Patient advocacy growing as a business | www.azstarnet.com ®

Patient advocacy growing as a business www.azstarnet.com ®: "Patient advocacy growing as a business
Your hired help at hospital or in ER could be lifesaver
By Carla McClain
Arizona Daily Star
Tucson, Arizona Published: 04.27.2008
advertisementAs patients die waiting in emergency rooms, as they lay neglected in hospitals beds, as they struggle to find proper care for injuries and illness, a new first commandment has emerged for anyone forced to seek medical care:

Never, ever go alone.
Do not enter a hospital, an emergency room, or any other medical facility without competent, assertive help by your side at all times. To do so puts your very life at risk. Even doctors and nurses on the front lines of the system will tell you that today.

As hospital care grows increasingly complex and medical errors kill some 100,000 Americans every year, a whole new industry is forming to deal with this disaster — offering hired help to get you through your hospital stay alive.

It is a trend emerging here and across the country, though it's not without controversy — and a hefty price tag. But it may be offering a vital, even lifesaving service in a severely overburdened medical system plagued by a shortage of nurses, doctors and hospital beds."

Patient advocacy growing as a business

Cash Up Front or Else — Why Hospitals Are Gouging Their Patients | Health Care Industry Blog | BNET

Cash Up Front or Else — Why Hospitals Are Gouging Their Patients Health Care Industry Blog BNET: "Cash Up Front or Else — Why Hospitals Are Gouging Their Patients"

Mydoctor launched by CMA

Mydoctor.ca launched by the Canadian Medical Association
Email the Editor Email a Friend By: Lisa Williams, assistant editor, InterGovWorld.com(Apr 03, 2008 06:00:00)
The Canadian Medical Association has launched a new health portal dubbed mydoctor.ca, which has online tools for tracking chronic diseases, as well as a physician-driven Canadian electronic patient health record platform.

The health portal allows patients to directly link to their physicians, and was developed by Ottawa-based Practice Solutions (a CMA company).

"The mydoctor.ca health portal provides a new way for physicians to give each patient the care and attention they deserve while also empowering patients to become active participants in their care," said Brian Day, president of the CMA in a released statement.

The portal was designed by physicians and allows patients to be registered by their doctors with any of the online tools on the portal, including an asthma tracker and a personal health record.

The setup is similar to online banking in which the patient inputs their health information via the secure portal in order for their physician to access and monitor. The data is then converted into a chart that displays the patient's results over time.

For more information visit www.mydoctor.ca

"Telemedicine" links Africans to Indian expertise on Yahoo! Health

"Telemedicine" links Africans to Indian expertise on Yahoo! Health: "Telemedicine' links Africans to Indian expertise
By Barry Malone - Thu Apr 3, 12:54 AM PDTProvided by:

An Ethiopian woman inside a clinic in Bahir Dar, March 10, 2007. Ethiopia's health problems are mirrored across Africa where doctors and nurses are often overworked and underpaid, villagers have to walk miles to the nearest clinic and drugs and treatment are often beyond the means of ordinary people. (Eliana Aponte/Reuters)
ADDIS ABABA (Reuters) - Troubled"

High Speed Internet Access & Health Care

High Speed Internet Access & Health Care: "Telemedicine
Learn More
High speed Internet and $15.5 million telehealth grant help care for rural patients in New Mexico
Telemedicine helps save time and lives in smaller hospitals
A National Blueprint for Technology and the Public Good
» View All Entries

» View Relevant ExamplesHigh-speed interactive broadband with instantaneous contact between health professionals and patients enables remote monitoring, efficient chronic disease management, and more effective responses to emergencies."

Combining Internet With Office Visits Cut Heart Attack Risks on Yahoo! Health

Combining Internet With Office Visits Cut Heart Attack Risks on Yahoo! Health: "Combining Internet With Office Visits Cut Heart Attack Risks
By HealthDay - Sun Mar 30, 8:45 PM PDT"

Overall, the results show that good communication -- whether it's done in the office or over the Internet -- between patients and doctors helps prevent cardiovascular disease, said Alfred Bove, professor emeritus of medicine at Temple's School of Medicine and chief of cardiology at Temple University Hospital.
He noted that telemedicine does have certain advantages.
"With rising health-care costs, a telemedicine system can encourage communication between patients and their doctors with less cost and time commitment than frequent doctor visits," Bove said in a prepared statement.
He believes telemedicine may help underserved patients lower their risk of cardiovascular disease and bridge the "medical divide" between treatment and outcomes for lower- and upper-income patients.

New Beginnings Seniors home fights to stay open

"Seniors' home faces closure; long-term care residence to close as of march 31
Posted By HEATHER TRAVIS

As Janet Spierenburg helped Howard Randall, a 78-year-old resident at New Beginnings put on his coat for the last time, she had tears in her eyes.
Spierenburg can't stand to watch the Ridgetown business she helped build, deteriorate in front of her eyes.
'I worked so hard to keep this place going and make it a home for seniors,' she said. 'It's hard to watch it go downhill.'
Spierenburg owned the long-term care facility for five years before selling it to current owner, Sieg Holle, in January 2007.
As the remaining three residents prepared to move out of the residence on Thursday, Spierenburg got choked up.
'Most of the people don't want to leave,' she said. 'They are not hard to care for.'
Above all, Spierenburg's heart broke as she helped Randall get into his son's truck to leave.
'It's hard, especially with Howard,' she said. 'We just seem to connect.'
Randall has spent the past seven years living at New Beginnings and was reluctant to leave the staff and his home.
Randall was relocating to a long-term care facility in Blenheim.
'I loved it here,' he said. 'They just give me everything I want.'"

The 18-room residence is scheduled to close on March 31, unless the owner is able to find new residents to fill the facility or if he receives financial support prior to that date to allow the place to stay open.
"We could (shut the doors), but we will probably keep them open until the 31st (of March)," said Holle. "If there is the support, then you can sustain it and keep it open. And if there isn't, well, there is no purpose (of staying open)."
Holle, who is located in Brantford, operates a similar long-term care facility in the city, called Sunridge. There are currently four residents living in the 10-room facility, however Holle said the low numbers are more manageable because the operation cost are lower.

save for chronic care

Solutions at long last but how long to put in place ? QJ

Canadians urged to save for chronic care expenses
Posted By CHRISTINA SPENCER

Creating a registered chronic care savings plan, similar to an RRSP, could help Canadians with the steep health bills they will face as they grow old, says a sweeping new report on health care and the elderly.
The study by the Special Senate Committee on Aging notes that chronic illness, particularly heart disease, arthritis, diabetes and dementia, is "a major concern for seniors."
It also notes that Canada's publicly funded health care system doesn't adequately cover home or long-term care, which people with chronic illness often require.
"Because home care is not entirely publicly funded, some . . . have suggested that Canadians be urged to save so that they will eventually be able to afford services to meet their needs," the committee says. "This could be done through the creation of a registered chronic care savings plan, similar to an RRSP."
An RRSP (registered retirement savings plan) lets people shelter income from taxation up to a certain annual maximum if they are saving for their retirement. A chronic care savings plan would operate on the same principle but permit people to use the money for old-age health needs.
The proposal is one of many explored in the committee's second interim report, "Issues and Options for an Aging Population." Among some of the other options identified:
Providing tax credits for seniors who volunteer. "Volunteering is strongly associated with social connectedness," the report says;
Expanding educational tax credits beyond those given for people who take accredited courses, so that seniors could also enrol in a range of classes. "Active learning helps maintain brain health," experts told the committee;
Creating a national respite program, so that those caring for an older relative could obtain temporary help in order to take a physical and emotional break;
Making compassionate care benefits, which already exist under Employment Insurance, available for longer periods so people looking after a frail elderly person could benefit;
Introducing a national home care program to provide minimum standards across all provinces. The committee asks, however, whether such a standardized program might actually reduce service in places that already have high levels of care;
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Expanding the number of training spots in gerontology and geriatrics. "The incorporation of interdisciplinary education about aging into the core programs of all health professionals would improve the delivery of age-appropriate services," the committee says;
Increasing training in palliative care and end-of-life care.
christina.spencer@sunmedia.ca
Article ID# 956232

Rural Care Crisis

What are the alternatives? better cost effective delivery systems maybe QJ

Forced to close; Newbury hospital loses outpatient physiotherapy
Posted By CHIP MARTIN

In a move called devastating to its local community, one of Ontario's smallest hospitals is being forced to close its outpatient physiotherapy program to balance its budget.
That means many of the 23,000 rural, small-town and elderly residents served by Four Counties Health Services in Newbury will have to travel farther and pay from their own pockets to replace the service. Or do without.

"This will have a huge impact," said Yvonne Lambert, board chairperson of the Middlesex Hospital Alliance that operates the 16-bed facility in Newbury. The physiotherapy service is slated to end Sept. 1.
"These are retired people, farmers and small businesspersons and less than a quarter of them have private (health) coverage" to cover the cost of private clinics. And the closest private clinic is 35 minutes away.
The announcement comes on the eve of today's provincial budget, expected to have little new money for health care.
New funding is unlikely despite hospital bed shortages across the London region and elsewhere because of a shortage of long-term and chronic-care beds.
For the Four Counties area, there's a slim chance residents will find replacement service at a hospital in Chatham covered by government health care, Lambert said. Private clinics are more likely.
Lambert said to balance its $10-million operating budget, Four Counties has had to chop $500,000, of which $300,000 is the 38-year-old outpatient clinic with three physiotherapists, an assistant and a manager shared with Strathroy-Middlesex hospital. The clinic had 6,350 outpatient visits last year.
"In a small hospital it is very hard to cut anything," Lambert said. She said talks about the situation continue with the Southwest Local Health Integration Network.
Monte McNaughton, a Newbury businessperson, described the closing as "devastating for patients, for the local economy and health care in Ontario."
McNaughton, a board member who ran for the Progressive Conservatives against local Liberal MPP Maria Van Bommel (Lambton-Kent-Middlesex), said provincial Liberals will buy 22 Made-in-Scotland buses for Toronto but won't support health care for local residents.
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"It just doesn't make sense and is a further slap in the face to our rural communities," he said.
Conservative health critic Elizabeth Witmer said the Four Counties situation "is happening across the province."
She said termination of services "has a very negative impact on people" and the government should allow private delivery of health care covered by government insurance.

All is not well in nursing homes

Provided by: Canadian PressWritten by: Alison Auld, THE CANADIAN PRESS
HALIFAX -

Almost half the residents at several nursing homes in Nova Scotia exhibited aggressive behaviour that ranged from outright violence to resisting help, according to a new study that buttresses concerns over the risks care-providers face on the job.

The report, released Thursday by the Canadian Institute of Health Information, also showed that many of the behaviours were linked to a handful of health conditions, including dementia, delirium and depression among the elderly.
Nancy White, the institute's manager of home and continuing care, said the findings shed light on how nursing home residents behave and why they might lash out.

"What we found was that certain types of behaviours are associated with certain underlying health conditions," she said from Ottawa. "Knowing this and understanding these conditions is really the first step to treatment and prevention."

In the survey of five facilities in the province from 2003 to 2007, the most common aggressive behaviour was resisting care, which could include pushing away a worker trying to administer medicine or change a diaper.
About 45 per cent of the 700 residents - or two out of five - showed behavioural symptoms, with a third of the residents resisting help. About 16 per cent were verbally abusive and 14 per cent engaged in "socially inappropriate" actions, like screaming.
About 10 per cent of the residents were physically abusive, which included hitting, scratching or sexually abusing others.
Doreen Charman, a long-term care provider at a Halifax nursing home, said the report backs up what care workers have been saying for years - that aggressive behaviour is a part of daily life.
"It's a day-to-day issue in dealing with aggression and fear and residents who are reacting to their environment," she said, adding that she's been kicked, punched and scratched on the job.
"It's not the person doing it - it's the condition that they're dealing with."
Charman, who's been in the sector for 21 years, said staff need more education on how to deal with challenging behaviour, and more resources to help over-taxed, weary workers.
"This report is reinforcing what we've been saying all along in long-term care - we need more education and we need more staff," she said.
Albert Banerjee, who led a recent study on abuse suffered by care providers, said the institute's findings corroborate a number of reports outlining the challenges of working in nursing homes.
Banerjee, a doctoral candidate in the sociology department at York University in Toronto, found that long-term workers in Canada are seven times more likely to be physically abused by elderly residents than their peers in Nordic countries.
"In Canada there seems to be a myth that this is just part of the job and what this shows is that it's not necessary," he said, referring to his study released earlier this month that surveyed workers in Ontario, Nova Scotia and Manitoba.
"But you need legislation to guarantee minimum standards of care, so documenting the needs of residents and workers is the first step."
White said the five nursing homes in Nova Scotia used a new model of assessing residents when they first entered the facility, giving workers a better handle on what health conditions they might need to address.
"Having good assessment information on these residents is a very important way of preventing behaviours or for dealing with them in a more effective manner," she said.
Nova Scotia was the first province to tabulate its findings for the institute and eight others, including British Columbia, Ontario and Saskatchewan, are going to provide information for the database.
White said the Nova Scotia rates appeared to be similar to other provinces, but added that the data will be used to track trends in the future.

New savings plan holds promise

New savings plan holds promise: "New savings plan holds promise


Article By: Gordon Pape

The new Tax-Free Savings Accounts announced in the budget will offer a range of investment opportunities, from income splitting to education savings.
One of the centrepieces of Finance Minister Jim Flaherty's recent budget was the announcement of legislation to create Tax-Free Savings Accounts (TFSAs), starting in 2009.
These plans will allow every Canadian over 18 to contribute up to $5,000 a year to an account that will tax-shelter all investment earnings. Unlike RRSPs, contributions will not be tax deductable, nor will withdrawals be taxed.
There is no doubt that this is an important program, one that will provide savers with a new range of strategies. Here are a few possibilities."

MindMentor, the first robot psychologist | Emerging Technology Trends | ZDNet.com

MindMentor, the first robot psychologist Emerging Technology Trends ZDNet.com: "People affected by emotional problems are often reluctant when they’re told to see a psychologist. Now, they can confidentially consult online MindMentor, the first robot psychologist. It will cost them €4.95 for one hour session (or about US$7.65 as of today). MindMentor has been developed by two Dutch psychologists specialized in Neuro Linguistic Programming (NLP). The system was tested on 1,600 ‘customers’ from over the world and 47% of them said they were satisfied after only one session. I haven’t tested the system myself, but one thing is really interesting. Instead of looking at a database, MindMentor uses a personal process to discover the right solution with you."

Interesting use of high tech -

More money for Hospitals?

Solutions not more public hand outs needed QJ

Chatham Daily News
Hospitals face tough timesPosted By JOHN MINERPosted 25 mins agoHalf of Ontario's hospitals are poised to operate in the red, a situation projected to get much worse next year despite the province's law banning hospital budget deficits.

The tough times for the key health-care sector were disclosed to hospital executives and boards this week by the Ontario Hospital Association, which surveyed member hospitals March 5.
Unless they cut services, 75 hospitals face a deficit for the fiscal year starting April 1.
That jumps to 104 hospitals - 68 per cent - the following year, the OHA survey warns.
The dire financial outlook for the province's hospitals comes less than two weeks before the Liberal government brings down its next budget.

Ontario prohibits hospitals from running deficits and, to end budget uncertainty, now tells the sector what its funding will be at least two years ahead of time. For example, it will get 2.4 per cent more money this coming year, and another 2.1 per cent the next.
The multi-year funding was supposed to end an era of annual standoffs between the hospitals and the Health Ministry over money, with hospitals demanding more to cover their operating shortfalls.
Hospitals in Strathroy and Newbury have already drawn up plans for service cuts in the face of significant deficits.
The Strathroy hospital is facing a $2.2-million operating deficit out of a $30-million budget, while Newbury hospital, with a $10-million operating budget, is short $500,000.
In its report sent to hospital executives this week, the OHA said Ontario hospitals are already very efficient compared to others in Canada.

"In fact, it would require $100 more per capita, or $1.2 billion, to bring Ontario hospitals up to the spending level on hospitals in the rest of Canada," the OHA report said.
OHA president Tom Closson said the annual increases from the Health Ministry aren't enough for the province's hospitals to deal with significantly higher wage and energy costs.

"Just looking at inflation alone, it is a big challenge," he said.
Hospital costs are also being pushed higher by increasing demands from the aging population and population growth.
"Hospitals are working hard to improve their efficiencies, but efficiency can only be improved so quickly," Closson said.
Unlike in previous years, when Ontario's hospitals negotiated with the Health Ministry, they now are required to reach balanced budget deals with Local Health Integration Networks, health care agencies set up by the government.
Closson said the OHA is advising hospitals in financial difficulty not to cut services, but to keep negotiating with their LHIN.
"We don't think the province wants us to cut services," Closson said.
An OHA advisory on tactics for negotiating with the LHINs warns hospital boards not to sign any agreement unless they can meet their obligations.
Laurel Ostfield, spokesperson for Health Minister George Smitherman, said this is the first year the hospitals have negotiated budgets with the LHINs and it's a difficult process that requires a lot of hard work on both sides.

"We do have a lot of confidence in the Local Health Integration Networks and we feel very certain they will be able to come to a resolution with the hospitals on their budgets," Ostfield said.
Hospital shortfalls
Based on no service cuts, 75 Ontario hospitals (49 per cent) project deficits for 2008/09.
For 46 hospitals (30 per cent), the deficits are greater than two per cent.
For 2009/10, 104 hospitals (68 per cent) project deficits.
For 66 hospitals (43 per cent), the deficits are greater than two per cent.

Go public, go private

Go public, go private: "Go public, go private


Article By: Jayne MacAulay

Will private for-profit clinics flourish in Canada, and will they be the death of medicare as opponents claim?"

Health Care Brief: Canadians not receiving adequate health care

Health Care Brief: Canadians not receiving adequate health care: "Health Care Brief: Canadians not receiving adequate health care


Article By: Athena McKenzie

More accessible, comprehensive and coordinated care is required, says agency report.
Are Canadians receiving adequate health care? According to the Health Council of Canada, the answer is no.
The intergovernmental agency prepared Fixing the Foundation: An Update on Primary Health Care and Home Care Renewal in Canada. It says the current health-care system is not well-coordinated, comprehensive or always available when needed. The report is based on the Canadian Survey of Experiences with Primary Health Care.
“Canadians continue to tell us reform is needed,” Dr. Jeanne Besner says. Besner is the chair of the Health Council of Canada.
The report highlights that more then 30 per cent of people who visited an emergency room believe they could have been treated by their family doctor if one was available. In addition, family doctors rarely learn if a patient is seen in an after-hours clinic.
Participants said that some doctors do not explain test results, nor do they warn of the possible side effects of medication. Other complaints included a lack of information from their physicians on adopting healthier lifestyles.
To address the issues within the system, the council is recommending several courses of action. These include electronic patient records, inter-professional care teams, and better communications between family doctors and after-hour clinics. The report also stresses the need for better coverage of home care strategies.
Read the council's report, Fix the Foundation."

excellent review

(lesson in being a good informed patient

Lessons in Being a Good Patient

It used to be that doctors were considered god-like, the keepers of life-and-death knowledge and abilities. This view of the medical profession is intimidating -- and in light of the troubling findings of a recent Dutch review study, it appears that many older individuals still feel that way. Researchers reviewed three studies with a total of 433 older patients to determine whether personal face-to-face coaching or printed materials would better help them become savvier consumers of health care, specifically at doctor visits. Not surprisingly, personal coaching (face-to-face, either group or individual) was found more effective, but even when coached it seemed that many elderly patients remained stubbornly passive about their care.

One study showed that after being educated about the importance of preparing for the visit and asking questions, when study participants next saw their doctor, more than half still didn't identify specific issues to discuss and more than 80% failed to bring a list of questions, problems and/or medications with them. In fact, very few asked the doctor any questions about their illness, tests or procedures. Here's the problem: The more passive patients are about health issues, the lower the likelihood of successfully solving their problems.

GET GOOD INFORMATION

Gerontologist Audrey Chun, MD, director of the Martha Stewart Center for Living at the Mount Sinai School of Medicine, had some interesting ideas on how to help older patients understand how they'll benefit by preparing for their visits. She points out that doctor/patient visits are limited to about 15 minutes, so it's more effective and efficient to come with an agenda. It's a good idea to bring along a son, daughter or other relative to visits -- mostly to offer support and strength, but also to ask questions and make note of details that are easily forgotten.

To get other suggestions about how older adults can be taught to become more active health care consumers, I also spoke with Robert N. Butler, MD, president and CEO of the International Longevity Center and professor of geriatrics and adult development at Mount Sinai School of Medicine, both in New York City. He agreed that it is crucial for all patients, regardless of age, to know as much as they can about their health issues. Since doctors now have, on average, more than 1,000 patients, it's far less likely they'll know patients' medical histories well -- though that is the way it used to be and older folks may not realize how much things have changed. The ideal way to gather information is, yes, the Internet -- and happily many older adults are comfortable using it today. But even those who spend lots of time on-line may not understand how important it is to filter advice by researching only credible sites -- Dr. Butler recommends www.mayoclinic.com and medlineplus.gov as good starting points for in-depth background information on health issues.

WHAT TO BRING TO YOUR VISIT
In order to better the odds of success at your doctor's visit, Dr. Chun urges all elderly patients to bring the following to every appointment:

A list of all medications or, if there are more than five or six, a brown bag with the medications themselves. A periodic review of drugs is vital, says Dr. Chun, because some may no longer be necessary, one may be causing problems that need to be investigated, or the combination of two or more may cause interactions that are problematic.

A list of all symptoms and any recent physical changes that might be pertinent for diagnosing a health problem.
A list of questions concerning any medications or conditions, whether new ones or those that were previously diagnosed.
A notepad for the doctor to write down names of unfamiliar diagnoses, tests and medications so that patients can investigate them further at home.

Also, patients should ask the doctor to list instructions for taking any newly prescribed drugs -- and, before leaving the office, make sure they can read the notes from the doctor.

If they get home and the writing is illegible, the instructions are useless. At the end of the visit, Dr. Chun suggests asking the doctor to briefly summarize the content of their time together. Patients may also want to ask about other sources of information they can explore on their own, along with resources such as support groups for those who have a chronic condition.

RESPECT IS KEY
Don't expect that one conversation will get an elderly parent or relative over the hurdle of being a passive patient. Given that many have spent a lifetime thinking they should never question a doctor, you'll likely need to reframe the issue. Dr. Chun notes that an important aspect of patient/doctor relations is good communication -- and a vital ingredient of communication is the patient's willingness to ask questions. Showing respect is a value that previous generations emphasized -- she says that many older patients worry their questions might send a message of doubt and disrespect. Try explaining that, in fact, when a patient asks questions, it lets doctors know whether they understand the information they've been given.

Not infrequently, misunderstandings cause problems down the road that a question or two might have cleared up right away. Patients can ask when is a good time to call the doctor if they have further questions.

Even better though, say both Dr. Butler and Dr. Chun, is to schedule a follow-up visit several weeks later. This additional time enables the doctor and patient to understand what's happening, how treatment is going and for questions to arise naturally. Also, the additional time together may increase the patient's comfort with the doctor, as well as allow the doctor to get to know the patient a little bit better. As a rule, insurance pays for the second visit and it is time -- and money -- well spent to maximize personal health care.

medical clinic checklist

Drugstore Medical Clinics Scorecard Americans spend double what residents of many other industrialized countries do on health care, yet we still have a hard time getting appointments with our doctors and so we often go without treatment for illnesses and injuries. A new solution available in many states is retail-based medical clinics, making walk-in clinics even more convenient by locating them in drugstores, supermarkets and other convenient facilities. These may not be the solution to the health care crisis at large -- but I believe walk-in clinics can fill a void by providing very basic care in a far more accessible way.

SO MUCH MORE CONVENIENT... With the elite concierge medical practices (for more on concierge medicine, see Daily Health News, October 3, 2005) on one end of the spectrum, these are at the other, with care that is down-to-earth and convenient to all. Medical professionals are on staff to treat simple-to-diagnose problems, such as a strep test for a sore throat or a case of poison ivy. They also offer flu shots. Some are operated by independent organizations or hospitals. And, of course, they offer convenient one-stop shopping in that you can even fill your prescription right there, if medication is required. It's all good for the consumer, but no surprise -- some physicians are up in arms complaining that store-based and walk-in clinics pose a threat to patient safety, not to mention their own profit margins. For an unbiased consumer perspective on the matter, I spoke with patient advocate Trisha Torrey, about.com's expert on patient empowerment and a syndicated newspaper columnist. She agrees that walk-in clinics offer real benefits for consumers, as long as they are used with appropriate caution.

EASY ACCESS, LOWER FEES In addition to the fact that many retail clinics are open weekends, evenings and holidays, the average visit, including waiting time, at retail clinics takes just 15 to 25 minutes, according to the Convenient Care Association (www.convenientcareassociation.org, an organization made up of convenient care clinics across the nation). This is quite a bargain in terms of time, especially when I think of my last doctor's visit. Even with an appointment, I waited two hours... and I know that's not an unusual experience nowadays. Torrey says prices are lower at walk-in clinics, and therefore it's not just time but also money you save by using walk-in clinics for medical care. This is especially important for people who are uninsured or under-insured and must pay out-of-pocket for their care. Many insurance plans allow treatment at retail clinics and, in fact, the CCA estimates that 70% of people who visit store-based clinics have health insurance and are using the clinics primarily for convenience. In those cases, the same insurance co-payments apply as with doctors' offices. Insurance plans vary so Torrey advises confirming your company's policy in advance. For example, some plans require you to call for preapproval if you go to any office other than your own provider (e.g., on a weekend). Otherwise, unless it is a bona fide emergency such as a car accident -- not a Sunday morning sore throat -- they won't cover it.

SAFETY CONCERNS PERSIST Still it is valid to raise questions about safety. Some states require a physician on the premises at all times, while others merely mandate that one is on call. Among the concerns doctors list are no continuity of care, the lack of familiarity with patients' medical histories and "less-than-expert treatment" delivered by nurse practitioners and physician assistants, rather than primary care physicians, though in truth, these professionals often do the same work in private physician practices as well. Symptoms can be difficult to interpret, Torrey notes. A seemingly innocuous problem, like a bad cough, may be a sign of something more serious than a cold. While there's no guarantee your physician would diagnose this correctly either, the fact that he/she has more training and immediate access to your medical history makes it likelier a more complicated illness would be correctly identified and treated before serious problems arise. The American Medical Association (AMA) is calling on state and federal governments to investigate how clinics are run and place regulations on what they do. A major reason for this is that many walk-in medical clinics are joint ventures with store-based pharmacies. This opens the door to a potential conflict of interest, since drugstores clearly stand to make money from the prescriptions written in their clinics.

THE DOS AND DON'TS OF DRUGSTORE CLINICS Torrey offered tips on how to use walk-in retail clinics safely and to your best advantage:
Don't go to a drugstore clinic for serious medical problems. If you have chest pain or trouble breathing, for example, call 911. Likewise, walk-in clinics may not be a good idea for people with other health issues, like cancer or even diabetes. You may be better off seeing your primary care physician.
Research options in advance. As noted above, depending on your particular state's regulations, you may be seen by a nurse practitioner, physician assistant or other "physician extender," says Torrey, while others have doctors in attendance at all times. It's a really good idea to call around before you need to visit such a clinic -- so you know in advance where to go for the best care when you are sick.
Ask about the clinic's policy on prescriptions. Also best done in advance, Torrey recommends that you ask staff what they would do if you wanted to fill your prescription elsewhere. How they respond offers insight into how the clinic operates. If prescriptions written by their medical practitioners can only be filled in their facilities, you may want to seek care elsewhere.

Bring a list of all drugs and supplements you take and the dosages. This is the single best way to avoid medical errors such as potentially dangerous drug interactions. Also, check beforehand whether you are up-to-date on immunizations, such as tetanus shots, as this can sometimes affect treatment.

Request copies of all medical records of your visit and make sure your regular physician receives these. While many say they do this automatically, Torrey cautions that they don't always follow through. The best advice on retail medical clinics is to use simple common sense. If you're in good health and have a minor medical issue, you may indeed find that walk-in medical clinics offer some advantages, including easy access, short waits and low prices. Those with chronic or serious health problems do better to seek conventional medical treatment.

These clinics are best used for treating illness and aren't targeted to achieving wellness.
( This is an opportunity area- Qj)

Reaching 100 is easier than suspected on Yahoo! Health

Reaching 100 is easier than suspected on Yahoo! Health

Can Web create shoppers' market for health care? - CNN.com

Can Web create shoppers' market for health care? - CNN.com: "Can Web create shoppers' market for health care?Story Highlights
New Web site allows consumers to search, compare medical services

'We want to let consumers define value,' says founder of Carol.com

Skeptical analyst: Users choices could be limited by their HMOs
Some may wish to pay out-of-pocket to get more care choices, founder says"

QJ What a great idea . Check it out This is a template for consumer choice options

Health myth busted

Fat people cheaper to treat, study says By MARIA CHENG, AP Medical Writer - Mon Feb 4, 11:58 PM PSTProvided by:

As adult obesity balloons in the United States, being overweight has become less of a health hazard and more of a lifestyle choice, the author of a new book argues.(AFP/File)
LONDON - Preventing obesity and smoking can save lives, but it doesn't save money, researchers reported Monday. It costs more to care for healthy people who live years longer, according to a Dutch study that counters the common perception that preventing obesity would save governments millions of dollars.
"It was a small surprise," said Pieter van Baal, an economist at the Netherlands' National Institute for Public Health and the Environment, who led the study. "But it also makes sense. If you live longer, then you cost the health system more."

lifetime cost per health type

healthy 84 years $ 417,000 from 20 on
obese 80 years $ 371,000
smoker 77 years $ 326,000

"This throws a bucket of cold water onto the idea that obesity is going to cost trillions of dollars," said Patrick Basham, a professor of health politics at Johns Hopkins University who was unconnected to the study. He said that government projections about obesity costs are frequently based on guesswork, political agendas, and changing science.

medical benchmarking

Top-Rated Hospitals Continue to Deliver Better Care

THURSDAY, Jan. 31 (HealthDay News) -- Patients admitted to the top-rated hospitals in the United States have an average 27 percent lower risk of dying than patients admitted to other hospitals in the country, a new study shows.

Latest Prevention & Wellness News
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Released Thursday by HealthGrades, an independent health-care ratings organization, the analysis of 27 procedures and diagnoses also found that patients who have surgery at the top-rated hospitals have an average 5 percent lower risk of complications during their hospital stay.
For this study, researchers analyzed nearly 41 million hospitalizations in 2004, 2005 and 2006 at all 4,971 of the nation's non-federal hospitals. If all hospitals had the quality of care of the top 5 percent of those hospitals, 171,424 lives may have been saved, and 9,671 major complications may have been avoided during the three years studied.
The study also found that the top 5 percent of hospitals lowered their in-hospital risk-adjusted death rates over those three years by an average of 15 percent.
The procedures and diagnoses included in the analysis included: cardiac surgery; angioplasty and stenting; heart attack; heart failure; atrial fibrillation; chronic obstructive pulmonary disease; community-acquired pneumonia; stroke; abdominal aortic aneurysm repair; bowel obstruction; gastrointestinal bleeding; pancreatitis; diabetic acidosis and coma; pulmonary embolism; and sepsis.

Nurse admits stealing body parts of dead - Yahoo! News

After you read this medical tourism does not seem to be a bad option

Nurse admits stealing body parts of dead - Yahoo! News: "Nurse admits stealing body parts of dead By MARYCLAIRE DALE, Associated Press Writer
Wed Jan 30, 10:18 PM ET


PHILADELPHIA - A nurse admitted Wednesday he cut body parts from 244 corpses and helped forge paperwork so the parts, some of them diseased, could be used in unsuspecting patients.
ADVERTISEMENT

Authorities say nurse Lee Cruceta was the lead cutter in a group that trafficked in more than 1,000 stolen body parts for the lucrative transplant market."

Colonoscopy -preventive medicine

proactive natural medicine

Health & Fitness - Basic Exercises - ArcaMax Publishing

Health & Fitness - Basic Exercises - ArcaMax Publishing: "Basic Exercises:
Here are some exercises that target specific areas of the body that can help you organize your workouts. These exercises can add variety to you workout and eliminate the potential for burnout that comes with consistent exercise as well as help both the serious and casual exercisers who are looking to tone their bodies."

Holidays - Making Resolutions Stick - ArcaMax Publishing

Holidays - Making Resolutions Stick - ArcaMax Publishing: "Making Resolutions Stick
Dawn-Elise Snipes
Every year I watch at the gym as it floods in January, then slows to a trickle by March. Why is it that we seem unable to make behavior change goals that last? Well, there are several reasons.

Failing to consider why you currently do (or do not) engage in certain behaviors."

Holidays - Questions to Ask Yourself for Your Best Year Ever in 2008 - ArcaMax Publishing

Holidays - Questions to Ask Yourself for Your Best Year Ever in 2008 - ArcaMax Publishing: "Questions to Ask Yourself for Your Best Year Ever in 2008
Art Sobczak
Early Happy New Year!

Today's issue is a New Year's tradition. It's usually one of our most popular issues of the year, and most-visited in the archives.

If you're serious about having your best year ever in 2008, TODAY is the best time to start. I do suggest you take some time to sit down with these questions Think about your answers. Challenge yourself. Write them down. Them go to work!

It's quite simple: if you want to be better in 2008, YOU need to do more than simply WANT it. You need to make some changes. Start now.

What are you going to do to improve your industry and product knowledge in 2008?"

YOU Staying Young Center -- Brain Foods

YOU Staying Young Center -- Brain Foods: "Brain Foods
Generally, what’s harmful to your heart is also harmful to your brain. Make no mistake about it -- while fried potato skins"

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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Canada's ministers for seniors vow to continue fight against elder abuse - Yahoo! News

Canada's ministers for seniors vow to continue fight against elder abuse - Yahoo! News: "Canada's ministers for seniors vow to continue fight against elder abuse "It would be nice if this ere true and not more idle posturing

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