challenged reports from South Carolina and Massachusetts suggesting that a high percentage of ED use is unnecessary and that reform efforts — particularly payment incentives — will reduce "inappropriate" usage. In South Carolina, a state legislator, Representative Bill Herbkersman, even recommended that special call boxes be placed in the homes of more than 3,000 Medicaid patients to give them 24-hour access to nurses who could diagnose them over the phone and reduce costly and unnecessary ED visits. Blue Cross Blue Shield of Georgia has also increased the co-pay on ED visits from $100 to $200 and has been steering its members away from EDs to urgent-care centers and retail clinics (with the help of a Google Maps application, soon be available as an app for members' mobile phones).

via time.com

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Tuesday, April 12, 2011

Unnamed 04/13/2011

Monday, April 11, 2011

Patient complaints do not fit the primary care office visit

How Vaccinations Work | International Medical Council on Vaccination

PreOp - Your Procedure | Gallbladder Removal Cholecystectomy

McDonald's Medicine: Too Impatient to Wait for Care, Time

Hospital scrubs and sandwiches should not mix | Reporting on Health

Popular drug for mild Alzheimer's largely a flop - Health - Alzheimer's Disease - msnbc.com

Unnamed 04/12/2011

Is the US healthcare system too litigious or too careless? | boxcuttersinc

Should Emergency Departments Turn Away Nonurgent Patients? - TIME

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Now it's time to talk about the actual procedure your doctor has recommended for you.

		On the day of your operation, you will be asked to put on a surgical gown.
		You may receive a sedative by mouth...
		...and an intravenous line may be put in.
		You will then be transferred to the operating table.