deandouglers: January 2013

Thursday, January 31, 2013

The incidence of MCI differs by subtype and is higher in men: The Mayo Clinic Study of Aging

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.

Authors
Rosebud.O. Roberts, M.B.Ch.B., Yonas E. Geda, M.D., David S. Knopman, M.D., Ruth H. Cha, Vernon (Shane).S. Pankratz, Ph.D., Bradley F. Boeve, M.D., Eric G. Tangalos, M.D., Robert J. Ivnik, Ph.D., L.P., Walter A. Rocca, M.D., Ronald C. Petersen, M.D., Ph.D.

Source: http://physicianupdate.mayoclinic.org/2012/02/17/the-incidence-of-mci-differs-by-subtype-and-is-higher-in-men-the-mayo-clinic-study-of-aging/

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Food Banks Look to Offer More Nutritious Food

With the holiday season upon us, many turn their thoughts to the importance of food banks to provide healthy meals for those in need. In fact, nearly 6.1 million U.S. households rely annually on food banks and pantries for their meals, and not just at Thanksgiving. To make sure that food banks provide nutrition as well as sustenance, several food banks are redefining their standard food offerings and working to make nutritious, healthy foods more available. The 12 participating food banks are part of the Healthy Options, Healthy Meals™ initiative, a partnership between MAZON: A Jewish Response to Hunger, and Kaiser Permanente. The Center for Total Health blog recently spoke with Marla Feldman, director for the Healthy Options, Healthy Meals™ initiative to learn more about this important work.

CTH blog:
Tell us about your organization and your approach to preventing hunger in our society.

Marla Feldman:

A Jewish Response to Hunger is a national nonprofit organization working to end hunger among people of all faiths and backgrounds in the United States and Israel. Since our founding in 1985, MAZON has practiced and promoted a holistic approach to preventing hunger, advocating to ensure that hungry people have access to the nutritious food they need today and working to develop and advance long-term solutions so that no one goes hungry tomorrow.

CTH blog:

What are you seeing right now in terms of demand for emergency food assistance and how food banks are meeting this demand?

Marla Feldman:

The downturn in the economy has caused tremendous growth in demand at food banks and food pantries—between 30-70 percent year-over-year since 2009—coupled with an appreciable decrease in donations to their organizations. Needless to say, these challenges put a significant strain on emergency food providers’ ability to meet the needs of hungry people in their communities, and many are struggling to keep up.

CTH blog:

You recently partnered with Kaiser Permanente on the Healthy Options, Healthy Meals™ initiative. What is the primary goal of the initiative and how did it originate?

Marla Feldman:

The goal of Healthy Options, Healthy Meals™ is simple: to get healthier food to the people who need it—specifically, those who must rely on food banks to feed their families.

MAZON has been helping to increase capacity within the anti-hunger community for 15 years. From 1998 to 2010, MAZON hosted annual conferences bringing California’s anti-hunger community together to discuss current budget and policy priorities and help direct their advocacy efforts. By 2003, our conference presented workshops that explored ways the anti-hunger community could play a lead role in preventing obesity and diet-related illnesses. Those initial discussions led to the 2007 launch of a three-year California initiative to promote healthier eating in low-income communities. This program attracted the interest of Kaiser Permanente, and Healthy Options, Healthy Meals™ was born.

It is important to note that food banks began in the 1970s with the intention of gathering surplus food to distribute as a stopgap measure to help people get through emergency situations. Whether or not the food that was provided was nutritious wasn’t really a primary issue, because it was providing for a need that was temporary. But as the role of food banks has evolved over time, food banks have had to adapt and grow. Now, with the rise in obesity and its relationship to food insecurity, food banks have come to embrace the role they play not only in alleviating hunger, but also in building healthier communities.

CTH blog:

Why is it so important to establish formal nutrition policies at food banks? Tell us more about the collaborative process you are engaging in to create these policies and the successes you’re seeing.

Marla Feldman:

In a nutshell, formal, written nutrition policies provide a concrete blueprint for how emergency food providers can increase the nutritional quality of the foods and beverages they distribute. Having policies is important for a number of reasons: they provide guidance in ambiguous situations, where “common sense” and good intentions may not be enough; they ensure continuity and consistency through staff changes; they support educating donors about the types of donations they prefer to receive; they help steer outreach and nutrition education efforts; and they change the way food banks are talking about their work. This process is about building organizational culture and making organizational changes that are helping food banks become nutrition banks.

Creating a nutrition policy is a more complex task than you might think, because the most effective ones are created through a deliberate process of cooperation and collaboration of all organizational stakeholders—from the Board of Directors and Executive Director to those who work in the warehouse; from procurement staff to marketing to operations; and from donors to agencies to clients. Engaging so many key stakeholders in the policy development process is not the cultural norm for food banks. That’s why our Healthy Options, Healthy Meals™ initiative is so revolutionary and important.

CTH blog:

What’s the best thing one person can do right now to help those in need get access to nutritious food?

Marla Feldman:

As a long-time employee of an anti-hunger advocacy organization, I’d have to say that it’s paramount that we create the political will to end hunger and malnutrition in America. I’d encourage people to get out and advocate on behalf of those who are vulnerable. Impress upon your federal and state policymakers that we will no longer accept that 50 million people, in the wealthiest country in the world, struggle to put nutritious food on the table. It’s much easier than you think to call your Senator and Congressperson or to make an appointment to speak with someone in their office. And, rest assured, they do want to hear from you, and it does make a difference!

Source: http://centerfortotalhealth.org/2012/food-banks-look-to-offer-more-nutritious-food/

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Blowing our own trumpet

We are very excited about our 2011 success rates and here are the reasons why. Most people use success rate statistics when making a decision about which IVF clinic to use, but these figures should not be taken in isolation. You should always talk to the clinic about your individual likelihood of success in relation [...]

Source: http://www.createhealthclinics.org/blog/success-stories/blowing-our-own-trumpet/

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Filariasis basics for travelers

Source: http://adventuredoc.net/2012/04/29/filariasis-basics-for-travelers/

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Black Blood Must Not Contaminate White Folks (Essay 25)

Source: http://bernardlown.wordpress.com/2011/09/03/black-blood-must-not-contaminate-white-folks/

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Cholera outbreak in Malaysian Borneo

New cases of cholera continue to reported in the Bintulu district of Borneo. Travellers should avoid buying drinks with ice, uncooked salad dishes and ice-cream, as the water used may not have been boiled to decontaminate it. They should also avoid premises that are not spotlessly clean.

Source: ProMed Newsgroup

For further advice, contact the Globe Travel Health Centre on 01603 667323

Source: http://www.globetravelhealthcentre.com/travel-advice/cholera-outbreak-in-malaysian-borneo.html?utm_source=rss&utm_medium=rss&utm_campaign=cholera-outbreak-in-malaysian-borneo

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Wednesday, January 30, 2013

Careers As Advanced Health Care Practitioner In Demand

According to data collected by the American Medical Group Association’s and Cejka Search 2011 Physician Retention Survey, careers in the advanced health care field are growing rapidly. As such, employment in medical groups for nurse practitioners (“NPs”) and physician assistants (“PAs”) has increased significantly in the past five years. According to the data, 75% of the responses to the survey indicated more NPs and PAs will be hired in the next five years.

Growth in these advanced health care professions is due largely to economics, according to an article in U.S. News and World Report. NPs, for example, can provide patients with many primary health care services at a fraction of the cost of an internist. In addition, FiercePracticeManagement reports that due to physician shortages and the demand to create a medical “team” to care for patients (accountable care organizations, “ACO”), medical groups are employing the NP and PA at increasingly high rates. This gives NPs and PAs the advantage of choosing where to work, thus creating a high turnover rate for these positions. In addition, recruiting and retaining these professionals are challenges to medical groups.

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.

Source: http://www.pagingdrblog.com/2012/04/17/careers-as-advanced-health-care-practitioner-in-demand/

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Power to the people: Patient in command

Source: http://bernardlown.wordpress.com/2012/11/03/power-to-the-people-patient-in-command/

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Healthy Aging in the New Year

At a time when most of us are digging deep to find the passion and will power that will help us make healthy changes in the new year, it is inspiring to come across a personal story like this one — someone who has made changes and continues those healthy habits (to great success) at the age of 85.

Jane Carlstrom didn’t start exercising regularly until she was 50. After more than 30 years, she actually enjoys spinning classes and weightlifting. She has found her activities support her physical health as well as her social well being. Check out Jane in action in this video.

If you are looking to become—and stay—more active in 2013, Kaiser Permanente’s Bob Sallis, MD, offers tips to help you stay on track with a walking regimen in the video below.

Here’s to a year of healthy choices and healthy changes in 2013!

Source: http://centerfortotalhealth.org/2013/healthy-aging-in-the-new-year/

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Private Practice Or Hospital Employment?

According to data released by Medscape Medical News, physician employment by hospitals has increased since 2000. This increase is partly due to the protection that working for a large entity affords a physician. Many physicians feel that they can truly focus upon their specialized field by working in a hospital environment, as opposed to opening a private practice.

Working for a hospital relieves the physician of trying to keep up with complex private health care insurance and government regulations, investing in medical equipment and technology, marketing and HR issues. While owning a private practice gives a physician more independence and the physician is not constrained by the hospital’s policies or procedures, the private-practice physician must be concerned with all the business issues, which could be undertaken by a hospital employer.

It seems the current trend is leaning toward more physicians choosing to work for a hospital, with the private-practice physician becoming rare. But, as Uwe Reinhardt, Ph.D., a healthcare economist at Princeton University, told Medscape, “Don’t forget, there are cycles. Some years from now, there will be a whole new trend. Physicians working in hospitals will see what is profitable and what is not, and will jump out and establish practices in the profitable things.”

Source: http://www.pagingdrblog.com/2012/04/12/private-practice-or-hospital-employment/

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Black Blood Must Not Contaminate White Folks (Essay 25)

Source: http://bernardlown.wordpress.com/2011/09/03/black-blood-must-not-contaminate-white-folks/

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Fight Seasonal Bugs with Good Hand Hygiene

It’s that time of year – cold and flu season is upon us. We all know the best way to keep sickness at bay is to wash our hands often. What most people don’t know is that there really is a right way to wash hands, and it takes about the same amount of time as singing “Happy Birthday.” It looks like this (courtesy of the World Health Organization):

The WHO has a global campaign around clean hands. Its website has resources for health facilities – like a Hand Hygiene Self-Assessment Framework, as well as tools for system change, training and education, reminders in the workplace, and evaluation and feedback.

Source: http://centerfortotalhealth.org/2012/fight-seasonal-bugs-with-good-hand-hygiene/

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Tuesday, January 29, 2013

Guidelines for sore throat management

Source: http://adventuredoc.net/2012/11/14/guidelines-for-sore-throat-management/

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Enormity of US Military impedes nuclear abolition (Essay 27)

Source: http://bernardlown.wordpress.com/2011/11/28/enormity-of-us-military-impedes-nuclear-abolition/

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New York State Governor Investigates Out-Of-Network Costs

New York State Governor Andrew Cuomo recently announced the continuation of an investigation into out-of-network medical costs. In 2011, the state received more than 2,000 complaints from consumers who unexpectedly received bills from out-of-network specialists and providers after taking measures to choose in-network providers and receive prior insurer approval. Consumers often are not told in advance which specialists are out-of-network, how much they charge, and how much of their fee will be covered by health insurance. The resulting bills contribute to financial strain on consumers, many of whom are unable to pay the amount charged and some of whom are forced into bankruptcy.

To aid consumers in obtaining information on out-of-network care, costs, and coverage, the New York State Department of Financial Services is calling for more transparency, better consumer protection, and system-wide reform. This follows efforts by the Obama administration to require health insurers to provide such easy-to-understand information to consumers. If you are concerned about the potential impact of reforms and new rules, please feel free to contact us to discuss your options and assist you in making decisions regarding your practice.

Source: http://www.pagingdrblog.com/2012/03/15/new-york-state-governor-investigates-out-of-network-costs/

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Nature has the upper hand. So far it has “gently” protested, but …

Source: http://bernardlown.wordpress.com/2013/01/27/441/

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Reflections on World AIDS Day with Michael Horberg, MD

World AIDS Day is Dec. 1; this year’s theme is ‘Working Together for an AIDS-Free Generation’

Michael Horberg, MD, is Kaiser Permanente’s national director for HIV/AIDS. Appointed to Obama’s Presidential Advisory Council on HIV/AIDS in 2010, Dr. Horberg hopes to make Kaiser Permanente’s best practices a part of national policy. Practicing at Michael Reese and Northwestern Memorial hospitals in the Chicago area for 10 years before coming to California, he has spent most of his medical career in the fight against the disease. He also is chair of the board of directors of the HIV Medicine Association, an organization of 5,000 HIV clinicians in the U.S. and abroad. We caught up with him recently about his work in this field.

CTH Blog:
You’ve been committed to the fight against AIDS/HIV for three decades. What has this journey been like for you?

Michael Horberg, MD:
Professionally, the journey has been extraordinarily rewarding. It has led to a career in advanced HIV care, research and advocacy, with leadership in the HIV Medicine Association, as well as previously the Gay and Lesbian Medical Association. I know I’m a better doctor because of my work in HIV — the continuing education, learning new research and new medications/treatments daily, and the phenomenal collaborations with my Kaiser Permanente colleagues.

On a personal level, the last three decades have also been quite a journey. In the early 1980s, when the first patients infected by the HIV virus were being treated, I was in my third year of medical school. I knew I was gay, but I wasn’t ready for anyone else to know that. It was the fear of rejection, the fear of being ostracized, even in the medical community, of not being able to attract any patients. Ironically, the onset of the AIDS crisis is what finally helped to liberate me. As patients with HIV symptoms, including some of my close friends, began coming to me in private practice, I realized stepping out of the closet would help them get the care they needed and allow me to be a more powerful advocate for specialized care. Furthermore, being able to help my gay and lesbian brothers and sisters fulfilled my desire to meld technical skill with compassion. Especially early in the crisis when there was a limit for what we could do for patients, really caring, really showing love was critical.

CTH Blog:
What continues to motivate you in the fight against HIV/AIDS?

MH:
It’s been more than three decades since AIDS was first reported and the statistics of the epidemic still continue to haunt me. Every day, more than 150 people in the United States become infected with HIV. That adds up to between 50,000 and 56,000 people a year – just in the United States. And racial and ethnic minorities in gay and bisexual men are disproportionately impacted by this epidemic. About half of the nation’s HIV population is African-American – yet African-Americans have a 15 percent greater chance of dying from HIV than white Americans. This is a disease of disparities.

Until we no longer have an epidemic, I will continue to be motivated.

CTH Blog:
At the International AIDS Conference Washington D.C this summer, of which Kaiser Permanente was a key sponsor, there was a lot of discussion about an AIDS-free generation. Do you think that’s possible?

MH:
Yes, there is great hope. It can be achievable, but it requires resources, increased research, and increased access to quality HIV care for all living with HIV. I am proud to support the concept of an AIDS-free generation and working towards that goal. As a leader in HIV treatment, what we are doing at Kaiser Permanente and the tools and research we can share with the world, it’s entirely possible.

CTH Blog:
How has Kaiser Permanente been a leader in HIV treatment?

MH:
Kaiser Permanente has an outstanding record of successful HIV clinical care outcomes. Our care teams have treated more than 60,000 people and have reduced disparities among its current HIV population of approximately 20,000 people by working to meet or exceed the objectives of the U.S. National HIV/AIDS Strategy. We also have an outstanding record of successful HIV clinical care outcomes. Such as:

HIV mortality rates that are half the national average
94 percent median treatment adherence among KP patients that are regularly in care and on antiretroviral therapy
No disparities among Kaiser Permanente’s African-American and Latino HIV-positive patients for both mortality and medication rates, compared to a 15 percent higher rate in the U.S. for mortality and medication
89 percent of Kaiser Permanente’s HIV-positive patients are in HIV-specific care within 90 days, compared to 50 percent in the U.S. within one year
69 percent of Kaiser Permanente’s HIV-positive patients have maximal viral control compared to 19-35 percent nationally

CTH Blog:
And how does this knowledge help other health care providers?

MH:
We started by challenging them. Earlier this year, the organization challenged all health care providers nationwide to follow its lead and improve the health equity for people living with HIV by sharing a toolkit of clinical best practices, tools, mentoring, training and health IT expertise (kp.org/hivchallenge).

We also reach out to our communities through grants. This year, Kaiser Permanente announced several grants for community organizations to continue their work on HIV/AIDS care and prevention.

In May 2012, Kaiser Permanente committed $2 million to award to eight community health organizations focusing on eliminating racial and ethnic disparities in health care and health outcomes, specifically related to HIV disease. The first four recipients will be announced later this year. Furthermore, we’ve also had significant grants in our Northern California, Southern California and Colorado regions. The organizations awarded grants were chosen specifically for having innovative approaches to preventing new HIV infections; identifying HIV positive patients sooner and connecting them with high quality HIV care; and reducing disparities among minority populations — particularly gay, African-American, youth and Latino — disproportionately impacted by HIV disease.

CTH Blog:
And we reach out to students and youth across the country as well, correct?

MH:
Yes! For more than two decades, Kaiser Permanente has been reaching out to millions of youth about HIV prevention through our Educational Theatre Program. In the early 1980s when many organizations were uneasy about talking about sexual behavior and prevention of HIV to adolescents, Kaiser Permanente wasn’t. In 1989, Kaiser Permanente’s Northern California ETP created the live production “Secrets,” aimed at educating young people about the growing epidemic. Since 1989, it’s been shown to 1.5 million youth in Northern California alone. Almost all of our theater programs, which serve communities where Kaiser Permanente is present in eight states and the District of Columbia, have adopted a production dealing with HIV prevention in one way or another. We continuously work with educators, community groups and Kaiser Permanente physicians, to update our productions to meet the needs of our communities.

CTH Blog:
World AIDS Day is just around the corner. What do you hope people reflect on Dec. 1?

MH:
I hope on World AIDS Day people reinvigorate themselves to meeting the challenge of fighting HIV. But I also hope they take the opportunity to show love — for themselves, and for those impacted by HIV. This isn’t the end, but at least we can envision the end realistically now.

Source: http://centerfortotalhealth.org/2012/reflections-on-world-aids-day-with-michael-horberg-md/

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Dr. Labor Publishes New Technology Article In National Publication

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.

Source: http://www.eyectexas.com/blog/dr-labor-publishes/

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Monday, January 28, 2013

Meningitis Update - Congress and FDA Oversight

The CDC reported November 19, 2012 that the updated number of people infected with fungal meningitis has climbed to 490, and the number of related fatalities is now at 34.

Congressional hearings took place on November 14 and 15 to determine what went wrong at the New England Compound Center now at the center of the growing fungal meningitis outbreak.

Source: http://www.spine-health.com/blog/meningitis-update-congress-and-fda-oversight

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Improvised chest seal

Source: http://adventuredoc.net/2013/01/05/improvised-chest-seal/

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Venous Access in Austere Settings: Part One

Source: http://adventuredoc.net/2012/12/02/venous-access-in-austere-settings-part-one/

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Reflections on World AIDS Day with Michael Horberg, MD

World AIDS Day is Dec. 1; this year’s theme is ‘Working Together for an AIDS-Free Generation’

CTH Blog:
You’ve been committed to the fight against AIDS/HIV for three decades. What has this journey been like for you?

CTH Blog:
What continues to motivate you in the fight against HIV/AIDS?

Until we no longer have an epidemic, I will continue to be motivated.

CTH Blog:
How has Kaiser Permanente been a leader in HIV treatment?

HIV mortality rates that are half the national average
94 percent median treatment adherence among KP patients that are regularly in care and on antiretroviral therapy
No disparities among Kaiser Permanente’s African-American and Latino HIV-positive patients for both mortality and medication rates, compared to a 15 percent higher rate in the U.S. for mortality and medication
89 percent of Kaiser Permanente’s HIV-positive patients are in HIV-specific care within 90 days, compared to 50 percent in the U.S. within one year
69 percent of Kaiser Permanente’s HIV-positive patients have maximal viral control compared to 19-35 percent nationally

CTH Blog:
And how does this knowledge help other health care providers?

We also reach out to our communities through grants. This year, Kaiser Permanente announced several grants for community organizations to continue their work on HIV/AIDS care and prevention.

CTH Blog:
And we reach out to students and youth across the country as well, correct?

CTH Blog:
World AIDS Day is just around the corner. What do you hope people reflect on Dec. 1?

Source: http://centerfortotalhealth.org/2012/reflections-on-world-aids-day-with-michael-horberg-md/

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Changes are Coming to Your Health Savings Accounts

It’s the season of open enrollment for health insurance plans, and if you have an HSA (Health Spending Account – sometimes called a Health Reimbursement or Flex Spending Account), it’s time to max it out! Tax laws have changed, and this coming year, 2012, is the last year that you can place the maximum $5,000 in your HSA. Starting in 2013, the maximum allowed in any Health Savings Account will be $2,500, which means that the entire cost of laser eye surgeries such as LASIK cannot be covered by your HSA pre-tax dollars after 2012.

If you have questions about the coming changes, or if you would like to set up a consultation for LASIK or other laser vision correction procedures, please contact Grochmal Eye Center at (410) 697-4090.

Source: http://www.grochmaleye.com/blog/hsa-flex-spending-account/

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Economy class syndrome and blood clots in travelers

Source: http://adventuredoc.net/2012/02/17/economy-class-syndrome-and-blood-clots-in-travelers/

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Sunday, January 27, 2013

Reflections on World AIDS Day with Michael Horberg, MD

World AIDS Day is Dec. 1; this year’s theme is ‘Working Together for an AIDS-Free Generation’

CTH Blog:
You’ve been committed to the fight against AIDS/HIV for three decades. What has this journey been like for you?

CTH Blog:
What continues to motivate you in the fight against HIV/AIDS?

Until we no longer have an epidemic, I will continue to be motivated.

CTH Blog:
How has Kaiser Permanente been a leader in HIV treatment?

HIV mortality rates that are half the national average
94 percent median treatment adherence among KP patients that are regularly in care and on antiretroviral therapy
No disparities among Kaiser Permanente’s African-American and Latino HIV-positive patients for both mortality and medication rates, compared to a 15 percent higher rate in the U.S. for mortality and medication
89 percent of Kaiser Permanente’s HIV-positive patients are in HIV-specific care within 90 days, compared to 50 percent in the U.S. within one year
69 percent of Kaiser Permanente’s HIV-positive patients have maximal viral control compared to 19-35 percent nationally

CTH Blog:
And how does this knowledge help other health care providers?

We also reach out to our communities through grants. This year, Kaiser Permanente announced several grants for community organizations to continue their work on HIV/AIDS care and prevention.

CTH Blog:
And we reach out to students and youth across the country as well, correct?

CTH Blog:
World AIDS Day is just around the corner. What do you hope people reflect on Dec. 1?

Source: http://centerfortotalhealth.org/2012/reflections-on-world-aids-day-with-michael-horberg-md/

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A Maverick’s Lonely Path in Cardiology (Essay 28)

Source: http://bernardlown.wordpress.com/2012/03/10/mavericks-lonely-path-in-cardiology/

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Life as a Remote Site Doctor

Source: http://adventuredoc.net/2012/01/31/life-as-a-remote-site-doctor/

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Rock Health: Accelerating Innovation in Health Care

Innovation starts with a seed, an idea fueled by passion and a desire to make meaningful change by building on that which has come before and making it better. In no field is this perhaps more vital than in health care.

Rock Health, a seed accelerator and nonprofit foundation focused on the intersection of health care and technology, develops global strategies to enhance care delivery, patient-clinician relations, and the health and well being of people the world over. The organization is partnering with organizations, entrepreneurs, researchers, thought leaders and innovators across multiple fields, including medicine, technology, venture capital, and corporate industry to advance digital technology in health care – two fields that touch each of our lives. Through start-up funding, research and public events, the foundation supports next generation health entrepreneurs committed to supporting digital innovation in health care.

Kaiser Permanente recently announced its partnership with Rock Health as a sponsor to provide financial support and work closely with the seed accelerator’s network of change makers to explore new ways to leverage digital innovation to improve the health of communities across the globe. In this move, Kaiser Permanente joins several other health and business leaders—including the Mayo Clinic, Harvard Medical School, General Electric, Nike, Genentech and others—who support Rock Health and the important work it is doing.

For more information on Rock Health, including its incubator program, its events, its own blog, and more, check out the website here.

Source: http://centerfortotalhealth.org/2012/rock-health-accelerating-innovation-in-health-care/

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Increase in mosquitos carrying dengue fever in Cuba

There has been an increase in the numbers of Aedes aegypti mosquitos in urban areas of Cuba, including Havana.

These insects can carry dengue fever, an unpleasant viral disease, (commonly named breakbone fever due to the severe joint and muscle pain involved). The authorities have established a surveillance system to monitor the situation, but travellers should nevertheless take steps to avoid being bitten by these mosquitos, which are active and biting during daylight hours.

Source: Agence France-Presse

For further advice, contact the Globe Travel Health Centre on 01603 667323

Source: http://www.globetravelhealthcentre.com/travel-advice/increase-in-mosquitos-carrying-dengue-fever-in-cuba.html?utm_source=rss&utm_medium=rss&utm_campaign=increase-in-mosquitos-carrying-dengue-fever-in-cuba

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BOTOX® and Dermal Fillers

Dr. Grochmal has again expanded his services for his patients, now, to include BOTOX® Cosmetic and dermal fillers to help soften the fine lines of maturing. He has chosen BOTOX® Cosmetic because of its proven track record and outstanding results. Where BOTOX® Cosmetic is not effective, one will have the option of having Juvederm (a dermal filler) injected to help eliminate more permanently the skin folds around the nose and mouth.

Dr. Grochmal is excited to be able to offer these treatments to complement his already extensive oculoplastic repertoire. Please call the office for more information, 410-697-4090.

Source: http://www.grochmaleye.com/oculoplastic/botox-and-dermal-fillers/

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Saturday, January 26, 2013

Activist Shares her Story to Increase HIV/AIDS Awareness

At birth, Hydeia Broadbent was abandoned at the University Medical Center of Southern Nevada in Las Vegas, where Patricia and Loren Broadbent adopted her as an infant. Although her HIV condition was congenital, she was not diagnosed as HIV-positive with advancement to AIDS until age 3. The prognosis was that she would not live past the age of 5. Now more than 20 years later, Broadbent spends her time spreading the message of HIV/AIDS awareness and prevention by promoting abstinence, safe-sex practices (for people who choose to have sex), and the initiative “Knowing Your HIV/AIDS Status.”

Broadbent was a keynote speaker at Kaiser Permanente’s 2011 National Diversity Conference, speaking to several hundred Kaiser Permanente physicians and employees celebrating and learning about diversity and inclusion. We caught up with Broadbent recently to see what messages she had to share in honor of World AIDS Day.

CTH Blog:
When did you start speaking publicly about HIV/AIDS?

Hydeia Broadbent:
I started speaking out at the age of 6. Back then my focus was talking about compassion for individuals living with HIV/AIDS to make sure they were treated fairly. In the late 1980s a lot of people lost their jobs or they were kicked out of their homes. Some kids couldn’t even go to school, so I really started speaking about compassion and understanding.

Now, my primary goal is to provide a clear understanding of how to avoid at-risk behaviors through self-examination and informed decision-making. With all that we know about the virus, it is clear to me that contracting HIV/AIDS today is a choice and we can’t allow anyone the power to make that choice for us.

CTH Blog:
What has your message been to clinical staff and caregivers?

HB:
Growing up I spent a lot of time in the hospital. For those who work with someone who is infected with HIV/AIDS, you guys are very important to our lives. We spend a lot of time with our doctors and our nurses and our case workers.

I know how important it is for communication between a doctor and patient. Patients want to be informed about the medicines and procedures that they go through. And it also goes back to compassion because a lot of times when people have chronic illnesses they may be facing them alone. Sometimes they don’t have the support of their families or friends. Service with a smile really does go along way.

CTH Blog:
There was a time last year when you were without insurance?

HB:
Yes, and that was very scary. I know how expensive these out-of- pocket costs can be. A lot of people wanted to help me, but I wanted to make sure we help others – it’s not just about Hydeia. I feel like I speak for a lot of people who don’t have a name or a face or a voice, but they are out there, and they deserve the compassion of their fellow brothers and sisters. Everything I go through serves a purpose. I want to inspire people, not to just care about me, but others who are living with HIV/AIDS.

CTH Blog:
At Kaiser Permanente’s 2011 National Diversity Conference, you mentioned you received care at a Kaiser Permanente facility?

HB:
I live in Las Vegas, but once I got sick when I was in Los Angeles and ended up at a Kaiser Permanente facility, so I know the care and the service that Kaiser Permanente provide, and it’s excellent.

CTH Blog:
What are you working on now?

HB:
On Nov. 26, a project I’ve been helping work on, “Forgotten but Not Gone: Kids, HIV & AIDS,” aired on Nickelodeon. The inspiration came to me after seeing a story about a 13-year-old boy in Pennsylvania who had applied to a private boarding school, but was refused because he is HIV-positive. The show is a powerful piece featuring many stories of youth who have been living with HIV, and it addresses stereotypes.

I’ve been doing a lot of work around youth lately, such as public service announcements that they can relate to. A lot of young people don’t like to be lectured to, so you have to make sure it’s more of a discussion and you’re not just preaching. And also when it comes to HIV, you have to install a sense of fear. We have kind of glamorized it because we wanted people with HIV to be accepted, but we forgot to talk about the reality of what this disease is, and it still kills people. There are medications, but not everyone can afford these medications, so we need to make sure we are speaking to the reality that these medications cost a lot of money.

CTH Blog:
World AIDS Day is around the corner. What do you hope people think about on Dec. 1?

HB:
I grew up in a time when there was no hope. I’ve seen countless friends die — my own doctor had passed away. We are definitely in a new time when there are advancements to medications and people aren’t dying at alarming rates from AIDS as they once did. But the fight is far from over. You have to go home and talk to your kids. You have to talk to them about HIV. You have to talk to them about sex. You have to talk to your nieces your nephews. We have come to a place where we are complacent about HIV/AIDS because people are healthier they are living longer and it’s kind of on everyone’s back burner. If you aren’t talking to your kids about these things, someone else probably is.

I’d also like people to stop and think: Do you know your own HIV status?

Below is an excerpt from Broadbent’s keynote at Kaiser Permanente’s 2011 National Diversity Conference.

Source: http://centerfortotalhealth.org/2012/activist-shares-her-story-to-increase-hivaids-awareness/

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Take A Walk On The Grass

When is the last time that you took off your shoes and yours socks and you walked barefoot on the grass. If you’re older than twelve I’m guessing it has been quite some time. It’s funny, when we’re kids, if we see a mud puddle we JUMP right in it. When we become adults we walk around the mud puddle. Not only do we walk around the mud puddle…we complain about it!

Stop complaining. It’s not really serving you. Start living. Get outside and re-connect with our planet. This isn’t some hippy dippy statement. We (human beings) are electrical beings. That’s right, we are electrical beings. Electricity is constantly flowing through our bodies. In fact, without electricity you wouldn’t be reading this post right now. Without electricity running through your body your brain would cease to function.

Sometimes we need to re-charge. We need to “ground” ourselves. One of the ways to do this is by getting outside and walking barefoot on the grass. While you’re walking (barefoot of course) do some deep breathing – you’ll be accomplishing two things at the same time (there is nothing like multi-tasking when it comes to your health). Walking barefoot on the grass will “ground” you, literally. Doing this will help you release built up electrical energy that’s in your body.

As stated above, your entire nervous system is run on electrical energy. Get walking, ground yourself, do your deep breathing, and make some positive changes in your life. This doesn’t cost you a dime. What have you got to lose?

Yours In Health!

G.E. Moon II

Source: http://www.abundanthealthcenter.com/blog/takeawalkonthegrass

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Spondylolisthesis Overview Video

A forward slippage of one vertebra out of normal spinal alignment is spondylolisthesis, and this can cause pain or affect the functionality of the spinal components. This video describes the different types of spondylolisthesis, the grading scale of the slippage, and typical symptoms of spondylolisthesis.

Video presented by Zinovy Meyler, DO

[TOC]

Video Transcript

Spondylolisthesis refers to a process in which one vertebra slips on top of the other and what we usually see is the vertebrae slipping on top of the other in the lower back or the lower segments. That being said, it is important to remember there are different types of spondylolisthesis. There are actually six types of spondylolisthesis - or the reasons for that slippage to occur.

Before we talk about the specifics of it, the basic theory is that there are structures that are opposing that slippage that are maintaining one vertebra properly aligned on another. Something happens to those structures, allowing that slippage. So if we think about it that way, everything else begins to make sense. So trauma to any of the structures and fracture of that point will allow slippage forward. There is a very specific trauma - or a specific lysis, or in other words “breaking away of the structures” - which is called pars interarticularis and that happens due to additional stress to that structure, allowing that slippage to happen. Of course, other sources can be developmental and those people that develop those abnormal connections allow that slippage to happen from birth and as they develop. Also, another source is pathologic. Pathologic can be due to infection or pathologic due to a tumor in the bone, weakening that bone and causing the fracture.

In thinking about all of these, we have to remember that slippage - regardless of the source - will frequently develop into very similar symptoms. Of course, the severity of the symptoms will depend on the severity of the slippage. So what we have to do is look at the slippage and grade it. The way we look at the slippage is we get x-rays. Those are the easiest and best way to look at spondylolisthesis. Spondylolisthesis is looked at by looking at both the lateral (or view from the side), anterior (looking directly on), and oblique views. The oblique views, specifically, are used to look at these structures - the pars interarticularis - to see if there is an actual dissociation or lysis of that structure. Also, when looking at the lateral views, we are looking at how much slippage there is of one vertebra on another. We grade it by percentage of the slip and there are four grades. Each one is essentially 25% of the slip, so this would be grade one (just 25%), 25-50% would be grade two, and so on and so forth all the way to the condition called spondyloptosis, where one vertebra slips completely off another.

In looking at spondylolisthesis, as you would imagine, something allows that slippage to happen, so we must think about instability. It doesn't present a problem, necessarily, at the beginning, meaning grade one is unlikely to be unstable. But anything beyond that, especially with variable symptoms based on position of the body or exertion, can become unstable. The way we evaluate for instability is by using what's called "flexion-extension films" and those are x-rays that look from the side. What happens is that the patient flexes forward first and the snapshot is taken and then flexes backwards. That way we can actually see if there is a change in the position of that vertebra on top of another and we can measure what translation of one vertebra on another is. We have set thresholds to allow some motion before we consider it unstable.

Now, in talking about the symptoms, symptoms usually tend to be muscle spasms, muscle tightness. There can be tightness in the buttocks. Tightness in the hamstrings is very common because that stabilizes the pelvis and really counteracts the forces that have changed because of that slippage. If the slippage is large enough, we can actually see a step-off. If we run our hand on the spine, we actually feel a bump and that bump is that slipped vertebra forward. So, that can be an indication to consider spondylolisthesis. If spondylolisthesis slips far enough, it can actually affect the foramen. Now, the foramen is an opening between the vertebrae that allows the passage of the nerve. If this vertebrae slides forward far enough, it can actually compress/affect this nerve one way or another and that can cause what we call "radicular pain" - or pain shooting down the leg and affecting the nerve and the muscles that are supported by that nerve. That can very important, obviously, depending on the degree of that slippage.

Short Teaser:

Learn about the types, grading, and typical symptoms of spondylolisthesis.

Thumbnail:

Author Node Id:

Zinovy Meyler, D.O.

Source: http://www.spine-health.com/video/spondylolisthesis-overview-video

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