What are are the recurring thoughts that are occuring in the space between your ears? Are your thoughts usually ones of doom and gloom? We’ve all heard it said before, “Change Your Thoughts, Change Your Life”. What if each day you started off your morning like little Jessica in this video…how different would your day be?
Take the time to start each new day with better thoughts…the changes can be powerful.
Recently, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued an advisory opinion regarding two types of Proposed Arrangements between an anesthesia provider (AP) and physician-owned ambulatory surgery centers (ASCs). This came as a result of a request for an opinion from an AP who, because of competitive market pressures, was considering one of two new business relationship models. Under the AP’s current professional arrangement, the ap offers exclusive anesthesia services to ASCs, employs personnel to meet the anesthesia needs of the ASCs, and independently bills patients and third party payors, including Medicare, for professional fees. The ASCs bill the same parties for professional services plus a facility fee for materials and ancillary staff.
Under Proposed Arrangement A, the AP would continue to provide exclusive anesthesia services to the ASC and to bill independently. Additionally, the AP would pay a market value “management services” fee to the ASC for each non-Federally funded patient. The ASC would both collect this fee and continue to charge a facility fee to Federal and third party payors.
Under Proposed Arrangement B, the ASC physician-owners would set up a separate subsidiary to exclusively provide anesthesia services to their patients. The subsidiary then would hire the AP as the exclusive independent anesthesia services contractor, handle all billing with the assistance of the AP and its staff, pay the AP out of fees collected, and retain any profits.
In analyzing the legality of the two arrangements, the OIG considered two questions: 1. Does either arrangement violate the Federal anti-kickback statute, and, 2. Would any safe harbor protection apply?
Under the anti-kickback statute, it is a criminal offense to offer, pay, solicit, or receive any remuneration for referrals reimbursable by a Federal health care program. This statute seeks to ensure that referrals are based on sound medical judgment and not financial or other incentives. Regarding Proposed Arrangement A, although the AP would pay a management services fee only for non-Federal health care program patients, this does not reduce the risk that the fee might be paid by the AP to induce referrals from the ASC of all types of patients. Additionally, the arrangement allows the ASC to be paid twice for the same services, and this could unduly influence the ASC to select the AP as the exclusive provider. The OIG concluded that Proposed Arrangement A could violate the anti-kickback statute. No safe harbor protections apply.
Safe harbor protections for ASCs, employment, and personal services and management contracts were determined to not apply to Proposed Arrangement B. The Subsidiary does not qualify as a Medicare-certified ASC because it would not provide surgical services, only anesthesia services. As such, its income and the profits distributed to the ASC physician-owners would not be protected by any safe harbor provisions. Additionally, the OIG is concerned about exclusive arrangements between those who refer business (the ASC physician-owners), and those who furnish goods or services reimbursed by a Federal health care program (the AP). The AP and the ASC physician-owners both would benefit financially in Proposed Arrangement B, with the AP receiving its negotiated rate and the physician-owners receiving residual profits from the subsidiary after expenses and payment to the AP. The OIG concluded that Proposed Arrangement B would permit the physician-owners to receive compensation in the form of profits from the subsidiary from referring patients to the AP; this payment would be for services that they themselves could not provide. The more than minimal risk of fraud and abuse and the prohibited remuneration both would be in violation of the Federal anti-kickback statute.
Physicians should be aware of this development, as it may affect current and future professional relationships. A health care attorney can offer assistance in interpreting the potential impact of the OIG decision and evaluating the need to restructure business arrangements.
November marks the start of the American Diabetes Month®, an event sponsored by the American Diabetes Foundation®. A leading cause of blindness among adults, ExamHealth reports on something that every diabetes patient should be thinking about this time of year: a comprehensive eye exam.
“The American Optometric Association (AOA) is reminding Americans with diabetes about the importance of scheduling annual, dilated comprehensive eye exams to help detect and even prevent eye and vision disorders that could lead to blindness,” explains ExamHealth. “Each year, 12,000 to 24,000 individuals lose their sight because of diabetes.” An all-too-common condition in the US, the American Diabetes Foundation reports that nearly 26 million Americans are living with the condition.
What’s more, “The AOA notes that the results from its 2012 American Eye-Q® consumer survey revealed that only 44% of Americans are aware that diabetic eye disease often has no visual signs or symptoms,” reports ExamHealth. “Additionally, 43% of Americans are unaware that a person with diabetes should have a comprehensive eye exam once a year.”
Not sure what you should be looking out for? Read on!
Diabetes and Your Eye Health
So, why are comprehensive eye exams so important for those living with diabetes? The answer is simple – those with diabetes are at a significantly higher risk for developing several of today’s most serious eye conditions. Here’s a brief introduction:
Glaucoma: Glaucoma is an eye disorder characterized by an increased pressure in the eye. A leading cause of blindness in the US, glaucoma is a progressive condition that causes a gradual loss of vision. And, while there is no cure, glaucoma can often be treated with eye drops and certain other medications. In some cases, we treat the condition with lasers or surgery. A condition where early detection is everything, diabetes sufferers need to be even more vigilant when it comes to regular glaucoma screenings.
Cataracts: You can think of a cataract as a clouding of the eye’s lens. A progressive condition, cataracts can ultimately affect one’s ability to see clearly. Most common among older patients, those with diabetes are also at an elevated risk for developing the condition. When it comes to treatment, patients will often benefit from Cataract Surgery. During the procedure, the eye’s natural lens is removed and replaced with an artificial lens also known as an Intraocular Lens (IOL).
Diabetic Retinopathy: Diabetic retinopathy is a condition that weakens the blood vessels that supply nourishment to the retina. This is the light-sensitive lining in the back of the eye where vision is focused. As these vessels leak, swell or develop thin branches, vision loss can ultimately occur. Our practice offers comprehensive Diabetic Eye Care including routine eye exams.
Schedule Your Eye Exam Today
Make sure you schedule your comprehensive eye exam this November! Our offices are located in in Winchester, serving Virginia, West Virginia and Maryland, and you can reach us directly at (540) 722-6200. Contact us today.
The majority of states in the USA have reported cases of West Nile Fever (WNF) this year.
In those people who were severely infected, about half went on to develop meningitis or encephalitis. Most cases however, are mild and without symptoms.
This disease was first detected in the States in 1999, and this year’s numbers are the highest so far.
The greatest numbers of cases have occurred in six states (Texas, Mississippi, Luoisiana, Oklahoma, South Dakota and California), with Texas having almost half of those cases.
WNV virus is spread by Culex mosquitos, which bite mainly from dusk to dawn. Travellers should take measures to avoid mosquito bites, such as covering up after dusk and using effective repellents.
Source: ProMED-Mail
For further advice, contact the Globe Travel Health Centre on 01603 667323
C. Daniel Smith, M.D. , chair of the Department of Surgery at Mayo Clinic in Florida, discusses minimally invasive surgical options for patients with gastroesophageal reflux disease (GERD). A novel device, a ring of tiny magnetic titanium beads that acts to keep stomach acid from leaking into the esophagus, is now offered at Mayo Clinic in Florida. Read more about the LINX Reflux Management System in the April 11, 2012, edition of MedCity News.
Mayo Clinic in Florida is one of the first health care institutions in the U.S. to offer a newly approved device to treat GERD. Mayo Clinic in Florida helped test the device in patients. The U.S. Food and Drug Administration (FDA) approved the device and treatment procedure on March 22, 2012, for patients with GERD who continue to have chronic reflux symptoms despite taking medication. Mayo Clinic in Florida was one of 14 centers nationally that participated in a clinical trial that led to the FDA’s approval of the device.
About GERD In patients with gastroesophageal reflux disease, liquid or food in the stomach flow back up into the esophagus due to the inability of a ring of muscle between the lower esophagus and the top of the stomach to close properly. If drugs aimed at neutralizing the acid in the stomach fails to prevent GERD, an operation designed to correct the mechanical defect is considered. Nearly 2 million patients of those patients could benefit from this treatment, which is much less complex than current surgical options, says Dr. Smith.
The results of the clinical study that led to approval of the device have not yet been published. “The data presented to the FDA, however, revealed striking results when compared to other GERD treatments that have been investigated over the past 20 years,” says Dr. Smith. “The system offers effective control of GERD with limited side effects and thus far an excellent safety record.”
The implanted device is a ring of tiny magnetic titanium beads that is wrapped around the junction between the stomach and esophagus, serving as a mechanical augmentation of the lower esophageal sphincter (the ring of muscle). The magnetic attraction between the beads is strong enough to keep the sphincter closed to refluxing acid, but weak enough so that food can pass through it into the stomach. The device can be implanted using minimally invasive surgery methods.
“I expect this device to be a game changer for the treatment of GERD in select patients who have failed management with drugs,” says Dr. Smith.
Kenneth R. DeVault, M.D. , chair of the Department of Internal Medicine at Mayo Clinic in Florida, also participated in the studies. “I have many patients who are searching for something more than medication for their reflux, but have been hesitant to undergo a traditional reflux surgery,” he says. “I think this procedure may well be a very attractive option for that group.”
Drs. Smith and DeVault were consultants to the company that developed the device and participated in the research study. Mayo Clinic licensed related technology to the company in exchange for equity.
Forefront is a complimentary magazine from the Mayo Clinic Cancer Center, a National Cancer Institute-designated cancer center located in Arizona, Florida and Minnesota. The Cancer Center specializes in translational research and the effort to discover better ways to prevent, detect and treat cancer. It serves diverse patient populations across a broad geographic area and collaborates across the full spectrum of cancer research, from basic biology to treatment.
Email edition available Forefront articles highlight Mayo Clinic’s cancer research and its translation into clinical advances. Forefront is published in print and online annually, but beginning in summer 2012 a complimentary quarterly email edition will also be available. Subscribers to the email version receive:
In many countries of the world chicken-pox vaccine is part of the routine childhood vaccination programme. In the UK a child may have free vaccination only if they are over the age of 12 and have not had the disease. There is no current plan to introduce varicella vaccination for children.
Two doses of the vaccine fully protects against chicken-pox in 99% of cases. The tiny number who do not get full protection will experience fewer spots, milder symptoms and a speedier recovery time.
The vaccine is available at the Globe Travel Health Centre.
Source: Joint Committee on Vaccination ad Immunisation (JCVI)
For further advice, contact the Globe Travel Health Centre on 01603 667323
LASIK Surgeon in Baltimore Announces BOTOX Cosmetic Special Offer for Valentine's Day
Dr. Jay C. Grochmal, a LASIK surgeon in Baltimore, has announced his practice will be hosting a special offer on BOTOX ® Cosmetic to provide patients with a rejuvenated appearance and improved self-confidence at a discounted rate. The offer will run until Valentine’s Day and will give patients the chance to take advantage of reduced pricing on BOTOX in Baltimore in preparation for celebrating the iconic holiday with their loved ones.
At his Baltimore cataract and LASIK surgery practice in Baltimore, Dr. Jay C. Grochmal has announced the beginning of a special offer on BOTOX ® Cosmetic for patients looking to boost their appearance before Valentine’s Day. From now until the upcoming holiday on February 14, the Grochmal Eye Center will be offering BOTOX ® Cosmetic at $9.75 per unit. Dr. Grochmal and his practice provide laser vision correction procedures such as LASIK in Maryland, as well as cosmetic enhancements including BOTOX ® injections, Juvederm®, and eyelid surgery.
Dr. Grochmal says cosmetic procedures such as the non-invasive BOTOX ® Cosmetic and surgical procedures like eyelid surgery can offer patients an aesthetic addition to their LASIK or laser vision correction surgery in order to provide a more comprehensive and noticeable enhancement to their new, clearer vision. Dermal injections like Juvederm® and BOTOX ® Cosmetic are designed to tighten loose skin and treat wrinkles and facial lines. He says with reduced pricing on BOTOX ® Cosmetic and his variety of aesthetic procedures, patients now have the opportunity to improve self confidence and tighten the skin under their eyes for a completely refreshed outlook on life.
For patients interested in taking advantage of the Grochmal Eye Center’s BOTOX ® Cosmetic special for Valentine’s Day, Dr. Grochmal says to contact his practice for more information. He also adds that consulting with an experienced and qualified practice is essential for achieving safe and effective treatment.
About Jay C. Grochmal, MD
Dr. Jay Grochmal received his medical degree from the University of Maryland, after which he completed a rotating internship at the U.S. Public Health Hospital in Baltimore. During his residency, he achieved the rank of Chief Resident at the Greater Baltimore Medical Center’s Department of Ophthalmology. Dr. Grochmal is on staff with the Greater Baltimore Medical Center and St. Agnes Hospital. He has participated in several medical mission trips to third world countries to provide his expertise in eye care, including Pakistan, Jamaica, and the Bahamas. Dr. Grochmal is also a member of the American Academy of Ophthalmology.
Located at 405 Frederick Road, Suite 102 in Baltimore, MD, the Grochmal Eye Center can be reached at (410) 697-4090. It can also be contacted online via the website grochmaleye.com or facebook.com/grochmaleye.
Generic drugs account for almost 80 percent of all prescribed medications in the United States and most states allow generic drugs to be dispensed in place of brand-name drugs. This is quite a large number of generic drugs being taken by quite a large number of the nation’s population. The possibility of people who take generic drugs and having reactions to the drugs is also large – unfortunately, this is what is happening across the country. People, who are taking generic drugs, are having severe complications from taking the drugs. Reactions to these generic drugs are very serious, with some consumers developing inflammatory bowel disease, gangrene, and even movement disorders.
What is even more distressing is that the manufacturers of these generic drugs are protected by a U.S. Supreme Court ruling. In a 5-4 decision, the Supreme Court ruled in June 2011 that makers of generic drugs cannot be sued for not including side-effect warnings on their labels, if the warnings are also not on the labels of their brand-name equivalent. This makes it difficult for consumers who may not know they are receiving a generic form of a drug, such as in a hospital, or may be required by their insurance plan to fill a prescription with a generic drug. If they develop a medical issue while taking a generic form of a prescription drug, they basically have no legal remedy.
The Supreme Court ruling is based on the Hatch-Waxman Act of 1984. This law allowed companies to skip the involved process required to approve new drugs, if they could prove that the generic drug was equivalent to its brand-name counterpart. However, Representative Henry A. Waxman, who co-wrote the Act, has stated that “Congress did not intend for consumers’ rights to be categorically eliminated simply because they purchased a generic rather than a brand-name drug.” Mr. Waxman is investigating a change in the ruling.
Consumers should protect themselves and do their own research before taking any drug – check with your doctor about generic versus brand-name prescriptions and find out about all the possible risks and side effects.
Rosebud O. Roberts, M.B.Ch.B. with the Division of Epidemiology, discusses a study that measured the incidence of MCI and its subtypes using published criteria. Results showed a statistically significant difference between incidence rates among men and women. The study also found that individuals with only a high school education developed either aMCI or naMCI at a higher rate than those with some higher education.
The study was published in the Jan. 25, 2012, issue of Neurology.
ABSTRACT Objective Although incidence rates for mild cognitive impairment (MCI) have been reported, few studies were specifically designed to measure the incidence of MCI and its subtypes using published criteria. This study estimates the incidence of amnestic MCI (aMCI) and nonamnestic MCI (naMCI) in men and women separately.
Methods A population-based prospective cohort of Olmsted County, Minn., residents age 70 to 89 on Oct. 1, 2004, underwent baseline and 15-month interval evaluations that included:
The Clinical Dementia Rating scale
A neurologic evaluation
Neuropsychological testing
A panel of examiners blinded to previous diagnoses reviewed data at each serial evaluation to assess cognitive status according to published criteria.
Results Among 1,450 subjects who were cognitively normal at baseline, 296 developed MCI.
The age- and sex-standardized incidence rate of MCI was 63.6 (per 1,000 person-years) overall, and was higher in men (72.4) than women (57.3) and for aMCI (37.7) than naMCI (14.7).
The incidence rate of aMCI was higher for men (43.9) than women (33.3), and for subjects with ≤12 years of education (42.6) than higher education (32.5).
The risk of naMCI was also higher for men (20.0) than women (10.9) and for subjects with ≤12 years of education (20.3) than higher education (10.2).
Conclusions The incidence rates for MCI are substantial. Differences in incidence rates by clinical subtype and by sex suggest that risk factors for MCI should be investigated separately for aMCI and naMCI, and in men and women.
LASIK Surgeon in Baltimore Announces BOTOX Cosmetic Special Offer for Valentine's Day
Dr. Jay C. Grochmal, a LASIK surgeon in Baltimore, has announced his practice will be hosting a special offer on BOTOX ® Cosmetic to provide patients with a rejuvenated appearance and improved self-confidence at a discounted rate. The offer will run until Valentine’s Day and will give patients the chance to take advantage of reduced pricing on BOTOX in Baltimore in preparation for celebrating the iconic holiday with their loved ones.
At his Baltimore cataract and LASIK surgery practice in Baltimore, Dr. Jay C. Grochmal has announced the beginning of a special offer on BOTOX ® Cosmetic for patients looking to boost their appearance before Valentine’s Day. From now until the upcoming holiday on February 14, the Grochmal Eye Center will be offering BOTOX ® Cosmetic at $9.75 per unit. Dr. Grochmal and his practice provide laser vision correction procedures such as LASIK in Maryland, as well as cosmetic enhancements including BOTOX ® injections, Juvederm®, and eyelid surgery.
Dr. Grochmal says cosmetic procedures such as the non-invasive BOTOX ® Cosmetic and surgical procedures like eyelid surgery can offer patients an aesthetic addition to their LASIK or laser vision correction surgery in order to provide a more comprehensive and noticeable enhancement to their new, clearer vision. Dermal injections like Juvederm® and BOTOX ® Cosmetic are designed to tighten loose skin and treat wrinkles and facial lines. He says with reduced pricing on BOTOX ® Cosmetic and his variety of aesthetic procedures, patients now have the opportunity to improve self confidence and tighten the skin under their eyes for a completely refreshed outlook on life.
For patients interested in taking advantage of the Grochmal Eye Center’s BOTOX ® Cosmetic special for Valentine’s Day, Dr. Grochmal says to contact his practice for more information. He also adds that consulting with an experienced and qualified practice is essential for achieving safe and effective treatment.
About Jay C. Grochmal, MD
Dr. Jay Grochmal received his medical degree from the University of Maryland, after which he completed a rotating internship at the U.S. Public Health Hospital in Baltimore. During his residency, he achieved the rank of Chief Resident at the Greater Baltimore Medical Center’s Department of Ophthalmology. Dr. Grochmal is on staff with the Greater Baltimore Medical Center and St. Agnes Hospital. He has participated in several medical mission trips to third world countries to provide his expertise in eye care, including Pakistan, Jamaica, and the Bahamas. Dr. Grochmal is also a member of the American Academy of Ophthalmology.
Located at 405 Frederick Road, Suite 102 in Baltimore, MD, the Grochmal Eye Center can be reached at (410) 697-4090. It can also be contacted online via the website grochmaleye.com or facebook.com/grochmaleye.
We were recently privileged to have New York Times bestselling author, and former Navy SEAL, Brandon Webb, speak at Eye Consultants of Texas in Grapevine. It was the idea of founder Phillips Kirk Labor, MD, to host this event, primarily for his staff and a group of local law enforcement officers, as well as special guests.
A highly sought-after motivational speaker, Brandon focused his talk on the importance of attention to detail and striving for excellence. His New York Times bestselling book, The Red Circle, shares his personal story of dealing with adversity in a positive and constructive way, and passes on valuable leadership lessons he learned as a Navy SEAL. Everyone in attendance at our practice was incredibly inspired, just like all of Brandon’s audiences in his speaking engagements across the U.S.
In addition to inviting him to speak, Dr. Labor invited Brandon into the operating room to observe actual cataract procedures. Recently, Brandon wrote about his Eye Consultants of Texas visit and experiences in his blog.
Here is an excerpt from Brandon’s blog:
“The last part of September I had a chance to visit with Dr. Kirk Labor and his team at Eye Consultants of Texas. I was invited to sit in on a few Cataract procedures, and actually assisted in a minor way. I’ve been fortunate to tour plenty of U.S. companies when I was an active SEAL and after. Companies like Smith & Wesson, Nixon, ABC news, St. Martin’s Press, L-3, and many others. I can honestly say that Dr. Labor and his staff run an excellent facility and operation compared to these other organizations. They set the bar high, and are far ahead of the competition from my perspective. I’d highly recommend his facility to anyone regardless of your geographic location. For now, my own sniper eyes are good-to-go, if they start having problems I’ll have no problem flying to Texas. Excellence matters and I want only the best working on my eyes.”
In an email to Brandon, thanking him for coming, Dr. Labor said:
“The reports I have from those in attendance have been nothing but positive. I really think it helped my staff to hear about those attributes from someone other than me, and will serve the practice and my patients well going forward. I hope you enjoyed being here as much as we enjoyed having you. I know the girls in the operating room loved having you there (as did the patients; particularly the Vietnam veteran we operated on)!”
A dozen people have become ill after gathering and eating shellfish from the shoreline in parts of the west and south-west of Ireland. Illness has been reported in Galway, Mayo and Sligo. It is possible these are linked to marine algal blooms occurring naturally in these areas.
Bivalve shellfish such as mussels, cockles, oysters, scallops and clams should only be purchased from reputable suppliers, (who manage the risks with a national monitoring propramme), not gathered in the wild for home consumption.
Source: ProMed Newsgroup
For further advice, contact the Globe Travel Health Centre on 01603 667323
The majority of states in the USA have reported cases of West Nile Fever (WNF) this year.
In those people who were severely infected, about half went on to develop meningitis or encephalitis. Most cases however, are mild and without symptoms.
This disease was first detected in the States in 1999, and this year’s numbers are the highest so far.
The greatest numbers of cases have occurred in six states (Texas, Mississippi, Luoisiana, Oklahoma, South Dakota and California), with Texas having almost half of those cases.
WNV virus is spread by Culex mosquitos, which bite mainly from dusk to dawn. Travellers should take measures to avoid mosquito bites, such as covering up after dusk and using effective repellents.
Source: ProMED-Mail
For further advice, contact the Globe Travel Health Centre on 01603 667323
Steven R. Ytterberg, M.D., with the Department of Rheumatology at Mayo Clinic in Rochester, Minn., discusses a study that examined similarities and differences between two forms of vasculitis: giant cell arteritis and Takayasu’s arteritis. Findings suggest that TAK and GCA may exist on a spectrum within the same disease. The study was published online on Feb. 10, 2012 in the Annals of the Rheumatic Diseases.
ABSTRACT Objectives To compare patterns of arteriographic lesions of the aorta and primary branches in patients with Takayasu’s arteritis (TAK) and giant cell arteritis (GCA).
Methods Patients were selected from two North American cohorts of TAK and GCA. The frequency of arteriographic lesions was calculated for 15 large arteries. Cluster analysis was used to derive patterns of arterial disease in TAK versus GCA and in patients categorized by age at disease onset.
Using latent class analysis, computer derived classification models based upon patterns of arterial disease were compared with traditional classification.
Results Arteriographic lesions were identified in 145 patients with TAK and 62 patients with GCA. Cluster analysis demonstrated that arterial involvement was contiguous in the aorta and usually symmetric in paired branch vessels for TAK and GCA. There was significantly more left carotid (p=0.03) and mesenteric (p=0.02) artery disease in TAK and more left and right axillary (p<0.01) artery disease in GCA. Subclavian disease clustered asymmetrically in TAK and in patients ≤55 years at disease onset and clustered symmetrically in GCA and patients >55 years at disease onset.
Computer-derived classification models distinguished TAK from GCA in two subgroups, defining 26 percent and 18 percent of the study sample; however, 56 percent of patients were classified into a subgroup that did not strongly differentiate between TAK and GCA.
Conclusions Strong similarities and subtle differences in the distribution of arterial disease were observed between TAK and GCA. These findings suggest that TAK and GCA may exist on a spectrum within the same disease.
Authors Peter C. Grayson, Kathleen Maksimowicz-McKinnon,Tiffany M. Clark, Gunnar Tomasson, David Cuthbertson, Simon Carette, Nader A .Khalidi, Carol A. Langford, Paul A. Monach, Philip Seo, Kenneth J. Warrington, M.D., Steven R. Ytterberg, M.D., Gary S. Hoffman, and Peter A. Merkel, for the Vasculitis Clinical Research Consortium
Abigail was a 36 year old when she came to us, she had severe endometriosis and she was not able to undergo ovarian stimulation because she suffered from extreme pelvic pain with ovulation and ovarian stimulation could make her endometriosis worse. Her husband’s sperm was normal. She had damaged tubes and needed IVF to help [...]
Human exposure to rabid animals has occurred in Iowa, Vermont and Texas this year. The animals involved were a bat, a stray cat and a cow that was a family pet.
Travellers should be aware that rabies virus is present in wild animals in the US, including racoons, skunks and bats.
Any animal bites should be promptly assessed by a doctor.
Source: ProMED-Mail 2012
For further advice, contact the Globe Travel Health Centre on 01603 667323
There is at present an acute shortage of rabies vaccine throughout the UK. There will be no further supplies for some time.
Globe Travel Health Centre has sufficient stocks for the time being. However, to conserve stocks:
Rabies vaccine will be available on Tuesday, Thursday and Saturday clinics only.
The vaccine will be administered by the intradermal route, using a small dose of vaccine.
This is just as safe and efficiacious as the more traditional intramuscular route, but uses less vaccine.
The World Health Organisation has stated:
‘Intradermal immunisation is an acceptable alternative to standard intramuscular vaccination. Intradermal vaccination has been shown to be as safe and immunogenic as intramuscular vaccination, yet requires less vaccine. This alternative should be considered in settings constrained by cost and/or supply issues’.
Intradermal rabies vaccination costs £30.00 per dose – a course of three doses is required for primary vaccination.
For further advice, contact the Globe Travel Health Centre on 01603 667323
Forefront is a complimentary magazine from the Mayo Clinic Cancer Center, a National Cancer Institute-designated cancer center located in Arizona, Florida and Minnesota. The Cancer Center specializes in translational research and the effort to discover better ways to prevent, detect and treat cancer. It serves diverse patient populations across a broad geographic area and collaborates across the full spectrum of cancer research, from basic biology to treatment.
Email edition available Forefront articles highlight Mayo Clinic’s cancer research and its translation into clinical advances. Forefront is published in print and online annually, but beginning in summer 2012 a complimentary quarterly email edition will also be available. Subscribers to the email version receive:
Millions of Americans receive medical implants yearly and those who do presume that the implants are safe and will alleviate, or at least help to ease, their specific medical problem. However, according to a May 2012 article in Consumer Reports, “Dangerous Devices”, most implants (artificial joints, defibrillators, surgical mesh) have not been tested for safety and effectiveness. The “testing” is done on the patient who has the medical device implanted. In other words, patients are living with implants that often times give them more pain and suffering than not having had the implant at all. According to the article, the FDA is not testing medical devices and most times all that is needed for the device to be placed on the market is for the manufacturers to “. . . file some paperwork and pay the Food and Drug Administration a user fee of roughly $4,000 to start selling a product that can rack up millions of dollars in revenue. . . .” Frequently, it takes years before the FDA even tests a product or reclassifies it to a high-risk category.
It is crucial for doctors, as well as their patients, to research a medical implant thoroughly before implantation, as the consequences can be debilitating. An orthopedic surgeon, for example, who had an all-metal hip replacement (the same type of device he implanted in his patients) experienced medical issues of increased chromium and cobalt levels in blood, sleep disturbance, constant pain, mood swings and anxiety, hearing loss, tinnitus, and visual problems.
Meiselman, Denlea, Packman, Carton & Eberz P.C. offers legal advice to physicians on medical issues. If you need legal assistance or guidance on a matter regarding your practice, please call our office.
During Health IT Week, an event held at the Center for Total Health—sponsored by the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology, the National Quality Forum, and Kaiser Permanente— examined the state of electronic measurement in health care, lessons learned from the Beacon Community Program, and what’s next in meaningful use. While at the event, we were able to speak briefly with a few of the presenters about the topic. This video features interviews with Kevin Larsen, MD, Craig Brammer, and Kerri Petrin, all three of whom are with the ONC.
There are many medications used for treating back pain. Medications can be grouped by delivery method – into oral medications, topical medications, and injected medications. There are also different types of medications, which include steroids, narcotics, muscle relaxants, pain killers (such as acetaminophen), and anti-depressants.
Different medications used to control back pain fall into different categories. Now, the broad spectrum of the categories can be broken down initially into the way we take the medication itself. So, (1) oral medications, (2) those that can be used as topical medications, and (3) those that need to be injected.
To talk about the oral medications, which are more commonly used as an initial treatment. Over-the-counter medications that control the pain, such as Tylenol, can be used to control the pain itself. Now if we are actually employ the use of the anti-inflammatory and pain control, we can seek the aid of non-steroidal anti-inflammatory medications. The most common ones are ibuprofen, naproxen, and the common brand names are Aleve, Motrin, Advil.
The other medications that can be used are steroids. If there is a lot of inflammation that causes the back pain, oral steroids can be employed. Now, generally, we don’t like to use oral steroids for a variety of reasons – they don’t tend to help pain that is axial, or in other words pain that is limited to the actual back without radiating into the extremities. So, we are actually using the steroids very sparingly because it has systemic effects - although minimal, but it does - and as with any treatment, we try to minimize the systemic effect or any side effect by achieving the highest yield in terms of relieving pain. So, steroids can be used, but are not commonly used.
Another type of medication is narcotic medication. Now, narcotic medications are opiods and they are used to dissociate the patient from the pain. They are usually used for severe, acute pain. They are meant to be used for a short period of time, such as the initial injury, trauma, or onset of acute pain or they can be used in post-operative pain control.
Another group of medications are muscle relaxants. Now, muscle relaxants are used to decrease the tone of the muscles and the reason to use them is because in many cases of back pain, muscle spasm is what usually accompanies it.
Another oral medication that can be used to control back pain is antidepressants and a variety of antidepressants can be used. An example of those would be tricyclic antidepressants or antidepressants like Cymbalta.
There are certain medications that can be used by just putting it on the skin over the area that is affected and that can be helpful. The benefit of these medications is that it is directly applied to where the pain is and where the injury is. The medications are either anti-inflammatory or pure painkillers. So the pure painkillers are things like lidoderm patch, which is lidocaine which is slowly released through a patch through the skin and that can be applied to just numb up the area and reduce the localized pain. Another type is the use of diclofenac, which is one of the older non-steroidal anti-inflammatory medications and that can be used in the form of a patch as Inflector patch or in the form of a cream, such as Voltaren or other formulations. The benefit of this is it is localized and systemic absorption is quite limited. That limitation is the fact that it only penetrates a certain depth and so really the use is, to an extent, limited.
Another group of the medications are the group that is injected and there are really two main ones that are used for back pain. One is non-steroidal anti-inflammatory medication that can be injected, such as Toradol, and that’s injected into the muscle and the effect is systemic - or in other words it affects the whole body - in reducing the pain and its anti-inflammatory action. Another one is anesthetic, which is anesthetic like lidocaine, bupivacaine, or any other form of an anesthetic that is used to numb up the area. That can be used either to break up a muscle spasm or to numb up an area so that other manipulations can be performed in order to relieve the pain.
Another medication that can be used as an injectable is a steroid. A corticosteroid, as opposed to an oral corticosteroid, goes directly to where the problem is. So, it doesn't have to be systemically absorbed - it bypasses the systemic effect - even though it is systemically absorbed to a small degree, but it bypasses the major systemic side effects and its concentration doesn't have to be diluted by all the processes that have to happen in our body to get that medication to the source of the pain.
So, that really is a general overview of the medications we can use in controlling, in relieving, and in treating back pain.
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There are a few different types of spinal injections, categorized by what is being injected and where the injection takes place. This video explains epidural steroid injections, selective nerve root blocks, facet joint injections, radiofrequency neurotomies, and sacroiliac joint injections, along with why and how each type of injection is used.
In discussing common spinal injections, it's important to remember what we’re trying to achieve and then choose the appropriate tool for the job. So, to discuss the injections, we'll break them up into small categories.
Epidural steroid injections can be done in mainly two ways. First of all, what we're trying to achieve is to place the steroid into the epidural space. Epidural space in itself denotes space that is intimately located above the dura. Dura is the outermost layer covering the spinal cord and the nerves that exit the spinal cord. Most of the inflammation occurs in that area and that is the area that we can place the medications most safely. This can be approached in two ways. One is what’s called "interlaminar" - that means between these lamina. That can be approached from what's called paramedian - or just off the mid-line - approaching this way. Another approach is called the transforaminal - what that means is "across the foramen." Foramen being this opening through which the nerve exits. The approach is taken by going into space where the nerve usually doesn't appear and this is done under the guidance of x-ray or fluoroscopy.
Another type of injection is called selective nerve root block. Selective nerve root block is selectively choosing a specific nerve in order to determine whether that nerve is causing the pain. And in order to that, we approach under the guidance of fluoroscopy, to target a specific nerve then place a small amount of (usually) contrast to outline that we are really concentrating on this nerve root, then place a very small amount of anesthetic. Now, the small amount is important because we don't want that that anesthetic to spread anywhere else and affect our outcome. If the pain is relieved with this injection, then we know that was the cause of the pain or a pain generator.
Another injection is a facet joint injection. This can be approached in two ways. One is the injection into the joint itself and in order to do that we use fluoroscopy for guidance and we approach the joint itself, going into the joint, and then place the medication into the joint. And the reason to do that is (1) to determine if injecting anesthetic and corticosteroid will relieve the pain - and that is the diagnostic part of this - and (2) the corticosteroid reduces the inflammation.
Another way to approach facet mediated pain is by blocking the nerve that actually transmits that pain. And the reason we can do that is because, anatomically, it is consistently found in the same place. It is found traveling along this path. And what we can do, once again under fluoroscopic guidance, we approach the anatomical location of this branch placing a small amount of medication, blocking the transmission of that nerve temporarily. And that, once again, diagnostically tells us: if we block this nerve, does this relieve the pain? Now, it’s not as simple as that because there are two nerves that usually supply each facet joint, so in order to really effectively block one joint, we have to block two nerves and that way we know that joint is blocked and then we see if it truly alleviates the pain or not.
That leads me into another type of an injection, which truly is not an injection, but more of an intervention to treat facet joint pain - that is the medial branch rhizotomy. And in order to do that, what we do is we place a probe - that is just like a needle - along the path of this medial branch and then we use radiofrequency to concentrate at the tip of that probe to heat it up and then lice the little nerve that travels along the path, effectively eliminating the transmission of the pain. The effect of this doesn't happen right away; it takes several weeks to take effect, but it provides a longer-term relief for people suffering from facet mediated pain.
Another type of a spinal injection is used to treat and diagnose sacroiliac joint pain. So, once again under fluoroscopic guidance in order to ensure the safety as well as the precision, we go into the sacroiliac joint placing a small amount of contrast to outline where the medication is going to spread, then we use a small amount of anesthetic with corticosteroid. The anesthetic serves as the diagnostic portion - if the pain is eliminated, then we know that was the pain generator and we've effectively diagnosed sacroiliac joint pain. Then, corticosteroid reduces the inflammation that usually is the cause of the pain and that is the therapeutic portion of this.
There are many other interventions that we can use for the spine, but these are the more common ones.
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Cataract & Refractive Surgery Today, a major industry publication, recently asked Phillips Kirk Labor, MD to share his expertise about a revolutionary cataract surgery technology he introduced to Dallas/Fort Worth in 2011. The result was an article Dr. Labor authored, Updating Your Practice With Advanced Technology, with the subtitle, Intraoperative aberrometry is a worthwhile investment for the practice and provides added security for cataract patients. The article appeared nationwide in the October 2012 issue.
A prime example of intraopertive aberrometry he discusses is the ORA System. This is a “wavefront aberrometry device,” the first of its kind to measure cataract surgery results in real time – during the procedure. Previously called ORange, Dr. Labor was the first metro Dallas/Fort Worth eye surgeon to use this technology when it was introduced in 2011. When ORange changed to the further enhanced ORA System, Dr. Labor remained at the forefront as an early adopter of this newer, better technology. Today, he is one of the top ORA surgeons in the world.
“Cataract & Refractive Surgery Today is a trusted, highly regarded publication among leading surgeons all over the world. I was grateful when they contacted me, and didn’t hesitate to do it,” Dr. Labor said. “Although written for our industry, my main goal, however, was to share my experiences and successes related to how this benefits the patient first.”
To learn more about the ORA System, or any our comprehensive eye care services, please call us in Grapevine at 877-516-4364. We’re conveniently located to all of Fort Worth and Dallas.
We were recently privileged to have New York Times bestselling author, and former Navy SEAL, Brandon Webb, speak at Eye Consultants of Texas in Grapevine. It was the idea of founder Phillips Kirk Labor, MD, to host this event, primarily for his staff and a group of local law enforcement officers, as well as special guests.
A highly sought-after motivational speaker, Brandon focused his talk on the importance of attention to detail and striving for excellence. His New York Times bestselling book, The Red Circle, shares his personal story of dealing with adversity in a positive and constructive way, and passes on valuable leadership lessons he learned as a Navy SEAL. Everyone in attendance at our practice was incredibly inspired, just like all of Brandon’s audiences in his speaking engagements across the U.S.
In addition to inviting him to speak, Dr. Labor invited Brandon into the operating room to observe actual cataract procedures. Recently, Brandon wrote about his Eye Consultants of Texas visit and experiences in his blog.
Here is an excerpt from Brandon’s blog:
“The last part of September I had a chance to visit with Dr. Kirk Labor and his team at Eye Consultants of Texas. I was invited to sit in on a few Cataract procedures, and actually assisted in a minor way. I’ve been fortunate to tour plenty of U.S. companies when I was an active SEAL and after. Companies like Smith & Wesson, Nixon, ABC news, St. Martin’s Press, L-3, and many others. I can honestly say that Dr. Labor and his staff run an excellent facility and operation compared to these other organizations. They set the bar high, and are far ahead of the competition from my perspective. I’d highly recommend his facility to anyone regardless of your geographic location. For now, my own sniper eyes are good-to-go, if they start having problems I’ll have no problem flying to Texas. Excellence matters and I want only the best working on my eyes.”
In an email to Brandon, thanking him for coming, Dr. Labor said:
“The reports I have from those in attendance have been nothing but positive. I really think it helped my staff to hear about those attributes from someone other than me, and will serve the practice and my patients well going forward. I hope you enjoyed being here as much as we enjoyed having you. I know the girls in the operating room loved having you there (as did the patients; particularly the Vietnam veteran we operated on)!”
Millions of Americans receive medical implants yearly and those who do presume that the implants are safe and will alleviate, or at least help to ease, their specific medical problem. However, according to a May 2012 article in Consumer Reports, “Dangerous Devices”, most implants (artificial joints, defibrillators, surgical mesh) have not been tested for safety and effectiveness. The “testing” is done on the patient who has the medical device implanted. In other words, patients are living with implants that often times give them more pain and suffering than not having had the implant at all. According to the article, the FDA is not testing medical devices and most times all that is needed for the device to be placed on the market is for the manufacturers to “. . . file some paperwork and pay the Food and Drug Administration a user fee of roughly $4,000 to start selling a product that can rack up millions of dollars in revenue. . . .” Frequently, it takes years before the FDA even tests a product or reclassifies it to a high-risk category.
It is crucial for doctors, as well as their patients, to research a medical implant thoroughly before implantation, as the consequences can be debilitating. An orthopedic surgeon, for example, who had an all-metal hip replacement (the same type of device he implanted in his patients) experienced medical issues of increased chromium and cobalt levels in blood, sleep disturbance, constant pain, mood swings and anxiety, hearing loss, tinnitus, and visual problems.
Meiselman, Denlea, Packman, Carton & Eberz P.C. offers legal advice to physicians on medical issues. If you need legal assistance or guidance on a matter regarding your practice, please call our office.
November marks the start of the American Diabetes Month®, an event sponsored by the American Diabetes Foundation®. A leading cause of blindness among adults, ExamHealth reports on something that every diabetes patient should be thinking about this time of year: a 
