how much does your love and caring caring cost? Doing right can be expensive- This useful article makes this point -Qj

The Costs For Family Caregivers Continues to Rise
Doing the right thing is an expensive proposition
By Mike Magee, MD

In the United States nearly a quarter of our multi-generational families have a family member working in a job that they never trained for, never asked for, and have never been paid for. That job is the informal family caregiver.1 It is estimated that there are 34 million Americans providing care for older family members and friends.2 They are drawn in primarily by a sense of responsibility and pressing need. For activities of daily living, which we often take for granted, like feeding, bathing, and toileting, success requires mobility, strength, balance and normal mental capacities. But the truth is that as we age, many of us lose the ability to care for ourselves. And as we do, family members step in to fill the gap. But they do so at great cost to themselves.How much cost? Well, if we are just looking at the dollars, on average, in a recent study of 1,000 informal family caregivers, the annual cost was $5,500 dollars. And if you were caring for a family member from afar, let’s say from another state or distant community, the average cost was $8,728 dollars per year. Where did the money go? It splits up almost evenly into four pieces: direct medical expenses; household items, including food; extra help and travel; and home repairs and basic day-to-day equipment. More specifically, 42 percent of respondents in this study had paid for household goods or food in the past year; 39 percent had funded transportation; 31 percent had covered the co-payment costs of an elder’s drugs or medical payments; 21 percent had purchased clothing and 13 percent had paid for home improvements.3Where does the money come from? Half of the family caregivers cut back on hobbies, leisure activities and vacations. One third dipped into savings and deferred major purchases for themselves. And a quarter cut back on their own groceries and seeing their doctors to cover the costs. Not surprising then, informal family caregivers, isolated in this complex world, overwhelmed and lacking system support and financial aid, often become sick themselves as they struggle to do the right thing.3

Probiotic Drink Helps Prevent Diarrhea from Antibiotics

Probiotic Drink Helps Prevent Diarrhea from Antibiotics

A persistent and alarming problem among elderly hospital patients is diarrhea -- which is sometimes even life-threatening. A frequent cause, ironically, is the antibiotic used to address either the original illness or an infection that develops during the hospital stay, to which elderly patients are even more vulnerable than others. It is a frustrating situation for everyone involved.

A recent study conducted at Imperial College in London investigated probiotic drinks as a way to help resolve the problem, in much the same way some non-hospital patients eat yogurt when on antibiotics. (Note: This should be high-quality yogurt with live cultures.) The study randomized 135 hospitalized elderly patients on antibiotics into two groups. Twice a day during the course of treatment and for one week after finishing the antibiotics, one group was given a dairy drink containing three types of probiotics -- Lactobacillus casei, L. bulgaricus and Streptococcus thermophilus -- while the other had a dairy drink with no probiotics. The probiotic drink used in the study was Actimel, sold in US supermarkets as DanActive from Danone, which partially funded the study.
The result: Risk of diarrhea relating to antibiotics was reduced by 21.6%.

WHICH PROBIOTIC FOR WHOM?
Probiotic use appears to be a no-brainer, but the picture is more complicated than it may seem. Lead author Mary Hickson, PhD, RD, a research dietician and honorary senior lecturer of investigative science at the Imperial College in London, told me the issue of using probiotics as standard hospital protocol is still open. The reason is, dose and timing cannot be as carefully controlled in a hospital setting as in a highly monitored research study. Probiotics may actually turn out to be even more useful than this research indicates, since some high-risk patients had to be excluded. Also, since the treatment did not prevent all diarrhea, it may be that different patients respond to probiotic bacteria differently. In other words, what is effective in certain situations for some individuals does not work all the time. Indeed, another strain of bacteria might work even better at preventing antibiotic-caused diarrhea than the ones in the drink used, and only further research will reveal the answer.

In this study there were no adverse events for patients, which has been true of previous published trials using probiotics -- though some questions remain relative to people with weak immune systems. In a very few cases, probiotic bacteria may have caused an infection in such patients, says Dr. Hickson, though it remains inconclusive. According to the National Center for Complementary and Alternative Medicine (NCCAM), the safety of probiotics has not been thoroughly studied so research should continue, especially in the elderly, children and anyone with a compromised immune system.

Next steps for the medical community? Dr. Hickson says that another study is now in order to see if using probiotics as a standard measure for post-antibiotic treatment causes diarrhea rates to fall in a broader hospital population. Next step for individuals? Based on years of work with probiotics, Daily Health News contributing editor Andrew L. Rubman, ND, points out that since each of us is unique, results may vary. While probiotic products will probably not be harmful, the same solution won't work for everyone. Consider working with a physician knowledgeable in this area.
Source(s): Mary Hickson, PhD, RD, honorary senior lecturer of investigative science at the Imperial College in London.

medical tourism tips and overview

If you are dying or need something to be better or healthy now -be proactive , knowledgeable and check the alternatives and the risks- Your knowledge is your power qj

Dangers of Overseas Surgery

You may have heard about medical tourism, as it is a concept that has recently taken flight in the media. Hundreds of thousands of Americans now travel overseas for medical procedures each year, which sounds exotic -- but may not provide such a great outcome. Health experts urge extreme caution to those considering medical travel.
For insight into the medical tourism trend, I contacted Ann Marie Kimball, MD, a professor of epidemiology and health services at the University of Washington School of Public Health in Seattle and author of Risky Trade: Infectious Disease in the Era of Global Trade (Ashgate). She told me there are several reasons behind the growth of medical tourism, including the fact that surgery often costs far less overseas. Other factors may include privacy (for elective cosmetic surgeries, for example) and accessibility to operations, such as transplants, that are harder to get or not available at all in the US.

TRIP OF A LIFETIME?
Patients fly to exotic destinations such as India for coronary bypass surgery, heart valve replacement and cancer therapy... Thailand for knee and hip replacement surgery and eye surgery... and Costa Rica, South Africa or Malaysia for plastic surgery, usually because it is far less expensive. Procedures people can have overseas but that are not available in the United States include stem-cell-infusion therapy for myocardial ischemia (end-stage heart disease) in Thailand and, believe it or not, pancreatic transplants from pigs in India.

Specialized medical tourism companies help travelers find the overseas doctors and facilities for the procedures they are seeking, and often assign "case managers" to serve as patient liaisons. These tourism companies advertise directly to consumers over the Internet and through promotional campaigns that tout state-of-the-art medical care at bargain prices. Public Citizen, a national, nonprofit consumer advocacy organization, warns that the reason alternative treatments may not be offered in the US is because of our more stringent safety or efficacy standards.

So just how much money are medical tourists saving? It's hard to know for sure, as most information on cost savings is supplied by organizations with a vested interest. However, according to some reports, costs can be as little as one-tenth or less of what such procedures cost in the United States. For instance, heart-valve replacement surgery that may cost $160,000 or more here could be as little as $10,000 in India. A knee replacement in Thailand costs about 75% of the price here. A facelift that would cost $20,000 can be had for $1,250 in South Africa. Some packages may also include travel and vacation expenses.

YOUR MONEY OR YOUR LIFE
Cheap, yes, but many health experts in our country call medical tourism a risky venture. The United States Department of Health and Human Services' Centers for Disease Control and Prevention (CDC) warns that the quality of health care in overseas facilities may not be on par with what is available in the United States, and that foreign facilities are not always subject to the same health standards and regulations. Few overseas health facilities are accredited by the Joint Commission International (JCI), an organization that accredits overseas hospitals according to quality and safety standards similar to those in the United States. Additionally, surgery abroad can put patients at risk of infection or other complications when they return home. In fact, the CDC has received several reports of nontuberculous mycobacterial infections after people received elective cosmetic surgery abroad. There are also concerns about the quality of post-operative care and, of course, medical errors. Such problems can happen in the US too, of course -- but the fact that your local physician may be unfamiliar with your case may pose additional challenges.
Dr. Kimball concurs. "My priority is from the point of view of infectious disease and infection control," she said. "People are the best vectors for disease. When you go to a hospital overseas, you run the risk of bringing new microbial agents into the United States. The problem is that your own health care provider may not be aware of them or how to treat them."
Dr. Kimball voiced special concerns about organ transplant surgery and most specifically from animal sources, such as those pancreatic transplants from pigs mentioned above. There's a frightening risk with xenotransplant (the transfer of organs or tissue from animals to humans), she told me. "We fear that transmission of infectious agents or a retrovirus could emerge. It's a theoretical but scientific possibility."

IF YOU ARE STILL INTERESTED...
Unfortunately, there is little reliable data regarding the efficacy, safety and outcomes of overseas health care. This is because most information about the safety of medical tourism has been generated by the medical tourism industry. "Medical tourism businesses are much more similar to travel businesses than to medical businesses," said Dr. Kimball. "It's not in their interest to do surveillance or track outcomes."
If you are considering having a procedure done overseas, keep the following in mind:

Involve your US doctor with all medical travel decisions. Don't view this as a travel decision, warns Dr. Kimball: "It's an important medical decision to be made only with professional advice." Your doctor at home should be in communication with your foreign doctor and should also be aware of any potential complications that may arise, and how to deal with them.

Get a second opinion at home before you travel. "Be really sure of the procedure that you need, because once you get to a far-away destination, it's hard to get a second opinion," said Dr. Kimball. "For instance, if your own doctor or cardiologist says you need a stent placed in your coronary artery, and you decide to go overseas for this, the doctors there may look at your films and suggest that you need bypass surgery instead. At that point you won't have the chance to go back and say, 'wait a minute' because you've just spent thousands of dollars traveling, and you can't get a second opinion. This is why communication with your own doctor about what you need is very, very key."

Find the best surgeon and hospital for your procedure. Research the surgeon's education, training, credentials and experience with your particular procedure. Learn as much as you can about where the surgery will be performed, and whether or not the facility is JCI-accredited, which means it meets quality and safety standards. (A list of accredited international health-care facilities is available at jointcommissioninternational.org.)

Determine whether or not your health insurance will cover the procedure and any complications. "Most insurance companies have non-portability, meaning medical insurance doesn't work outside of the country," said Dr. Kimball. "If you are considering medical travel, you may want to check whether or not your insurance company is not only covering the service, but would cover complications that arise."

Understand everything about your procedure, and what may happen after it -- before you leave home. Remember, there may be a language barrier between you and those who know the answers to questions that arise, so be sure to know everything about your procedure before you leave home. Learn about the benefits and the risks involved, whether or not travel is compatible with your procedure, what to expect during recovery time, what kind of follow-up care you may need during your recovery, and what would happen if there were any complications.

It is understandable that at times, desperate situations call for desperate measures -- and so there are terminally ill individuals who will try anything in their effort to regain health. Be careful and do your homework. As for those procedures of convenience or bargain hunting, let the buyer beware.
Source(s): Ann Marie Kimball, MD, a professor of epidemiology and health services at the University of Washington School of Public Health and Community Medicine in Seattle and author of Risky Trade: Infectious Disease in the Era of Global Trade (Ashgate).

Experts cite must-haves for effective rehab - CNN.com

Experts cite must-haves for effective rehab - CNN.com: "Experts cite must-haves for effective rehab"

google and medical records breakthroughs

They are your medical records

In fact, by 2005 it had become quite clear to many leaders in the field that “the record” properly resided with the patient from whom health data emerged, and that the data that flowed through the hands of hospitals, doctors and nurses was only a part of the overall picture. Thus the concept of a “personal health record” is gradually subsuming the vision of an electronic medical record.3,4,5,6

This is a good development. The personal health record combines data, knowledge and software tools, which help patients become participants in their health care. But if we are truly to anticipate where health care trends are taking us, even this is not enough.
It is now clear that in a truly preventive system, “health” is not a collection of late-stage, reactive interventions. That kind of thinking will soon be a relic of the past.8

Rather, health should be defined as a life fully lived – hopeful, productive, fulfilling, rewarding and manageable. The determinants of such a life begin before birth, embedded in the healthful behaviors of ones’ future parents, and they extend beyond death to ones’ survivors.

Considering this broader view of health, the right concept for our health record system should be a Lifespan Planning Record -- or LPR.7

Cures for Our Ailing Health-Care System | Newsweek Health for Life | Newsweek.com

Cures for Our Ailing Health-Care System Newsweek Health for Life Newsweek.com: "Cures for an Ailing System
With health care emerging as a major issue in the 2008 presidential race, NEWSWEEK asked seven Harvard experts to identify specific problems that ought to be addressed, and the steps that should be taken to solve them"

Grey solutions for the aging of America

this is an insight artile on what are the solutions to the greying of America. qj

Home Centered Health: Part 1
What will it take to create the ideal healthy home?
(Note: This article is from the Health Politics archives)
By Mike Magee, MD
Some 40 years ago, I recall visiting General Electrics’ “Carousel of Progress” at the World’s Fair in New York. The attraction, now housed at Disney World in Florida, documented the changes in the technology and social structure of the American home over five or six decades, ultimately creating a vision of the future, a case for progress. I think the time has come to build something similar for health care. This “Carousel of Progress” would provide a vision of the past, present and future for something far more important than refrigerators and toasters – our nation’s health. At the core of this carousel would be a vision that’s just within our reach – something that will change health care as we now know it. I’m talking about the concept of home-centered health, in which technology, advanced information systems and a new, more team-oriented medical approach would make it possible for more health care to take place in the home than we ever imagined possible. A key role in this scenario is a home health manager to link the patient with the physician. In fact, the home health manager will certainly help make home-centered health a reality in the coming years.
What are some of the issues that designers of this “Carousel of Progress” will need to consider as they try to capture our health care movement from 1960 to 1980 to 2000 to 2020?

First is aging. Fifty percent of current 60 year olds have a parent alive, and by 2050 there will be more than 1 million Americans over age 100. This means that the four- and five-generation family, not the three-generation family, will be the norm. 1

Second is health consumerism. In the past 25 years, we have moved from paternalistic health care doctor says/patient does – to partnership models. Educational empowerment and direct consumer engagement are increasingly the rule. As patients are placed at clinical and financial risk for their decisions, physicians are restructuring to create both clinical and educational teams, with patients themselves as team members. 2

Third is the Internet, a critical technologic advance that has ended the age of information segregation. The general public is rapidly absorbing the scientific lexicon, a basic knowledge of organ function, and regularly updated theories regarding causes, diagnoses, and treatments of diseases. Patients are pursuing their own research, double-checking facts, and connecting with other patients with similar conditions. Those few physicians who have created nurse-led virtual education teams have found rapid enrollment of their patients, seeking knowledge, guidance, emotional support, and encouragement. 3

Fourth, the caregiver revolution. One quarter of American households have elder caregivers in place. Eighty-five percent of these caregivers are family members -- the vast majority being third-generation women. To manage these roles, the caregivers are rapidly growing in the understanding of the seven major chronic diseases; the mechanics of Medicare and Medicaid reimbursement; basic health law; and the hiring and management of additional help if they can afford it. These caregivers are also learning how to stretch and prioritize resources; define and personalize quality of life; and avoid unnecessary doctors’ office visits and hospitalization. As third-generation home health managers gain knowledge and confidence caring for fourth- and fifth-generation family members, they are slowly realizing that the strategies and tactics mastered could apply equally well downstream to the benefit of themselves and the younger generations below. 4

Fifth is the shifting health care value proposition. Americans are attempting to move from reactive intervention to proactive prevention, and this changes the playing field for everyone – hospitals, doctors’ offices, health insurers, and pharmaceutical and medical device companies alike. It implies healthy behaviors, early diagnosis, regular screenings, knowing your numbers, effective long-term treatments with excellent adherence, and a personalized, information- and relationship-rich support system that is equitable and just. It suggests that to be valued in our future health care system, each player, in addition to his or her traditional unique contributions, will also need to be engaged in educational and behavioral modification to claim insider status. 5,6,7
With these in mind, the health care “Carousel of Progress” has been created. Now, we’re circling counter-clockwise and the last set appears. Ten realities have been skillfully integrated into this calm and well-organized vision of a healthy home:

A home health manager, previously the informal family caregiver, has been designated for each extended family.
Health insurance covers nearly all Americans, and a medical information highway has been constructed primarily around the patient, with caregivers integrated in, rather than the other way around.
The majority of prevention, behavioral modification, monitoring and treatment of chronic diseases now takes place at home.
Physician-led, nurse-directed virtual health networks of home health managers provide a community-based, 24/7, educational and emotional support team.
Health care insurance premiums for families have just gone down due to expert performance of the home health manager, as reflected in outcome measures of family members.
Basic diagnostics, including blood work, imaging, vital signs, and therapeutics are performed by the home health manager and transmitted electronically to the physician-led, nurse-directed educational network, which provides feedback, coaching, and treatment options as necessary.
Sophisticated behavioral modification tools, age adjusted for each generation, are present and utilized, funded in part by diagnostic and therapeutic companies who have benefited from expansion of insurance coverage and health markets as early diagnosis and prevention has taken hold.

Physician office capacity has grown, as most care does not require a visit. Physician reimbursement has increased in acknowledgement of their roles in managing clinical and educational teams and multigenerational complexity. Nursing school enrollment is up as the critical role as educational director of home health manager networks has become a major magnet for the profession.
Family nutrition is carefully planned and executed; activity levels of all five generations are up; weight is down; cognition is up; mental and physical wellbeing are also up.

Hospitals continue to right size – they’re more specialized and safer, with better outcomes. And scientific advances have allowed early diagnosis and more effective treatment, making the need for hospitalization increasingly rare.
Is this all a far-fetched scenario? Not really. Many of these elements are well within the reach of an integrated and progressive vision for tomorrow’s health.
References
1. Alliance for Aging Research. Medical Never-Never Land: Ten Reasons Why America is Not Ready for the Coming Age Boom. 2002.
2. Magee M. The Best Medicine

Top health stories of 2007 - CNN.com

Top health stories of 2007 - CNN.com: "Top health stories of 2007Story Highlights
Contaminated food, questionable drugs made medical headlines

Major stem cell development could mean cures without destroying embryos

Year also saw 19 top health breakthroughs for women"

holiday blues -19 tips to avoid

19 tips for coping with holiday stress and depression:

1. Make realistic expectations for the holiday season.
2. Set realistic goals for yourself.
3. Pace yourself. Do not take on more responsibilities than you can handle.
4. Make a list and prioritize the important activities. This can help make holiday tasks more manageable.
5. Be realistic about what you can and cannot do.
6. Do not put all your energy into just one day (i.e., Thanksgiving Day, New Year's Eve). The holiday cheer can be spread from one holiday event to the next.
7. Live and enjoy the present.
8. Look to the future with optimism.
9. Don't set yourself up for disappointment and sadness by comparing today with the good old days of the past.
10. If you are lonely, try volunteering some time to help others.
11. Find holiday activities that are free, such as looking at holiday decorations, going window shopping without buying, and watching the winter weather, whether it's a snowflake or a raindrop.
12. Limit your drinking, since excessive drinking will only increase your feelings of depression.
13. Try something new. Celebrate the holidays in a new way.
14. Spend time with supportive and caring people.
15. Reach out and make new friends.
16. Make time to contact a long-lost friend or relative and spread some holiday cheer.
17. Make time for yourself!
18. Let others share the responsibilities of holiday tasks.
19. Keep track of your holiday spending. Overspending can lead to depression when the bills arrive after the holidays are over. Extra bills with little budget to pay them can lead to further stress and depression.

The New Health Mecca
Should we focus our health care spending on “bricks and mortar” or technology?...Or both?
By Mike Magee, MDThere's a lot of money flowing into Health right now – raising two big questions: First, are you investing in the past, present or future? Second, will your investment pay off? For those who want to buy in a traditional way, take a look at Grand Rapids Michigan.1 Prominent local donors have committed $1 billion there. For that, they're getting a new medical school (which will house Michigan State programs), a children's hospital, a cancer treatment center, two medical office buildings, and a seven-level parking garage. One billion dollars for "bricks and mortar" in the hope, in their words, of "sustaining the economy and culture of a rebounding city of more than 193,000 residents".

1 For a different type of health bet, look at Royal Philips Electronics NV -- or Philips for short -- a "household name" whose consumer electronics business, overtaken by Asian clones, lost $2.2 billion in 2001. 2 They paid $750 million last year for Massachusetts’ based "Lifeline", a service system and network to help seniors age in place.3 They plan to take it global. Like other big technology vendors with a history in health (think of GE), Philips has been hospital-centric, selling X-ray and CAT Scan equipment with some success. But CEO Gerard Kleisterlee thinks times are changing. "Patients are behaving more and more like consumers. They go on the Internet and get second opinions. Care is being pushed out of the hospitals, which are expensive, and into homes ...." In the past, he says, "It was all about technology." But times have changed, causing him to ask, "What is the hand of cards that I have and how do I play them?" 2 Kleisterlee formed an internal work group to explore new value propositions and point Philips in a new direction. And what did they find? Health - but not the same old health! They started, said Senior VP Paul Smit of their Medical Systems Division, with "an existing, new complex product and redesigned it completely for lay people." What was the product? The "Heart Start Home Defibrillator." 4 Available at $1,200 without a prescription, homes -- and banks, and hotels, and shopping centers, and airplanes -- have eaten the product alive. That triggered the Philips CEO, in September of 2004, to launch a new Consumer Health Care Division.5

The simple command? "Look for opportunities outside the hospital." Mr. Kleisterlee and peers such as Craig Barrett from Intel, are now true believers.6 They have traveled the globe, attending medical meetings, visiting health thought leaders, learned everything they can about aging, and helped form and support the Center for Aging Services Technologies (CAST) in Washington, an arm of the American Association of Home Services for the Aging (AAHSA).7, 8 What are the "sweet spots"? Self-reliance, connectivity, and prevention of functional decline. How's it looking for 2007? Philips Consumer Health Unit is projecting sales of $1.5 billion. 2 Talk inside of Philips is that its CEO has "fundamentally changed the identity of what a lot of people at Philips stand for and believe in." 2 He's done it, they say, by playing the cards he was dealt. And here they are: 1. Take the technology developed for professional use, and redesign it for lay use. 2. Embrace the demographic megatrends of Aging, Consumerism, and the Internet.3. Move health from the hospital to the home. 4. Leverage connectivity, self-reliance and prevention (That's why Philips originally bought "Lifeline.") So there you are. You have the Grand Rapids vision and the Philips vision for our health care future. Both are needed, but to what extent? Who takes the lead, and where is the center? One vision is "bricks and mortar,” the other service. One vision is professional-centric, the other consumer-centric. One is hospital-based, the other home-based. One is driven by historic health sector leaders, the other by new health sector players. Where to put your money for the future? I'd invest in a vision that is led by those with financial assets, IT expertise, and an existing position (with products and services) in the home -- especially if they wisely build future planning around connecting the people to the people who are caring for the people.

Over-70 Adults Get New Food Pyramid

Stress on Nutrient-Rich, High-Fiber Foods, Not Supplements

By Daniel J. DeNoon
WebMD Medical News

People tend to become less active and to eat less as they age. This makes them vulnerable to getting too few nutrients, note Tufts University nutrition expert Alice H. Lichtenstein, ScD, and colleagues.

Moreover, older adults may not be as Internet savvy as younger adults, making it hard for them to use the USDA's official, web-based "MyPyramid" food guide. So Lichtenstein's team has updated their 1999 "Modified Food Guide Pyramid" for older adults to create their new "Modified MyPyramid for Older Adults" in print form.

"The basic message in the Modified MyPyramid for Older Adults is that it is preferable to get essential nutrients from food rather than supplements," Lichtenstein and colleagues note.

However, a little flag flying atop the pyramid signals seniors that supplements or fortified foods -- particularly those containing calcium, vitamin D, or vitamin B-12 -- may be helpful for many seniors but not for all.

At the bottom of the pyramid are icons representing physical activities appropriate for healthy seniors. Next comes a row of water glasses, stressing the importance of fluid intake for older people.

Above these rows, the different food groups portray healthy choices in forms -- such as packages of frozen vegetables -- easily accessible to seniors.

Emphasis is on:

Whole grains and a variety of grains
Variety and nutrient-density of fruits and vegetables
Low-fat and nonfat dairy foods, including milk products with reduced lactose
Oils low in saturated fats and lacking trans fats
Low-saturated fat and vegetable choices in the meat-and-beans food group
Fiber-rich foods in all food groups
"It is important to communicate to older adults that eating should remain an enjoyable experience," Lichtenstein and colleagues note. "The guidance provided can be used as a road map and should be adaptable so it can accommodate many different dietary preferences, patterns, and lifestyles."

Lichtenstein and colleagues provide detailed recommendations in an article in the January 2008 issue of The Journal of Nutrition.

'Hospitalist' Physicians Help Shorten Patient Stays

By Ed Edelson HealthDay Reporter
THURSDAY, Dec. 20 (HealthDay News) -- A new breed of medical specialists, called hospitalists, can make a small but significant difference in shortening how long a patient needs to stay in the hospital, a new study shows.

At the same time, researchers found no difference in the rate of either patient death or readmission when hospitalists were involved, according to the report in the Dec. 20 issue of the New England Journal of Medicine.

A hopsitalist refers to a physician who cares solely for hospitalized patients.

The term may be new to the general public, but, in the medical profession, "hospitalist has been a recognized and accepted term that has been around for about a decade," said study author Dr. Peter K. Lindenauer, an associate professor of medicine at Baystate Medical Center and Tufts University, in Boston.

In fact, "There is a Society of Hospital Medicine with 5,000 to 10,000 members, and it is estimated that there may be 20,000 hospitalists across the United States now," Lindenauer said.

"What you can't debate is the number of hospitalists around the country -- there is no going back," added Dr. Laurence McMahon, chief of the division of general medicine at the University of Michigan, in Ann Arbor.

"We need to think about how these new doctors get into the health-care system and how they care for patients who are hospitalized," said Mcmahon, who also authored an accompanying editorial on the issue.

Traditionally, a person's private physician has been responsible for care after hospitalization, he said. That began to change about 30 years ago, with the emerging role of emergency room physicians and critical care physicians, Lindenauer said. "They have been assuming the role of attending physician in those situations," he said. "In some respect, the growth of the hospitalist model of care represents the completion of a series of steps toward specialization that began 30 years ago."

According to Lindenauer, the advent of the hospitalist means another question should be asked when individuals choose a private physician: Will that doctor turn over care to a hospitalist, if and when someone needs hospital care?

"It is a discussion that a patient should have with a primary-care physician when he is thinking about enrolling with that physician," Lindenauer said.

The differences shown in the study -- a shortening of length-of-stay by 0.4 days, on average -- are not great, he acknowledged, but they do add up over time.

"Shortening the length of stay by 0.4 days is small, but when you multiply it out over time by thousands of physicians, the effects can be very large. With 5,000 cases a year, [that's] a savings of 2,000 bed-days," he said.

The study was not able to assess patient satisfaction with treatment by a hospitalist rather than a primary-care physician, Lindenauer said, "But we know that efficiency is important, as important to patients as to physicians." he said.

And while full official recognition of the hospitalist speciality is yet to come, the Society of Hospital Medicine is working closely with the of American Board of Medical Specialties toward such an end, Lindenauer said.

"The differences between hospitalists and other doctors who take care of patients in hospitals are pretty minor," McMahon said. "What really is quite revolutionary is the change in how we take care of patients in the hospital."


SOURCES: Peter K. Lindenauer, M.D., associate professor of medicine, Tufts University, Boston;

7 Common Medical Myths Debunked

Researchers Say There's No Evidence for Some Widely Held Beliefs

By Miranda Hitti
WebMD Medical News

Reviewed By Louise Chang, MD

Take a look at these seven medical myths, noted in BMJ (formerly called the British Medical Journal).

The debunkers include Rachel Vreeman, MD, a fellow in children's health services research at Indiana University's medical school in Indianapolis.

1. Medical Myth: Drink at least eight glasses of water per day.
Reality: There's no evidence that you have to drink that much water to assure adequate fluid intake -- and drinking too much water can be unhealthy.

2. Medical Myth: We use only 10% of our brains.
Reality: Most of the brain isn't loafing. Detailed brain studies haven't found the "non-functioning" 90% of the brain.

3. Medical Myth: Hair and fingernails continue to grow after death.
Reality: Hair and fingernails don't keep growing after death. But it may seem that way because dehydration can make the skin shrink back from hair and nails, making them look longer.

4. Medical Myth: Reading in dim light ruins your eyesight.
Reality: Dim light isn't great for focusing, but it's "unlikely to cause a permanent change in the function or structure of the eyes," Vreeman's team writes.

5. Medical Myth: Shaving causes hair to grow back faster or coarser.
Reality: "Shaving does not affect the thickness or rate of hair regrowth," write Vreeman and colleagues. But shaved hair doesn't have the fine taper of unshaved hair, making it seem coarser.

6. Medical Myth: Mobile phones are dangerous in hospitals.
Reality: "Rigorous testing in Europe found minimal interference and only at distances of less than one meter [about 3.28 feet]," write the researchers. But that may be a point of controversy. In September, Dutch doctors reported that cell phones may interfere with critical care equipment and shouldn't be used within a meter of medical equipment or hospital beds.

7. Medical Myth: Eating turkey makes people especially drowsy.
Reality: Turkey isn't all that rich in tryptophan, the chemical linked to sleepiness after eating turkey. But eating a big, decadent meal can cause sleepiness, even if turkey isn't on the menu.

SOURCES: Vreeman, R. BMJ, Dec. 22-29, 2007; vol 335: pp 1288-1289. WebMD Medical News: "Turn Off Cell Phones in Hospital Rooms."

© 2007 WebMD Inc. All rights reserved.

The Long & Short of It - Health Care Traveler

The Long & Short of It - Health Care Traveler: "Patient wishes and futile interventions

By: Leah Curtin

The experts say one should never use the term 'futile care,' and most especially not around families. Care is never futile, but medical interventions sometimes are. And that is the point: How do you know for sure that further medical care is futile? When you do know, how do you communicate this to patients and families? And, finally, in the face of inevitable death, how do you provide care that comforts and soothes, that prepares families for loss, while it helps patients leave life with their dignity and hope intact? Most of all, how do you do this in today's busy, bottomline-driven institution?"

Online Checking Account, Bank Account, Internet, Pay Bills

Online Checking Account, Bank Account, Internet, Pay Bills

useful information on the advantges of online checking accounts

1.The biggest advantage of online checking account is that you need not stand in a queue any more. Everything can be done right from the comfort of your home. You can do banking while sitting in front of your computer. There is no need to plan your daily schedule days ahead and considering that we are talking about a checking account in which case the payments need to be paid regularly, elimination of the need to visit the bank every time means a lot of time saving.

2. Another advantage of an online checking account is that the chances of fraud are way less. The entire process of online banking takes place under cloaks of heavy duty encryption. This means that the chances of forged checks or that of any other way of fraud become extremely low. You can be confident while writing checks.

3.Third advantage is that an online checking account is a much better option to make payments for your online purchases as compared to credit or wire transfer. You are not sharing crucial information like that of your credit card. Rather you are just writing a check just like in any traditional transaction. This means that an online checking account keeps you safe yet allows you to take advantage offered by online trading.

4.Fourth advantage of online checking account is that you can easily pay your bills and taxes. Most of the online checking accounts come with a facility that clears all your bills automatically as soon as they are pinged to your account. It is possible to make payments towards some of your taxes as well using the same bill pay service.

If you do not have a on line account you can also use your own secured master card debit card The One World United is a great option for you. For more information

Seasons greetings

 

useful weekly health information

Saturday, December 1, 2007 GOD'S CURES REVEALED
If you knew the secrets to curing your best friend's cancer, your spouse's heart disease, your parent's Alzheimer's, your own chronic pain, wouldn't you want to tell the world? The true cures have been covered up by the system you're supposed to trust with your life. But now one of the world's leading authorities on natural medicine is unveiling its greatest discovery—a treasure trove of health breakthroughs that could help to wipe out virtually ALL DISEASE. http://www1.youreletters.com/t/1406711/7000995/837018/1362/

Monday, December 3, 2007 Stones In the Road
Just ask any kidney stone patient and they'll tell you: passing that stone was the worst pain of their lives – just as intense as the pain of childbirth. Whether you're in the Passed- A-Stone club or not, kidney stones are clearly something you want to avoid. Fortunately there are a number of useful steps you can take to significantly reduce your risk. http://www1.youreletters.com/t/1406711/7000995/836821/0/

Tuesday, December 4, 2007 Brain Preservers "Oxidative stress contributes to brain aging."
That observation leads off a new intervention study that shows how long-term use of a common antioxidant supplement may significantly reduce the risk of cognitive decline. We'll also look at other key supplements that offer protection from dementia. http://www1.youreletters.com/t/1406711/7000995/836938/0/

Wednesday, December 5, 2007 Make every night the best night's sleep you've had in years!
If the thought of getting into bed includes visions of tossing, turning and lying awake until the wee hours of the morning, then we've got a solution for you! An all natural combination of herbs and nutrients clinically-designed to help you fall asleep and stay asleep all night – so you can wake up completely refreshed and recharged in the morning. http://www1.youreletters.com/t/1406711/7000995/836939/1362/

Wednesday, December 5, 2007 Master of Disaster When HSI Panelist Allan Spreen, M.D., referred to vegetarianism as a "total disaster," he knew there would be fallout, and boy was there! We'll look at responses from HSI members who have a bone to pick with Dr. Spreen while they defend the meatless diet. http://www1.youreletters.com/t/1406711/7000995/836823/0/

Thursday, December 6, 2007 Corndogs and Ice Cream
For anyone who may be experiencing middle-aged expansion in the mid region, this e-Alert looks at two reasons why it's so important to be disciplined about dietary choices during the holidays. We'll also tell you about a nutrient that might significantly help prevent widening of the waistline. http://www1.youreletters.com/t/1406711/7000995/836822/0/

Poverty and Health | Health Commentary

Poverty and Health Health Commentary
This is in the U.S however it holds true in Canada. There is a supposed free care system which really does not work and is there to feed government health care custodians who suck huge resoures and funds out of the system while generating sub par results. QJ

Here are the facts:
Poverty is on the rise in the United States. It rose overall from 11.3 percent to 12.6 percent from 2000 to 2005.3,4 Severe poverty, that is 50 percent or more below the poverty level or less than $10,000 a year to support a family of four, increased from 4.4 percent of our population to 5.4 percent. Children accounted for one in three poor people and rates in blacks and Hispanics were 24 percent and 21 percent compared to whites at 8 percent.3,4,5

Except for the top 10 percent, U.S. household income is declining. While total population income grew 9 percent in 2005, income for those below the 90 percent percentile declined by .6 percent.6
Income inequality -- that is, the distance between our richest and poorest citizens -- is rising. The portion of our nation’s total income coming from our wealthiest ten percent rose from less than a third (31 percent) in 1980 to nearly half (44 percent) of our combined earning in 2006. Those in the top one percent, earning more than $250,000, now account for 17 percent of national income compared to just eight percent in 1980.6 And the gap between employer and employee income has exploded. In 1965, the average U.S. corporate CEO’s salary was 24 times that of the average employee. In 2005, it increased to 262 times the average worker’s salary.7

But what does this have to do with health? The simple answer? Everything! Consider that the greater your poverty, the more limited your health insurance, the lower your adherence to treatment plans, the more likely you are to forego medicines or screening exams, and the more likely to smoke, be inactive, have poor diet and be overweight.2 And these effects compound in children, building a burden of disease for the nation that extends for decades down the line. Poverty also means less education. Rates of chronic disease after correction for other variables in those without a high school degree compared to college graduates are world’s apart. In the former, diabetes affects 12%, compared to just 6% in college grads. And for coronary artery disease the rate is 10% for poorly educated compared again to 6% in college educated citizens.8

As we look ahead, we would do well to look back. What would my father do? Build more hospitals and chase the disease curve? Not likely! I expect he’d try to figure out how to give his patients a hand up, how to get them a better job or at least a higher hourly wage, how to get their children better educated, how to network them into community resources to address their fear, safety and depression, how to get them to save and plan and dream and accomplish. As Dr. Woolf says, “Improved income and education could reshape disease trajectories and medical spending, but their benefits could also extend beyond the health sector to more broadly improve the lives of individuals, communities and the economy.”2
As dad would say, “that’s just good common sense.”

References
1. Isaacs SL and Schroeder SA. “Class – the ignored determinant of the nation’s health.” New Engl J of Med. 2004; (3511):1137-1142.
2. Woolf SH. Future Health Consequences of the Current Decline in US Household Income. J Amer Med Assoc. Oct 24/31, 2007; 298(16):1931-1933.
3. DeNavas-Walt C et al. Income Poverty and Health Insurance Coverage in the United States. 2005. Washington, DC: US Government Printing Office. 2006:60-231. US Census Bureau Current Population Reports, consumer Income.
4. Woolf SH, Johnson RE, Geiger HJ. "The rising prevalence of severe poverty in America: a growing threat to public health." Am J Preventive Med. 2006; 31(4): 332-341.
5. DeNavas-Walt C, Proctor BD, Smith J. Income, Poverty and Health Insurance Coverage in the United States 2006, Washington DC: US Government Printing Office: 2007:60-233. US Census Bureau Population Reports, Consumer Income.
6. Piketty T, Saez E. Income inequality in the United States, 1913-1998. Quarterly J Economics. 2003;118:1-39.
7. Economic Policy Institute. "CEO-to-Worker pay imbalance grows.” Economic Snapshots. 21 June 2006.
8. Pleis JR, Lethbridge-Cejku M. Summary health statistics for U.S. adults: National health Interview Survey. 2005. National Center for Health Statistics. Vital Health Stat 10. 2006:10(232):1-153.
Topic Tags: education, health care reform, poverty
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